THE READERS' CORNER

PETER M. SINCLAIR, DDS, MSD

1. What is your preferred retention procedure? Have you noticed differences in relapse with or without retention? How do you handle patient cooperation in the retention period?

Types of Retainers

Readers almost universally preferred a Hawley-type retainer for maxillary retention. They frequently mentioned the advantage of a wraparound retainer, with no wires crossing the occlusion, in allowing for settling of the occlusion. Using a flat wire for the labial bow, to better control incisor rotations, was also suggested.

Considerable variation was reported in the retention procedures used in the lower arch, with influence given to factors such as the amount of lower incisor crowding and whether extractions had been performed. The bonded cuspid-to-cuspid retainer was the most popular choice, particularly in nonextraction cases. The banded cuspid-to-cuspid retainer was advocated by those who were concerned with potential dislodging of the bonded variety. "Zachrisson" bonded retainers (for both arches) and light-cured composites were also mentioned.

Suggestions included:

"On extraction cases we leave the lower first molar bands on with a lingual hook, in case the extraction space reopens within a few months. If space opens, an .012" ligature is threaded between the banded 3-3 retainer and the lingual hook, ligated at the solder joints, and twisted to activate. The ligature is removed after the space has closed and remained that way for three to six months."

"I use a wraparound Hawley, but if the second molars have not erupted, or the crowns are short, we use an Adams clasp on the upper first molar and solder the flat labial bow to it."

Retention Duration and Relapse

Several practitioners commented on wanting "lifetime retention", but recognized that this might not be practical. The most common regime was to wear the retainers until growth was complete and the third molars had been dealt with. Six to 12 months of full-time removable retainer wear, followed by nighttime wear, was most commonly suggested.

The clinicians almost unanimously reported an increased incidence of relapse without retention, and many felt uncomfortable about having patients go for even short periods without retainers.

Patient Cooperation

The readers felt the best way to ensure continued cooperation was to remind patients and parents constantly of the possibility of relapse. Comments included:

"I have the patient sign a release form if they are not wearing their retainers as directed."

"When removing braces I show the patients a print of their original malocclusion, as well as comparing their before-and-after models, to emphasize the importance of wearing their retainers 'to remind the teeth of their new and preferred positions'."

"Lower fixed retainers are kept indefinitely, and the responsibility for retainer supervision is 'handed over' to the patient's family dentist and the patient in my post-treatment letter. At this time I do not feel I have to remove them simply to avoid liability."

2. If a child says that he or she does not want to have orthodontic treatment, how do you deal with that?

Without exception, readers said they would not start treatment if the patient clearly indicated that he or she was not interested. Comments:

"I set up a contract based on improvement of the child's oral hygiene (at exam, records, and consultation appointments). If there is no improvement, I tend not to start treatment, or do so only with the thorough understanding of one or both parents."

"During the questioning phase, I try to establish some of their heroes. A large percentage of the kids have high school athletic heroes. If I'm lucky, I can point to the fact that certain athletic stars have braces."

"There is no question that this is an important factor, and looking back, I might have avoided some real closet cases had I confronted this issue more directly."

"If a child says that he does not want orthodontic treatment, first I try to explain to him about his orthodontic needs, then show him similar cases before and after treatment. I also let him talk to selected patients who are under treatment. If he is still negative-- no treatment at all."

"I never try to talk anyone into orthodontics. The orthodontic guarantee comes to mind: 'With poor cooperation, I guarantee you a lousy result'."

JCO wishes to thank the following participants in this month's column:Dr. John P. Doley, Williamsburg, VADr. Lamont R. Gholston, Louisville, KYDr. Lloyd R. Griffith, Port Angeles, WADr. Kim Nga Nguyen-Khuong, Houston, TXDr. Peter I. Pfaffenbach, Schenectady, NYDr. Stephen C. Roehm, Peoria, ILDr. Gary R. Wolf, Norwalk, OHDr. Barry F. Wood, Williamsville, NY

Journal of Clinical Orthodonics

THE READERS' CORNER

1. What is your preferred retention procedure? Have you noticed differences in relapse with or without retention? How do you handle patient cooperation in the retention period?

2. If a child says that he or she does not want to have orthodontic treatment, how do you deal with that?

PETER M. SINCLAIR, DDS, MSD

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