Have We Conquered Relapse?

Lifelong retention is now the buzzword as far as orthodontic treatment goes.

However, we do not see our patients lifelong. A survey reports that we stop seeing our patients for removable retainer checks sometime between 2 and 3 years post-debonding. ¹ The logic of year-plus retention is based on the evidence that the gingival collagen-fiber network takes 4-6 months for complete remodeling, and the elastic supracrestal fibers remodel in about 7 months or so. Thus, there is a need for a year of retention. ²

While removable retainers cause discomfort, they are associated with less retainer failure and better periodontal health. ³ With fixed retainers, the story is even worse, with some orthodontists concluding, rightly or (mostly) wrongly, that long-term stability can be achieved only with fixed retention. ¹

Have we accepted defeat, or are the theorems and schools of retention not valid? So, occlusion, lower incisor axial inclination, muscle equilibrium, the apical base, or the transverse dimensions are for history books, OR we have not focused sufficiently on this topic, even though the Cochrane Review has warned us that “given that the vast majority of orthodontic patients undergo a phase of retention, this vital area of orthodontic research should be given priority in the near future.” ³ There does not seem to be much consistency in how practitioners choose the retainer types they use. Does the tail wag the dog, with patients determining the retainer type?

The pessimist complains about the rain, the optimist hopes it will improve, and the pragmatist takes an umbrella. Replace rain with relapse and the umbrella with retainer.

So, what are we?