RETENTION AND

RELAPSE
Contents

• School of retention

• Causes of relapse

• Theories of retention

• Types of retention

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Schools of retention

• The occlusion school

• The apical base school

• The mandibular incisor school

• The musculature school

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Causes of relapse

• Periodontal ligament traction

• Relapse due to growth related changes

• Bone adaptation

• Muscular forces

• Failure to eliminate the original cause

• Role of third molars

• Role of occlusion
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Theories of retention

• Theorem 1

• ‘Teeth that have been moved tend to return their former

position’.

• Theorem 2

• ‘elimination of the cause of malocclusionwill prevent

relapse’.

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• Theorem 3

• ‘malocclusion should be over corrected as a safety factor’.

• Theorem 4

• ‘proper occlusion is a potent factor in holding teeth in their

corrected position’.

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• Theorem 5

• ‘bone and adjacent tissues must be allowed time to

reorganize around newly positioned teeth’.

• Theorem 6

• ‘If the lower incisors are placed upright over basal bone they
are more likely to remain in good alignment.’

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• Theorem 7

• ‘Correction 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’

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• 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’.

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 Raleigh’s Six Keys of Retention

23/02/2023 Raleigh Williams. Eliminating lower retention. JCO 1985;19(5):342-349 11

Raleigh Williams - Keys to eliminate lower
retention

• Key 1: Incisal edges of the lower incisors should be placed

on the A‐P line or 1mm in front of it.

• Key 2: Lower incisors apices should be spread distally to

the crowns.

• Key 3: Apex of lower cuspid should be positioned distal of

the crown.

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• Key 4: All four lower incisors apices must be in the same
labiolingual plane.

• Key 5: Lower cuspid root apex must be positioned slightly

buccal to the crown apex.

• Key 6: The lower incisors should be slenderized as needed.

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Types of retention

I. Natural or no retention.

II. Limited or short term retention.

III. Permanent or semi-permanent retention

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Retainers

• According to Graber a good retainer should possess;

1) It should retain all the teeth that have been moved into
desired position.

2) Able to allow for functional occlusion.

3) It should be self cleaning and should permit oral hygine

maintenance.

4) Patient-friendly in both comfort and wear routine.

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Classification of retainers

• Removable retainers

• Fixed retainers

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 Hawley Retainer

• Designed in the 1919 by C.A. Hawley. It is the most

frequently used retainer.

23/02/2023 Hawley, C.A.: A removable retainer, Dent. Cosmos 61:449- 554, 1919. 17
 Circumferential Retainer

• Dr. P.R. Begg used a circumferential retainer which is made

up of a single wrap around labial bow extending from the
distal of the right molar to the left molar.

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 Wrap around retainer

• It consists of a wire that passes along the labial as well as

lingual surfaces of all erupted teeth which is embedded in a
strip of acrylic.

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 Clip-on Retainer/Spring aligner

• This appliance consists of a wire framework that is fitted on

to the labial surface of the incisors. It then passes towards
the lingual surface between the canine and premolar. Both
the labial and lingual wire segments are embedded in strip of
clear acrylic.

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 Ricketts Retainer

• Named after its developer Robert M. Ricketts. This type of

retainer is useful in patients treated with extractions, as the
labial wire does not cross through the embrasure between the
maxillary canine and maxillary premolar.

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 The Van der Linden Retainer

• The Van der Linden retainer is constructed to offer

complete control over the maxillary anterior teeth, with
firm fixation provided by clasps on the canines.

23/02/2023 van der Linden FP. The Van der Linden retainer. JCO. 2003 May;37(5):260-7 22
 Tooth Positioner

• It was described by H.D Kesling in 1945. It is made up of

thermoplastic rubber like material that spans the inter-
occlusal space and covers the clinical crowns of upper and
lower teeth and a small portion of the gingiva.

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 Invisible Retainers

• The invisible retainer was developed by Robert Ponitz of

Ann Arbor, Michigan (1971).

• This retainer is formed from a sheet of thin transparent

thermoplastic sheets.

23/02/2023 Ponitz RJ. Invisible retainers. Am J Orthod. VoZume 59 Number 3. 1971. 24

 Essix Retainers

• The Essix retention appliance was first introduced by John J

Sheridan in 1993.

Sheridan JJ, Essix retainers: fabrication and supervision for permanent retention. J Clin Orthod. 1993
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Jan;27(1):37-45.
 Bonded Fixed Retainers

• Bonded fixed retainers consist of a length of orthodontic

wire bonded to the teeth with acid-etch retained composite.

• Direct-bonded lingual 3-3 retainers have been used to

improve the long-term stability of orthodontic treatment
results.

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 Preformed Bondable Retainers

• Preformed lingual retainer can be fit directly to the patients

teeth or indirectly on a model for maximum adaptation.

• Wires are soldered to laminated mesh pads for maximum

strength and comfort.

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 Central to central Lateral to lateral

Cuspid to cuspid Bicuspid to bicuspid

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Special consideration in retention of certain
malocclusion.

• Class II malocclusion
• Relapse in treatment of class II conditions arises mainly
due to differential growth of the jaws and to minor extent
by the dental factors.

• It is recommended to overcorrect the occlusal relationships

to prevent relapse.

Traditional retainers should be worn full time for at least 1

year.
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• Mandibular retrognathism – functional appliances similar to
activator or bionator can be used after the active phase of
class II correction.

• Maxillary prognathism – use of headgears to restrict

maxillary growth in conjunction with a retainer to maintain
the dental alignment.

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• Guideline: The more severe the initial Class II problem and the
younger the patient at the end of active treatment, the more likely
that either headgear or a functional appliance will be needed as a
retainer.
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 Class III malocclusion

• Mandibular prognathism: chincup to rotate the mandible

downward, causing growth to be expressed more vertically
and less horizontally.

• In mild Class III problems: functional appliance such as a

reverse activator, FR. 3 or class III bionator should be
given as retainer until active growth period is completed.

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• Early treatment of severe class III cases that relapse
following active orthodontic therapy may require surgical
correction after growth ceases.

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 Deep bite

• Corrected deep overbite in either class I or class II

malocclusions usually require retention in a vertical plane
(moderate retention).

• Deep overbites – retained by removable upper retainers

made in such a way that the lower anteriors contact the base
plate behind the maxillary anteriors.

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 Open bite

• Reason:

The persistence of the etiological agents.

Continuous growth at the molar region to a little extent and

the intrusive effect of etiological factors on the incisors.

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 THANK YOU

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