rms

1. RETENTION
Presented by:
Shareef M.T. Shanableh
2’nd Year Orthodontic Resident

3. Lecture’s Outline:
•Definitions.
•Causes of Relapse.
•Schools of Retention.
•Rationale of Retention.
•Types of Retention.
•Duration of Retention.

4. Definition
Moyers ‘1973’ defined orthodontic
Retention as :
“The holding of teeth in the treated
position, following orthodontic
treatment, for the period of time
necessary for the maintenance of
the result”.

5. Joondeph and Riedel “1985”
explained Retention as:
“ The holding of teeth in ideal
aesthetic and functional
positions”.

6. Relapse
Defined by BSI “1993” as :
“The return, following correction, of the original
features of malocclusion”
Moyers
“The loss of any correction achieved by orthodontic treatment”.
UPDATED DEFINITION
“Unfavorable change (s) from the final tooth position at the
end of orthodontic treatment”.

7. Reasons of Relapse
1. Periodontal or Physiological recovery
Due to Elastic Recoil of the periodontal tissues (principal fibers of PDL,
collagenous fibers of the gingiva “supraelastic fibers”, and alveolar
bone). Hixon
“1969”
2. Pressure from the Surrounding Orofacial Tissues
When neutral equilibrium zone disturbed or due to Soft tissue
Maturation with Aging.
Proffit “1978”
3. Unfavorable Growth or growth changes. “Growth relapse”
4. Pressure from Occlusion. Proffit “1978”

8. Reasons of Relapse
5. Continuous Habits.
6. Iatrogenic cause of relapse “True relapse”,
Due to poor outcomes.
For example: Changing Intercanine Width. “Felton et al 1987”
Since the teeth are placed in purely evidence based unstable
position.
7. Idiopathic cause of relapse.
For example: Relapse after treating a high angle Class II malocclusion
due to idiopathic condylar resorption.
8. Combination.

9. Relapse Risk Factors
Factors present PRE-
Treatment
Factors created
DURING treatment

10. Factors present
PRE-Treatment
Class III Growing w’
family history or
unfavorable growth
Class II div 2
AOB
Hyperactive
Mentalis
High lower lip
Incompetent
lips
Primary Tongue
Posture
Slipped Contacts
or Rotations
Median
Diastema
Spacing in
adults
Palatal
Canines

11. Factors created
DURING
treatment
Incisor
Advancement
Incisor
Retraction
Incisor
Extrusion
Intercanine
Expansion
Extraction
Spaces in
adults

12. Different SCHOOLS of Thought of
RETENTION
The Occlusal School
Kingsley “1880” stated,
“The occlusion of teeth is the
most potent factor in
determining the stability in a
new position”.

13. Different SCHOOLS of THOUGHT of
RETENTION
The Apical Base school
In the middle 1920s a 2nd school of thought formed
around the writings of
 Axel Lundstorm “1925”, who suggested that the apical base
was one of the most important factors in the correction
of malocclusion and maintenance of a correct occlusion.
 McCgauley “1944” suggested that intercanine width
and intermolar width should be maintained as
originally presented to minimize retention
problems.
 Strang “1958” further enforced and substantiated this theory.
Nance “1947” noted, “Arch length may be
permanently increased only to a limited extent”.

14. Different Schools of Thought of Retention
The Mandibular Incisal school:
Grieve “1944” and Tweed “1952”
suggested that the mandibular
incisors must kept upright and
over basal bone.
The Musculature school:
Rogers “1922” introduced a consideration
of the necessity of establishing proper
functional muscle balance.

15. Rationale of Retention
Retian “1967” mentioned that one of the main rationales behind retention is to:
I. Allow reorganization of the gingival and periodontal tissues
affected by orthodontic tooth movement “resist physiological
relapse”.
His study showed that:
 The principal fibers of PDL takes 3 - 4 months to reorganize.
 The collagenous fibers of the gingiva take 4 - 6 months.
 The elastic fibers of the gingiva “supracrestal” takes 232 days.
 The alveolar bone takes one year.

16. Rationale of Retention
II. To prevent unwanted movement resulting from
growth changes “resist growth relapse”.
III.To prevent relapse tendency of teeth that have been
moved to an inhertintly unstable position “resist true
relapse and soft tissue maturation changes”.

17. Basic Theorems for Retention
Richard And Riedel “1960” Has discussed a number of possible
explanations of Retention and Relapse
Theorem 1: Teeth that have been moved tend to
return to their former positions.
Theorem 2: Elimination of the cause of
malocclusion will prevent recurrence.
Theorem 3: Malocclusion should be overcorrected
as a safety factor.

18. Theorem 4: Proper occlusion is a potent factor in
holding teeth in their corrected
positions.
Theorem 5: Bone and adjacent soft tissues must be
allowed to reorganize around newly
positioned teeth.
Theorem 6: If lower incisors are placed upright
over basal bone, they are more likely to
remain in good alignment.
Theorem 7: Corrections carried out during periods
of growth are less likely to relapse.

19. Theorem 8: The farther the teeth have been moved,
the less likelihood of relapse.
Theorem 9: Arch form, particularly in the mandibular
arch, cannot be permanently altered by
appliance therapy.
----Someone Added----
Theorem 10: Many treated malocclusions require permanent
retaining devices.

20. Normal Age Related Changes
First: Sinclair and
Little 1983
1. A decrease in arch length.
2. A decrease in intercanine width “esp females from
13 – 20”.
3. Intermolar widths were fairly stable.
4. Small decrease in OJ and OB.
5. An increase in lower incisors irregularity.

22. Normal age related changes
Second: Iowa Facial Growth
Bishara et al 1997
1. Maxillary and Mandibular arch length and
Intercanine width all increase until age 13
then decreases esp. in females.
2. Maxillary and Mandibular intermolar
width increases until age 13 then becomes
static with little decrease in females.

23. Factors that affect POST treatment
stability
• Alteration of arch form.
• Periodontal and gingival
tissues.
• Mandibular incisor
dimensions.
• Influence of environmental
factors and
neuromusculature.
• Post treatment tooth
positioning and
establishment of functional
occlusion.
• Role of developing third
molars.
• Influence of the elements of
the original malocclusion.

24. Alteration of Arch From
• It is generally agreed that arch from and width
should be maintained during orthodontic
treatment.
Evidence shows that intercanine and intermolar
widths decrease during the postretention
period, especially if expanded during treatment.
For this reason, the maintenance of the arch
form rather than arch development is
generally recommended.

25. • HAAS “1980” and SANDSTORM “1988”, found that
maintenance of 3 – 4 mm intercanine width and upto 6
mm intermolar width was possible when expansion was
carried out simultaneously with maxillary apical base
expansion.
• De La Cruz et al. “1995”, carried out a 10 year post retention
study on 87 pts to determine the long term stability of
orthodontically induced changes in maxillary and mandibular
arch form. The results showed that although there was
considerable individual variability, arch form tended to return
toward the pretreatment shape.
They concluded that the patient’s
pretreatment arch form appeared to be the best
guide to future stability.

26. Periodontal and gingival tissues
• Orthodontic correction of tooth rotations is proposed to result in
stretching of the collagen fibers.
• The PDL organization is important for stability.
• But supracrestal fibers remodeling is very slow and can exert
forces capable of displacing a tooth at one year after removal of
orthodontic app.
• Brain “1969” and Edwards “1970” advocated gingival fiber surgery
“Circumferential Supracrestal Fiberotomy” to allow
release of soft tissue tension and reattachment of the fibers in a passive
orientation.

28. Mandibular Incisors Dimensions
• It was reintroduced by Peck and Peck “AO 1972” after a study of 45
untreated normal occlusions.
• They advocated reduction of mandibular incisors to a given faciolingual/
mesiodistal ratio to increase stability.
• Their work was criticized since their recommendations were based on a
study involving untreated rather than treated cases. In addition, there
were young pts with ideal lower incisor alignment. And it is possible
that these cases would show crowding if followed long term.
• Gilmore and Little “AJO 1984”, studied 134 treated and 30 control cases
w’ minimum 10 yrs post retention. They showed that:
A weak association between long-term irregularity and
either incisor width or faciolingual/mesiodistal ratio.

29. Influence of Environmental factors and
Neuromusculature
• Little et al “AJO 1985” and Houston et al “1990” in 2 studies:
The initial position of the lower incisors has been shown to
provide the best guide to the position of stability.
• If lower incisor advancement is a treatment objective,
permanent retention is essential for maintenance of the
result.

30. Growth modification treatment
“Following the use of head gear
or functional appliances,
Retention using a modified
Activator appliance has been
reported as effective in
maintaining Class II correction”.
Weislander “AJO 1993”

31. Consideration of Continuing Growth
• Litowitz “AO1948”, cases exhibiting greatest amount of growth
during treatment showed less relapse.
• Nanda and Nanda “ajo1992”,
1. Agreed with Riedel and stated that any skeletal changes that occur
during retention may attenuate, exaggerate or maintain the dento-
skeletal relationship.
2. Found that pubertal growth spurt for pts with skeletal deep bite
occurs on average 1.5 – 2 years later than open bite cases. Therefore, a
longer retention period for deep bite patients.

32. Post treatment tooth positioning and
establishment of functional occlusion
• Adequate Interincisal contact
angle may prevent overbite
relapse and good posterior
intercuspation prevents
relapse of both crossbite and
anteroposterior correction.

33. Role of Developing Third Molars
• Implies a passive role of the third molars in the
development of late crowding by hindering that
adjustment.
• Recent studies show a statistically significant but not a
clinically significant role of third molars in post
retention crowding.
• In summary: Minor importance of third molars
contribution in development of incisor crowding.

34. Influence of the ORIGINAL malocclusion
• It is suggested that Overbite Relapse tends to occur in the first 2 years post
treatment.
• Most studies do not support a greater relapse in CLASS II div 1 cases when
compared with other malocclusion groups.
• A slight change in OJ toward pretreatment values was demonstrated in all
malocclusion groups.
• Kaplan “AJO 1966”, advocated Overcorrection.
• Little et al “AJO 1981”, greater than 50% of the rotations or displacements
relapsing in an opposite direction.

35. Role of Transverse Discrepancies
The expansion appliance must be maintained passively or
removable appliance placed to aid in transverse retention.

36. Factors that will help minimize Relapse:
“Destang and kerr 2003”
1. During treatment Planning:
Consider extraction of severely displaced teeth in the plan of extraction
pattern.
2. During Active treatment: Move upper incisors to within lower
lip control.
Correct rotations early in treatment.
Tuverson 1980 suggested reshaping of
contact points to aid stability.
Overcorrection of the malocclusion.
Maintain existing arch form.
Maintain intercanine width.
Avoiding posterior expansion .
Maintain AP position of lower
incisors.

37. 3. During Finishing stage:
Maximize Interdigitation.
Correct incisors to achieve normal edge. “Centroid relationship”
Correct Root torque & ensure root Parallelism.
Consider IPS for triangular teeth.
Labial Frenectomy prior to debond to minimize re opening of
diastema.
CSF within 4 - 6 months after debonding.

38. 4. During retention phase:
Prolong retention “Bonded retainer” for PDL
compromised cases and cases of high risk of relapse.
Retain if possible until growth cease.
Elimination of habits.

39. Factors Affect Choosing the Type of
Retainer
1. Informed consent about
the possibility of relapse
and the rationale of
retention.
2. Age “adult pts”.
3. Type of malocclusion.
4. Type of treatment and
tooth movement.
5. PDL status.
6. Duration of treatment.
7. Patient’s motivation.

40. Adult Patients
If PDL status is normal and no occlusal
settling is required, there is
no evidence to support
any changes in retention
protocol for the adult patients
compared with adolescent patient.

41. Patient with a history of Periodontal
Disease or Root Resorption
• Permanent retention is advised.
• “There is evidence of an increased
risk of deterioration of lower
incisor alignment post-retention
in cases with root resorption or
crestal bone loss”.
Sharpe 1987

42. Correction of Post. and Ant. Crossbites
“When the incisor overbite
and posterior
intercuspation are adequate
for maintaining the
correction, no retention is
necessary”.
Kaplan Ajo
1993

43. Correction of Deep Overbite
• The use of anterior bite plane
until the completion of facial
growth has been recommended.

44. Retention After Deep Bite Correction
• Requires control of overlap of
incisors during retention.
• This is accomplished by using a
removable upper retainer
combined with a bite plane.
• As vertical growth continues into
the late teens, the retainer is often
needed for several year.

45. Correction of Anterior Open Bite
Incorporating posterior
bite blocks has been
recommended for prolonged
retention.

46. Retention after Anterior Open Bite
Correction
• Excessive vertical growth and eruption of posterior teeth often continue
until late teens or early twenties.
Controlling eruption of upper molars is therefore the key to retention in
open bite patients.

47. • High pull head gear to the upper
molars, in conjunction with a standard
removable retainer to maintain tooth
position, is one effective way to
control open bite relapse.
• A better alternative is an appliance
with bite blocks between the
posterior teeth “an open bite
Activator or Bionator”.
• In severe open bite, conventional
maxillary and mandibular retainers for
daytime wear, and an open bite bionator
as a night retainer from the beginning of
the retention period.

48. Spaced Dentition
“Permanent retention
has been recommended
following orthodontic
treatment to close
generalized spacing or
midline diastema in an
otherwise normal
occlusion”.
Graber

49. Retention after CLASS II correction

50. • Overcorrection of the occlusal relationships as a finishing procedure is an
important step in controlling tooth movement.
• Even with good retention, 1 – 2 mm of anteroposterior change caused by
adjustments in tooth positions is likely to occur after active treatment stops.
• As a general guideline,
If more than 2 mm of forward repositioning of lower incisors,
permanent retention is required.

51. This relapse tendency can be controlled in one of the two ways:
The first, is to continue head gear to the upper molars on a reduced basis “at
night” in conjunction with a retainer to hold the teeth in alignment.
The second method, is to use a functional appliance of the activator or
bionator type to hold both tooth position and occlusal relationship.
This type of retention is needed for 12 – 24 months or more with patients with a
severe skeletal problem initially.

52. The guideline is:
The more severe the initial Class II problem and
the younger the patient at the end of active
treatment, the more likely that either head gear
or a functional appliance will be needed as a
retainer.

53. Retention after CLASS III correction

54. Applying a restraining force to the mandible, as
from chincap tends to rotate the mandible
downward, causing growth to be expressed more
vertically and less horizontally, and Class III
functional appliances have the same effect.
If face height is normal or excessive after
orthodontic treatment and relapse occurs from
mandibular growth, surgical correction after the
growth has expressed itself may be the only answer.
In mild Class III problems, a functional appliance
or a positioner may be enough to maintain the
occlusal relationships during post treatment growth.

55. Retention of Lower Incisor Alignment
• If the mandible grows forward or rotates downward, the
effect is to carry the lower incisors into the lip, which creates a force
tipping them distally.
• Incisor crowding also accompanies the downward and backward rotation of
the mandible seen in open bite problems.
• A retainer in the lower incisor region is needed until growth has declined into
adult levels.
• It is also suggested, retention should be continued, at least on a part-time
basis, until third molars have either erupted into normal occlusion or
have been removed.

57. SUMMARY OF POST TREATMENT
CHANGES
• Intercanine width reduction is seen, whether expansion
was made or not.
• Intermolar width tends to return to pretreatment value.
• Mandibular anterior crowding continues into the fifth
decade.

58. Maxillary Surgeries
• Willmar”1974”, performed LE FORT 1 osteotomy on 106 pts
with the use of surgically placed metal markers.
Insignificant 10% reported relapse on anterior
marker.
• Washburn, Schendel and Epker “1982”, performed superior
maxillary repositioning on 15 young pts. Jaw
relationship was maintained even in pts who experienced
postsurgical growth.

59. Mandibular Surgeries
• Huang and Ross “AJO 1982”, evaluated short term and long term effects of
surgical lengthening of retrognathic, growing
mandible in children.
• 22 pts (12 boys and 10 girls), at the mean ages: boys at 14.1 and girls at 13.4 years.
• The results were:
The response varied with the amount of lengthening performed, but did not
vary with age, sex, cause.
Lengthening more than 11 mm, was accompanied by extensive relapse
with major remodeling of the condyle or posterior symphysis.
Lengthening less than 9 mm, was followed be little or no relapse.
No significant growth of mandible after the age of 11.
The mandible returned to its preoperative growth direction within 2
years postsurgical.

60. Retention Planning

61. Retention Planning
It is divided into 3 categories, depending on type of treatment
instituted:
1.Limited retention.
2.Moderate retention “in terms of both time and appliance
wearing”.
3.Permanent and semi permanent retention.

62. Conditions where Limited retention is
required
1. Corrected Crossbites:
 Anterior: with adequate OB, retroclined or upright tooth & favorable growth.
 Posterior: with adequate cuspal interdigitation and OB, inclination of buccal
teeth & favorable growth.
2. Dentitions that have been treated by serial extraction:
 High canine extraction cases.
3. Corrections that have been achieved by retardation of
maxillary growth.
4. Dentitions in which the maxillary and mandibular teeth
have been separated to allow for eruption of teeth previously
blocked out.

63. Where Moderate retention is required
A. CLASS I NON EXTraction cases.
B. CLASS I or II EXTraction.
Generally desirable to use a maxillary Hawley type
retainer until normal function adaptation has occurred.
sometimes its desirable to use either a maxillary Kloehn-type
head gear, or a Labiobuccal type of appliance with cervical
or occipital resistance applied at night.

64. Moderate retention
C. Corrected deep overbites in either CLASS I or
CLASS II malocclusions:
 Retention in a vertical plane.
Bite plane on a maxillary retainer is desirable.
Worn continuously for the first 4 – 6 months,
including meal time.
Vertical dimensions should be held until growth can catch
up.

65. Moderate retention
D. Early correction of rotated teeth to their normal
positions:
Before root formation has been completed.
E. The Corrected CLASS II Div 2 malocclusion, requires
extended retention to allow for the adaptation of
musculature.

66. Where Permanent retention
I. EXPANSION cases has been choice of treatment,
esp. mandibular arch.
II. Cases of GENERALIZED SPACING, after space closure.
III. Instances of SEVERE ROTATION or SEVERE
LABIOLINGUAL MALPOSITION , by bonded retainer.
IV. DIASTEMA, particularly in adult patients.

67. Timing of Retention
• It should be:
 FULL TIME for the first 3 – 4 months, except that
the retainers should be removed on meal times. “unless
circumstances like periodontal bone loss require permanent
splinting”.
 PART TIME basis for at least 12 months, to
allow time for remodeling of gingival tissues.
If significant growth remains, continued PART TIME
until completion of growth.
All patients treated in early permanent dentitions will require retention of
incisor alignment until late teens.

68. Requirement of Retaining Appliances
1. Should restrain each tooth that has been moved into the
desired position.
2. Should permit the forces associated with functional
activity to act freely on the retained teeth.
3. It should be as self cleansing as possible.
4. It should be constructed in a manner to be as inconspicuous as
possible, yet should be strong enough.

69. Types and Design of Retainers
A. Removable Retainers:
1. Hawley Retainer.
2. Spring or Barrer Retainers.
3. Begg Retainer.
4. Thermoplastic Retainer VFR.
5. Positioner.
6. Damon Splint.
7. HG, FABP, Chin Cup,
Functional appliance and
Modified Activator.
B. Fixed Retainers:
1. The Fixed Appliance itself.
2. Dental Bridge: like Resin
bonded or Fixed. “used in
hypodontia cases”.
3. Banded Retainer.
4. Bonded Retainer.

70. REMOVABLE RETAINERS

71. 1. Hawley Retainer
No Clasp Ball Clasp
0.032
C Clasp
0.032
Soldered
- .032 Labial Bow 3x3
- "T-Traditional Pink" Acrylic

72. 1. Hawley Retainer
Adams
0.028 wire SS
WrapAround
0.02 wire SS
Reverse Curve
Loop
QCM
WrapAround

73. 1. Hawley Retainer
• Types:
i. U-loops.
ii. Reverse U-loops
“better control of
Canines”.
iii. Labial Bow Soldered
to the molar cribs.
• Advantages:
 Posterior occlusal settling
in the initial 3 months.
 Bite plane can be added to
maintain Overbite reduction.
 Acrylic tooth can be added.
 Can be activated. “To close
residual spaces”.
 Maintain lateral
expansion.

74. 2. Spring or Barrer Retainer
Acrylated bows both labially and lingually .
Designed to allow minor adjustment of
rotated incisors.

75. 3. Begg Retainer
• Labial bow soldered to a
thinner wire.
• Minor tooth movements
can be achieved.
• When setttling is desirable.

76. 4. Thermoplastic Retainer
• Full posterior coverage.
• Worn for short time.
• Fabricated from 1.5 mm
polyvinylchloride sheet.
Advantages:
 Aesthetic.
 Easy to construct.
 Cheap.
 Active tooth movement.
 Acrylic tooth can be
added.
 Better control for incisor
alignment than Hawley.
Disadvantages:
 Can’t retain expansion cases,
unless supported by thick
wire.
 Can’t retain extrusion and
intrusion.
 No settling.
 If partial cover is used, pt may
develop AOB.
 Inc. risk of decalcification.

77. 5. Positioner
Uses:
 Minor correction after debond.
 Beneficial at the end Begg ttt.
 If the pt decided to discontinue
ttt.
 As a Retainer.
 The pt is advised to practice repeated
cycles of clenching then relaxation to
encourage tooth movement.
 By 3 weeks, it becomes passive retainer.
Problems:
 Costly.
 No rotational or overbite correction.
 Needs pts cooperation.

78. 6. Damon Splint
 Advantages:
 Holds teeth and arches in corrected
positions.
 Retentive splints for CLASS II, CLASS III,
bilateral Crossbites and Orthognathic cases.
 Assists in tongue training.

79. 7. HG, FABP, Chin cup, Functional
appliance & Modified activator
 After correction of Severe Skeletal problems in Growing pts.
 To complete treatment in presence of 2 – 3 mm CLASS II discrepancy.
 Appropriate to construct the appliance to an edge to edge relationship,
reduce the vertical opening to 3 mm and to keep the block interfaces vertical at 90’.

80. FIXED RETAINERS
 For long term retention of
the Labial Segment,
esp. reduced periodontal
support and for midline
Diastema.
Proffit
 Failure rates 47%.
Bearn “AJO 1995”
Indications:
1. Maintenance of Lower
Incisor Position.
2. Diastema maintenance.
3. Maintenance of Implant
Space.
4. Keeping Extraction Space
Closed in Adults.

81. 1. The Fixed Appliance itself

82. 2. Dental Bridge
Used in Hypodontia
cases.

83. 3. Banded Retainer
Bands placed on the lower
premolars with a
connecting soldered heavy
arch wire 0.030, closely
adapted to the lower labial
segment.

84. 4. Bonded Retainer
Advantages
1. Easy.
2. Aesthetic.
3. Doesn’t interfere with speech.
4. Less reliant upon
compliance.
5. Reduce risk of development
of lower labial segment.
6. Allow some physiologic
movement.
7. No evidence of long-term
periodontal problems, but
calculus can build up around
them.
Disadvantages
1. Time consuming.
2. Technique sensitive.
3. Interfere with bite “deep bite”.
4. Caries.
5. Prevent settling.
6. Don’t retain transverse
expansion.
7. High failure rate “23%”.

85. Indications
1. Prolong retention.
2. PD compromised.
3. Adults “poor compliance”.
4. CLP pts, with RA to maintain
transverse relationship.
5. AOB.
6. Palatal canines.
7. Diastema and Generalized
spaces.
8. Extraction space closure in
adults.
9. Proclined lower labial
incisors.
10. Alteration in intercanine
width.
11. Severely displaced teeth.
12. Prophylactic in lower arch.

86. 4. Bonded Retainer
Rigid
 Bonded on Canines only.
Indications
Severe pretreatment lower inc. crowding
or rotations.
Planned alteration in intercanine
width.
After advancement of lower inc.
during active ttt.
After NON extraction, in mildly crowded
pts.
After correction of deepbite.
0.030 – 0.032
inch.
Sandblasted
round S.S
wire.

87. Flexible
• Bonded on each tooth
individually.
• Allow physiological tooth
movement.
Materials:
 .015, .0175, .0195 or .0215
multistrand.
Orthoflex chain, made from gold
or SS.
Fiber glass strips.
Nimri “2009” found that no difference between multistrand and round, except more plaque on mutistrand.

88. Bonded
Retainer Design
Six Lower
Anterior
Extended to
Premolars
Labial/Buccal

91. Conclusion
Maintaining the treatment result following orthodontic
treatment is one of the most difficult aspects of the entire
treatment process. Normal maturational changes, together
with post-treatment tooth alterations, conspire against long
term stability. All treated malocclusions must eventually be
returned from control by appliances to control by the patient’s
own musculature. Permanent retention is increasingly being
recommended as the only way to ensure long-term stability of
an orthodontic treatment result. Proper goals of treatment,
careful mechanotherapy, precise occlusal equilibration, and
well-chosen retention procedures play a role in achieving
occlusal homeostasis.

92. References
• Sinclair PM, Little RM. Maturation of untreated normal occlusions.
• Retanium Splint Placement
https://www.youtube.com/watch?v=0qrLca760Wk
• Supra crestal Fibrotomy https://www.youtube.com/watch?v=HdOkoKEieos
•
•

93. THANK YOU