acific Coast Society of Orthodontists Bulletin Summer 2018 - 44

Special Section

Faculty Files

RETENTION

considered and addressed. First: how long after
the seven-year period should the patient continue to wear retainers, how frequently, and what
is our responsibility in communicating this information to the patient (i.e., do we actively pursue
patients so that we can see them for retainer
removal at the appropriate time, and when is the
appropriate time)? Second: what, if any, are the
benefits and/or detrimental effects of continued
retention (particularly fixed permanent retention)
if wear is continued beyond a seven- to eight-year
period when the above-mentioned criteria have
been met? Because we are treating and dealing
with individuals, and expect to see large individual variations in response and outcome, there are
individual answers to these questions and issues.
Any debate will be inconclusive, and answers
require significant research before we have any
indication regarding the achievement of an
enlightened and reasonable answer. How each
style or type of retainer meets the needs of the
individual patient is largely dependent upon how
the appliance is managed, thus confounding
research and complicating an arrival at any sort
of consensus, let alone a rationale we can agree
upon as a profession.
However, there are some things we should be
able to agree upon as being logical and independent of treatment methods, modalities, appliance selection, and type of retention:
 Nothing in the body is ever really stable. Teeth
are expected to change position to some
degree, regardless of the treatment rendered.
There is some degree of propensity for teeth
to return to their former positions, but elimination of the root causes of malocclusion may
reduce or prevent these relapse tendencies.

44

 Retention is inseparably connected with treatment. 10 As such, it should be considered part
of treatment. A well-diagnosed, well-planned,
and well-executed treatment that considers
the functional aspects of the dentofacial complex and is in balance and harmony with
these functional demands can be expected to
exhibit the stability proposed in this article.
 Adhering to principles of proper orthodontic
treatment and finishing cases in a proper
occlusion, where cusps are seated in opposing
fossa, incline planes support the occlusal correction, function is free from interferences
because of anterior and canine guidance,
arches are leveled, arch forms coordinated,
and teeth are placed upright in their supporting bone, will all contribute to a healthier and
more stable result.
 Regardless of the type or style of retainers
used, a well-planned retention protocol that is
adhered to by the patient will enhance stability. Most of us must concede that retainers are
a valuable asset in our attempts to maintain
treatment results, and any retainer is better
than no retainer.
The Alexander Discipline11 has a saying;
Effort = Results. This holds true for us as well as
our patients, regardless of whether we are looking at treatment or the retention period that
follows. It is worth the effort to maintain the
results we work so hard to achieve. Having a
good understanding of what relapse really is and
what should be reasonably expected in the way
of stability can help us differentiate between
relapse and the natural changes that are part of
life. If we grasp this, we are in a better position to
educate our patients and avoid the conflicts that

PCSO Bulletin  Summer 2018



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