RETENTION

Chapter # 18

Presented By:

Dr. Sundus Munir

 ROUTE MAP
1) Need of retention

2) Removable Retainers

3) Fixed Retainers

4) Active Retainers
 WHY IS RETENTION NECESSARY?
1) Gingival & periodontal tissues affected by
tooth movement require time for
reorganization when appliances are removed.

2) Teeth in unstable position after treatment

constant soft tissue pressures relapse.

3) Changes produced by growth alter treatment

results.
 PRINCIPLES OF RETENTION AGAINST
INTRA-ARCH INSTABILITY
1) Teeth tend to move back in direction from which
they came, due to elastic recoil of gingival fibers &
unbalanced tongue–lip forces.

2) Require daily (full-time) retention after for 1st 3 to

4 months.

3) Teeth should be free to flex individually during

mastication Reorganization of PDL
4) Retention should be continued for at least 12
months, due to slow response of gingival fibers,

5) Some non growing patients require permanent

retention because of greater lip, cheek & tongue
pressures,

6) Growing patients need retention until growth has

slowed / stopped.
 OCCLUSAL CHANGES RELATED TO GROWTH

• Skeletal problems in all 3 planes of space tend to

recur, if growth continues.

• Transverse growth completed first, so transverse

changes are of less problem clinically than changes
from late anteroposterior & vertical growth.
• Continued growth causes relapse after treatment of
following conditions;

a. Retention when Class II pattern exists

b. Retention when Class III pattern exists

c. Retention after deep bite correction

d. Retention After Anterior Open Bite Correction

e. Retention of Lower Incisor Alignment

 A. RETENTION WHEN CLASS II EXISTS
Q) Reason of Recurrence??

Ans) a. Tooth movement

(forward in upper , backward
in lower arch, or both)

b. Differential growth of maxilla,

relative to mandible.
• Do not move lower incisors too far forward.

• Lower incisors move forward easily with Class II

elastics lip pressure upright protruding
incisors Crowding , Overbite & Overjet returns.

• Occurs when full-time retainer wear is stopped.

• If > 2 mm of forward repositioning of lower incisors

occurred during treatment permanent
retention required
 METHODS TO CONTROL RECURRENCE
CAUSED BY DIFFERENTIAL JAW GROWTH

1) Headgear

2) Functional appliance i.e Activator or Bionator

 1) HEADGEAR
• Continue to use on a reduced basis (at night)
together with a retainer to hold the teeth in
alignment.

❖ Problem Associated:
• Patient compliance
 2) FUNCTIONAL APPLIANCE
• Holds tooth position & occlusal relationship.

• No compliance issue.
• If no excessive overjet exists at end of treatment,
construction bite is taken out, without any
mandibular advancement prevent Class II
relapse.

• Use of a functional appliance as an extra retainer;

from the beginning for patient with severe growth
problem.
• For patients with less severe problems Use
conventional maxillary & mandibular retainers
initially & replace them with functional appliance
to be worn at night.

❖ Duration Of Retention:
• 24 months or more after daytime retainer has
been discontinued.
 B. RETENTION WHEN CLASS III EXISTS

• Retention in early permanent dentition can be

frustrating, because of;

a. Continuing mandibular growth occurs

b. Extremely difficult to control growth

• Applying a restraining force to mandible, from a
chin cup not effective

• In mild Class III , positioner enough to maintain

occlusal relationships, during posttreatment
growth.
Q) Need of Surgical Correction ??

• If face height is normal or excessive after

treatment & recurrence occurs from
mandibular growth.
 C. RETENTION AFTER DEEP BITE
CORRECTION
• During retention, control of vertical overlap of
incisors is necessary to prevent relapse
from uncontrolled incisor eruption.

• Post treatment growth in short face pattern

Excessive Overbite recurs.
 Q. HOW TO CONTROL ??

• By using removable upper retainer with a

biteplate lower incisors touch baseplate of
retainer, if they slip vertically behind the upper
incisors or if bite deepens.

• Retainer does not separate the posterior teeth.

• BITE DEPTH CAN BE MAINTAINED BY WEARING
RETAINER, ONLY AT NIGHT.

Lower incisors contact palatal acrylic of upper Hawley

retainer, while upper incisor contact facial surface of
lower Moore retainer Prevents Incisor Eruption
 D. RETENTION AFTER ANTERIOR OPEN
BITE CORRECTION
Q) Reason Of Recurrence ??
1. Depression of incisors
2. Elongation of molars.

• If active habits e.g thumb-sucking, persists after

treatment Leads to;
Altered posture of
Intrusive forces on jaw allows posterior
incisors teeth to erupt
• Controlling eruption of upper molars is the key to
retention, in patients with open bite.

❖ Methods To Control:

a) Palate-covering removable appliance (modified

Hawley retainer) with bite blocks b/w posterior
teeth, to create several mm of jaw separation
b) High-pull headgear to upper molars + removable
retainer to maintain tooth position.

Q) Why removable appliance with Bite blocks

preferred over high pull headgear ??

Ans ) Due to 2 reasons, i.e;

Controls eruption of both Easier to wear , so

upper & lower molars better tolerated
 E. RETENTION OF LOWER
INCISOR ALIGNMENT
• Mandible grows forward/rotates downward
move lower incisors into lip Force created
tip lower incisors distally.

• Continued mandibular growth in normal or Class III

patients is strongly associated with crowding of
lower incisors.
 TIMING OF RETENTION

• Daily (full-time) for 1st 3 to 4 months,

• Continued on a part-time basis for at least 12

months to allow time for remodeling of gingival
tissues,

• If significant growth remains, continued part-time

until completion of growth.
 REMOVABLE RETAINERS
• Following retainers will be discussed , i.e ;

1) Hawley retainers

2) Wraparound (clip) retainers

3) Clear (Vacuum-Formed) Retainers

4) Positioners as Retainers
 A. HAWLEY RETAINERS
• Most common active tooth moving retainer for
closing spaces between maxillary incisors.

• Includes clasps on molar teeth &

an outer bow with adjustment
loops, spanning from canine to
Canine.
• Covers palate provides potential bite plane
Control Overbite.

• Outer bow provides excellent control of incisors

even if it is not adjusted to retract them.
❖ Modification Of Hawley Retainer;
• Use = Extraction cases

✓ 1st Design:
• Bow soldered to buccal section of Adams clasps
on 1st molars hold extraction site closed.
✓ 2nd Design:
• Wrap labial bow around entire arch, using
circumferential clasps on second molars for
retention, or

• Bring labial wire from baseplate b/w lateral incisor

& canine and bend or solder a wire extension
distally to control canines.
 CLASP LOCATION
• Should be selected carefully, because clasp
wires crossing occlusal table can disrupt tooth
relationships established during treatment.

• Circumferential clasps on terminal molar

preferred over Adams clasp if the occlusion is
tight.
 ACRYLIC DESIGN

• Acrylic behind upper incisors should be high

enough to control bite depth.

• Hawley design does not work well for lower

arch because undercuts compromise insertion-
removal path & clasp effectiveness.
 B) WRAPAROUND (CLIP) RETAINERS
• Consists of a plastic bar (usually wire-reinforced)
along labial & lingual surfaces of teeth.

• Indication = To prevent spaces from reopening.

 MANDIBULAR ARCH

• Canine-to-canine clip-on retainers used

frequently, occasionally extending to include 1st
premolars.
• In extraction case, canine-to-canine wraparound
distally on lingual aspect only to central groove of
1st molar. This is called Moore retainer.

• Provides control of 2nd premolar & extraction site.

• Must be made carefully to avoid lingual undercuts

in premolar & molar region.
 MAXILLARY ARCH

• Useful in adults with long clinical crowns.

• Not tolerated in younger patients due to occlusal

interferences.
 C) CLEAR (VACUUM-FORMED) RETAINERS
• Wraparound retainer made with clear heat-
softened plastic, acrylic & wire , sucked down
tightly over teeth with a vacuum-forming device.

• Most widely used retainer for maxillary arch.

LIMITATIONS
1) Thickness of material over occlusal surface of
teeth Posterior teeth separates in
occlusion.

2) Maintains alignment but does not control bite

deepening.

3) After 6 to 9 months, vacuum-formed retainer

tends to crack & discolor.
 D) POSITIONERS
• Either used as a removable retainer or continued
as a retainer after serving initially as a finishing
device.

• Used primarily as finishing devices for patients

with an open bite.
ADVANTAGE OVER OTHER RETAINERS
• Maintains occlusal relationships as well as intra-
arch tooth positions.

• Suitable for patients with an unfavorable growth

pattern.

• For patient with Class III relapse, positioner

made with jaws rotated downward & backward
may be useful
 FIXED RETAINERS
• Used where = intra-arch instability is anticipated
& prolonged retention is planned

• Indications:
1) Maintenance of lower incisor position during
late growth

2) Diastema maintenance

3) Maintenance of posterior tooth position in adults

 A) MAINTENANCE OF LOWER INCISOR POSITION
DURING LATE GROWTH

• Retainer Used = Fixed Lingual Bar

• Attached only to canines & resting against flat

lingual surface of lower incisors, above cingulum
Prevents incisors from Maintains correction of
• Advantages:
moving lingually rotations in incisor
segment
 WIRE USED

• For fixed retainer with adjacent teeth bonded use a

braided steel archwire of 17.5-mil diameter.

• Springy wire of this type must be quite passive

when bonded in place.
• Canine-to-canine fixed retainer allows movement
of mandibular incisors without restraint.

• Does not resist re-rotation.

 B) MAINTENANCE OF DIASTEMA CLOSURE

• Retainer Used = Bonded section of flexible wire.

• Wire should be contoured so

that it lies near cingulum, to
Keep it out of occlusal contact.
❖ Role Of Retainer:

• To hold teeth together while allowing them some

ability to move independently during function.

• Extending bonded wire to premolars increases

chance of bonding failure.
 INADVERTENT TOOTH MOVEMENT WITH
FIXED LINGUAL RETAINERS

• Loss of lower incisor alignment from inadvertent

tooth movement occurs when wires break.

• Canine to- canine wires must be larger & are

unlikely to break.

• If bond to one canine is lost, retainer break loose

from other one.
• If bonds to incisors failed but canines remained
bonded inadvertent torque forces
displacement of tooth roots fenestration of
labial or lingual alveolar cortical bone.
C) MAINTENANCE OF SPACES IN DENTAL ARCH

• Fixed retainer is best choice to maintain space

where an implant or bridge will be placed.

Retainer Used for Posterior Restorations = Heavy

intracoronal wire bonded to adjacent teeth
DRAWBACKS OF FIXED RETAINERS

1) Interproximal hygiene procedures difficult,

especially in lower anterior area.

2) Greater plaque buildup when multi-strand wire

is bonded to all lower anterior teeth, than when a
heavier round wire is bonded only to canines
 ACTIVE RETAINERS
• Relapse or growth changes after treatment
need for some tooth movement during retention.

• Accomplished with = Removable appliance that

continues as a retainer after it has repositioned
teeth.
❖INDICATIONS

• Active retainer is reserved for two specific

situations:

Realignment of Management
irregular incisors with of Class II or Class III
spring retainers relapse with modified
functional appliances
I) REALIGNMENT OF IRREGULAR INCISORS WITH
SPRING RETAINERS
• 2 ways to complete realignment;

1) Active canine to- canine

clip-on device,

2) Short series of aligners produced in-office

with 3D printer.
 ❖ STEPS OF MAKING ACTIVE RETAINER

1) Reduce interproximal width of irregular incisors &

apply topical fluoride to newly exposed enamel
surfaces;

2) Prepare laboratory model on which teeth can be

reset into alignment;

3) fabricate alignment device to fit the model

II) CORRECTION OF OCCLUSAL DISCREPANCIES:
MODIFIED FUNCTIONAL APPLIANCES

• Retainer Used In Class II Relapse = Activator or

Bionator, if not more than 3 mm of occlusal
correction is needed.

• Functional appliance as active

retainer can be used in teens, but is of no value in
adults.
ANY QUESTIONS ??

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