Retention and stability: A review of the literature,☆☆,,★★

https://doi.org/10.1016/S0889-5406(98)70212-4Get rights and content

Abstract

Long-term posttreatment stability is an issue of great concern to all orthodontists. This article highlights the factors reported to play a role in posttreatment crowding and reviews the long-term retention studies evaluating the stability of various treatment modalities. Recommendations, based on well-documented basic principles, are made to try to insure greater posttreatment stability of our orthodontically treated cases. (Am J Orthod Dentofacial Orthop 1998;114:299-306)

Section snippets

NORMAL DEVELOPMENT

Posttreatment changes in the dentition may be affected by physiologic dentoalveolar adaptation. During normal development a moderate increase in arch width is seen until permanent cuspid eruption,3, 4 followed by a reduction of intercanine width.5, 6, 7 The intermolar width remains stable from 13 to 20 years,1, 3, 4, 6, 7and there is a reduction in the AP dimension of the mandibular arch with time.3, 6, 7, 8, 9, 10, 11 Incisor irregularity increases during the teenage years and is more

FACTORS THAT AFFECT POSTTREATMENT STABILITY

Although numerous factors have been reported to play a role in posttreatment crowding, no definite conclusions regarding the relative contribution of these factors have been reached. Some areas of investigation are discussed in the following section.

TREATMENT MODALITIES

Several long-term retention studies evaluating the stability of different treatment modalities have been reported. The main center for much of this research is the University of Washington. Most of the research is centered on the mandibular arch with the assumption that alignment of the lower arch serves as a template around which the upper arch develops and functions.

Most of the studies report on the Irregularity index,10 arch length, and intercanine width. It is important to note that the

SUMMARY OF POSTTREATMENT CHANGES

Similar long-term alterations in arch form are seen in most of the treatment groups studied. Arch length reduction is evident to some extent after orthodontic treatment. Variables such as Angles classification, length of retention, patient's age, gender, pretreatment overbite, overjet, arch width, or arch length cannot be used to predict these posttreatment arch changes. A lingual displacement of the anterior mandibular segment relative to the body of the mandible is seen.102 This has also been

CONCLUSION

Permanent retention is cited by several authors87, 96, 103 as the only way to ensure long-term posttreatment stability. However, as trained orthodontists it is incumbent on us to take a more proactive approach in dealing with the factors associated with relapse. We should aim to remove the primary burden of preventing relapse from our patients and would be well advised to maintain as treatment goals the following well documented basic principles:

  • 1.

    The patient's pretreatment lower arch form should

References (103)

  • R Moussa et al.

    Long-term stability of rapid palatal expander treatment and edgewise mechanotherapy

    Am J Orthod Dentofacial Orthop

    (1995)
  • JG Edwards

    A study of the periodontium during orthodontic rotation of teeth

    Am J Orthod

    (1968)
  • H Kole

    Surgical operations on the alveolar ridge to correct occlusal abnormalities

    Oral Surg Oral Med Oral Pathol

    (1959)
  • LR Boese

    Increased stability of orthodontically rotated teeth following gingivectomy in Macaca nemestrina

    Am J Orthod

    (1969)
  • WE Brain

    The effect of surgical transsection of the free gingival fibres on the regression of orthodontically rotated teeth in the dog

    Am J Orthod

    (1969)
  • JG Edwards

    A surgical procedure to eliminate rotational relapse

    Am J Orthod

    (1970)
  • JG Edwards

    A long-term prospective evaluation of the circumferential supra- crestal fiberotomy in alleviating orthodontic relapse

    Am J Orthod Dentofac Orthop

    (1988)
  • LL Fricke et al.

    Comparison of electrosurgery with conventional fiberotomies on rotational relapse and gingival tissue in the dog

    Am J Orthod Dentofacial Orthop

    (1990)
  • M Redlich et al.

    The response of supraalveolar gingival collagen to orthodontic rotation movement in dogs

    Am J Orthod Dentofac Orthop

    (1996)
  • C Gilmore et al.

    Mandibular incisor dimensions and crowding

    Am J Orthod

    (1984)
  • RJ Smith et al.

    Incisor shape and incisor crowding; a re-evaluation of the Peck and Peck ratio

    Am J Orthod

    (1982)
  • PJ Puneky et al.

    Tooth morphology and lower incisor alignment many years after orthodontic therapy

    Am J Orthod

    (1984)
  • K Reitan

    Principles of retention and avoidance of posttreatment relapse

    Am J Orthod

    (1969)
  • TE Shields et al.

    Stability and relapse of mandibular anterior alignment: a cephalometric appraisal of first premolar extraction cases treated by traditional edgewise orthodontics

    Am J Orthod

    (1985)
  • RS Nanda et al.

    Considerations of dentofacial growth in long-term retention and stability: is active retention needed

    Am J Orthod Dentofac Orthop

    (1992)
  • GF Schudy

    Posttreatment craniofacial growth; its implications in orthodontic treatment

    Am J Orthod

    (1974)
  • RE Siatkowski

    Incisor uprighting: mechanism for late secondary crowding in the anterior segments of the dental arches

    Am J Orthod

    (1974)
  • M Dewey

    Third molars in relation to malocclusion

    Int J Orthod

    (1917)
  • B Lindqvist et al.

    Extraction of third molars in cases of anticipated crowding in the lower jaw

    Am J Orthod

    (1982)
  • R Kaplan

    Mandibular third molars and postretention crowding

    Am J Orthod

    (1974)
  • A. Ades et al.

    A long-term study of the relationship of third molars to mandibular dental arch changes

    Am J Orthod Dentofacial Orthoped

    (1990)
  • ME Simons et al.

    Changes in overbite: a 10 year postretention study

    Am J Orthod

    (1973)
  • JL Hernandez

    Mandibular bicanine width relative to overbite

    Am J Orthod

    (1969)
  • G Lopez-Gavito et al.

    Anterior open-bite malocclusion: a longitudinal 10 year. postretention evaluation of orthodontically treated patients

    Am J Orthod

    (1985)
  • TN Elms et al.

    Long term stability of Class II Division I nonextraction cervical face-bow therapy: 1. model analysis

    Am J Orthod Dentofacial Orthop

    (1996)
  • C Sanin et al.

    Factors that affect the alignment of the mandibular incisors; a longitudinal study

    Am J Orthod

    (1973)
  • RM Little et al.

    Årtun J. An evaluation of changes in mandibular anterior alignment from 10-20 years post-retention

    Am J Orthod

    (1988)
  • RM Little et al.

    Mandibular arch length increase during the mixed dentition: postretention evaluation of stability and relapse

    Am J Orthod Dentofacial Orthop

    (1990)
  • R Moussa et al.

    Long-term stability of rapid palatal expander treatment and edgewise mechanotherapy

    Am J Orthod Dentofacial Orthop

    (1995)
  • C Sadowsky et al.

    Long-term stability after orthodontic treatment: nonextraction with prolonged retention

    Am J Orthod Dentofac Orthop

    (1994)
  • RM Little et al.

    Post-retention evaluation of stability and relapse: mandibular arches with generalized spacing

    Am J Orthod

    (1989)
  • RE Moyers

    Handbook of orthodontics for the student and general practitioner

  • RA. Riedel
  • CFA Moorrees

    The dentition of the growing child

    (1959)
  • L Vego

    A longitudinal study of mandibular arch perimeter

    Angle Orthod

    (1962)
  • RO Fisk

    Normal mandibular arch changes between the ages of 9 and 16

    CDA J

    (1966)
  • K Allred

    Stability and relapse of maxillary anterior alignment: a postretention study of premolar extraction cases treated by traditional edgewise orthodontics [Masters Thesis]

    (1986)
  • A Schaeffer

    Behaviour of the axes of human teeth during growth

    Angle Orthod

    (1949)
  • D Witzel

    Long-term stability of the mandibular arch following differential management of arch length deficiencies [MSD Thesis]

    (1978)
  • RA Riedel

    A review of the retention problem

    Angle Orthod

    (1960)
  • Cited by (0)

    aLecturer Consultant, Department of Child Dental Health, Dublin Dental Hospital.

    ☆☆

    bIn private practice.

    Reprint requests to: Marielle Blake, BDent Sc, FDS(Orth), MOrth, MRCDC, Lecturer Consultant, Department of Child Dental Health, Dublin Dental Hospital, Lincoln Place, Dublin 2, Ireland.

    ★★

    8/1/85459

    View full text