June 21, 2021

A work of staggering genius on orthodontic retention

Occasionally someone publishes a great piece of work about an orthodontic problem.  I was impressed with the latest edition of the British Dental Journal. The whole issue was devoted to orthodontic retention.  This collection is a “must-read” for all dental clinicians.

We all know that orthodontic retention is one of the biggest mysteries of orthodontic treatment. We base most of our retention regimes on clinical knowledge and experience. However, recently some good research has been done, and I have posted about this before.  Nevertheless, I have never really understood the rationale behind many of the decisions that I have taken on retention for my patients. So, I thought that this new series of papers provided us with excellent information.

The British Dental Journal produced a special issue on orthodontic retention. Simon Littlewood and Padhraig Fleming edited the edition.  I have been honoured to know and work with both Simon and Padhraig for many years.  I am pleased to see their careers develop over the years to become foremost orthodontic authorities. It is really great to see this work.

I will outline the significant chapters in the edition and provide links to these open access papers.  I would also like to acknowledge the BDJ for commissioning this work and making it open access for four weeks. So get downloading!

What did they want to do?

Simon and Padhraig aimed to

“Present a relatively complete guide to orthodontic retention. They wanted to attempt a holistic review of the effects of retention”.

They worked with many prominent orthodontic clinicians and academics on this series of papers. I have taken the main points from each article.

Fixed retention: Pitfalls and complications.

In this chapter, they point out that patients tolerate bonded retainers very well. But, unfortunately, when they fail, they may cause harmful tooth movements.  As a result, they should be regularly reviewed by dentists, hygienists and orthodontists. They also outlined the choice of materials that we may use for these retainers.

Bonded retainers a practical guide

Bob Kirschen led on this subject. This chapter was simply an excellent practical guide to placing, repairing and maintaining bonded retainers.  I thought that the simplicity and clarity of this paper were fantastic.

Orthodontic treatment planning: can we plan for stability?

Padhraig clearly outlines the dilemma that we face between the trade-off between aesthetics and long term stability.  He describes a clear and logical hierarchy of stability.  He based this hierarchy on the post-treatment forces that may influence the prognosis of the final result.  I thought that this was another clear chapter that outlines daily clinical issues.

Removable orthodontic retainers: practical considerations

Esma Dogramaci led on this paper. I thought that this was a very clear outline of the development of removable retainers. In addition, they considered recent research on this type of retainer.

Retention: taking a more active role

A multinational team of prominent authors wrote this section. It was about the use of active retainers.  They outlined how we may use active retainers to correct and maintain alignment, sagittal correction, expansion and vertical problems.

The rationale for orthodontic retention: piecing together the jigsaw

Declan Millet wrote this contribution. First, he outlines the aetiology for relapse. He divides this into periodontal/gingival, soft tissue, growth and occlusal factors. He then follows this with possible strategies to prevent and manage relapse.  Finally, he points out that our understanding of why retention is required is incomplete.  I thought that this was a good and bold conclusion. Unfortunately, very few authorities in orthodontics are prepared to say, “I do not really know”.

The editor included these papers in the clinical section of the journal. The other articles were on:

These continued to develop many clinically relevant themes. Unfortunately, I do not have the space to outline these, but they were equal additions to the series.

Final comments

I thought that this was a collection of excellent, thought-provoking papers by a great team. I suggest that every dentist, orthodontist and speciality trainee read them.

 

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Have your say!

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    I am starting a residency in orthodontics in a few weeks and have been puzzled by the topic of retention – this looks like a fantastic series of articles that will break down where we are at on this front!

    Much appreciate Kevin!

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    This new publication is like a new translation of the scriptures for orthodontics. One that’s never been done so well before

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    I’m going to be controversial…Yes, it is good thesis on retention, but, as it is published in one of the most widely read dental journals, IMHO it missed a couple of opportunities.
    1. Explaining the role of GDP and how GDPs can mange retention
    2. That undergraduate education is severely lacking in teaching orthodontic retention and how this could be addressed

    Ross

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    Thanks Kevin. Enjoy reading your blog. I am a UNC grad, trained under Prof and practice in the US. How do I go about getting a copy of this edition of the BDJ? Subscribe or is there a way just to get this issue? Thanks so much. Phil Parker

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      Hi Phil, I think that if you follow the links you can download the papers for free for a limited period of time?

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    Good, but nothing new. Orthodontic retention still is an enigma.

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    any idea why this ended up in BDJ and not an ortho journal?

    I was surprised to see the links actually take me to the BDJ articles, I thought it would have been subscription-only- so maybe it doesn’t matter that it’s not an ortho journal. But if it becomes only accessible to people who can get BDJ, there’s a fair loss to the specialty. Does this sort of “review of our generation” stuff come up in ortho journals often?

    Stephen
    Swords Ortho

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