There are many reasons for Class II treatment relapse. Among them we can describe:
Unfavourable growth, lack of patient cooperation, lack of muscular adaptation, instable post treatment occlusion, persistence of labio-lingual dysfunction or harmful habits, lack of post-therapy contention.
Very often we do not know which approach is the best for particular patients. Among removable and fixed appliances there are activators, positioners, retainers or full fixed therapy.
Cooperation is a drawback in such cases and sometimes it is difficult to treat the relapse with a removable activator or positioner.
The Ritto Appliance® could do this job in an easy way. It is only necessary to place two upper bands, and brackets on lower canines and first premolars. Lower incisors are free because the lingual retainer is bonded.
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The Relapse case
This patient had a deep bite Class II malocclusion which was treated with fixed appliances and Class II elastics for 23 months.
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Retention was achieved with a Hawley appliance and a bonded lower 3/3 wire. Some artificial composite contacts were bonded on palatal surfaces of the upper incisors to prevent the deep bite relapse.
After one year of treatment, the overjet was 6mm (4mm of relapse) and an infantile swallow appeared.
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The patient had a dual bite. After advance the mandible to Class I there are not an intercuspation in the premolar area.
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The relapse was probably due to an inadequate use of the Hawley appliance, i.e, discontinued use and night time only for 2 months. Another factor that could be involved is the early treatment period. This male patient started the treatment at 9 years old and finished the treatment at 11 years old, before the growth peak. However, all the permanent teeth were present.
It was decided to retreat the patient at 13 years old, during growing peak.
We decided to retreat the case with the Ritto Appliance®. The main advantage of this system is that we can use only brackets on lower canines and molars, because the lower fixed 3/3 lingual retainer is still in place. On the upper arch, upper molar bands were fitted.
Class I intercuspation was achieved in four months.
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The appliance was removed and a Hawley Appliance was fitted for use at night during one year.
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One year after the retreatment, the occlusion remains stable. The retainer was removed.
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Two years after the retreatment everything is stable with a nice Class I intercuspation.
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This approach for Class II relapse cases is very easy, comfortable and aesthetic. It has the advantage of being a fixed appliance it is used during 24 hours allowing growth and the settling of occlusion in Class I.
The retreatment can be carried out in few months, and a retainer can be placed only at night