Pacific Coast Society of Orthodontists Bulletin Summer 2014 - (Page 52)

SUMMARY ANNUAL SESSION SWEET FAREWELL: RETAINERS AND RETENTION Presented by Gerald Samson, DDS at the PCSO Annual Session on October 18, 2013. Summarized by Charity Siu, DMD, PCSO Bulletin Northern Region Editor. Y our office has to be exceptional in order for it to be successful: the exceptionals of 2013 function on evidence-based information. Statistics do not always reflect reality; they do not always apply to a given Dr. Sampson individual. Nowadays, the measure of a successful business is its repeat business and customer referrals. Therefore, "retainers and retention" is a critical concept: if a patient comes back to the office with crooked teeth after his/her braces have been removed, he/she usually blames the orthodontist (not himself/herself). and aging. In 1986, Rolf Behrents discussed growth in the aging craniofacial skeleton, and noted that females age more vertically and males more horizontally.1 In aging, the key areas to consider are the nose, lips, chin, and teeth. At age 35, the nose grows in size and turns down, and the lips thin with age. The chin usually comes forward, and the teeth upright with age. Deep bite relapse happens in brachycephalic, low-angle patients, no matter what is done for retention, so realistic expectations are necessary in these cases. It all comes back to the diagnosis and treatment planning of the existing malocclusion and the future occlusion. In order to create realistic expectations, guarded or questionable areas of the prognosis must be identified and explained to the patient before he/ she begins treatment. If patients have unrealistic expectations, encourage them to get a second opinion; if they decide not to proceed with a second opinion, that fact should be documented. Providing multiple treatment options at the initial appointment can create frustration for patients because they typically don't have enough information to make an informed decision at that point and yet they want to do what is best for the final outcome. With regards to wisdom teeth, there is no evidence that prophylactic removal of asymptomatic third molars causes less crowding. Retainer design is opinion based: Dr. Samson prefers to bond at least three lower teeth, and he bonds the wire one month before debanding in order to avoid bond failure. Information regarding complications of bonded retainers should be presented, and informed consent obtained, before a retainer is inserted. Dr. Samson's personal preference is an 040 C+ Essix, worn at night right from deband, and only covering half of the second molars. What defines successful treatment? The hallmarks are good esthetics, straight teeth, proper function, reasonable stability, and ensuring the patient's needs and expectations are being addressed. But variation is the rule, not the exception, and attractiveness is based on balance. Also, these parameters change with growth People have not stopped searching for Ponce de Leon's Fountain of Youth. Wick Alexander says that if there was a magic potion that would cause a person to age by only four years if used every night for 40 years, people would use it faithfully. Since teeth naturally shift with age, it is important to counsel them that retainers are like a magic potion that will need to be used over the rest of their life. The big takeaways from this lecture were that proper diagnosis, providing patients with the proper information regarding the risks for treatment and retention, and meeting realistic expectations are the keys to a successful practice. 1. Behrents R. JCO/interviews Dr. Rolf Behrents on adult craniofacial growth. J Clin Orthod 1986;20:842-847. S 52 PCSO BULLETIN * SUMMER 2014

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2014

The Big Easy: Not Always So Easy
About the PCSO Mission Statement
AAO Trustee Report
PCSO Business
AAO Council on Scientific Affairs (COSA) Report
Component Reports
PCSO at a Glance
AAOF Report
Decrease Stress and Increase Volume
Resident Spotlight: Loma Linda School of Dentistry Postgraduate Orthodontic Program
Younger Member Spotlight: Dr. Melissa Bailey
Third Molar Protocols
Editorial: Special Section
PCSO Program Talk: Orthodontic Residency Programs and the Use of TADs
Case Report: Pre-Treatment
Faculty Files: TADs in Orthodontics: A Review
Seasoned Practitioner's Corner: Dr. Terry McDonald Interviews Dr. Michael Chaffee on TADs
Case Report: Post-Treatment
Pearls of the Pacific: Instant Edentulous Anchorage
Portrait of a Professional: Dr. Earl S. Johnson
Sweet Farewell: Retainers and Retention
In Memory: Dr. Burton Littleton Fletcher

Pacific Coast Society of Orthodontists Bulletin Summer 2014