Lina Hadi, drg., Sp. Ort.

, FISID
• Retention  The last phase of
orthodontic treatment and one of the
most important, where teeth are held in
an esthetic and functional position.
• Any Treatment is a failure unless the
treatment result can be retained.
• The term “Retention” has been define
d as : “The holding of teeth in idealisti
c and functional position”.
(Joondeph and Riedel, 1985)
The need for retention is important to
maintain the stability of the occlusion
achieved by the orthodontist and
patient.
Without stability, the esthetic and
functional result may relapse.
 What is Relapse?
“loss of any correction achieved by any
orthodontic treatment”  RELAPSE
• Teeth are in a stable position because of the
equilibrium of forces of chewing, swallowing,
tongue, and cheek movements.
• There is a balance between the internal and
external oral musculature.
Causes of Relapse
Causes of Relapse
Other causes:
• Periodontal ligament traction
• Relapse due to growth related changes
• Bone adaptation
• Muscular factors
• Failure to eliminate the original cause
• Role of third molars
• Role of occlusion
Causes of Relapse
 The most basic of them all is the
persistence of the etiology.
 If the underlying etiology is not
removed, the treatment is destined to
Relapse.
 The removal of the etiologic factor
before finishing is mandatory.
Causes of Relapse

Relapse following fixed appliance therapy involving the extraction

of all first premolars due to an unresolved tongue thrust habit
Causes of Relapse The major causes
of relapse after
orthodontic
treatment
include the
elasticity of
gingival fibers,
cheek/lip/tongue
pressures, and
jaw growth.
 Relapse Management
 Retention is planned “to antagonize the
movement of the teeth in the direction of
their tendency, and to allow the teeth
freedom of movement in every direction
except that toward which they tend to
return.”
 Hellman said in summary, “We are in almost
complete ignorance of the specific factors
causing relapses.”
 Relapse Management
• Basically, retention prevents the relapse from occurring or in
other words prevents the teeth from returning to their original
position of malocclusion.
• Earlier, “retention was discribed as that period after active
treatment when passive fixed/removable appliances were
worn for approximately two years to stabilize the occlusion
which had been created.”
• Now with our increased knowledge of the biomechanics
envolved in relapse, the concept of “ lifetime retention” has
evolved.
 School of Retention
THE OCCLUSION SCHOOL
• Norman Kingsley  “the occlusion of teeth is the most important factor in
determining the stability in a new position.”

THE APICAL BASE SCHOOL

• Axel Lundstrom  “the importance of the apical base in the maintenance of
treatment results.”
• McCauley  “Intercanine width and intermolar width should be maintained.”
• Nance “arch length may be permanently increased only to a limited extent.”

THE MANDIBULAR INCISOR SCHOOL

• Grieve and Tweed “the mandibular incisors must be placed upright or slightly
retroclined over the basal bone.”

THE MUSCULATURE SCHOOL

• Paul Roger  “the necessity of establishing proper muscle balance.”

THEOREM 1
RIEDEL’S Theorems “Teeth that have been
Basic Retention 
moved tend to return to
their former positions.”
THEOREM 4
“Occlusion is an
important factor in
retention.”
THEOREM 7
“Corrections carried out
during period of growth
are less likely to relapse.”
THEOREM 2
THEOREM 3
“The elimination of the
“Overcorrection of a
causes of a malocclusion
malocclusion is a safety
should aid in the retention
factor in retention.”
of its correction.”
THEOREM 5
THEOREM 6
“Bone and adjacent
“Lower incisors must be
tissues must be allowed to
placed upright over the
reorganize around of
basal bone”.
newly positioned teeth .“
THEOREM 9
THEOREM 8 “Arch form, particularly in
“The further teeth have the mandibular arch,
been moved, the less the cannot be permanently
likelihood of relapse.” altered by appliance
therapy.”
 RALEIGH Williams’ 6 KEYS OF RETENTION
Incisal edges of the lower incisors should be placed on the A‐P line or 1mm in front of it.

Lower incisors apices should be spread distally to the crowns

Apex of lower cuspid should be positioned distal of the crown

All four lower incisors apices must be in the same labiolingual plane

Lower cuspid root apex must be positioned slightly buccal to the crown apex

The lower incisors should be slenderized as needed.

REIDEL – Retention Planning
Natural Retention / No Retention Required

Limited Retention / Retention for a limited period

Permanent or Prolonged Retention

 Natural Retention / No Retention Required
Anterior Cross bite

Serial extraction procedures

Blocked out or highly placed canines in Class I extraction cases

Posterior cross bite in patients having steep cusps

Corrections achieved by retardation of Maxillary growth once the p

atient has completed growth.
 LIMITED OR SHORT TERM RETENTION
Class I non extraction with dental arches showing proclination and spacing

Deep bites

Class I, Class II div 1 and 2 cases treated by extraction.

Early corrections of rotated teeth to their normal position before root completion

Cases involving ectopic eruption or supernumery teeth

Class II div 2 cases for muscle adaptation.

 Permanent or Prolonged Retention
Midline diastema
Severe rotations
Arch expansion
Class II div 2 with deep bite cases
Patients exhibiting abnormal musculature or tongue habits
Expanded arches in cleft patients
 Retainer
• Passive Orthodontic appliances
• Maintaining and stabilizing the position
of teeth to permit reorganization of the
supporting structures
• After the active phase of orthodontic
therapy.
IDEAL REQUIREMENTS OF RETAINING APPLIANCES
• Graber put forward certain criteria that any retaining
appliance should possess.
– 1. Should restrain each tooth in its direction of relapse.
– 2. Should permit the forces associated with functional
activity to act freely on the teeth.
– 3. Should be self-cleansing, easy to maintain optimal
hygiene.
– 4. Should be as inconspicuous as possible, esthetically
good.
– 5. Strong enough to bear the rigors of day-to-day usage.
Removable Fixed
 Removable Retainer
• Hawley-type retainers
– With long labial bow
– With contoured labial bow
– Labial bow crossing distal to lateral incisor and short distal extension
– Continuous labial bow soldered to clasps
– With elastic replacing labial bow
• Begg’s retainer
– Single arrowhead partial wraparound retainer
• Clip-on retainer/spring realigner
• Wrap around retainer
• Kesling tooth positioner
• Osamu’s Invisible retainer/ Vacuum-formed retainers
Removable Retainer
Hawley’s retainer
with long labial bow

Hawley’s retainer on the

maxillary arch
Retainer with long
labial bow soldered to
Adam’s clasp
Removable Retainer
Retainer with
labial bow
soldered to
Adam’s clasp

Hawley’s retainer with labial bow

crossing distal to lateral incisor
Removable Retainer
Wrap around
Begg’s retainer

Single arrowhead
partial wraparounds
retainer
Removable Retainer

The spring retainer

Modified Hawley’s retainer
with light elastics replacing
the labial bow
Removable Retainer

Osamu’s invisible
upper and lower
retainers

Kesling’s tooth
positioner
 Hawley Retainer
Advantages
• Do not cover the occlusal
surfaces of the teeth.
• Can be used successfully
for retaining overjet
reduction as they act like a
strap across the front of
the upper incisors.
• Can be worn whilst eating.
Disadvantages
• Do not have a very tight fit
anteriorly.
• Costlier and more time-
consuming to manufacture.
• Poor at retaining any
vertical tooth movements.
• Poorer at maintaining
space closure in spaced
dentitions.
 Vacuum-formed retainers
Advantages
• Much quicker and cheaper
• Easier and quicker to remake
• The most aesthetic of the
removable retainers
• Successfully for retaining overjet
reduction
• slightly better at maintaining
alignment of both upper and
ower labial segments
• May be of help where patients
have a significant gag reflex, do
not cover the palate.
Disadvantages
• Cover the occlusal surfaces of
the teeth.
• Poor at retaining any vertical
tooth movements that may have
been needed during more
complex, fixed appliance
orthodontic treatment.
• Poorer at maintaining space
closure in spaced dentitions (e.g.
hypodontia or diastema closure
cases)
• Should not be worn whilst eating
Fixed
ADD Retainer
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Fixed
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Fixed
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• Fixed appliance
• Band and Spur retainer
• Banded canine to canine
retainer
• Bonded lingual retainers CLASSIFICATION
- Intra – Coronal
- Extra - Coronal
Temporary Fixed Intra-Coronal Retainers
• not usually used
• Not recommended for routine use because of
their inherent disadvantages:
– Loss of healthy tooth material
– Tend to discolor
– Potential sights of sensitivity and caries
– Maintenance of oral hygiene might get
compromised
– If fracture, replacement is tedious
 Fixed intra-coronal silver amalgam retained
(the amalgam should not form an overhang in the interproximal region)
Temporary Fixed Extra-Coronal Retainers
– Direct contact splinting
– Lingual 3 to 3 retainers: banded/bonded
– Flexible Spiral Wire Retainer
– Mesh Pad Retainers
Direct contact splinting of the
maxillary central incisors to
maintain the diastema closure
 Banded retainer
(band on canine)

Lingual 3 to 3
retainers: Commercially available bonded
Bonded wire banded/ bonded retainer with mesh throughout
retainer with the length of the retainer
mesh on canine
• Advantages of bonded over banded extra-coronal
retainers:
– 1. Completely invisible from the front
– 2. Reduced caries risk, as complete adhesion to the
tooth surface
– 3. Reduced need for long-term patient cooperation
– 4. No time gap between removal of fixed appliance and
bonding of retainer (can even be placed before
debonding of brackets)
– 5. Can be bonded directly/indirectly
• Disadvantages of banded type extra-coronal
retainers:
– 1. Lack of esthetics, the metallic bands are visible
– 2. Build up of debris and plaque around bands
and the connecting wire
– 3. More susceptible to caries in the cement
washout areas
– 4. Not always effective against the return of
flaring, spacing or incisor torque changes
• Flexible Spiral Wire Retainer:
– Thick Wire (0.032’’)
– Thin Wire (0.02’’)

Bonded spiral wire

retainers (thin wire)

Bonded wire retainers (thick wire)

• Mesh Pad Retainers
directly bonded to the lingual or palatal
aspect of the teeth.

Bonded mesh retainer

• Invisible from the labial side
• Reduced caries risk
• Reduced need for patient co-operation
• Interval between debonding and retainer
placement is eliminated.