Retention is the phase of orthodontic treatment which maintains the teeth in their orthodontically corrected positions.

Orthodontic retainers resist the tendency of teeth to return to their pretreatment positions under the influence of periodontal, occlusal and soft tissue forces, and continuing dentofacial growth. The most commonly used retention period is 12 months.

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For 3 major reasons: The gingival and periodontal tissues are affected by orthodontic tooth movement and require time for reorganization when the appliances are removed.

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The teeth may be in an inherently unstable position after the treatment, so that soft tissue pressure constantly produce a relapse tendency.
Changes produced by growth may alter the orthodontic treatment result

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1) Lower Incisor Alignment:

Increases in lower incisor irregularity occur throughout life in a large proportion of patients following orthodontic treatment and also in untreated subjects.

Prolonged retention of the lower labial segment until the end of facial growth may reduce the severity of lower incisor crowding.
As a general guideline, if more than 2mm of forward repositioning of the lower incisors occurred during treatment, permanent retention will be required.

The use of an anterior biteplane until the completion of facial growth has been recommended. This may be particularly useful when there is evidence of an anterior mandibular growth rotation.

Use of retainers incorporating posterior bite blocks has been recommended for prolonged retention of anterior open bite malocclusions with unfavourable growth patterns.

In severe periodontal disease, permanent retention is adviced. In minimum to moderate disease, a more routine retention protocol can be used.

There is evidence of an increased risk of deterioration of lower incisor alignment post-retention in cases with root resorption or crestal bone loss.

When the incisor overbite and posterior intercuspation are adequate for maintaining the correction, no retention is necessary.

Permanent retention has been recommended following orthodontic treatment to close generalised spacing or a midline diastema.

The more severe the initial class II problem and the younger the patient at the end of active treatment , the more likely that either headgear or functional appliance will be needed during post treatment retention in conjunction with retainer to hold the teeth in alignment.

Relapse from continuing mandibular growth is very likely to occur and such growth is extremely difficult to control.

Esentially FULL TIME for the first 3-4 months, but should be removed while eating. Continued on a part-time basis for atleast 12 months, to allow time for remodeling of gingival tissues. If significant growth remains, continued part-time until completion of growth.

REMOVABLE APPLIANCES AS RETAINERS:

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Hawley Retainer. Removable Vacuum Formed Retainers. Wraparound or clip-on retainer.

Can be worn during eating. Have the advantage of facilitating posterior occlusal settling in the initial 3 months of retention. Has a metal wire that sorrounds the teeth and keep them in place. The advantage of this type of retainer is that the metal wires can be adjusted to finish treatment and continue moving teeth as needed. 6 months full time wear with 6 months night time only has been recommended .

Recently, a more aesthetic version of the Hawley retainer has been developed in which the front metal wire is replaced with a clear wire called the ASTICS.

Relatively less expensive. Can be quickly fabricated on the same day as appliance removal. Full posterior occlusal coverage is advisable in order to reduce the risk of over eruption of these teeth during retention. They are significantly more effective than Hawley retainer at maintaining the alignment of the labial segment. Less likely to allow posterior occlusal settling than Hawley retainer.


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Indiactions:
Maintenance of lower incisor position during late growth.

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3) 4)

Diastema maintenance.
Maintenance of pontic or implant space.

Keeping extraction spaces closed in adults

The major objection to any fixed retainer is that it makes interproximal hygiene procedures more difficult.

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