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Orthodontic Relapse

Orthodontic relapse refers to the tendency of teeth to shift back to their original positions after orthodontic treatment, such as with braces or clear aligners. We will discuss the factors that might contribute to this relapse.

Inadequate Retention Phase Management

  1. Non-compliance with Retainer Use

After active orthodontic treatment, such as  with braces or aligners, a retainer is used to maintain the teeth’s new positions. Retainers work by holding your teeth in place, preventing them from shifting back to their original alignment.

Non-compliance with retainer use is the most common cause of orthodontic relapse. This can happen when a patient does not wear the retainer as instructed by the orthodontist. For instance, some retainers must be worn all the time for the first few months, except while eating and cleaning teeth, and then nightly thereafter. Others may be used only at night right from the beginning.

If a patient fails to adhere to these instructions—perhaps due to discomfort, negligence, or misunderstanding—the teeth are not sufficiently held in place and are likely to start shifting back to their original position, leading to a relapse of the orthodontic treatment.

invisalign clear aligners orthodontist
Wearing a retainer after Invisalign treatment is just as important as when braces come off.
  1. Improper Fit of the Retainer

A retainer must fit properly to effectively maintain the teeth’s new positions. If a retainer is ill-fitting, it will not provide the adequate support needed to hold the teeth in place.

This could be due to a couple of reasons:

– The retainer has warped or deformed over time due to wear and tear or improper care (such as exposure to heat).

– The mouth structure has changed since the retainer was made, possibly due to factors like age, growth, or oral health issues.

When a retainer is not fitting as it should, it’s important to consult with the orthodontist that treated you with braces immediately to get the ill-fitting retainer adjusted or replaced to prevent teeth from shifting.

  1. Extended Retainer Loss or Damage

There may be instances where a retainer is lost or damaged. In such situations, the time gap until the retainer is replaced is a period when the teeth are not being actively retained. This can allow the teeth to start moving towards their original position, especially if the loss or damage occurs soon after the active treatment phase.

It’s crucial to treat a lost or damaged retainer as an emergency. If the retainer cannot be immediately found or repaired, it’s advisable to contact the orthodontist as soon as possible to arrange for a replacement. A prompt response can minimize the time the teeth are without retention and reduce the risk of orthodontic relapse.

If you are a patient of Burke & Redford Orthodontists and lose your retainer, contact our staff in the front office to make an appointment with Dr. Ryan Redford in our Temecula office. If you have been treated elsewhere, contact your treating orthodontist or general dentist.

Biological Factors

  1. Growth and Development

The human jaws continue to grow and develop into adolescence and early adulthood. During this time, the size of the jaw can change, potentially impacting the way the bite fits together. This is not an issue for most patients, but those (a very small subset) with an underbite growth pattern need to be watched over time. This is why it’s important for orthodontists to factor in a patient’s growth when planning and timing orthodontic treatment, especially in adolescents.

Dr. Redford and Dr. Burke take this into consideration when assessing a new patient for braces.

braces for children temecula ca
Braces Before and After Pictures with Burke & Redford Orthodontists
  1. Age-Related Changes

As people age, natural wear and tear occurs in the mouth, just like in any other part of the body. Over time, the teeth can shift slightly due to several factors:

Loss of attachment around teeth: Each tooth is surrounded by bone and gum tissue. These structures help to keep the teeth stable. Loss of these attachments with age can lead to less stable teeth.

Wear of Teeth: The wear and tear from chewing and biting can change the teeth’s shape, altering how they fit together and causing them to shift over time.

Loss of Teeth: Losing teeth without a replacement can cause neighboring teeth to shift to fill the vacant space, affecting overall teeth alignment.

Age-related changes can occur even after successful orthodontic treatment, contributing to potential orthodontic relapse.

  1. Genetic Factors

Our genes play a significant role in our dental health, including the structure of our jaws and the alignment of our teeth. Certain genetic traits can predispose people to malocclusions (problems with teeth alignment), and these same genetic factors can contribute to orthodontic relapse.

For example, some people may be genetically predisposed to having a small jaw, leading to crowded or overlapping teeth. Even after orthodontic treatment corrects these issues, the genetic predisposition may cause a tendency for the teeth to revert towards their original positions, leading to relapse.

Understanding a patient’s family dental history can provide insight into the likelihood of such genetic influences, which Burke & Redford Orthodontists will then factor into treatment plans and post-treatment strategies.

Remember that these factors don’t make orthodontic relapse inevitable; they merely present challenges that need to be managed. Regular check-ups with your orthodontist can help monitor these potential issues and act as necessary to maintain the results of orthodontic treatment.

Oral Health Issues

  1. Gum Disease (Periodontal Disease)

Gum disease, or periodontal disease, is an infection of the tissues that hold the teeth in place. It’s typically caused by poor oral hygiene leading to plaque buildup on the teeth and gums. Gum disease can range from simple gum inflammation (gingivitis) to serious bone loss (periodontitis) that results in damage to the soft tissue and bone supporting the teeth.

In the context of orthodontic relapse, gum disease can weaken the support for the teeth, making them more prone to movement. In severe cases of periodontitis, the destruction of bone and gum tissue can create spaces (periodontal pockets) around the teeth, reducing the stability of the teeth and allowing them to shift more freely. If gum disease develops or progresses after orthodontic treatment, this can lead to relapse.

Periodontal Disease and Gum Disease can Cause an Orthodontic Relapse if Dental Checkups and Cleanings are Missed.
Periodontal Disease and Gum Disease can Cause an Orthodontic Relapse if Dental Checkups and Cleanings are Missed.
  1. Tooth Loss

Losing a tooth can significantly impact the alignment of the remaining teeth. This is because teeth support each other and help maintain each other’s positions in the mouth. When a tooth is lost and not replaced in a timely manner, the neighboring teeth can start to drift into the vacant space, while opposing teeth may over-erupt (move out of their sockets), leading to misalignment.

These changes can affect the overall alignment of the teeth, causing a relapse after orthodontic treatment. That’s why it’s important to replace missing teeth as soon as possible, using options like dental implants, bridges, or partial dentures, to maintain the stability of the remaining teeth and prevent orthodontic relapse.

Dr. Redford and Dr. Burke can assess each patient’s oral health and refer patients to the most reputable dentist, if necessary.

  1. Bone Loss Around Teeth

Bone loss around teeth is often a result of advanced periodontal disease. However, it can also be caused by other factors such as trauma, infection, or certain medical conditions.

The bone that surrounds and supports teeth (alveolar bone) plays a crucial role in maintaining teeth stability. When this bone is lost, it can destabilize the position of the teeth, making them more prone to movement. If bone loss occurs after orthodontic treatment, it can undermine the stability of the newly aligned teeth and lead to relapse.

To prevent this, it’s important to maintain good oral hygiene and have biannual dental check-ups to catch and address oral health issues like gum disease early. In cases of significant bone loss, procedures like bone grafting may be required to restore bone and provide sufficient support for the teeth.

Oral Habits
  1. Bruxism (Teeth Grinding)

Bruxism is a condition characterized by grinding or clenching the teeth, usually unconsciously during sleep or times of stress. This habit puts excessive pressure on the teeth and the periodontal ligament (the connective tissue that holds the teeth in the jawbone), which can lead to several issues, including tooth wear, jaw pain, and, importantly for our discussion, shifting of teeth.

The force exerted during grinding can disrupt the alignment of the teeth, especially in individuals who have recently completed orthodontic treatment and the teeth have not yet fully stabilized in their new positions. Therefore, bruxism is a risk factor for orthodontic relapse.

If a person has a known issue with bruxism, our expert orthodontists may recommend wearing a night guard after completing your orthodontic treatment to protect the teeth from grinding forces and help maintain the new alignment.

  1. Tongue Thrusting

Tongue thrusting is a habit when, during swallowing, the tongue pushes against the front teeth instead of the roof of the mouth. This habit exerts pressure on the teeth, and while a single swallow won’t cause a shift, repeated pressure from habitual tongue thrusting can slowly cause the teeth to move over time.

If tongue thrusting continues after orthodontic treatment, it can push the teeth out of their corrected positions, leading to orthodontic relapse. For patients with this habit, orthodontists may include orofacial myofunctional therapy in their treatment plan, which involves exercises to retrain the pattern of muscle function in the mouth and face.

Before and after pictures of a young patient where we used a habit appliance only to stop a thumb sucking habit and correct an anterior open bite. No braces were used, and the goal was not to achieve perfectly straight teeth–just correction of the overbite from thumb sucking.

stop thumb sucking
Tongue Thrust – Thumb Sucking
  1. Thumb Sucking and Other Finger Habits

Thumb sucking is common in children, and it’s usually not a concern for those under the age of four. However, if the habit continues beyond this age – especially once the permanent teeth start to come in – it can cause several issues, including changes in the roof of the mouth and misalignment of the teeth.

The pressure from thumb sucking can cause the front teeth to jut out and create an open bite (where the front upper and lower teeth slant outward and do not touch in the vertical plane of space when the mouth is closed). If a child receives orthodontic treatment to correct such issues but continues the thumb sucking habit, it can undo the corrections made and lead to orthodontic relapse.

In such cases, behavioral therapy or an orthodontic habit appliance could help discourage thumb sucking and may be part of the orthodontic treatment plan to ensure long-term success.

In all these scenarios, the key to preventing orthodontic relapse lies in recognizing these habits and addressing them as part of the comprehensive orthodontic treatment plan.

Make sure and speak with Dr. Redford about any oral habits your child or teenager may have during your initial free orthodontic consultation or mention if something changes during your child’s orthodontic treatment.

Restorative Dental Work
  1. Poorly Fitted Bridges, Crowns, or Fillings

Dental restorations such as bridges, crowns, or fillings are designed to replace or cover areas of the tooth that have been lost or damaged due to decay, breakage, or other reasons. Ideally, these restorations should closely mimic the original tooth’s shape, size, and position to maintain the bite’s alignment and ensure proper function.

However, if these restorations are not correctly fitted—meaning they are too high, too low, or improperly contoured—they can push against adjacent or opposing teeth. This sustained pressure can cause the affected teeth to shift over time, leading to changes in the bite that can result in orthodontic relapse.

Therefore, it’s important for restorative dental work to be done with precision and to be checked for proper fit and bite. If a patient feels that a dental restoration is uncomfortable or causing pressure on other teeth, they should notify their dentist for adjustments to prevent potential movement of teeth.

  1. Changes in the Bite Due to Dental Restorations

Dental restorations not only replace or restore lost or damaged tooth structure but can also affect the overall bite, which is how the upper and lower teeth come together when the mouth is closed.

For instance, a crown or bridge that is too tall or too thick can cause changes in the bite by altering the contact points between the upper and lower teeth. This change can force the teeth to adapt by shifting their positions, which can lead to orthodontic relapse, especially if the teeth have been recently aligned through orthodontic treatment.

Furthermore, if orthodontic treatment was completed without considering future restorative work—such as placement of implants, crowns, or bridges—the new restorations could disrupt the alignment of the teeth.

To prevent this, orthodontic treatment should ideally be coordinated with restorative treatment. This means that the orthodontist and restorative dentist should communicate and plan the treatments together, considering both the current alignment of the teeth and the planned restorations.

It is important to be seen by your orthodontist after new restorations are completed to ensure the original retainer still fits properly. In most cases, a new retainer that adapts intimately to the newly restored teeth will be advised.

Lack of Long-Term Follow-up Orthodontic Care

Long-term follow-up care after orthodontic treatment is an integral part of ensuring the longevity of the results achieved. While the active phase of orthodontic treatment — which involves moving the teeth into their new positions — is undoubtedly crucial, the retention phase, which comes after the braces are removed, is also important.

During this phase, retainers are typically worn to keep the teeth stable in their new positions. This period is necessary because the bone and soft tissues around the teeth need time to adjust to the new alignment. Without proper follow-up care and retainer usage, the teeth may not fully stabilize and can begin to shift back towards their original positions, leading to orthodontic relapse.

child orthodontic - children orthodontist - kids braces - child braces
Make Sure to Come in for Your Follow-Up Visits with Dr. Redford After Your Braces or Invisalign Treatment has Ended to Ensure Your Teeth Stay in Position.

Long-term follow-up care usually involves:

Regular check-ups with the orthodontist: These visits allow the orthodontist to monitor the stability of the new tooth positions and the health of the mouth. Any potential issues can be detected early and addressed promptly, reducing the chances of relapse.

Continued retainer use: The orthodontist typically provides a clear guideline about how long and how often the retainers should be worn. It’s crucial for patients to follow these instructions to maintain their new smiles.

Patient education: The orthodontist and their team will ensure that the patients understand the importance of follow-up care and retainer usage in preventing orthodontic relapse.

At Burke & Redford Orthodontists, with offices in Lake Elsinore and Temecula, California, Dr. Ryan Redford, and Dr. Michael Burke have built a reputation for comprehensive care that includes a strong emphasis on effective long-term follow-up.

The top-recommended orthodontists in the Inland Empire know their job does not end when the braces are removed. Their focus on regular visits and teaching patients about dental care helps keep the smiles they have crafted beautiful for a lifetime.

The dedication of the Burke & Redford team to meticulous follow-up care has been instrumental in their ability to provide consistently excellent orthodontic outcomes for their Southern California patients for over 30 years. They are a testament to the difference that quality orthodontic care can make in the health and confidence of a community.

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