Letters to the editor*

Question about relapse of corrected

deepbites
I
would like to congratulate Dr Derek Pollard et al for their
article in the April 2012 issue (Pollard D, Akyalcin S,
Wiltshire WA, Rody WJ Jr. Relapse of orthodontically cor-
rected deepbites in accordance with growth pattern. Am J
Orthod Dentofacial Orthop 2012;141:477-83). Because
a deepbite malocclusion has a high relapse tendency, it is
one of the most challenging problems to treat. This article
compared deepbite relapse in 3 groups of patients catego-
rized by vertical growth. The authors proposed that high-
angle subjects tend to relapse less in overbite than do
low-angle and normal-angle subjects in the long term. I
want to express several concerns regarding this article.
First, the authors did not evaluate or report the
amount of crowding before treatment. As we know,
the more crowding before treatment, the greater the
relapse after treatment.
Second, the authors also did not refer to the nished
occlusal relationships. It has been concluded that the
better the quality of the orthodontic nished occlusion,
the better the occlusal status at the postretention stage
in patients treated with 4 premolar extractions.
1
Third and perhaps most important, all subjects un-
derwent routine edgewise therapy followed by different
retention times. I believe that the differences in retention
could affect the results of the study.
Zhou Yu
Wenzhou, China
Am J Orthod Dentofacial Orthop 2012;142:152
0889-5406/$36.00
Copyright 2012 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2012.06.004
REFERENCE
1. Freitas KMS, Janson G, Freitas MR, Pinzan A, Henriques JDC, Pin-
zan-Vercelino CRM. Inuence of the quality of the nished occlu-
sion on postretention occlusal relapse. Am J Orthod Dentofacial
Orthop 2007;132:428.e9-14.
Author's response
T
hank you for your letter and your interest in our ar-
ticle. The rst question raised, regarding the amount
of crowding present before treatment, might not add
a signicant value to the discussion. The reason is that
the subjects were selected from a pool of nonextraction
patients. We outlined in the methods that, of the 858
screened patients, 309 were treated without extractions.
The sample group of 60 subjects was selected from
those who had mild to moderate crowding that required
no extractions. Therefore, the amount of crowding
a transversal plane assessmentis nothing but another
statistical mean when evaluating the long-term changes
in the deepbite malocclusion of nonextraction patients.
Speculatively, the severity of crowding could have an im-
pact on anterior alignment. However, Erdinc et al
1
argued
that, with the exception of the interincisal angle, there is
no statistically signicant differences between extraction
and nonextraction patients who had clearly distinguish-
able initial crowding values. Asystematic reviewconrmed
these ndings.
2
After all, posttreatment mandibular rota-
tion, which might actually affect the degree of deepbite
relapse as speculated in our article, was not associated
with the relapse of mandibular incisor alignment.
3
I believe your second question has also found an
answer, since you referred to a study that relates to the
quality of nished occlusions with 4 premolar extrac-
tions. However, I certainly agree that posttreatment oc-
clusion, regardless of the treatment modality, is a potent
factor in maintaining the treatment outcome. This is
why patients with good-quality treatment results and
records were included, and the 309 available subjects
were reduced to 60 in the study.
As for your third question, the minimumperiod of re-
tention for any patient in the study was 2 years, as stated
in the article. Therefore, our results are limited to the
outcome assessments for at least 2 years of retention
time, which is a common practice. On a side note and
for further reference, Bondemark et al
2
concluded that
the lengths of treatment times and retention periods
could not be used to predict stability changes because
of large individual variations.
Sercan Akyalcin
Houston, Tex
Am J Orthod Dentofacial Orthop 2012;142:152-3
0889-5406/$36.00
Copyright 2012 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2012.06.005
REFERENCES
1. Erdinc AE, Nanda RS, Isiksal E. Relapse of anterior crowding in
patients treated with extraction and nonextraction of premolars.
Am J Orthod Dentofacial Orthop 2006;129:775-84.
*The viewpoints expressed are solely those of the author(s) and do not reect
those of the editor(s), publisher(s), or Association.
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