Bone volume, tooth volume, and incisor relapse: a 3-dimensional analysis of orthodontic stability.

ABSTRACT

INTRODUCTION: Orthodontic relapse is a common and significant problem. Few risk factors have been identified, and the role of bone has only recently been investigated. The purpose of this study was to examine the influence of alveolar bone volume and tooth volume on dental relapse. METHODS: The sample was chosen from the postretention database at the Department of Orthodontics of the University of Washington in Seattle. Based on the 10-year postretention (T3) irregularity index (II), 40 relapse subjects (T3 II > 6 mm) and the 40 most stable subjects (lowest T3 II < 1.5 mm) were identified for the study. Cone-beam computed tomography (CBCT) scans were taken of the posttreatment (T2) models. Total volume (V) was defined laterally by the distal contact points of the canines and vertically by the cusp tips of the canines to a depth 7 mm below the most inferior gingival margin. Alveolar volume (AV) was defined as the region below a vertical line at the most inferior gingival margin and tooth volume (TV) as the region above that line. The ratio TVAV was calculated. Logistic regression analysis was used to determine the association between relapse and AV, and to adjust for potentially confounding variables (TV, initial II, sex, age, retention time, and postretention time). Mandibular cortical thickness (CT) measured on T2 lateral cephalograms was used as another measure of bone quantity. Nine patients from the graduate orthodontic clinic who had pretreatment CBCT scans were identified. V, AV, and TV were measured on both the in-vivo scans and the scans of their dental casts to verify the method. RESULTS: The relapse group had significantly greater V and AV and significantly lower CT. TVAV was not different between the groups. T2 II was found to be a significant predictor of relapse based on logistic regression analysis, whereas AV was not. CT was poorly correlated with AV. V and AV were highly correlated between in-vivo scans and dental cast scans, whereas TV approached significance. CONCLUSIONS: Although postretention relapse was associated with increased V and AV, when other variables were controlled, bone volume was not a significant predictor of relapse.