Make your care last longer
Featured Products Promotional FeaturesPosted by: Dental Design 5th December 2024
Successful orthodontic care requires patients to dedicate a great deal of their time, diligence and, in some cases, financial expense. In turn, clinicians will always endeavour to obtain each individual’s ideal result. Over time, however, an aesthetic and functional outcome that has taken months to achieve could be subject to disarray, eventually creating misalignment once more.
When clinicians begin to formulate a treatment plan, they must consider how a result can be preserved in order to maintain the health and positioning of the resulting dentition. This can be difficult when some popular treatment methods rely on patient compliance, for example with removable retainers.
Understanding the importance of treatment retention, and how it can be achieved successfully, can lead to the success and longevity of hard-earned treatment outcomes.
Recognising continual tooth movement
The major motivations for seeking orthodontic treatment in adult patients are typically to straighten teeth and improve smiles – both notably aesthetic-driven concerns.[i] With one of the most negative aspects of treatment being the financial impacts of care,i patients will be looking for brilliant results that make their time and expense worthwhile, for years to come.
However, after orthodontic intervention the dentition is inclined to move back to its original position. This is due to the tension present in periodontal fibres, particularly the interdental and dentogingival fibres.[ii]
The stability of the final result may also be compromised by unfavourable occlusal contacts, as studies have observed that the more unstable the contacts, the greater the tooth displacement found.[iii] This issue can and must be tackled in the treatment planning process, by devising an approach that avoids unfortunate instances of occlusal contact. Clinicians must be aware of the negative influence of instances where neither mesial nor distal marginal and tripoidism contacts are present, and there are occlusal contacts between the upper and lower incisors.iii
Teeth may also move because of the changing shape of the jaw, everyday pressures of eating and talking, and oral health issues such as periodontal disease or bruxism.[iv] It is, in effect, unavoidable. Whilst patients should be aware of this, clinicians should ensure that they are not discouraged from pursuing orthodontic care; treatment should be framed as a positive influence on their dentition that would aid their health and dental appearance, and with appropriate care the results can be made to last.
Choosing effective retention methods
Where it is appropriate, patients should be advised that retainers, fixed or removable, may be effective following the end of their orthodontic care. However, without a suitable retention protocol, some degree of relapse is almost inevitable.ii
There is no evidence to suggest that retention regimens should differ between treatments for adults and adolescent patients, as long as the periodontal supporting tissues are in normal condition.ii
Choosing the right solution for each patient can rely on a number of factors, including patient preference (the choice of fixed or removable may be influenced by their compliance during orthodontic care), pre-treatment characteristics and treatment-induced changes[v]. Patients are not necessarily at a disadvantage dependent on the form of retainer they choose, but it is interesting to note that permanent retainers are becoming increasingly popular.[vi]
Removable retainers rely on a patient’s active choice to wear them for extensive periods of time. Poor adherence is commonplace. One study that aimed to compare the stability of fixed and removable retainers over a period of at least 4 years saw non-compliance levels in removable retainers reach 67% after just 24-months.v
The push for fixed retention solutions may also be in response to the long-term dental changes that orthodontists see in their own practices.[vii] Where individuals are striving to minimise retreatment, be it to aid patient satisfaction or to promote a minimally invasive, long-term approach, fixed appliances have the additional advantage of sustained impact – no matter patient compliance.
How to help patients
Clinicians that provide orthodontic treatment must also consider how they can help patients retain their results. They must understand the efficacy of various retention methods, and how to safely place solutions for long-lasting results.
By taking the Ortho-Restorative course with the IAS Academy, clinicians can develop their skills by combining their existing orthodontic experience with restorative and aesthetic dentistry, providing patients with brilliant results. The course delves into retention principles and management, and even allows clinicians to gain hands-on experience in applying the Dahl technique to a fixed bonded retainer. Led by renowned tutors and clinicians such as Dr Tif Qureshi and Dr Guy Wells, the Ortho-Restorative course equips clinicians for excellence.
Orthodontic treatment can be a transformative experience for many patients, and providing effective retainer solutions can lead to long-lasting impacts. Dental professionals should be prepared to deliver such brilliant results, no matter whether patients prefer fixed or removable options.
For more information on upcoming IAS Academy training courses, please visit www.iasortho.com or call 01932 336470 (Press 1)
Author:
Dr Tif Qureshi founder and a clinical director of IAS Academy, qualified from Kings College London in 1992. He is a Past President of the British Academy of Cosmetic Dentistry, an International faculty that provides mentored education for general dentists on a pathway from appropriate simple to comprehensive orthodontics.
[i] Singh, P. (2016). Adult orthodontic patients in primary care and their motivation for seeking treatment. Orthodontic Update, 9(2), 69-72.
[ii] Johnston, C. D., & Littlewood, S. J. (2015). Retention in orthodontics. British dental journal, 218(3), 119-122.
[iii] Gomes de Oliveira, S., Seraidarian, P. I., Landre Jr, J., Oliveira, D. D., & Cavalcanti, B. N. (2006). Tooth displacement due to occlusal contacts: a three‐dimensional finite element study. Journal of oral rehabilitation, 33(12), 874-880.
[iv] Roland, J., Khosravi, R., (2020). Why Teeth Shift After Dental Procedures and Over Time. Healthline. (Online) Available at: https://www.healthline.com/health/teeth-shifting [Accessed July 2024]
[v] Al-Moghrabi, D., Johal, A., O’Rourke, N., Donos, N., Pandis, N., Gonzales-Marin, C., & Fleming, P. S. (2018). Effects of fixed vs removable orthodontic retainers on stability and periodontal health: 4-year follow-up of a randomized controlled trial. American Journal of Orthodontics and Dentofacial Orthopedics, 154(2), 167-174.
[vi] Higuera, V., Archibald, J., (2019). Pros and Cons of Permanent Retainers. Healthline (Online) Available at: https://www.healthline.com/health/permanent-retainer [Accessed July 2024]
[vii] Pratt, M. C., Kluemper, G. T., Hartsfield Jr, J. K., Fardo, D., & Nash, D. A. (2011). Evaluation of retention protocols among members of the American Association of Orthodontists in the United States. American Journal of Orthodontics and Dentofacial Orthopedics, 140(4), 520-526.
