6 Tips to Avoid Orthodontic Relapse

Posted by POS Course Adviser on 4/1/21 2:47 PM
Have you ever been excited when you removed braces and saw a gorgeous finish? But then you noticed a few months to two years later, that your patient's teeth didn't have the same beautiful alignment, maybe with spaces reopening or teeth rotating back to their original positions? 
This "April Fools" type of case is called "relapse" and occurs because teeth often want to go back to their original positions. 
If you've struggled with this, read this blog to help you get better case stability. You can control you case and have great lifetime orthodontic results if you think about relapse prevention early.
This April 1st we will be sharing six specific tips to help you avoid the dreaded "April Fools" case of orthodontic relapse.

1. Set up a proper diagnosis and treatment plan

While there is a lot to consider in diagnosing your case, one helpful hint is to make sure you consider the facial balance of your patient before deciding to extract or not. If you don't extract when you should or vice versa, the teeth or bite can have a hard time settling properly.

Want more info on facial balance? Read our article analyzing Disney characters' dentofacial balance.

2. Overcorrect rotated teeth

Since you already know that teeth want to move back, plan for it. Our favorite way to do this is to use "smart" appliances like the IP Appliance. IP brackets are designed to not only correct tooth rotations but overcorrect them slightly. Additional force for rotation enables teeth to settle better long term.

Don't worry! Slight overcorrections don't look weird during the finish since the overcorrection is so subtle it's typically imperceptible to the eye. 

3. Finish strong

Have a good finishing plan. Make sure all roots are parallel and rotations are fully correct.

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Take a progress panorex before taking of braces or telling your patient they are done. If the roots are not parallel, you may need more time or may choose to tweak the mechanics before moving forward.

Crowns can be deceiving; roots don't lie. 

You can see the root parallelism with this case from a POS graduate. See full case here.


4. Address any habits

Identify any habits that may contribute to relapse. Talk to your patient if they have tongue thrust or thumb sucking. You may need to prescribe therapy for certain habits before starting orthodontic treatment to get the best results. Just think, if your patient has improper swallowing and tongue use, their bite (often anterior open bite) may want to come back due to the oral pressures still there after you treat them.

5. Look at soft tissue interference

Address periodontal ligament fibers that may cause relapse. Sometimes your soft tissue gets in the way and needs to be treated. For example, the central diastema often relapses from this.

You can consider cutting the tissue between your patient's centrals doing a frenectomy to prevent relapse expansion of the gum from the muscle pull. You can do a quick fiberotomy a couple months before debanding or laser it to sever the tissue between the centrals. 

Get more tips on this article: How to Prevent the Dreaded Central Diastema Relapse


6. Emphasize retainer use

Communicate how important wearing retainers are to your patient. For most cases, you should tell patients to expect to to wear their retainers for life.


If your orthodontic cases need stability, please know that help is available. Our classes and mentoring are designed to help you get the orthodontic foundation and tools to provide excellent long term results and experience the joys of orthodontics. 
Have you experienced relapse? Which of the 6 tips did you find helpful? Share in the comments below.

Topics: POS Instructor Tips, Tips for Success, Current POS Students, Case Finishing, Orthodontics for Beginners, Mechanics, Orthodontic Supplies

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