Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines-a randomized controlled trial

Abstract

Objective: To evaluate whether retention is needed after orthodontic treatment of impacted maxillary canines.

Trial design: Two-arm parallel group single-centre randomized controlled trial.

Materials and methods: Sixty-three patients, 39 girls and 24 boys, were recruited to the study. The inclusion criteria were patients with at least one impacted or unerupted maxillary canine, and moderate irregularity of the maxillary six anterior teeth according to Little's index (LI). After gaining informed consent from the patient and their custodians, the patients were randomized to one of two groups, i.e. to a non-retention group or a retention group. The randomization process was prepared and carried out by an independent person not involved in the trial and the randomization used blocks of 20 (10 + 10). Primary outcomes were changes in single contact point discrepancy, and LI measured on digitalized three-dimensional study casts 1-year post-treatment. The study casts were anonymized before assessment and the changes were blinded for the assessor. Data were evaluated on an intention-to-treat basis. Thus, all randomized patients were incorporated into the final analysis. In the non-retention group a 10-week interim period was used to detect patients who eventually have a relapse immediately after treatment. If so, the patient got the arch-wire reinserted. Most patients in the retention group received a vacuum-formed retainer and pretreatment spacing cases got a bonded retainer.

Results: Mean irregularity change was 0.4 mm in the retention and 1.3 mm in the non-retention group (P < 0.001). Maximum change was 2.5 mm in the retention and 3.2 mm in the non-retention group (P < 0.001). Most changes in the non-retention group occurred during the 10-week interim period. In the non-retention group, one patient developed contact point discrepancy of >2 mm during the interim period and was realigned.

Harms: One patient met the stopping guideline criteria. This patient had the arch wire reinserted for 2 months. After realignment, the patient received a retention appliance.

Limitations: The trial was a single-centre study and short-term changes were evaluated.

Conclusions: Changes between the retention and the non-retention group were statistically but not clinically significant. Since satisfactory clinical results 1-year post-treatment were found in the non-retention group, retention does not appear to be needed. The 10-week interim period was useful in detecting patients who might have a relapse immediately after treatment.

Trial registration: The trial was not registered.

Figure 1.

Primary and secondary outcome measures in OnyxCeph3™.

Figure 2.

A patient who met the stopping guideline criteria during the 10-week interim period.

Figure 3.

CONSORT flow chart.

Figure 4.

The changes in irregularity index in the two groups between T1 and T2 presented as Tukey boxplots.

Figure 5.

Correlations between changes in irregularity and (A) duration of treatment (rho = 0.28); (B) maximum CPD (rho = 0.15) and (C) maximum derotation (rho = 0.15). CPD, contact point discrepancy.

Figure 6.

Post-treatment changes in irregularity without retention.

Figure 7.

Case with Little’s index 1.9 mm.