An approach to maintain orthodontic alignment of lower incisors without the use of retainers

The purpose of this investigation was to examine the long-term stability of orthodontic alignment of lower incisors without the use of retainers. The study sample comprised 56 patients treated according to a protocol that included over-correction of rotated teeth at an early stage of treatment and systematic enamel reduction (stripping) of the approximal surfaces in the mandibular anterior region, both during treatment and follow-up. Care was also taken to maintain dental arch form and to avoid lateral expansion of the lower dental arch and proclination of the incisors. Dental study casts were obtained pre-treatment, at the end of treatment, and 3 years post-treatment. Alignment of the mandibular incisors was recorded using Little's irregularity index. The inter-canine distance and the sum of the mesio-distal widths of the mandibular incisors and canines were also measured. The total amount of enamel removed from the approximal surfaces of the lower anterior teeth ranged from 0.3 to 5.0 mm (mean 1.9 mm). The mean increase in irregularity index score of 0.6 from post-treatment to 3 years follow-up indicated good stability. In 45 per cent of the patients the change in score during this period was less than 0.5, indicating that the treatment approach presented may be considered an alternative strategy to placement of lower retainers to safeguard the stability of alignment of mandibular incisors.