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Stability is determined when the patient stops wearing retainers

Stability is determined when the patient stops wearing retainers

American Journal of Orthodontics and Dentofacial Orthopedics, 2022-05-01, Volume 161, Issue 5, Pages 615-616, Copyright © 2022

I completed my orthodontic training >40 years ago. If I had presented the case in “Class II malocclusion treatment with a customized dual force distalizer” (Aliaga-Del Castillo A, Soldevilla L, Valerio MV, Bellini-Pereira SA, Vilanova L, Arriola-Guillén LE, et al. Am J Orthod Dentofacial Orthop 2021;160:743-56), I would not have passed my final examination.

I have no problem with the mechanics used; these orthodontists are obviously very skilled clinicians. I do have an issue with the treatment plan. The mandibular incisors are proclined by 10°, have severe crowding, and at the end of treatment have proclined by another 7°. I would be concerned about teeth being pushed out of the alveolar trough and the potential for gingival stripping and dehiscences in the future.

When discussing treatment alternatives, I would have included the extraction of 4 premolars [second premolars in my plan]. Treat to a Class II occlusion, upright the mandibular incisors, and then perform mandibular advancement surgery to achieve a Class I occlusion with a normal chin position. If the patient did not want surgery, I would have offered treatment, including the extraction of 4 premolars.

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The authors mention a 2-year follow-up showing stability. The patient is still wearing retainers. Stability is determined when the patient stops wearing retainers. If this patient stops wearing retainers, I believe the amount of relapse would be unacceptable. In patients like this, it may be best to take a cone-beam computed tomography scan during treatment to see what is happening to the roots and supporting bone.