mohamad aboualnaser-awatef shaar-oussama sandid- orthodontist-orthodontist paris france-Seminars in Orthodontics-Orthodontic & Dental Continuing Education, Seminars & Courses-orthodontist Kingdom of Saudi Arabia ksa-orthodontist qatar-orthodontist koweit-orthodontist emirats- lebanon beirut, dentist beirut lebanon-pediatric dentsitry beirut lebanon-dentiste orthodontiste beyrouth lebanon-pediatrique dentistrie beyrouth liban- periodontics lebanon-orthodontic lebanon-lebanese university dentistry-american university of beirut dentistry orthodontics-beirut arab university dentistry- universite saint joseph beirut dentistry-pediatre beyrouth liban-pediatrics beirut lebanon-makassed hsopital beirut lebanon-ORTHODONTIST BEIRUT LEBANON-PEDIATRIC DENTISTRY BEIRUT LEBANON-DENTISTRY BEIRUT LEBANON -DENTISTS BEIRUT LEBANON

1. 141-Relapse in Orthodontics
la récidive en Orthodontie
Awatef SHAAR (BAU-LB), Orthodontist.
Mohamad ABOULNASER- Orthodontist, BAU, Connecticut, USA.
Oussama SANDID- Orthodontist, D.C.D., D.U.O, C.E.S.B.B, C.E.S.O.D.F ,
S.Q.O.D.F, Paris. France.
Contact: dr.aboualnaser@hotmail.com
www.orthofree.com

3. Intoduction
1-Definition
2-Orthodontic relapse causes
• a-Periodontal ligament traction
• b-Relapse due to growth related changes
• c-Muscular factors
• d-Role of occlusion
• e-Failure to eliminate the original cause
• f-Role of third molars
• g-Bone adaptation
3-Preventing relapse
• a- Percision- Circumferential Supracrestal-Fiberotomy
• b- Prolonged Retention
• c- Placement of Teeth in Orofacial Soft Tissue Balance
• d- Placement of Teeth in Occlusal Equilibrium
e-Orthodontic Overcorrection 6
• f- Importance of Lower Incisor Position in Stability
g- Maintain Inter-canine & Inter-molar Distances
• h- Adaptation of Bone and Adjacent Soft Tissues
• i- Treatment of Rotated Teeth at an Early Age
Conclusions
Bibliography
RELAPSE IN ORTHODONTICS
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

4. Newton’s third law
‘’for every action there is an equal and oppositereaction’’
Any treatment is a failure unless the treatment results can be maintained.
Relapse is one of the most challenging problems that encounter the orthodontists
during and after finishing orthodontic treatment.
Relapse after orthodontic treatment without permanent retention
Introduction
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

5. • It has been defined as the loss of any correction achieved by orthodontic
treatment.
• Is the return, following correction, of the features of the original
malocclusion
J LEMAY www.orthodontisteenligne.com
1- Definition
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

6. A-Periodontal ligament traction.
B-Relapse due to growth related changes.
C-Failure to eliminate the original cause.
D-Role of occlusion.
E-Role of third molars.
F-Muscular factors.
G-Poor cooperation patient.
2- Causes of Relapse
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

7. Whenever teeth are moved orthodontically through braces, the periodontal and
gingival fibres that encircle the tooth are stretched. These stretched fibres can
contract and can cause the teeth to come back to their original untreatedposition
causing the relapse.
A- Causes of RelapsePeriodontal Ligament Traction
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

8. Growth is a process that continues throughout life. Patients with skeletalproblems
may exhibit relapse due to continuation of the abnormal growth pattern after
orthodontic therapy. Hence prolonged retention is indicated until active growth is
completed.
http://pocketdentistry.com/1-craniofacial-growth/
B- Causes of Relapse
Relapse Due to Growth Related Changes
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

9. Mandibular height very slowly increases after puberty throughout life, excessive forward
growth and rotation of the mandible can result in an increase in overbite, and anterior
crowding
B- Causes of Relapse
Relapse Due to Growth Related Changes
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

10. Excessive backwards growth and rotation of the mandible (matrix rotation with fulcrum
around the condyle), can reduce the overbite with possible development of a skeletal
anterior open bite, and the patient may also become more classIII
B- Causes of Relapse
Relapse Due to Growth Related Changes
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

11. The cause of the malocclusion should be determined at the time of diagnosis and adequate
treatment steps should be planned to eliminate them. Failure to remove the etiology can result
in relapse e.g. some times the orthodontic problem is because of some habit like thumb
sucking, mouth breathing or Tongue thrust.
If the habit is not treated at the beginning of the treatment, then relapse will occur after removing
the braces.
Presence of certain habits such as clenching, grinding, nail biting, lip biting are important causes of
relapse
C-Causes of Relapse in orthodontics
Failure to Eliminate the Original Cause
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

12. D-Causes of Relapse in orthodontics
Role of Occlusion
Good intercuspation of upper and lower teeth is important factor in
maintaining the stability of treated cases.
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

13. • uu
D-Causes of Relapse in orthodontics
Role of Occlusion
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

14. The third molars erupt very late in the development of dentition. They erupt inmost
cases between the ages of 18-21 years.
By this time most of the patients have completed their orthodontic treatment.
The pressure exerted by the erupting third molars is believed to cause the late
anterior crowding causingrelapse
http://www.orthodls.com/blog/do-wisdom-teeth-make-your-teeth-crowded
E-Causes of Relapse in orthodontics
Role of Third Molars
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

15. Orthodontists can control or correct to help prevent relapse. But what about the
following muscular interferences?
Tongue thrust when swallowing, Mouth breathing, Thumb sucking
Lip and tongue pressure
F- Causes of Relapse in orthodontics
Muscular Factors
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

16. Posture of tongue and orthodontic relapse
F- Causes of Relapse in orthodontics
Muscular Factors
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

17. • oMoacroglossiaor largetongue
Lateral tongue posture
Anterior tongue posture
F- Causes of Relapse in orthodontics
Muscular Factors
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

18. If the bonded wire comes loose or breaks, the orthodontist must replace it
immediately.
Meanwhile, the patient must wear the clear aligner 24hours.
If the patient did not commend to take an appointment for replacement of the fixed
retainer then relapse willoccur.
G- Causes of Relapse in orthodontics
Poor Patient Co-operation
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

19. • a- Percision- Circumferential Supracrestal-Fiberotomy
• b- Prolonged Retention
• c- Placement of Teeth in Orofacial Soft Tissue Balance
• d- Placement of Teeth in Occlusal Equilibrium
• e-Orthodontic Overcorrection
• f- Importance of Lower Incisor Position in Stability
• g- Maintain Inter-canine & Inter-molar Distance
• h- Adaptation of Bone and Adjacent Soft Tissues
• i- Treatment of Rotated Teeth at an Early Age
3-Prevention of Relapse
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

20. a- Percision- Circumferential Supracrestal-Fiberotomy
• Relapse of severely rotated teeth due to rebound of elastic fibres in the Supera-crestal tissues
can be reduced by percision.
• Fibrectomy (CSF) Prevents Orthodontic Relapse CSF is performed immediately after removal of
the orthodontic appliance. By releasing the soft-tissue tension and allowing the reattachment of
periodontal fibers..
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

21. Fixed and removable retention
b- Prolonged Retention
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

22. Musculatures
Proper meshing of the teeth so that they function in harmony with the jaw
joints and muscles will allow teeth to wear and function evenly, be stable,
and decrease trauma to the surrounding supporting bone.
c- Placement of Teeth in Orofacial Soft Tissue Balance
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

23. Obtaining proper occlusion is an important factor in maintaining corrected positions
It has been suggested that good interdigitation of teeth post-treatment may reduce the
likelihood of relapse and improve the stability of the final result of orthodontic treatment
Malocclusion
should be
overcorrected
as a safety
factor
Normal occlusion
The mesiobuccal cusp of the maxillary first molar is aligned with the buccal
groove of the mandibular first molar. There is alignment of the teeth, normal
overbite and overjet and coincident maxillary and mandibularmidlines..
d- Placement of Teeth in Occlusal Equilibrium
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

24. Overcorrection is especially likely to be needed for these types of movement:
1- Rotations (particularly single-rooted teeth whose roots have a
circular cross-section)
2- Labial-lingual alignment (particularly of incisors)
3- Expansion
4- Extrusion (because the PDL tends to pull the tooth back into the socket)
J LEMAY- www.orthodontisteenligne.com
e-Orthodontic Overcorrection
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

25. More stable results are obtainediwhen the mandibular incisors
are either upright or slightly retroclined over the basalbone.
Obtaining proper occlusion is an important factor in maintaining
corrected positions
f- Importance of Lower Incisor Position in Stability
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

26. Relapse due to growtthrelatedchanges
Between the ages of 13
and 20 years, the upper
arch length and
intercanine width show
significant reduction, and
can produce anterior
crowding
In the lower arch, the
intercanine width and
arch length peak at the
age of approximately 8
years old, and also show
significant reduction
from then omwards
g- Maintain Inter-canine & Inter-molar Distance
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

27. Bone and adjacent tissues must be allowed to reorganize around newlypositioned
teeth
h- Adaptation of Bone and Adjacent Soft Tissues
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

28. Stability of rotated teeth is enhanced by means of early correction.
i- Treatment of Rotated Teeth at an Early Age
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

29. Late incisor crowding (post-adolescent crowding) is widely regarded as a
normal maturation
Current Controversies in Late Incisor Crowding
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR

30. • Singh, Gurkeerat. Textbook of orthodontics. JP Medical Ltd, 2015.
• Florman, Michael, L. Jerrold, and M. Partovi. "Indefinite Orthodontic
Retention." Continuing Education Digest (2005): 35-41.
• Normando, David. A method to re-treat the relapse of dental misalignment, Dental
Press J Orthod 48 2011 Sept-Oct;16(5):48-53
• Khursheed Alam, Mohammad, A to Z ORTHODONTICS, PPSP Publication, August
2012, volume 21, 978-967-0486-10-9
References
Oussama SANDID- Mohamad ABOUALNASER- AwatefSHAAR