Pacific Coast Society of Orthodontists Bulletin Winter 2017 - 54

Presentation Summary

Clinical Staff

Mastering Retention
Dr. Morvarid Emamy

Presented by Dr. Neil Kravitz at the PCSO Annual
Session, Oct. 14, 2017
In his lecture, Dr. Kravitz provided many orthodontic pearls for Phase 1 and Phase 2 retention.
He also covered extraction space retention
protocol, as well as debonding followed by Essix
retention protocol.

Dr. Neil Kravitz
Kravitz Orthodontics
South Riding, VA

Phase 1 Retention
Upper Hawley retainer and lower holding arch:
in Phase 1, the lower holding arch is much better
than a lower Hawley retainer to help guide in the
lower canines and premolars. Hawley retainers
need to be adjusted: reduce acrylic in premolar
region. If you do not adjust the retainer on the
premolar region, teeth will erupt too buccal.

 You can also add an anterior bite plate for a
brachycephalic patient.
 You might add an inclined plane to the bite
plane for correction of Class II; this anterior
inclined plane Hawley acts like a Bionator or a
single piece Twin Block: the patient will simply
slide forward the lower jaw into a Class I
position.
 You can add the inclined plane on the lower
Hawley retainer for a Class III patient and the
patient will simply slide retrude the lower jaw
into a Class I position.
 Bonded bite plate for compliance; acrylic is
tight against incisors and it also allows for
some overbite.
 Permanent retention in Phase 1: upper 2-2
bonded fixed retainer (Ortho-FlexTech).
 Ugly duckling stage: Canines erupt along the
distal aspect of the lateral root.
 Normal guidance theory: Canine will erupt
into the correct position.
 Iatrogenic resorption: In Phase 1, orthodontists
frequently upright the lateral incisors; their
roots will run into the erupting canines. Do
not distal tip the lateral roots. You could flip
the right and left lateral incisors' brackets-
that will flip the tip of the lateral incisors.
Dr. Kravitz just simply keeps the slots of the
brackets parallel to the floor. If there is too

great a risk of running into the erupting
canines, do not bond the lateral incisors.
 A more focused approach on Phase 1 without
using brackets: Once the canine comes down
about halfway, you could upright the laterals.
 Phase 1 zero-point-five: This is a made-up
phrase to describe complimentary interceptive treatment. You could add resin to the
incisal edge of the lower incisors to jump the
bite. Do it for free. Parents will appreciate it.
Use Triad Gel with only 10% filler. Bracket
composite is 75% filler, and may lead to tooth
wear.
Phase 1.5

 Ectopic canines: Do not miss correcting at this
phase. Clinical pearl: Slide the chain through
comfort plastic sleeves to prevent it from digging into the gingiva.

 Herbst retainer: For severely retrognathic
patients in the absence of a cervical headgear,
end Phase 1 with a Herbst and leave it in as a
retainer with upper permanent retainer. Bond
U21-12 lingual retainer; when the patient
comes back for Phase 2, you could use
Invisalign Teen.
Phase 2 Retention

 Frenectomy in thick biotypes. Do not forget to
cut through the superior part of the frenum;
make sure you remove it all the way up to the
top. Otherwise you will have a tissue tag.
 Do the frenectomy, and then deliver your
retainers.
 Polishing kit / disposable burs: use a flat bur to
contour the incisal edges (donut bur).
 Always use fresh burs when debonding. Will
save time and minimize scratches.
 Should you reduce mammelons after Phase 1?
Dr. Kravitz reduces most of the mammelons in
Phase 1, not all of them.
 When using polishing burs on the buccal surfaces of the teeth, use water: You will have
better results and you will not scratch the
enamel.

PCSO Bulletin  Winter 2017

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2017