Stability, Retention and Relapse in Orthodontics

by Drs. Christos Katsaros and Theodore Eliades Quintessence Publishing, Surrey, UK www.quintpub.co.uk

Drs. Katsaros and Eliades have assembled a group of 30 dental professionals with unusual experience in the study of the myriad features of orthodontic retention to produce the most thorough publication to date regarding this elusive and frustrating aspect of the orthodontic process. This book has all of the expected characteristics of a Quintessence book with excellent fidelity in photographs, easily deciphered charts and tables, thick durable pages, and clear, well-edited narratives.

Drs. Katsaros and Eliades have divided the book into three sections, the first of which begins with a history of retention, the biological basis for orthodontic relapse, and a review and assessment of the clinical evidence. The second section begins with an interesting chapter on the change in irregularity of teeth with and without orthodontic treatment, followed by chapters on transverse stability, stability and relapse of Class II malocclusions, stability and relapse of Class III malocclusions, stability of open bite therapies, and the stability of orthognathic surgery patients. The final section provides chapters on acrylic removable retainers, fixed retention, biomaterials for fixed retainers, and a final chapter on the long-term effectiveness of fixed retainers.

One could only hope that this remarkable book might offer some final conclusions about the best, most reliable, and durable retention protocols. Unfortunately, no such regimen exists because clinicians use so many differing techniques. They have discovered that a majority now prefers fixed retention, at least in the mandibular arch, whereas Hawley retainers and Essix retainers remain the favorites for the maxillary arch. Interestingly, with removable retainers, their use in only the evening hours seems adequate to retain the orthodontic correction.

Orthodontic clinicians need to realize they deal with a dynamic, chaotic system where posttreatment changes are not all due to relapses, and that the only way of maintaining the result is to rely on lifetime retention. My late friend, Dr. Jack Sheridan, may have come up the best advice ortho-dontic clinicians can give patients at the conclusion of their therapies. “I am the creator of your smile, I am not the guarantor of your smile. That is your responsibility.” At some point, orthodontists need to give patients the responsibility they should have assumed throughout treatment.

Review by Dr. Larry White