acific Coast Society of Orthodontists Bulletin Summer 2018 - 43

Special Section

Faculty Files

RETENTION

process. This should seem like a ludicrous, illogical, and unnatural stance, and would be completely unexpected, regardless of the technique
or skill of the surgeon. Time marches on, and
there is nothing we as professionals can do to
stop it or its effects on the human body. There is
no question that we can have an influence, but
there is a monumental chasm between influence
and control - just ask any parent of a teenager.
Yet it seems that as a profession, we have historically sold our patients on the idea that we are
somehow able to disconnect our tooth movement from the reality of the dynamic living quarters in which the dentition resides, as well as the
effects of time, function, and age. In addressing
the issue of stability for cosmetic surgery
patients, the American Board of Cosmetic Surgery
answers the question How will facelift results
look over the long term? by stating that "when
performed by an experienced, board certified cosmetic surgeon, a facelift is designed to achieve
results that not only look natural now, but will
also age naturally with you. While nothing can
stop the normal aging process, after a facelift you
should always look years younger than you
would have without the surgery. However, there
are certain things you can do to keep your results
looking their best. Maintaining a healthy, stable
weight is important as significant weight fluctuations can cause skin to stretch out again. You
should also adopt a consistent, quality skin care
regimen to keep your skin healthy and protected
from unnecessary aging."8
As orthodontists, there are many parallels with
our plastic and cosmetic surgery colleagues, and
this is one of them. The above question could
well be rewritten for the orthodontic specialty as
follows: How will orthodontic results look over
the long term? "When performed by an experienced, board certified orthodontic specialist,
orthodontic treatment is designed to achieve

Summer 2018  PCSO Bulletin

results that not only look natural now, but will
also age naturally with you as you enjoy
improved oral health and function. While nothing
can stop the normal aging process, after orthodontic treatment you should always look better
than you would have without treatment. However, there are certain things you can do to keep
your results looking their best. Maintaining a
healthy, stable oral environment is important, as
many conditions can affect the gums and supporting dental structures and encourage unnatural and undesirable tooth movement. You should
also adopt a consistent, quality retainer wear regimen and continue to see your general dentist to
protect from dental disease that can destabilize
the teeth."
Duration of Retainer Wear
Another issue at the forefront of retention is
duration of retainer wear. Dr. A. J. Haas has stated
that he has "rarely, if ever, removed a lower fixed
lingual retainer in less than six years, with the
usual lower retention time being approximately
six to eight years, the rationale being that if (cellularly speaking) man is a new body every seven
years, all those taut Sharpey's fibers should now
be comfortably relaxed, third molars should have
erupted, be poised for good eruption, or have
been removed. Probably most significant, ramal
growth should have ceased. In addition, incisors
should have achieved a homeostasis with alveolar and periodontal structures, forces of occlusion, and existing muscular forces."9 It can also
be understood that as part of achieving homeostasis, the occlusion will have settled, anterior
coupling will be achieved, and any traumatic or
heavy occlusal contacts have been resolved either
through functional occlusal forces or some type
of equilibration. Once this state of homeostasis
is achieved, and sufficient time has passed to
recycle our complete cellular composition and
generate a new person, two questions must be

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