Treatment without retainers? Madness or innovation? Simon Littlewood

orthodontics In summary

Simon described the concept of ‘no retention’, the methodology and literature on the topic, with his expert option included.

Conclusion

· Controversial to not wear retainers

· Simon still asks patients to wear retainers

· Interproximal reduction helps but we don’t know why

Classic study

Riedel and Little

· 10 years out of retention

· 70% relapse – require retreatment, 30% no retainers and no treatment needed

· No identifiable factors – therefore to keep teeth straight require retainers

Treatment protocol and retrospective study of no retainers

Aasen EJO 2005

· During treatment

1. Respect lower archform

2. Maintain lower incisor position

3. Overcorrect of rotations

4. Heavy final wire 21x25 SS for 2-3 months

5. Relapse ‘test’: 4 weeks no archwire

· Results

1. After 3 years 1.1mm (Little’s Index)

§ Not significant clinical change

Randomised control trial Lower arch

Tynelius 2010, 2013

· Lower bonded retainer Vs IPR and no retainer

· 2 years = no difference in stability

Randomised control trial Upper arch

Naraghi 2020

· Upper VFR Vs no retainer

· 1 year follow up

o Relapse with retainer 0.4mm

o Relapse without retainer 1.3mm

· Not clinically significant

Post – treatment changes

1. Relapse

2. Age related changes

a. Abdulraheem 2020, 12 year follow up

i. Tooth displacement index

1. 25% = age related

2. 75% orthodontic relapse

Reference

Aasen, T.O. and Espeland, L., 2005. An approach to maintain orthodontic alignment of lower incisors without the use of retainers. The European Journal of Orthodontics, 27(3), pp.209-214.

Edman Tynelius, G., Bondemark, L. and Lilja‐Karlander, E., 2013. A randomized controlled trial of three orthodontic retention methods in C lass I four premolar extraction cases–stability after 2 years in retention. Orthodontics & craniofacial research, 16(2), pp.105-115.

Naraghi, S., Ganzer, N., Bondemark, L. and Sonesson, M., 2020. Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines—a randomized controlled trial. European Journal of Orthodontics.

Tsiopas, N., Nilner, M., Bondemark, L. and Bjerklin, K., 2013. A 40 years follow-up of dental arch dimensions and incisor irregularity in adults. The European Journal of Orthodontics, 35(2), pp.230-235

Abdulraheem, S., Schütz-Fransson, U. and Bjerklin, K., 2020. Teeth movement 12 years after orthodontic treatment with and without retainer: relapse or usual changes?. European Journal of Orthodontics, 42(1), pp.52-59