The Impact of Orthodontic Retainers on Gingival Recession: A Best-Evidence Review.

Retention is a critical phase of orthodontic therapy and aims to maintain occlusal stability and avoid crowding relapse. This best-evidence article reviews the effects of the different types of orthodontic retention appliances, fixed and removable, on the development and progression of gingival recession at the mandibular anterior teeth. Searched databases included PubMed, Scopus, Cochrane Library, Embase, and Dentistry and Oral Sciences. Eleven qualifying publications, including retrospective, prospective, and cross-sectional studies, were included in this review. These studies either did not demonstrate an association between orthodontic retainers and gingival recession or reported that the resulting recession defects were minimal when an association was shown. An important consideration is that recession could be a late finding following the placement of a retainer and, therefore, may be incipient or absent in short-term evaluations. Prospective studies that specifically address the role that properly positioned fixed retainers may have on gingival recession are needed before a definitive conclusion can be generalized with regard to recommended retention protocols. Factors such as duration of retainer use, number of bonded teeth, and position of fixed retainers relative to their proximity to gingival tissues are not fully elucidated but may have influencing roles on gingival recession. The use of retainers should be based on orthodontic indications to maintain a stable dental arch form, esthetics, and occlusion. Effective oral hygiene and follow-up regimens remain the gold standard in maintaining periodontal health and preventing gingival recession.

Orthodontic-Orthognathic Management of a patient with skeletal class II with bimaxillary protrusion, complicated by vertical maxillary excess: A multi-faceted case report of difficult treatment management issues.

This case reports the unsuccessful first treatment and the subsequent retreatment of a 35-year old Asian female with a skeletal class II with bimaxillary protrusion, complicated by a deep bite and vertical maxillary excess. This case report highlights the multiple facets of a challenging treatment plan and discusses the ramifications of treatment when treatment does not go as planned. The initial treatment plan consisted of a surgical approach with a maxillary Le Fort I surgery to correct the malocclusion as per the patient's requests without mandibular surgery due to the inherent risk of paraesthesia. The second treatment plan consisted of a bimaxillary surgery with genioplasty. The surgical treatment utilized virtual surgical planning (VSP). The orthodontic treatment was concluded with a corrected overjet and overbite achieving optimum function and balancing the facial profile aesthetically. This case report highlights the need for clear communication of the treatment plan and also the unpredictability of certain treatment outcomes especially when the literature does not provide for definitive conclusions. In addition, it sheds light on the challenge of unpredictable response of soft tissue after surgical treatment and the importance of patient expectations of outcomes. It is hoped that the paper provides a platform for future discussions of difficult malocclusions.