Wherever possible, routines and standard approaches should be introduced into orthodontic practice. This systemized approach cuts down the day-to-day decision-making and improves efficiency. This statement applies to all aspects of orthodontics, including retention. It is essential to have a good retention protocol.
The authors routinely place a lingual bonded retainer in the lower arch for most of their patients (Fig. 11.1), although they accept that not all patients need this. Some lower labial segments would remain straight without the use of a bonded retainer, but it is not possible to know which cases belong in this category.
This approach has the disadvantage that some patients will have retainers needlessly, just as they may have insurance, but never use it. I lowever, this policy does at least avoid lower incisor crowding or relapse during late adolescence. Such late changes are greatly disappointing to patients, and come at a time when they are not receptive to further treatment (Fig. 11.2). I.ate changes are also quite demanding on practice resources and undermine efficiency.
Reitan1 showed that the periodontal ligament needs at least 232 days to re-organize after tooth movement, and the elastic supra-crestal fibers need 1 year. There is a clear need to retain the result against the orthodontic relapse tendency, and against changes caused by late unfavorable growth. Retention protocol is an individual choice for each orthodontist, and there will be differing views concerning how rigid it should be. But a policy should be created and adhered to.
Fig. 11.1 A .015 bonded spiral wire retainer in place after non-extraction treatment. The authors routinely place lingual bonded retainers for most of their patients.
Fig. 11.2 This first premolar extraction case showed lower incisor relapse at age 18, and required further treatment to realign the lower anterior segment. A lingual bonded retainer would have prevented the relapse.
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