Understanding post-orthodontic relapse: Causes, treatment and prevention

Understanding post-orthodontic relapse: Causes, treatment and prevention image

Avant’s Refine Aligner solution is an easy, affordable clear aligner treatment option for correcting minor post-orthodontic relapse.

According to Orthodontics Australia, patients can pay anywhere from around $6,000 for traditional metal braces, right up to $15,000 for lingual braces. That’s a sizeable investment many people are making in their smile. 

However, post-orthodontic relapse can wipe away the gains – and fast. 

It’s why post-orthodontic treatment is so important, and patients must be made aware that following retainer protocols is critical to maintaining orthodontic treatment. 

Dr Lawrence Neville, principal dentist and owner of Spa Dental in Sydney, says that post-orthodontic retainers – whether fixed or removable – are non-negotiable for successful treatment outcomes over the long term. 

“I like to explain it to patients as similar to the braces that hold up your pants,” he says. “Retainers hold up your smile. Teeth tend to move as we age, and people who have had orthodontic treatments may be more prone to tooth movement. We can stop that with retainers.”

Still, Dr Lawrence says post-orthodontic relapse cases are surprisingly common. Fortunately, many minor relapse cases can be effectively treated with clear aligners. 

Avant’s Refine Aligner solution, for example, has been designed by certified orthodontists to treat minor post-orthodontic relapse cases with an easy five-step workflow that can be completed within four to eight weeks for minor refinement cases involving two to four stages. It’s a much more accessible solution for patients who need minor refinements to restore their smile without resorting to another full orthodontic smile design treatment. 

Common causes of post-orthodontic relapse

Dr Neville says the most common cause of post-orthodontic relapse is typically the patient’s failure to wear their retainers in line with their dentist’s instructions. Patients must be made aware that teeth will often move after an orthodontic treatment, and the only way to prevent unwanted tooth movement is with a post-orthodontic retainer. 

“Teeth are not set in stone, so much so that anyone can experience teeth shifting – and not just following an orthodontic treatment,” Dr Neville explains. “A patient in their 20s might be lucky and have naturally straight teeth. But as they get into their late 30s, 40s and 50s their teeth may actually start to move.”

Patients who have orthodontic treatments are even more at risk of experiencing post-orthodontic tooth movement if they don’t wear their retainers. Dr Neville says the more teeth have been shifted during the orthodontic treatment, the more likely it is the tooth will move again after treatment. 

“For example, if you moved a tooth from a 90-degree angle all the way around to zero, that tooth has more chance of relapsing than a tooth that may have only required a 20-degree adjustment,” he explains.  

Incomplete orthodontic treatment or faster than necessary treatment timelines may also increase the risk of post-orthodontic relapse. Some patients may put pressure on dentists to shorten orthodontic treatment timelines. But they need to be made aware that teeth take time to set, and speeding up the process may leave them more vulnerable to post-orthodontic relapse.

Another cause of post-orthodontic relapse can be the failure to resolve a causative factor – such as a molar intrusion – as part of  the original treatment. With a causative factor still present after treatment, the same conditions in the mouth will likely increase the risk of the patient experiencing post-orthodontic relapse.  

Patient habits such as teeth grinding and smoking may also contribute to post-orthodontic relapse. Likewise, poor oral hygiene that leads to gum disease, enamel wear and tooth loss can cause teeth to move or become unstable.   

Dr Neville adds that ongoing monitoring is also important to reduce the risk of post-orthodontic relapse: “Ideally, you want to be seeing the patient at least every six months. You’re looking for any signs of tooth movement, and using the opportunity to reinforce how important it is for the patient to wear their retainer.” 

How to treat post-orthodontic relapse

Treating post-orthodontic relapse cases depends predominantly on the extent of the movement that has occurred since the initial orthodontic treatment. Dr Neville says assessing the current fit of the patient’s retainer should provide a good indication of the severity of the movement, and which teeth are affected. 

“If you suspect a patient’s teeth have moved following an orthodontic treatment, in the first instance, try in their retainer to see if it fits. In the most minor of post-orthodontic relapse cases, there is a chance you may be able to push the retainer over the teeth to slightly realign them.”

However, Dr Neville says most post-orthodontic relapse cases will require a greater degree of realignment. That will likely require a clear aligner treatment. 

“Clear aligners are great for realigning one tooth or a couple of teeth,” he explains. “Clear aligners give you the ability to quite easily correct post-orthodontic relapse and stop it getting worse. So you can reassure the patient that they don’t have to redo their original treatment. And because you’re not going back to the beginning of the smile design process, it’s typically much cheaper for the patient too.” 

Minor clear aligner treatments can take as little as four to eight weeks, but Dr Neville says it can be difficult to estimate a timeline for clear aligner treatments, because every patient – and case – is different.

“Teeth move at different rates depending on the patient’s particular bone structure and gum health,” he explains. “It also depends on where the teeth started, and how much movement was required during the original orthodontic treatment.”

5-step Refine Aligner workflow

Generally speaking, Dr Lawrence says the sooner the patient begins clear aligner treatment the better. Clear aligners do have some limitations, and if the patient waits too long to address post-orthodontic relapse, they may have to return to braces.

However, Avant is making clear aligner treatment easier – and more accessible – than ever with our new Refine Aligner solution. Refine Aligner has been designed by certified orthodontists to treat minor post-orthodontic relapse cases without adding to your daily workload.

As part of the treatment planning process, we can help you decide when each movement occurs, including expansion, rotations, intrusion, extrusion, mesialisation and digitalisation. And we can plan the amount of interproximal reduction needed for improved teeth movement.

We custom fabricate Refiner Aligners to meet your patient’s individual treatment needs, and our Refine Aligner workflow is fully compatible with all intraoral scanning systems. And we accept physical impressions if you prefer an old-school approach. 

That means Refine Aligner easily integrates with your existing digital workflow with no need to buy any new equipment. 

We’ve reduced the entire process to a simple five-step workflow:

1. Take an intraoral scan (or provide a physical impression), clinical photos, lateral ceph/OPG radiographs, and a cone beam for root movement analysis if needed.

2. Use the Avant Dental website to complete the order form and upload the case materials or book a pick-up. 

3. Avant Dental reviews your case and provides a PDF treatment plan and a video showing the movement of the treatment for your review and approval.

4. Avant Dental prepares trays in TGA approved materials and completes a quality control check. 

5. The patient kit (including an aligner case, removal key, chewies and up to your  first six trays) is delivered to your practice.

We also provide immediate phone or instant messaging access to the same lab technicians making your patients’ aligners. 

How to prevent post-orthodontic relapse 

With the patient’s clear aligner treatment complete, it’s time to return focus to maintaining their restored smile. When it comes to preventing post-orthodontic relapse, Dr Neville says retainers are really the only way to ensure a good long-term outcome. 

Dr Neville uses both removable and permanent (or fixed wire) retainers, depending on the particular circumstances. 

Fixed retainers typically consist of a solid or braided lingual wire that is bonded to the inside of the patient’s teeth. They are most often used on the lower teeth, and Avant provides a putty guidance key to help the dentist engage the lingual wire in the exact position to achieve optimal treatment outcomes.

Clear plastic retainers, on the other hand, are essentially a thin plastic or polyurethane mould that encases the patient’s teeth and can be easily removed by the patient for cleaning and eating. 

Hawley retainers are another type of removable retainer. A thin metal wire is attached to a plastic or acrylic plate shaped to fit the roof of the patient’s mouth. The metal wire curves around the outside of the patient’s teeth to maintain the appropriate alignment.“You really need to get through to your patients how important it is for them to wear their retainers,” he says. “If they fail to use their retainers appropriately, then there’s a good chance they’ll be back with another relapse case.” 

Dr Neville says it’s important to get an up-front commitment from your patient and ensure that they understand part of any cosmetic treatment means consistently wearing a retainer in line with the dentist’s instructions. 

“The hardest thing about removable retainers is getting that patient compliance,” he explains. “Obviously, if the patient isn’t wearing their retainer, it’s not going to work. We talk to our patients a lot at the start of the treatment so they understand the commitment that is needed to get the outcome they want.

“It’s also important to coach the patient throughout their journey,” he adds. “They might start off committed to wearing their retainer, but some people can get fatigued and that commitment might wane over time. So whenever a patient comes in for their six-month checkups, we’re asking about their retainer and reminding them how important it is for them to continue to wear it. 

“This also gives the patient an opportunity to bring up any fit or comfort issues they might be having with their retainer, and we can address that right away before they fall back into that relapse threat.” 

If a patient isn’t showing a sufficient commitment to removable retainers, Dr Neville suggests recommending a fixed wire retainer. A fixed wire retainer overcomes that patient compliance issue. They are very durable and typically much less prone to breakage, damage or loss than removable retainers. 

“However, fixed wire retainers typically attract a little more plaque, so the patient needs to be aware that it will need extra cleaning,” Dr Neville explains. “So it’s also important that they come in every six months for a routine clean.”

Avant can also look after your retainer workflow. On request we can store your patient case files in our lab management system, so you don’t need to resupply scans or impressions to order replacement retainers. Simply contact us and we can start manufacturing replacement retainers immediately.

The final word

The take-home message for patients is that orthodontic treatments don’t end when their braces come off. Rather, post-orthodontic retainers are a critical element of every ongoing orthodontic treatment. Whether you prefer removable or fixed retainers – or a combination of both – patients must commit to the ongoing use of retainers if they are to maintain their treatment outcomes over the long term.

However, if patients don’t follow retainer protocols and experience minor post-orthodontic relapse, all is not lost. Dentists can use specifically-designed clear aligner solutions like Avant’s Refine Aligner to make minor adjustments to restore the patient’s smile and stop the progression of post-orthodontic relapse. 

Avant is making post-orthodontic relapse treatment fast, easy and affordable. Refine Aligner can be immediately integrated into your existing digital workflow with treatment planning and a video showing the movement of the treatment provided by Avant’s expert lab technicians. 

Once the treatment plan is approved, we then manufacture aligner trays from TGA approved materials, and deliver a treatment kit to your practice that’s ready to pass straight onto your patient.  

It’s all part of our effort to make minor post-orthodontic treatment easy, and provide an accessible  minor refinement option for patients who don’t need a full smile design solution to restore the outcomes from their original orthodontic treatment. 

Whether you have an existing relationship with us or are new to the Avant family, we’re here to talk you through the process and provide any guidance you need to start treating post-orthodontic relapse with Refine Aligner.

 

Want to find out more about partnering with Avant for post-orthodontic relapse treatments? Please email contact@avantdental.com.au or phone 1800 287 336.

This regular newsletter will deliver articles and information for business-minded dentists looking for ways to improve patient care and their businesses.

    Contact us