acific Coast Society of Orthodontists Bulletin Summer 2018 - 42

Special Section

Faculty Files

RETENTION

follow-up visit occurs one month after initial
delivery. The results of this survey tend to indicate that Hawley retainers remain the preferred
choice for the vast majority of those using
removable retainers, while fixed permanent
retention is preferred for the lower arch. The primary determinant of retainer choice was the initial presentation of the dentition, followed by
patient preference. It was recommended that
larger longitudinal studies be conducted in order
to follow the trends in retention practices.
Dealing with Relapse
Concerning retention in general, one of the big
issues facing the profession is what constitutes
relapse, and how it is differentiated from what
should be expected as a natural outcome of the
treatment as planned and rendered, combined
with the changes that are expected as a natural
result of the normal aging and maturation
process.
Orthodontists are not the only health professionals who deal with relapse. It is a very common
battle for our medical colleagues who deal with
behavioral medicine and drug abuse, as well as
those who treat conditions like multiple sclerosis,
malaria, and other diseases that exhibit periods
of latency with intermittent periods of activity
that are termed relapse or recrudescence. In
medicine, the term for recurrence of a past condition is relapse or recidivism. Dictionary.com
defines relapse as a "fall or slip back into a former
state or practice, a fall back into illness after
apparent or partial recovery," and provides backslide and recidivate as related words, with
regress, revert, and lapse as synonyms.6 These
terms fit well within what can reasonably be
assumed to be congruent with most orthodontists' understanding of cases that deteriorate
shortly after completion of treatment. However,
one must question whether the dentition is ever

truly stable and wonder if it is unrealistic to
expect that our results will be perfectly maintained in the dynamic oral environment. Part of
the answer to this question is dependent upon
our definition of stability. Merriam-Webster provides some valuable insight, defining stability as
"resistance to change or to physical disintegration, having strength to stand or endure, or the
quality of being not easily changed or moved."7
We are all experienced in the finding that teeth
are often easily moved in the most undesirable of
directions. For example, there is the maximum
anchorage case, where in spite of our efforts to
conserve anchorage, it is burned in total disregard for our conservation attempts. It appears
that in this context, stability is ethereal and will
elude an application to retention. Merriam-Webster does not leave us without hope, as the most
apropos definition for our needs is the one provided for kids: "the condition of being reliable or
unlikely to change suddenly or greatly."7 The idea
can be advanced that this definition holds the
key to our understanding of orthodontic stability.
Typical orthodontic relapse takes place rapidly
and over a short duration of time; the changes
associated with the natural aging and maturation processes are gradual and tend to occur over
extended periods of time. Are there exceptions
to this rule? Most assuredly there are, but these
are exceptions, not the norm or the routine.
What should our patients expect from a welldiagnosed, well-planned, and well-executed
treatment regimen? A result that is aesthetic,
functional, healthy, and stable, but still anticipated to change with time and normal wearand-tear.
Time Marches On
A plastic surgeon cannot espouse a philosophy or
advise his/her patients that a facelift or other
cosmetic surgery will prevent any further aging
and stop the natural effects of the maturation

PCSO Bulletin  Summer 2018

http://www.Dictionary.com

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