Treatment without retainers? Madness or innovation? Simon Littlewood. Episode 61 October 30th 2020

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Hosted by
Farooq Ahmed

Simon described the concept of ‘no retention’, the methodology and literature on the topic, with his expert option included.



  • Controversial to not wear retainers
  • Simon still asks patients to wear retainers
  • Interproximal reduction helps but we don’t know why


Classic study

Riedel and Little

  • 10 years out of retention
  • 70% relapse – require retreatment, 30% no retainers and no treatment needed
  • No identifiable factors – therefore to keep teeth straight require retainers


Treatment protocol and retrospective study of no retainers

Aasen EJO 2005

  • During treatment
    1. Respect lower archform
    2. Maintain lower incisor position
    3. Overcorrect of rotations
    4. Heavy final wire 21×25 SS for 2-3 months
    5. Relapse ‘test’: 4 weeks no archwire
  • Results
    1. After 3 years 1.1mm (Little’s Index)
      • Not significant clinical change


Randomised control trial Lower arch

Tynelius 2010, 2013

  • Lower bonded retainer Vs IPR and no retainer
  • 2 years = no difference in stability


Randomised control trial Upper arch


Naraghi 2020

  • Upper VFR Vs no retainer
  • 1 year follow up
    • Relapse with retainer 0.4mm
    • Relapse without retainer 1.3mm
  • Not clinically significant


Post – treatment changes

  1. Relapse
  2. Age related changes
    1. Abdulraheem 2020, 12 year follow up
      1. Tooth displacement index
        1. 25% = age related
        2. 75% orthodontic relapse





Aasen, T.O. and Espeland, L., 2005. An approach to maintain orthodontic alignment of lower incisors without the use of retainers. The European Journal of Orthodontics27(3), pp.209-214.


Edman Tynelius, G., Bondemark, L. and Lilja‐Karlander, E., 2013. A randomized controlled trial of three orthodontic retention methods in C lass I four premolar extraction cases–stability after 2 years in retention. Orthodontics & craniofacial research16(2), pp.105-115.


Naraghi, S., Ganzer, N., Bondemark, L. and Sonesson, M., 2020. Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines—a randomized controlled trial. European Journal of Orthodontics.


Tsiopas, N., Nilner, M., Bondemark, L. and Bjerklin, K., 2013. A 40 years follow-up of dental arch dimensions and incisor irregularity in adults. The European Journal of Orthodontics35(2), pp.230-235


Abdulraheem, S., Schütz-Fransson, U. and Bjerklin, K., 2020. Teeth movement 12 years after orthodontic treatment with and without retainer: relapse or usual changes?. European Journal of Orthodontics42(1), pp.52-59


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