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Retention: Evidence-­Based Solutions for Every Clinician Dr Simon J Littlewood Consultant & Specialist Orthodontist, UK Introduction • Orthodontic retention is arguably the most important subject in orthodontics and should form a central part of every treatment plan • Relapse is recognised as the most common risk in orthodontics • This lecture will aim to discuss the best quality of evidence available on orthodontic retention !Relapse •
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Relapse is unpredictable Aetiology of relapse1 includes periodontal and occlusal factors (which we can control) and soft tissue changes and late growth changes (which we can’t control as they are part of the normal ageing process) Consent process should include information about retention, and treatment should only proceed if patients are willing and able to follow advice about reducing relapse !Worldwide retention •
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Retention regimens differ signiHicantly across the world This either means different populations have different relapse potential; or it suggests it does not matter which retainers we use; or perhaps more likely, at the present time we are not aware of the best evidence on retention !Evidence on retention •
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High quality research evidence, eg RCTs, reduces the chances of bias. This means we are more likely to Hind out the truth when looking at the results of high quality research trials For more information on high quality evidence in orthodontics see www. ohg.cochrane.org Higher quality evidence is now available on retention in orthodontics2 !How often to wear retainers •
Evidence on number of hours per day to wear vacuum-­‐formed retainers and Hawley retainers will be discussed3-­‐5 !Hawley retainers •
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These are compared to vacuum-­‐formed retainers in research looking at patient satisfaction, cost-­‐effectiveness and stability6-­‐7 We have new evidence looking at how often our patients truly wear Hawley retainers (compliance)8 !Vacuum-­formed retainers •
There are made from many different materials, and materials showing the best resistance to wear will be discussed9-­‐10 There are potential dangers of inappropriate wear of vacuum-­‐formed retainers & a case will be illustrated11 •
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Commonest problem is bond failure – methods of reducing this will be discussed High quality research has compared bonded with vacuum-­‐formed retainers12 Relapse can occur even when bonded retainers are in situ and a case will be discussed13 Dual retention combining bonded retainers with vacuum-­‐formed retainers is now popular •
Retention is unpredictable, so we have to assume all cases have the potential to relapse, either due to our orthodontic treatment, or due to age changes We now have higher quality evidence on how many hours per day removable retainers need to be worn, as well as good studies comparing Hawley retainers, vacuum-­‐formed retainers and bonded retainers All retainers carry risk, and if we are asking our patients to wear them long-­‐term we need to ensure our patients understand how to look after them and the importance of good maintenance. •
!Bonded retainers !Summary •
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Simon J Littlewood, April 2014 www.littlewoodortho.com
References 1. Melrose, C & Millett, D T (1998) Toward a perspective on orthodontic retention? AJODO, 113: 507-­‐514 2. Littlewood SJ, Millett DT, Bearn DR, Doubleday B, Worthington HV (2011) Retention (Chapter 12 – chapter in textbook) Evidence-­‐based orthodontics (edited by Huang, Richmond & Vig, Publisher Wiley-­‐Blackwell) 3. DS Gill, FB Naini, A Jones, CJ Tredwin (2007). Part-­‐time versus full-­‐time retainer wear following Hixed appliance therapy: a randomized prospective controlled trial. World Journal of Orthodontics;8:300-­‐306. 4. Thickett E, et al (2010) A randomized clinical trial of thermoplastic retainer wear. EJO 32: 1-­‐5 5. Shawesh, M et al (2010) Hawley retainers full-­‐or part time? A randomized clinical trial. EJO 32: 165-­‐170 6. Hichens, L et al ( 2007) Cost-­‐effectiveness and patient satisfaction: Hawley and vacuum-­‐formed retainers. EJO, 29: 372-­‐378 7. Rowland H, et al (2007) The effectiveness of Hawley and vacuum-­‐formed retainers: A single-­‐center randomized controlled trial. AJODO, 132: 730-­‐737 8. Schott et al (2013) QuantiHication of patient compliance with Hawley retainers and removable functional appliances during the retention phase. Am J Orthod Dentofacial Orthop 2013;144:533-­‐40 9. Raja TA, Littlewood SJ et al (2013) Wear resistance of four types of vacuum-­‐formed retainer materials: A laboratory study. The Angle Orthodontist In-­‐Press. doi: http://dx.doi.org/10.2319/061313-­‐448.1 10. Sun J et al (2011). Survival Time Comparison between Hawley and Clear Overlay Retainers: A Randomized Trial. Journal of Dental Research;90:1197-­‐1201 11. Abudiak H, Shelton A, Spencer RJ, Burns L, Littlewood SJ (2011). A complication with orthodontic Hixed retainers: A case report. Ortho Update; 4(4): 112–117. 12. McDermott, Millett, Field, van den Heuvel, ErUid (2008). Lower incisor retention with Hixed or vacum formed retainers. In: IADR Conference Abtstract 0642. Toronto, 2008 13. Littlewood SJ (2013) Retention (chapter in textbook) Introduction to Orthodontics 4th Edition (chapter 16). Publisher: Oxford University Press. !
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www.littlewoodortho.com