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Post-treatment changes in permanent retention  

Post-therapeutische Veränderungen unter permanenter Retention

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objectives

While permanent retention is today the method of choice to stabilize orthodontic treatment outcomes, recent studies have increasingly reported posttreatment changes in tooth position during permanent retention. We conducted this study to analyze changes in the anterior mandible, whether the changes follow an underlying movement pattern, and, aiming for a preventive strategy, whether any risk factors could be identified comparing findings with the pretreatment situations.

Methods

We included 30 patients who had worn fixed Twistflex retainers (UK 3–3) extending from canine to canine in the mandible. Casts reflecting the intraoral situations before orthodontic treatment (T0), directly after completion of active therapy (T1), and 6 months later (T2) were scanned and superimposed using Imageware Surfacer software. Posttreatment changes (T2−T1) of tooth position within the retainer block were analyzed on 3D virtual models and were compared to pretreatment (T0) and treatment-related (T1−T0) findings to identify potential risk factors.

Results

Almost all analyzed patients revealed three-dimensional changes in tooth position within the retainer block. Comparing these movements, we repeatedly found rotated retainer blocks in labio-oral direction, while the center of rotation was located at the first incisors. This pattern was associated with intercanine expansion and excessive overjet correction during orthodontic treatment. The canines underwent the most pronounced (rotational and translational) movements.

Conclusions

In general permanent lingual retainers are safe but in special clinical cases retainers can induce undesired tooth movement. Risk factors seem to be intercanine expansion and excessive overjet correction during orthodontic treatment. In specific cases an additional retention device might be needed.

Zusammenfassung

Zielsetzung

Permanente Retention ist häufig das Mittel der Wahl, um ein orthodontisches Behandlungsergebnis zu stabilisieren. In jüngster Zeit werden häufig Fallberichte über Veränderungen unter permanenter Retention publiziert. Ziel der vorliegenden Studie war es, mögliche posttherapeutische Veränderungen unter permanenter Retention in der Unterkieferfront zu analysieren und zu prüfen, ob diesen Veränderungen ein grundsätzliches Bewegungsmuster zugrunde liegt und ob sich durch Korrelation zum prätherapeutischen Anfangsbefund Risikofaktoren zur Etablierung einer geeigneten Präventionsstrategie benennen lassen.

Material und Methoden

Ausgewählt wurden 30 Patienten, die während der Retentionsphase ausschließlich mit festsitzenden Twistflex-Retainern (UK 3-3) retiniert wurden. Die entsprechenden Unterkiefermodelle direkt nach Abschluss der aktiven Therapie, sowie Kontrollmodelle mindestens 6 Monate später wurden digitalisiert und mit einer Surfacer-Software überlagert. Stellungsveränderungen der Frontzähne unter permanenter Retention wurden in allen drei Raumebenen analysiert und mit dem prätherapeutischen Modellbefund zur Benennung risikorelevanter Faktoren in Beziehung gesetzt.

Ergebnisse

Die Daten zeigen in fast allen untersuchten Fällen Veränderungen in allen drei Raumebenen im retinierten Unterkiefersegments. Beim Vergleich der einzelnen Stellungsabweichungen fällt ein wiederkehrendes Bewegungsmuster auf, das sich in Form einer labiooralen Schwenkung des Retainerblocks mit einem Drehzentrum im Bereich der ersten Inzisivi manifestiert. Dies scheint mit einer therapeutischen Expansion der intercaninen Breite und der exzessiven Korrektur des sagittalen Overjets zu korrelieren. Die stärksten Stellungsveränderungen wurden an den Eckzähnen in rotatorischer und translatorischer Bewegung festgestellt.

Schlussfolgerungen

Die permanente Retention mittels Lingualretainern stellt eine sichere Retentionsmaßnahme dar, die allerdings in einigen Fällen posttherapeutische Veränderungen auslösen kann. Das Ausmaß der therapeutischen Reduktion der sagittalen Stufe und die Erweiterung der intercaninen Distanz scheinen Risikofaktoren für das Auftreten von posttherapeutischen Veränderungen unter permanenter Retention darzustellen. In ausgewählten Fällen erscheint eine zusätzliche Retention empfehlenswert.

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Acknowledgments

We wish to thank the staff at the University of Bonn Department of Orthodontics, Oral Technology and the Medical Faculty for assistance in this study.

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Authors and Affiliations

  1. Department of Orthodontics, University of Bonn, Welschnonnenstrasse 17, 53111, Bonn, Germany

    Michael Wolf, U. Schulte, S. N. Papageorgiou, N. Daratsianos & A. Jäger

  2. Orthodontic Practice, Friesenplatz Cologne, Cologne, Germany

    K. Küpper

  3. Endowed Chair for Oral Technology, University of Bonn, Bonn, Germany

    C. Bourauel, L. Keilig, S. N. Papageorgiou & C. Dirk

  4. Department of Orthodontics, University of Regensburg, Regensburg, Germany

    C. Kirschneck

  5. Department of Orthodontics, University of Jena, Jena, Germany

    Michael Wolf

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  1. Michael Wolf
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Corresponding author

Correspondence to Michael Wolf.

Ethics declarations

This article does not contain any studies with human participants or animals performed by any of the authors. All presented findings belong to retrospective data.

Conflict of interest

M. Wolf, U. Schulte, K. Küpper, C. Bourauel, L. Keilig, S.N.Papageorgiou, C. Dirk, C. Kirschneck, N. Daratsianos, A. Jäger state that they have no conflicts of interest.

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Michael Wolf: Priv.-Doz. Dr.

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Wolf, M., Schulte, U., Küpper, K. et al. Post-treatment changes in permanent retention  . J Orofac Orthop 77, 446–453 (2016). https://doi.org/10.1007/s00056-016-0054-0

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