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.
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.
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.
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.
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.
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.
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:
- The evidence base of orthodontic retention
- The future of retention
- Shared decision making
- History of retention.
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.
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.