RETENTION

• TEETH TEND TO RETURN TOFORMER POSITIONS

• ELIMINATE ETIOLOGY

• CORRECTIONS DURING GROWTH

• GROWTH EFFECTS

• MAINTAIN ARCH FORMPARTICULARLY LOWER

RETENTION

• OVERCORRECTION

• IDEAL STATIC AND FUNCTIONAL OCCLUSION

• TEETH UPRIGHT OVER BASAL BONE

• LOWER INCISOR UPRIGHTING

• ALLOW TISSUES TIME TO RE-ORGANIZE/ADAPT

PRE-TREATMENT POST-TREATMENT

RELAPSE UNPREDICTABLE

RETENTION

RELAPSEFUNCTIONAL OPEN BITE

SHORT UPPER LIP

RELAPSE

PRE-ORTHO AFTER SERIAL EXT. POST-TREAMENT

POST-RETENTION

RELAPSE

THE ETIOLOGY OF LATE LOWER ARCH CROWDING

RICHARDSON, ME. AJODO 1994

CROWDING IN ORTHODONTICALLY TREATED PATIENTS OVER TIME

ARCH LENGTH AND ARCH DEPTH DECREASE AFTER ERUPTION OF SECOND MOLARS……. LEADING TO CROWDING

CROWDING IN UNTREATED SUBJECTS BETWEEN 12-18-30 YEARS

NORMAL PHYSIOLOGIC PHENOMENON• (10 REFERENCES)

GROWTH

MANDIBLE > MAXILLA LATE MANDIBULAR GROWTH

BASAL BONE > ALVEOLAR BONE MANDIBULAR ARCH CONTAINED BY

MAXILLARY ARCH GROWTH DIRECTION CLOSING

ROTATION: MESIAL PATH OF ERUPTION OF POST. TEETH OPENING ROTATION: RETROCLINATION OF INCISORS

GROWTH

MUSCLE FORCESLIPS, CHEEKS, TONGUE

MESIALLY DIRECTED FORCES-PHYSIOLOGIC MESIAL DRIFT

-ANT. COMPONANT OF FORCES OF OCCLUSION

-THIRD MOLAR DEVELOPMENT

RETENTION

PRIOR TO RETENTIONTHIRD MOLARSNORMAL DEVELOPMENT

FEW YEARS POST-TREAMENTLOWER THIRD MOLARSHORIZONTAL IMPACTIONS

OBJECTIVES FOR RETENTIONOBJECTIVES FOR RETENTIONTeeth tend to return toward pretreatment condition

Retain what has been achieved

Consider the three dimensions + ROTATIONS

MAXILLARY HAWLEY RETAINER

Palate = transverse+antero-posterior

Labial bow = overjet + alignment standard or circumferential

Anterior bite plane = overbite

Finger springs = rotations, spaces, lingual tipping

Clasps for retention of appliance-ball, Adams, interproximal, “C” clasp

Headgear for Class II to molar bands

RETAINERS

MAXILLARY CIRCUMFERENTIAL HAWLEY RETAINER

MANDIBULAR HAWLEY RETAINER

MAXILLARYHAWLEY RETAINER

UPPER HAWLEYFINGER SPRINGS

POST-TREATMENTSMALL LATERALS

MAXILLARY FRENUMMIDLINE DIASTEMADEEP OVERBITE

CLASS I MALOCCLUSION

FULL FIXED APPLIANCES POST-TREATMENT

SPLINTING/PERMANENTRETENTION

0.022 SPIRAL WIREALLOWS FOR PHYSIOLOGIC

MOVEMENT OF ADJACENT TEETH

SPLINTING LONG-TERM CLASS III CASEPOST-TREATMENT RELAPSEMIN. OVERJET+OVERBITE

MANDIBULAR RETAINERS

HAWLEY RETAINER labial bow=space closure +alignment

occlusal rests

FIXED BONDED 3-3

BONDING TECHNIQUE

MANDIBULAR RETAINERSFIXED BONDED LINGUAL

3-3 0.030 BLUE ELGILOY

OR 4-4 (OVERBITE/CURVE OF SPEE)

INTERCANINE WIDTHINCISOR MALALIGNMENTTHIRD MOLARS???

LONG-TERMHOLD AGAINST GROWTHINCISOR UPRIGHTING

LOWER ESSIX RETAINER UPPER ESSIX RETAINER

POST-TREATMENTMISSING LATERALS

ESSIX RETAINERSWITH ACRYLIC TEETH

IMPRESSIONS FORTOOTH POSITIONER

LAB SET-UP FORTOOTH POSITIONER

RUBBER TOOTH POSITIONER

PRE-TREATMENT INCISOR ROTATION

CIRCUMFERENTIALSUPRA-CRESTAL FIBEROTOMY

KEYSTONINGINTER-PROXIMALSTRIPPING

PRE-TREATMENTCROWDING AND ROTATIONS

LAB. SET-UP FORSPRING ALIGNER

SPRING ALIGNERIDEAL SET-UP INITIAL PLACEMENT

SCHEDULE MANAGEMENT DURING RETENTION

• LETTERS TO PATIENTS AND PARENTS

• LETTER TO DENTIST-explain plan and request help in monitoring fixed lingual retainer.

• L

SCHEDULE MANAGEMENT DURING RETENTION

• PLACE RETAINERS• 6-8 WEEK RECALL• 4 MONTH FOLLOW-UP• 6-8 MONTHS FOLLOW-UP• ONE YEAR LATER• AFTER 2 YEARS AS NEEDED• NO RECALLS-letter to patient and dentist

FEES ???

FIXED BONDED RETAINERAFTER 8 YEARS

REMOVAL OF FIXED LINGUAL RETAINERCONSIDER LOWER HAWLEY/ESSIX WHILE

SLEEPINGRELAPSE MAY NEED TO BE MANAGED

LONG-TERM

CLASS I MALOCCLUSIONINCREASED OVERBITESMALL UL LATERAL

CONGENITALLY ABSENTUPPER RIGHT LATERAL

POST-TREATMENT

ACID ETCH BRIDGE UPPER RIGHT LATERAL

BONDING BUILD-UP LEFT LATERAL INCISOR