Upload File

retention: a sensible, evidence-based approach dr … · retention: a sensible, evidence-based...

  • Home
  • Documents
  • Retention: a sensible, evidence-based approach Dr … · Retention: a sensible, evidence-based approach Dr Simon J Littlewood Consultant & Specialist Orthodontist, UK Challenge of
2
Retention: a sensible, evidence-based approach Dr Simon J Littlewood Consultant & Specialist Orthodontist, UK Challenge of preventing relapse • Preventing relapse is arguably the most challenging problem for any orthodontist • Aetiology of relapse includes both orthodontic factors (periodontal @ibres/occlusal factors) and normal physiological changes or “aging" (growth and long-term soft tissue changes) 1 • If retainers are not worn, long-term unwanted changes after orthodontic treatment should be regarded as normal, not unlucky • Long-term observational studies of patients who have not had orthodontic treatment show deterioration in the alignment of teeth, as a result of natural reduction of arch length, reduction in arch depth and reduction in intercanine width 2 • Currently the best way we know to prevent relapse long-term appears to be wearing retainers long- term • There is currently a general lack of scienti@ic evidence to support which type of retainer is best 3 • This lecture will discuss some of the potential challenges of asking patients to wear retainers long- term, including oral health issues and compliance Oral health issues of long-term retainer wear • Patients with bonded retainers have different oral @lora. There is an intra-oral increase of bacteria capable of causing caries and periodontal disease 4 • Fortunately, most clinical studies suggest that provided good oral hygiene is maintained, this does not necessarily translate into active clinical disease • There is however the potential for severe caries if patients have a high cariogenic diet, while wearing removable retainers, particularly full coverage vacuum-formed retainers 5 • Bonded retainers have the potential to move teeth into unfavourable positions if they are not placed in a passive position, or if they are distorted and become active 6 • It has been suggested that one possible cause of unwanted tooth movement as a result of bonded retainers may be due to commonly used twisted multistrand wires which could be unwinding 7 CAD/CAM Nitinol bonded retainers • In an attempt to ensure a passive, well-@itting bonded retainer, commercially available CAD/CAM fabricated nitinol retainers are now available (Memotain ® ) • These indirectly produced retainers offer the potential for a high-precision @it, customised to each patient. This may be particularly useful in the upper arch, where positioning is key to minimise occlusal trauma and distortion • The nitinol material should allow good physiological movement, as well as being less likely to be be distorted in use. • This a relatively new product and a future prospective RCT is planned to investigate them further and this study will be discussed. Compliance • Compliance (better referred to as “adherence”) is key for removable retainers. • Factors that affect adherence will be discussed 8 • A method of successfully improving adherence of removable retainers that has been tested in an RCT will be discussed 9 Simon J Littlewood, April 2017 www.littlewoodortho.com

Upload: lamtram

Post on 01-Sep-2018

223 views

Category:

Documents


0 download

Report

TRANSCRIPT

Page 1: Retention: a sensible, evidence-based approach Dr … · Retention: a sensible, evidence-based approach Dr Simon J Littlewood Consultant & Specialist Orthodontist, UK Challenge of

Retention:asensible,evidence-basedapproachDrSimonJLittlewood

Consultant&SpecialistOrthodontist,UK

Challengeofpreventingrelapse• Preventingrelapseisarguablythemostchallengingproblemforanyorthodontist• Aetiologyofrelapseincludesbothorthodonticfactors(periodontal@ibres/occlusalfactors)and

normalphysiologicalchangesor“aging"(growthandlong-termsofttissuechanges)1• Ifretainersarenotworn,long-termunwantedchangesafterorthodontictreatmentshouldbe

regardedasnormal,notunlucky• Long-termobservationalstudiesofpatientswhohavenothadorthodontictreatmentshow

deteriorationinthealignmentofteeth,asaresultofnaturalreductionofarchlength,reductioninarchdepthandreductioninintercaninewidth2

• Currentlythebestwayweknowtopreventrelapselong-termappearstobewearingretainerslong-term

• Thereiscurrentlyagenerallackofscienti@icevidencetosupportwhichtypeofretainerisbest3• Thislecturewilldiscusssomeofthepotentialchallengesofaskingpatientstowearretainerslong-

term,includingoralhealthissuesandcompliance

Oralhealthissuesoflong-termretainerwear• Patientswithbondedretainershavedifferentoral@lora.Thereisanintra-oralincreaseofbacteria

capableofcausingcariesandperiodontaldisease4• Fortunately,mostclinicalstudiessuggestthatprovidedgoodoralhygieneismaintained,thisdoes

notnecessarilytranslateintoactiveclinicaldisease• Thereishoweverthepotentialforseverecariesifpatientshaveahighcariogenicdiet,whilewearing

removableretainers,particularlyfullcoveragevacuum-formedretainers5• Bondedretainershavethepotentialtomoveteethintounfavourablepositionsiftheyarenotplaced

inapassiveposition,oriftheyaredistortedandbecomeactive6• Ithasbeensuggestedthatonepossiblecauseofunwantedtoothmovementasaresultofbonded

retainersmaybeduetocommonlyusedtwistedmultistrandwireswhichcouldbeunwinding7

CAD/CAMNitinolbondedretainers• Inanattempttoensureapassive,well-@ittingbondedretainer,commerciallyavailableCAD/CAM

fabricatednitinolretainersarenowavailable(Memotain®)• Theseindirectlyproducedretainersofferthepotentialforahigh-precision@it,customisedtoeach

patient.Thismaybeparticularlyusefulintheupperarch,wherepositioningiskeytominimiseocclusaltraumaanddistortion

• Thenitinolmaterialshouldallowgoodphysiologicalmovement,aswellasbeinglesslikelytobebedistortedinuse.

• ThisarelativelynewproductandafutureprospectiveRCTisplannedtoinvestigatethemfurtherandthisstudywillbediscussed.

Compliance• Compliance(betterreferredtoas“adherence”)iskeyforremovableretainers.• Factorsthataffectadherencewillbediscussed8• Amethodofsuccessfullyimprovingadherenceofremovableretainersthathasbeentestedinan

RCTwillbediscussed9

SimonJLittlewood,April2017

�

www.littlewoodortho.com

Page 2: Retention: a sensible, evidence-based approach Dr … · Retention: a sensible, evidence-based approach Dr Simon J Littlewood Consultant & Specialist Orthodontist, UK Challenge of

References

1. LittlewoodSJ,KandasamyS,HuangG.(2017).Retentionandrelapseinclinicalpractice.AustralianDentalJournal;62:(1Suppl):51–57

2. TsiopasN,NilnerM,BondemarkL&BjerklinK(2013).A40yearsfollow-upofdentalarchdimensionsandincisorirregularityinadults.EuropeanJournalofOrthodontics;35:230–235

3. LittlewoodSJ,MillettDT,DoubledayB,BearnDR,WorthingtonHV(2016).Retentionproceduresforstabilisingtoothpositionaftertreatmentwithorthodonticbraces.CochraneDatabaseofSystematicReviews2016,Issue1.Art.No.:CD002283.DOI:10.1002/14651858.CD002283.pub4.

4. TurkoC,BavbekNC,VarlikSK&AkcaG(2012).In@luenceofthermoplasticretainersonStreptococcusmutansandLactobacillusadhesion.AmJOrthodDentofacialOrthop;141:598-603

5. LittlewoodSJ(2012).StabilityandRetention(chapterintextbook).Orthodontic:PrinciplesandPractice(editedbyDalgitGill,PublisherWiley-Blackwell)

6. AbudiakH,SheltonA,SpencerRJ,BurnsL,LittlewoodSJ(2011).Acomplicationwithorthodontic@ixedretainers:Acasereport.OrthoUpdate;4(4):112–117.

7. KuceraJ&MarekI(2016).Unexpectedcomplicationsassociatedwithmandibular@ixedretainers:Aretrospectivestudy.AmJOrthodDentofacialOrthop;149:202-11

8. MirzakouchakiB,ShiraziS&ShiraziS(2016).AssessmentofFactorsAffectingAdolescentPatients’CompliancewithHawleyandVacuumFormedRetainers.JournalofClinicalandDiagnosticResearch.2016Jun,Vol-10(6):ZC24-ZC27

9. LinF,SunH,NiZ,ZhengM,YaoL(2015)AfeasiblemethodtoimproveadherenceofHawleyretainerinadolescentorthodonticpatients:arandomizedcontrolledtrialPatientpreferenceandadherence;9:1525-1530

�

www.littlewoodortho.com


effectivehealthcare.ahrq.gov · Rapid Evidence Product . Retention Strategies for Medications for Addiction Treatment in Adults With Opioid Use Disorder: A Rapid Evidence Review

Initiatives to Improve LTC Direct Care Workforce Retention: What is the Evidence Base?

Building student engagement and belonging in Higher ... · regards to student retention and success, and to further build the evidence base for successful retention practice. This

Guidelines for Preservation and Retention of Biological ...ohiopa.org/bertf.pdf · Guidelines for Preservation and Retention of Biological Evidence ... • Drug paraphernalia such

The Retention of Social Workers in the Health Services: An ... Retention of Social Workers.pdf · The Retention of Social Workers in the Health Services and Evidence Based Assessment

Rapid Retention Survey Toolkit: Designing Evidence-Based Incentives for Health Workers

Genetic evidence supports larval retention in the …vprichards-lab.com/pub/osuen.pdfREPORT Genetic evidence supports larval retention in the Western Caribbean for an invertebrate

Recruitment, e ort, and retention e ects of performance ...€¦ · Recruitment, e ort, and retention e ects of performance contracts for civil servants: Experimental evidence from

British Dental Association Evidence to€¦ · morale, motivation, recruitment and retention in dentistry. 1.1.2 This evidence applies to England only. We are providing evidence for

Sounds Sensible - EPS Literacy and Interventioneps.schoolspecialty.com/.../268077_Sounds-Sensible-Sampler-FRev1.pdf · Sounds Sensible ® 2 800.225.5750 Sounds Sensible® provides

INDIRECT FIRED UNITS - DRUM AND TUBE...Heat Wheel Sensible Plates Heat Pipe Recovery Type Sensible & Latent Sensible Sensible Sensible Effectiveness Up to 85% Up to 70% Up to 60% Carry-Over

The retention of lexifier inflectional morphology in …web.stanford.edu/~bresnan/pidgin/inflpidgins.pdfThe retention of lexifier inflectional morphology in pidgins: Evidence for the

Retention with thermoplastic retainers: what you need … · (eds), Orthodontic Aligner Treatment: A Review of Materials, Clinical Management and Evidence Retention and relapse in

Razón sensible

Vertical Integration and Firm Boundaries: The Evidence · Vertical Integration and Firm Boundaries: The Evidence ... development of sensible vertical merger pol- ... and then discuss

PERCEPCIÓN SENSIBLE

Retention of talented academic researchers: Evidence from

InfoStretch - Retention of Test Evidence

Using research and evidence to improve student retention and success Professor Liz Thomas

New! Staff Recruitment, Retention,& Training Strategies · worksheets that help organizations put the strategies to work With the sensible, easy-to-implement suggestions in this invaluable

DO INDIVIDUALS MAKE SENSIBLE HEALTH INSURANCE DECISIONS? EVIDENCE ... · DO INDIVIDUALS MAKE SENSIBLE HEALTH INSURANCE DECISIONS? EVIDENCE FROM A MENU WITH DOMINATED OPTIONS Saurabh

Razon sensible

Creating a sensible cold-chain !. To observe & record existing Packing standards. To confirm efficacy (Temperature Retention). To assess duration index

Wages and Health Worker Retention: Evidence from Public ... · PDF fileWages and Health Worker Retention: Evidence from Public Sector Wage Reforms in ... and seminar participants at

Evidence of meltwater retention within the Greenland ice sheet

Dell WP CIO Strategies Retention & Deletion of Emaili.dell.com/.../it/Documents/cio-strategies-email-retention-deletion_it.pdf · Willful destruction of potentially relevant evidence

The use of data and evidence in retention and progression

Evidence-based practices for retention in care of mother ...childrenandaids.org/sites/default/files/2019-04/UNICEF-ESARO_EBPs-for-retention-in... · PMTCT Prevention of mother-to-child

The Retention of Social Workers in the Health Services: … Retention of Social Workers.pdf · The Retention of Social Workers in the Health Services: An Evidence-Based Assessment

Naturaleza sensible

aula sensible

Sensible Heat

SPOLIATION OF EVIDENCE AND RETENTION OF EVIDENCE … · spoliation of evidence and retention of evidence in a high tech world chapter 3 iv iii. other remedies for spoliation .....5

Sensible scaling

Spoiliation of Evidence in Texas and Corporate Records Retention Policy