acific Coast Society of Orthodontists Bulletin Summer 2018 - 47

Special Section

Retention

RETENTION

Mixed Dentition Patients
This retainer will hold incisor alignment and arch
length molar width and can be worn through
transition without affecting the emerging buccal
segments.

Retainer Wear Requirements
We ask patients to wear the retainer full-time for
four weeks and then only at night. Many practices
use full-time retainers for a much longer period.
We think this just adds to doctor time and risk of
broken or lost appliances without any benefit to
stability. After fixed appliances are removed, the
circumferential fibers tighten up in response to
mastication without the support of archwires. If
the retainer is worn full-time, this adaptation is
delayed.
Retention Period Visits
Our basic plan is three to four visits after the
deband/retainer delivery appointment. Retainers
are delivered the same day as deband or the day
after. You must have an in-house lab to do this,
but it is pretty easy if the retainers are an upper
slipcover and lower fixed.
1. Eight weeks to check cooperation: At this
point, the patient has been using the removable retainers at night only for one month.
Final records have been reviewed by the doctor, and copies of photos and radiograms have
been sent to the dentist. The patient can be
shown the beginning records at this visit and
complete a testimonial form.
2. Four months later: Confirm cooperation, follow up on referrals, e.g. third molars.

Summer 2018  PCSO Bulletin

3. Twelve months later: Some patients will be
dismissed at this visit (often those with fixed
lower lingual bars).
4. At 12 months, dismiss from practice: At this
time we advise the referring dentist that the
patient should continue to use the retainer
without visits to our office and has been told
that he/she is welcome to come in if there are
any concerns.
Minor Tooth Movement
If a patient has a need for some minor tooth
movement after deband, such as closing a slight
space, or controlling a rotation tendency, we consider this an active phase, and see the patient
every six weeks until our minor tooth movement
goal is met. Then we start our normal retention
protocol. Consequently, we try pretty hard to
avoid any discrepancies at deband.
Retainer Loss
If a patient loses a removable retainer or a fixed
retainer becomes loose, and there has been some
movement, our typical choice is to bracket the
involved anterior teeth, align for two months, and
then replace the retainers. This choice uses much
less doctor time than using an active spring
retainer. We know this from sad experience.
Final Records
We use final records to plan the retention period,
to evaluate interproximal bone, to look at the cortical bone layer of the condyles, and to verify the
condition of the root forms. Because of our carefully crafted approach to obtaining them, we
rarely have any resistance to final records. Here's
the sequence: when the deband visit is put into
the schedule, the computer trips a letter to the
patient's home and to his/her dentist explaining
that treatment will end on (date) and that if
there are any concerns about the finish, we
should be notified. The letter explains the need
for the X-rays, models, and photos, which will be
done at the deband appointment. Combining
final records with this appointment makes the
most sense for the patient's family, who are

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