1. RETENTION AND
RELAPSE IN
ORTHODONTICS
Submitted by : Ekta chaudhary

2.  Definition : It has been defined as the loss of
any correction achieved by orthodontic
treatment.

3. 1. Periodontal ligament traction:
Teeth moved orthodontically
streching of periodontal principal fibres and the
gingival fibres encircling the teeth
Fibres contract
RELAPSE

4. Patient with skeletal problems associated
with class II and class III
continued abnormal growth pattern after
orthodontic therapy
RELAPSE

5. Teeth moved recently are surrounded by
lightly calcified osteoid bone.
No adequate stabilization of teeth.
RELAPSE

6. Teeth are encapsulated in all directions by
muscles.
If muscular imbalance at the end of
orthodontic therapy.
RELAPSE

7. Cause of malocclusion not eliminated.
RELAPSE

8. If third molar erupt after the orthodontic
treatment .
Exert pressure on the teeth.
Late anterior crowding .
RELAPSE

9.  Defined as maintaining newly moved teeth in
position, long enough to aid in stabilizing their
correction. (Moyer)
Need Of Retention
1. Gingival and periodontal tissue require time post-
treatment to reorganize
2. Soft tissue pressures are likely to cause relapse
if teeth are placed in an unstable position
3. Growth post-treatment may cause relapse

10.  Relapse potential may be predicted by evaluation
of initial occlusion; teeth usually want to return to
their original position; this is due to gingival fibers
and unbalanced lip-tongue forces
 Full-time retention is required for 3-4 months to
allow for reorganization of PDL
 Retention should continue for at least 12 months
in non-growing patients or until growth has ceased
in growing patients

11. 1. The Occlusal School
2. The Apical Base School
3. The Mandibular Incisor School
4. The Musculature School

12. According to KINGSLEY proper
occlusion is a key factor in
determining the STABILITY of the
newly moved teeth.

13.  ALEX LUNDSTROM (1920s) suggested that
the apical base is an important factor in the
correction of malocclusion and maintenance
of the stability of treated cases.
 McCauley added that the inter canine and
inter-molar widths should be maintained
during orthodontic therapy.

14.  Grieves and Tweed suggested that post
treatment stability was increased when
mandibular incisors were placed upright or
slightly retroclined over the basal bone.

15.  According to Rojers functional
muscle balance is necessary in
order to ensure post treatment
stability.

16. Theorem 1.
“Teeth that have been moved tend to return to
their former position”
Theorem 2.
“Elimination of the cause of malocclusion will
prevent relapse”
Theorem 3.
“Malocclusion should be over corrected as a
safety factor”

17. Theorem 4.
“Proper occlusion is a potent factor in holding
teeth in their corrected positions”
Theorem 5.
“Bone adjacent the tissue must be allowed time
to reorganize around newly positioned teeth”
Theorem 6.
“If the lower incisors are based upright over basal
bone they are more likely to remain in good
alignment”

18. Theorem 7.
“Corrections carried out during periods of growth
are less likely to relapse”
Theorem 8.
“The farther the teeth have been moved , the
lesser is the risk of relapse”
Theorem 9.
“Arch form, particularly in the mandibular arch,
cannot be permanently altered by appliance
therapy”
Theorem 10.
“Many treated malocclusions require permanent
retaining devices”

19. Retention can be three types :
1. Natural or no retention
2. Limited or short term retention
3. Prolonged or permanent retention

20.  Conditions that do not require retention are:-
1. Anterior crossbite.
2. Serial extraction procedures.
3. Posterior cross bite in patients having steep
cusps.
4. Highly placed canines in class 1 extraction cases.

21.  Most cases routinely treated fall in this category.
Retention is given to allow bone n PDL tissues to
adapt in their new location.
1. Class I, class II div 1 and div 2 cases, treated by
extractions.
2. Deep bites.
3. Class 1 non extraction with dental arches showing
proclination and spacing.

22.  Cases requiring permanent retention are
1. Midline diastema.
2. Severe rotations.
3. Arch expansion achieved without ensuring good
occlusion.
4. Certain class II, div 2 deep bite cases.
5. Patients with abnormal musculature or tongue
habits.
6. Expanded arches in cleft palate patients.

23.  Retainers are passive orthodontic appliances
that help in maintaining and stabilizing the
position of teeth long enough to permit
reorganization of supporting structures after the
active phase of orthodontic therapy
 Three types:-
1. Removable Retainers
2. Fixed Retainers
3. Active Retainers

24.  Should retain all teeth that have been
moved into desired positions.
 Should permit normal functional forces to
act on the dentition.
 Should be self cleansing and should permit
oral hygiene maintenance.
 Should be as inconspicuous as possible.

25. 1. Hawley’s
appliance
2. - Designed in 1920
by Charles Hawley.
 Most frequently used
retainer
 Consists of claps on
molars and a short
labial bow extending
from canine to
canine having
adjustment loops

26. HAWLEY’S Retainer with
HAWLEY’S Retainer
long labial bows

27. 1. Bow can be soldered to clasps on 1st molars
2. Place C-clasps on second molars and allow bow to run around entire
arch

28. Hawley’s Retainer with labial bow soldered with Adam's clasp

29.  Consists of a labial wire that extends till the
last erupted molar and curves around it to
get embedded in acrylic that spans the
palate.
Advantage :
There is no cross over wire that extends
between the canine and premolar thereby
eliminating the risk of space opening.

31.  Appliance made of wire framework that runs
labially over the incisors and then passes between
canine and premolar and is recurved to lie over
lingual surface.
 Both the labial as well as lingual segments are
embedded in a strip of clear acrylic.
 Used to bring about correction of rotations
 Less comfortable than Hawley
 Not as good in overbite maintenance
 Indicated in perio cases where splinting is needed

33.  Extended version of spring aligner
that covers all the teeth.
 Consists of wire that passes along
the labial as well as lingual
surfaces of all erupted teeth which
is embedded in a strip of acrylic.
 Use : In stabilizing a periodontally
weak dentition.
 Not routinely used.

34.  Described by H.D Kesling in 1945
 Made of thermoplastic rubber like material that spans the inter
– occlusal space and covers the clinical crowns of the U/L
portion of teeth and a small portion of the gingiva.
 Needs no activation at regular intervals and is durable
 Disadvantages
1. Bulky and difficult to wear full-
time.
2. Difficulty in speech and risk of
TMJ problems
3. Do not retain incisor position as
well as a conventional retainer
b/c patients usually wont wear

36. VACCUM-FORMED (ESSIX)
RETAINER
 Developed in 1993
 This is a polypropylene or polyvinylchloride (PVC) material, typically .020" or .
030" thick.
 Plastic removable appliance
 Advantages:
 Esthetic
 Patient is more likely to wear
 Inexpensive
 Quick fabrication
 Minimal bulk
 High strength
 No adjustments
 Usually does not interfere with speech or function
 Studies have determined that Essix retainers are as efficient as Hawley-type
or bonded wire retainers

37. DAMON SPLINT
 Basically, upper and lower Essix
retainers connected
 Retentive splint for Class II, Class III,
and bilateral crossbite treatment
 Assists in tongue training
 Holds teeth and arches in corrected
position
•Designed By Dr. Dwight Damon
•Can be used by adults or patients in mixed dentition
•Minimal vertical opening to allow for air slot.
•Esthetic.
•Can be made using hard pressure formed, dual hardness/soft
liner and elastic silicone.

38.  Advantages of removable retainer
1. Reestablishes normal tissue when gingival hyperplasia is
present.
2. Maintains occlusal relationship and intra-arch position.
3. Unlikely to break.
4. Can be made with jaws rotated down and back to prevent Class
III relapse.
5. Can be constructed to prevent relapse in skeletal Class II and
open bite cases

Growth control is less effective than part-time functional
appliance or headgear

39.  Utilized in cases where stability is questionable and
prolonged retention is planned
 Four main indications:
1. Maintaining lower incisor position
2. Diastema maintenance.
3. Implant or pontic space maintenance
4. Retaining closed extraction spaces

40. 1. Maintaining lower incisor position
during late mandibular growth:
 Even mild mandibular growth between
the ages of 16-20 can cause lower
incisor relapse
 A fixed lingual bar bonded only to
canines can prevent distal tipping of
lower incisors
 A heavy wire, 28 or 30 mil, should be
used due to long span
 Studies indicate that placing retention
loops on canines will decrease
breakage

41.  If teeth were severely rotated or spaced, all teeth (3-3) can
be bonded together using a 17.5 mil braided steel wire –
as it is not desirable to use too rigid of a wire (must allow
physiologic tooth movement)
 Patients who were evaluated after 20 years of having a
lower fixed retainer showed NO signs of periodontal
problems
 If proper flossing is maintained, fixed retainers can remain
indefinately

42. 2. Holding diastema closed:
 Utilize lighter wire
(17.5 or 19.5 mil twist)
 Bond above cingulum –
out of occlusion
 Can prevent bite deepening if
lower incisors erupt

43. 3. Implant or pontic space maintance:
 Reduces mobility of teeth making it easier to place
bridge
 Holds space if prolonged periodontal treatment is
required post-ortho, prior to placement of restoration
 Implants should be placed as soon as ortho is
completed so it can be included in initial stages of
retention

44.  For posterior teeth, heavy wire is bonded to shallow
preparations in adjacent teeth
 The longer the span, the heavier the wire
 Placed out of occlusion
 For anterior teeth, a pontic can be placed on a removable
retainer for short term use
 If the patient must wait an extended period of time prior to
completion of vertical growth for placement of final restoration,
a bonded bridge is preferred

45. 4. Retaining closed extractions spaces:
 Placed on facial surfaces of posterior teeth
 Mainly used in adults, as they tolerate this better than
removable retainers
 More reliable than removable retainer

46.  The Fixed Appliance
 Banded Canine to Canine Retainer:
 Bonded Lingual Retainers:
 Band and Spur Retainers

47.  Commonly used in lower anterior region
 Canines are banded and a thick wire is contoured
over the lingual aspects and soldered to the canine
bands
 The bands predispose to poor oral hygeine and are
unesthetic.

48.  Retainers bonded on the lingual aspect
 S.S wire is adapted lingually to follow the anterior
curvature.
 Ends are curved over the canines where its
bonded.
 Various pre fabricated lingual retainers also are
available that can be bonded on the teeth
 Recently use of spiral wire is recommended that
can be boneded to each tooth individually.

50.  Used in cases where single
tooth has been orthodontically
treated for rotation correction
or labio lingual displacement.
•The tooth that has been moved is banded and spurs
are soldered on to the bands so as to overlap the
adjacent teeth.

51.  Reduced need for patient corporation
 Can be used when conventional retainers
cannot provide same degree of stability.
 Bonded retainers are more esthetic
 No tissue irritation unlike what may been
seen in tissue bearing areas of Hawley’s
retainer
 Can be used for permanent and semi
permanent retention.
 Do not effect speech.

52.  More cumbersome to insert
 Increased chair side time
 More expensive
 Banded variety may interfere with oral
hygiene maintainence
 More prone to breakages
 Loss of healthy tooth material
 Tend to discolor

53.  Relapse in these patients are most likely due to a combination of
dental and skeletal changes
 Dental changes (short-term relapse) :
 1-2mm of A-P change tend to occur immediately following
treatment, especially when Class II elastics are used
 Overcorrection is important in preventing relapse
 Forward movement of lower incisors more than 2mm will
require permanent retention, as lip pressure tends to upright
these teeth, leading to an increase in crowding, overbite, and
overjet

54.  Skeletal changes (long-term relapse):
 Depends on age, sex, and maturity
 If original growth pattern continues, treatment that involved
growth modification will most likely result in loss of at least
some correction
 Continue headgear at night along with retainer
 Use a “passive” functional appliance (activator/bionator) to
hold position at night and conventional retainers during day
(continue for 12-24 months)
 Patients most likely to require these treatments:
1) The younger the patient at the end of treatment
2) The greater the initial Class II problem
 Much easier to prevent relapse than to correct later

55.  Bionator/Activator
 Maintain occlusal relationship
 Bite registration is taken in CR,
so appliance is “passive”
 Not edge to edge like when
used for “active” Class II
correction

56.  Relapse occurs mainly from mandibular growth
 Use of chin cups to restrict mandibular growth has been recommended
by some authorsto counter the continued growth tendency of mandible
 But Chincups and functional appliances: rotate mandible downward
causing more vertical growth.
 Not as effective as maintaining Class II
 If relapse occurs in normal or excessive face height patients: may need
surgical correction after growth
 In less severe Class III cases: Utilize functional appliances such as
reverse activator, FR 3 or class III bionator or positioner.
 Will maintain occlusal relationship in these cases
 May position jaws down and back to prevent relapse

57.  Must control overbite during retention
period
 Construct upper removable retainer with a
baseplate to prevent lower incisors from
over-erupting; posterior occlusion is
maintained
 After stability is achieved, worn at night
only
 Nanda and Nanda found that the pubertal
growth spurt in deep bite patients is 1.5-2
years later than that of open bite cases;
therefore longer retention period is
required for deep bite cases

58.  Patients with habit (thumb or tongue):
 Relapse occurs due to incisor intrusion.
 Important to control the habit.
 Patients without habit:
 Relapse is due to excessive growth tendencies and
continued eruption of posteriors mainly upper molars
(extrusion).
 Important to control eruption of upper molars.

59.  Best retained by high pull headgears to
upper molars with use of conventional
removable retainers.
 Appliance with posterior bite blocks (open
bite activator or bionator) at night and
conventional retainers during the day
 Use of bite block appliances such as posterior
bite plane streches the musculature and
produces an intrusive force on the dentition
 Preferred because:
 Prevents eruption of upper an
lower molars
 Better patient acceptance