acific Coast Society of Orthodontists Bulletin Summer 2018 - 25

Editorial
Special Section

RETENTION

Retention in Orthodontics

Dr. Jae Hyun Park
PCSO Bulletin Editor

Retention is an important part of orthodontics
that is often underappreciated. To provide a high
standard of care in orthodontic treatment, retention must be addressed. It should be viewed as
a phase of treatment on its own, and it can be
one of the most important and challenging parts
of every treatment plan. That is in part because
there is no set agreement on the best approach
to retention. While the ultimate goal for patients
is not to have retainers, this is rarely possible.
Consequently, the goal of retention is to provide
some form of stability after orthodontic treatment is complete in order to prevent relapse.1
Retention is a normal practice for all patients
because it is difficult to determine which patients
will remain stable after orthodontic treatment.
Some patients remain stable without long-term
retention, while others do not. Therefore, it is
important to treat all patients as if they have the
potential to show relapse. This is why recent
trends have changed from prescribing retainers
for only one to two years to recommending longterm retention.1 Even so, it is also important to
have a clear understanding of each patient's
desires, expectations, and circumstances; these
factors will have an effect on the need for retention. Factors that may positively or negatively
influence the retention phase include the
patient's compliance with removable retainers,
age, attitude towards relapse, ability to clean
around a fixed retainer, and finances.1 Therefore,
it is important that the retention phase be customized to the patient's expectations and desires
as well as their needs.

Summer 2018  PCSO Bulletin

Understanding Why Relapse Occurs
Before we discuss the different retention protocols, it is first important to understand why
relapse occurs. Teeth are in a dynamic and constantly changing relationship with their environment. Some factors linked to relapse include
uncooperative patients, unfavorable skeletal patterns, and muscular functions and habits.2 Typically, relapse is the result of three influences:
periodontal and gingival tissues, occlusal factors,
and soft tissue pressures. The majority of periodontal and gingival fibers take three to four
months to remodel to the new tooth position
after tooth movement has occurred; elastic fibers
can take eight months or more to remodel.1 Teeth
need to be stabilized in their proper positions
while fibers remodel. In addition, how teeth
occlude at the completion of orthodontic treatment can affect stability of dentition, which is
why it is important to align teeth in the proper
occlusal relationships to minimize relapse.
Orthodontists can take measures to reduce
changes brought forth by occlusal, soft tissue,
and periodontal effects. Another important
change factor that is unfortunately beyond the
control of the orthodontist is physiological
growth.1 Therefore, it is important to educate
patients that normal physiological changes due
to age - such as facial growth - can affect
occlusion. These changes are unpredictable and
can often lead to relapse. Patients should be
advised of this fact prior to treatment. One solution is to advise patients to wear their retainers
for as long as they want to keep their teeth
straight.

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Table of Contents for the Digital Edition of acific Coast Society of Orthodontists Bulletin Summer 2018

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