Retention And Relapse
Question 1. Define retention and relapse. Discuss the different schools of thought of retention and various causes of relapse after orthodontic treatment.
Or
Define retention and relapse. Describe in detail various causes of relapse.
Or
Write short note on causes of relapse.
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Write short notes on factors causing relapse.
Or
Write short note on causes of relapse
Or
What are the causes of relapse after orthodontic treatment.
Answer.
Definition of Retention
Retention is defied as “Maintaining newly moved teeth in position long enough to aid in stabilizing their corrections”.
Definition of Relapse
Relapse is defied as “The loss of any correction achieved by orthodontic treatment” or “Relapse is defied as tendency of orthodontically treated teeth to rearm back to their original position”.
Schools of Thought of Retention
- There are various philosophies to explain post-treatment stability.
- These are referred to as the “school of retention”.
Read And Learn More: Orthodontics Question And Answers
The Occlusion School of Thought
According to Kingsley—“Proper occlusion is a key factor in determining the stability of the newly moved teeth”.
The Apical Base School
- It is formulated by Alex Landstrom, McCauley and Nance.
- In 1920 Alex Landstrom suggested that apical base is important factor in the correction of malocclusion.
- McCauley added that the intercanine and intermolar width should be maintain during orthodontic treatment.
- Nance noted that the arch length cannot be permanently increased to a major extent.
The Mandibular Incisor School
Grieves and Tweeds suggested that post-treatment stability was increased when mandibular incisors were placed upright on slightly retroclined over the basal bone.
The Musculature School
It states that functional muscle balance is necessary in order to ensure post-treatment stability.
Causes of Relapse after Orthodontic Treatment
- Soft Tissue Factors
- After orthodontic treatment gets completed, teeth remain in unstable position.
- Pressure from the sof tissue leads to the relapse.
- Teeth should be placed in the new position of balance.
- Muscular factors
- Teeth acquiring new position take some time to get stabilize.
- Any abnormal habit which persists will alter the equilibrium and causes relapse of teeth.
- Supporting Tissues
Both gingival and periodontal tissues get changed or altered subsequent to orthodontic tooth movement and need time for their reorganization.
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- Reorganization of periodontal fibers
- During the movement of tooth, PDL space and collagen fiber bundles are altered.
- After the removal of fixed appliances there is restoration of normal periodontal architecture. This is due to the reorganization which take place when tooth start responding individually to functional forces like masticatory force.
- Reorganization of PDL occurs over a 3 to 4 months period.
- As reorganization occurs, there is active stabilization of tooth due to the PDL metabolism which comes in effect.
- Reorganization of gingival fibers
- Reorganization of gingival fibers occur slowly.
- Collagen fibers complete their reorganization in 4 to 6 months.
- Supracrestal elastic fibers remodel slowly and they take nearly one year to reorganize.
- That’s why pericision is recommended in teeth corrected for rotations.
- Reorganization of periodontal fibers
- Occlusal Factors
- Tooth size discrepancy
- Tooth size discrepancy between both the maxillary and mandibular teeth causes relapse after the correction.
- Features of maxillary tooth material excess are deep overbite, combination of increased overbite and overjet, anterior crowding, improper buccal occlusion.
- Features of mandibular tooth material excess are end-to-end incisor relationship, space in maxillary anterior region, mandibular anterior crowding and improper buccal occlusion.
- Axial inclination
- Tooth size discrepancy
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- Excessive lingual tipping of anterior teeth causes deep bite.
- It is necessary to provide proper angulation between maxillary and mandibular incisors.
- Transverse discrepancy
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- Tendency for relapse associated with palatal expansion techniques is more. So long-term retention is needed.
- Third molars
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- Role of third molars in causing late mandibular incisor crowding is doubtful.
- Extraction of lower third molar has beneficial effects in decreasing mandibular anterior crowding.
- Extraction of third molars provides space for distal and lingual movement.
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- Facial growth and occlusal development
- Dentoalveolar adaptation maintains occlusal relationship even with skeletal malrelationship.
- If skeletal growth continues in a marked fashion, occlusal changes will occur.
Question 2. What is retention and relapse after orthodontic treatment? Describe common causes of relapse and its management.
Or
What are various causes of relapse. Describe various methods to overcome it.
Or
Define retention and relapse in orthodontics. Write about the appliances used in retention.
Or
Write short note on retention appliances
Answer.
Definition of Retention
Retention is defied as “Maintaining newly moved teeth in position long enough to aid in stabilizing their corrections”.
Definition of Relapse
Relapse is defied as “The loss of any correction achieved by orthodontic treatment” or “Relapse is defied as tendency of orthodontically treated teeth to rearm back to their original position”.
Management of Relapse
- Elimination of cause of malocclusion will prevent relapse.
- Malocclusion should be overcorrected as a safety factor.
- Proper occlusion is a potent factor in holding teeth in their corrected positions.
- Bone and adjacent tissues must be allowed time to reorganize around newly positioned teeth.
- Correction carried out during period of growth is less likely to relapse.
- Many treated malocclusion require permanent retaining devices.
Types of Retainers
- Removable Retainers
- Hawley retainer
- Begg retainer
- Clip on retainer/Spring aligner
- Wrap around retainer
- Kesling’s tooth positioners
- Invisible retainer or Essix retainer
- Functional appliance
- Fixed Retainers
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- Banded canine-to-canine retainer
- Bonded canine-to-canine retainer
- Band and spur retainer
- Anti-rotation band
Appliances used in Retention
Appliances used in retention are removable and fixed retainers.
Removable Retainers
These appliances serve effctively for retention against intraarch stability.
They are effective in growth problems, wherein functional appliances or headgears are used as retention appliances.
Hawley Retainer
- Hawley retainer is commonly used retentive appliance.
- The retainer incorporates clasps on molar teeth and a labial bow, which spans from canine-to-canine.
- Palatal or lingual portion of the appliance is constructed of acrylic and covers the palatal mucosa.
- Due to palatal coverage, it acts as the potential bite plane to control overbite.
- Drawback of Hawley’s retainer is when it is used in first premolar extraction cases, it causes the space to open because of its wedging effct.
Begg Retainer
- It is made up of single wrap round labial bow extending from the distal of second molar to the opposite second molar.
- Following are the advantages:
- Wrap around wire eliminates the potential occlusal interferences and allow vertical setting of occlusion.
- In extraction cases, it maintains canine and second premolar in tight contact, thereby eliminating the risk of space opening up.
Clip on Retainer/Spring Aligner
- It is mainly used in lower anterior region in correcting the minor rotations of anterior teeth.
- The appliance is made by wire framework which runs labially and lingually over the incisors passing between canine and the premolar. Both labial and lingual wire segments are embedded in the strip of clear acrylic.
- Its main advantage is that, it is well tolerated by the patients and can be used to realign lower incisors.
Wrap around retainer
- It is the extended version of spring aligner which covers all teeth.
- It has a wire reinforced plastic bar made with clear acrylic along both the labial and lingual surfaces of teeth.
- It is not routinely used in orthodontic practice.
- The retainer splints the teeth together firmly and is usually used in stabilizing the periodontally weak dentition.
Kesling’s Tooth Positioner
- It is devised by Kesling and is used as a finishing appliance.
- This positioner itself can be used as retaining appliance.
- Main advantage of this appliance is that it maintains intraarch tooth position and occlusal relationships also.
- Disadvantages include bulkiness of appliance, it does not retain incisor irregularities and rotations as efficient as standard retainers. The appliance has tendency for deep bite.
Essix Retainer/Invisible Retainer
- Essix canine-to-canine retainer is made from clear thermoplastics.
- This retainer incorporates all the advantages of canine-tocanine clip-on retainer.
- In extraction cases, the appliance extend to cover the extraction site.
- This appliance is esthetically acceptable.
Functional Appliances
- These appliances are used in subjects who have still growth left
- Commonly used appliances are activators and oral screen.
Fixed Retention Appliances
- Fixed retainers are indicated in conditions where long-term retention is needed.
- It is indicated in conditions where intra-arch instability is anticipated.
Banded Canine-to-Canine Retainer
- This retainer is indicated for maintenance of lower incisor position at the time of growth.
- This retainer consists of fied lingual bar which is attched to the canines or premolars in some of the cases.
- Fixed lingual bar should be soldered to the canine bands on the lingual aspect.
Bonded Canine-to-Canine Retainer
- A fixed lingual canine-to-canine retainer can be fabricated without bands by bonding to the lingual surface.
- The appliance is attached only to the canines and rest passively against lingual surface of central and lateral incisor.
- It is made by heavy wire for resisting the distortion.
- Ends of wire should be sandblasted to improve retention.
- Modification: In rotation and crowding correction, bond the lingual wire to one or more incisor teeth. In this situation, a flexible braided steel arch wire is used.
Antirotation Band
- It is used to maintain corrected single tooth rotation.
- Band on the rotated tooth consists of two spurs welded to it—labially and lingually.
- Spurs rest over adjacent teeth and prevent relapse.
Band and Spur Retainer
- It is used in cases of orthodontic correction of single tooth rotation or labiolingual displacement.
- This appliance prevents tooth from returning to its original position.
Question 3. Write short note on retention.
Or
Write short note on types of retention.
Answer. Retention is defied as “Maintaining newly moved teeth in position long enough to aid in stabilizing their correction”.
Malocclusion may need a certain period of retention to ensure stability.
Retention can be of Following Types
- Natural/No Retention: Some condition do not require any retention, e.g. anterior crossbite, serial extraction period.
- Limited/Short Term Retention: This retention extends from 3–6 months. It is done to allow the bone and PDL to readapt in new position in case of:
- Class 1 showing proclination
- Deep bite.
- Moderate/Medium-term Retention: It is done when the supporting tissues will take long time to adapt. Retention extends between 1–5 years.
It is used in cases of:
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- Class 1 and class 2 extraction cases
- Class 1 non-extraction case
- Deep overbite correction in cases of class 1 or 2 malocclusion.
- Prolonged/Permanent or Semipermanent Retention: It is carried out in cases of:
- Midline diastema
- Cases treated through expansion in mandibular arch
- Severe rotation
- Patients with clef palate
- In adult patients with periodontal problem.
Types of Retainers
Removable Retainers
- Hawley retainer
- Begg retainer
- Clip on retainer/Spring aligner
- Wrap around retainer
- Kesling’s tooth positioners
- Invisible retainer or Essix retainer
- Functional appliance.
Fixed Retainers
- Banded canine-to-canine retainer
- Bonded canine-to-canine retainer
- Band and spur retainer
- Anti-rotation band
Question 4. Write short note on importance of retention appliance.
Answer. Retention appliances (Retainers) are passive appliances that help in maintaining and stabilizing the teeth in new position.
- Retainers prevent relapse.
- Retainers permit reorganization of the supporting structures aftr the active phase of orthodontic therapy.
Criteria for Retainers
- The retainers should retain all teeth that have been moved into desired positions.
- The retainers should permit normal functional force to act freely on the dentition.
- It should be self-cleansing and should permit oral hygiene maintenance.
- It should beds inconspicuous as possible.
Question 5. Write short note on theorems and schools of retention.
Or
Write briefly on theorems of retention
Or
Write short note on schools of thought of retention.
Or
Define retention and relapse. Discuss in brief the theories of retention.
Answer.
Theorems of Retention
Riedel had given 9 theories of retention and Moyers put forward the 10th theory which are as follows:
Theorem 1
‘Teeth that have been moved tend to return to their former Position’.
- Orthodontically moved teeth have tendency to move back to their original position after orthodontic treatment.
- Causes for this relapse are many and a single etiology cannot be highlighted.
Theorem 2
‘Elimination of the cause of malocclusion will prevent relapse’.
- Cause for malocclusion is identifid at time of diagnosis and adequate steps should be taken in treatment plan to eliminate it. Failure to remove the causes increases the relapse potential.
- This theorem is applied in existing malocclusion such as thumb sucking, tongue thrusting, etc. and not in any malocclusion where cause is elusive.
Theorem 3
‘Malocclusion should be over corrected as a safety factor’.
- Overcorrection is done so that after treatment the relapse which will occur can lead to normal occlusion.
- It is done while treating Class 2 and Class 3 malocclusion.
- Data is not available to validate the theorem.
Theorem 4
‘Proper occlusion is a potent factor in holding teeth in their corrected positions’.
- Post treatment stability get increased by the good occlusion.
- Orthodontist should not restrict the treatment to achieve good intercuspation when the jaws are closed but should aim at good functional occlusion.
Theorem 5
‘Bone and adjacent tissues must be allowed time to reorganize around newly positioned teeth’.
- As orthodontic tooth movement occur, numerous changes occur in bone and surrounding tissues. So there is considerable time for reorganization to get complete.
- Newly deposited osteoid around recently moved teeth take time to mature and offer inadequate retention.
- Periodontal as well as other gingival fibers take time to mature and reorganize.
Theorem 6
‘If the lower incisors are placed upright over the basal bones they are more likely to remain in good alignment’.
- When mandibular incisors are placed upright over the basal bone results are stable.
- Mandibular or occlusal plane is used as a reference plane.
- Treatment should be aimed at positioning the lower incisor perpendicular to mandibular plane or even retroclined.
Theorem 7
‘Corrections carried out during period of growth are less likely to relapse’.
- Orthodontic treatment should be instituted at earliest possible age.
- Early treatment procedures involve the growth modulation aimed at intercepting skeletal malrelations, prevent fullfldged malocclusions and compensation from occurring.
- Treatment carried at active growth period is more stable allowing tissue systems to adapt well and therefore reduce relapse potential.
Theorem 8
‘The farther the teeth have been moved, the lesser is the risk of the relapse’.
- As the tooth moves away from its position lesser are the chances of the tooth to come back to its original position.
- Extensive tooth movement should be minimized.
- There is only a little evidence to support this concept.
Theorem 9
‘Arch form, particular in the mandibular arch, cannot be permanently altered by appliance therapy’.
- Alteration in the existing arch leads to increased risk of relapse.
- It is mandatory to maintain the existing molar & canine width and build arches around them.
Theorem 10
‘Many treated malocclusions require permanent retaining Devices’.
- This theorem was added by Moyers.
- Some malocclusions require a patient to be fitd with a permanent retaining device.
- This is true in cases that are not treated to achieve occlusal goals which stand for stability.
Question 6. Write short note on various removable appliances used for retention.
Answer. Following are the removable appliances which are used for retention:
- Hawley’s retainer
- Begg’s retainer
- Spring retainer
- Clip-on retainer/Spring retainer
- Wrap around retainer
- Kesling’s tooth positioned
- Invisible retainer or Essix retainer.
Question 7. Briefly differentiate between retention and no retention cases.
Answer.
![Orthodontics Retention And Relapse Retention Cases and No Retention Cases](https://bdsnotes.com/wp-content/uploads/2023/05/Orthodontics-Retention-And-Relapse-Retention-Cases-and-No-Retention-Cases.png)
Question 8. What are the various theories of retention. Briefly describe permanent retention.
Or
Write short answer on permanent retention.
Answer.
Permanent Retention
It is also known as prolonged retention.
Cases in which permanent retention should be given are:
- In severe rotations.
- In midline diastema cases
- Patients having abnormal musculature as well as tongue habits.
- In class 2 div 2 deep bite patients.
- Arch expansion without ensuring proper occlusion
- In expanded arches with the clef palate cases.
Question 9. Define retention and relapse. Describe all types of retention. Give in detail about all types of retainers used in orthodontics.
Or
Define retention and relapse. Explain different types of retention procedures used in orthodontics. Explain various types of retainers used in orthodontics.
Answer.
Definition of Retention
Retention is defied as “Maintaining newly moved teeth in position long enough to aid in stabilizing their corrections”.
Definition of Relapse
Relapse is defined as “The loss of any correction achieved by orthodontic treatment” or “Relapse is defied as tendency of orthodontically treated teeth to rearm back to their original position”.
Question 10. Write short note on No retention cases.
Answer. They are also known as natural cases or self retentive cases.
Various conditions should not require any retention, i.e. serial extraction procedure, anterior crossbite, highly placed canines in class 1 extraction cases, posterior crossbite in subjects having steep cusps.
Question 11. Write short note on Begg’s retainer.
Answer. Begg’s retainer as the name suggests, was given by PR Begg.
Begg’s retainer is also known as circumferential maxillary retainer.
In Begg’s retainer labial bow extends distally posterior to last erupted molar and curves around it to be embedded in the acrylic base plate without clasps.
Begg’s retainer is ideal for cases where setting of occlusion is needed mainly in the posterior segments.
![Orthodontics Retention And Relapse Begg's retainer](https://bdsnotes.com/wp-content/uploads/2023/05/Orthodontics-Retention-And-Relapse-Beggs-retainer.png)
Begg’s Retainer Advantages
- There is no crossover wire between any teeth, thus, eliminates the risk of space opening up.
- Less occlusal interference with retainer and increased patient compliance.
- It can be used in cases with partially erupted molars.
Begg’s Retainer Disadvantages
- Retention of the appliance may not be good.
- Modification of Begg’s Retainer
- Begg’s retainer can be modifid as a single arrowhead partial wrap around retainer.
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