Current Dilemmas and Future Challenges in Retreatment Dr. David Musich Dr Musich reported on a study of 100 patients that he has retreated in his practice. He mentioned that retreatment is a part of all dental and medical treatments. Orthodontic retreatment is needed for reasons of relapse and physiologic change. Of the 100 retreatment patients, 90% were treated by an orthodontist, 47% had teeth extracted, and some admitted that they did not comply with instructions during treatment and retention. Patients had different perceptions of their treatment: 16% thought it was excellent, 40% thought it was good, 30% thought it was fair, and only 9% thought it was poor. Those thinking it was poor were not litigious. It is appropriate for orthodontists to warn patients about possible future unfavorable changes. The most frequent problem observed was a skeletal problem that needed surgical treatment, but instead was treated by orthodontics only. The next most frequent problem was lower incisor crowding. Dr. Musich recommended long term retention of lower incisors using a bonded lingual wire from canine to canine. The third most common problem involved upper central and lateral incisor malalignment. Dr. Musich recommended fibrotomies for rotated upper incisors, and bonded lingual wires to keep diastemas between upper central incisors closed. Other problems seen included posterior crossbites. Correction with surgical assisted rapid maxillary expansion is a good solution for these problems. When growth patterns are too severe for orthodontic treatment, it is necessary to communicate this finding to your patients. Unstable lower incisor problems should be addressed by placing proper root torque and angulation during treatment, equilibrating when needed, and using bonded retainers. Dr. Musich recommended a post treatment conference for patients who had poor compliance to outline the possible need for retreatment and costs associated with that treatment.