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Background <p>​​ Orthodontic relapse remains a challenge in clinical practice. This study aimed to comprehensively evaluate the independent contributions and time-dependent patterns of multidimensional factors influencing the relapse risk, to provide insights for formulating personalized stability strategies.</p> Methods <p>​​ This multi-center retrospective cohort study included 474 participants with a median follow-up of 6 years. Variables included baseline, anatomical, treatment, and retention factors. Relapse was assessed by comparing intraoral photographs at post-treatment and follow-up (≥ 3 years post-debonding). Multivariate logistic and Cox regression analyses were performed to identify relapse predictors, with stratified analyses by molar relationship.</p> Results <p>​​ Relapse rate was 21.3%. Protective factors included female sex (odds ratio [OR] = 0.475, <i>p</i> = 0.013) and tooth extraction treatment (OR = 0.437, <i>p</i> = 0.006). Convex facial profile (OR = 2.057, <i>p</i> = 0.031), high-angle vertical pattern (OR = 2.086, <i>p</i> = 0.043) and longer follow-up duration (OR = 1.152, <i>p</i> = 0.010) were risk factors. Retainer adherence was strongly protective: full-time wear (OR = 0.070, <i>p</i> &lt; 0.001) and nighttime wear (OR = 0.316, <i>p</i> = 0.004) during the first year, as well as longer total wear duration (1–2 years: OR = 0.408, <i>p</i> = 0.028; &gt;2 years: OR = 0.352, <i>p</i> = 0.006) significantly reduced relapse risk. Cox regression confirmed that full-time wear (hazard ratio [HR] = 0.231, <i>p</i> &lt; 0.001) and wear duration &gt; 2 years (HR = 0.366, <i>p</i> &lt; 0.001) significantly reduced the instantaneous hazard of relapse. Stratified analysis revealed convex profile (OR = 5.706, <i>p</i> = 0.006) and high-angle pattern (OR = 4.234, <i>p</i> = 0.015) specifically increased relapse risk in Class II patients, whereas female sex (OR = 0.101, <i>p</i> = 0.003) was most protective in Class III patients.</p> Conclusions <p>​​ Convex facial profile and high-angle pattern indicated increased relapse risk, particularly in Class II patients. Female sex (especially in Class III patients) and extraction treatment showed protective effects. ​​High retainer adherence (full-time wear and prolonged use) was the most critical stability factor.​​ Clinical practice calls for personalized retention strategies based on individual risk profiles.</p>

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Analysis of predictive factors for post-orthodontic stability: a retrospective cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月28日

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  • Xiaochen Zhang,
  • Axian Wang,
  • Xu Zhang,
  • Haolin Zhang,
  • Zixuan Chen,
  • Xulin Liu,
  • Bin Yan,
  • Xiaodong Zhang,
  • Zexu Gu,
  • Yanning Ma,
  • Zuolin Jin

摘要

Background

​​ Orthodontic relapse remains a challenge in clinical practice. This study aimed to comprehensively evaluate the independent contributions and time-dependent patterns of multidimensional factors influencing the relapse risk, to provide insights for formulating personalized stability strategies.

Methods

​​ This multi-center retrospective cohort study included 474 participants with a median follow-up of 6 years. Variables included baseline, anatomical, treatment, and retention factors. Relapse was assessed by comparing intraoral photographs at post-treatment and follow-up (≥ 3 years post-debonding). Multivariate logistic and Cox regression analyses were performed to identify relapse predictors, with stratified analyses by molar relationship.

Results

​​ Relapse rate was 21.3%. Protective factors included female sex (odds ratio [OR] = 0.475, p = 0.013) and tooth extraction treatment (OR = 0.437, p = 0.006). Convex facial profile (OR = 2.057, p = 0.031), high-angle vertical pattern (OR = 2.086, p = 0.043) and longer follow-up duration (OR = 1.152, p = 0.010) were risk factors. Retainer adherence was strongly protective: full-time wear (OR = 0.070, p < 0.001) and nighttime wear (OR = 0.316, p = 0.004) during the first year, as well as longer total wear duration (1–2 years: OR = 0.408, p = 0.028; >2 years: OR = 0.352, p = 0.006) significantly reduced relapse risk. Cox regression confirmed that full-time wear (hazard ratio [HR] = 0.231, p < 0.001) and wear duration > 2 years (HR = 0.366, p < 0.001) significantly reduced the instantaneous hazard of relapse. Stratified analysis revealed convex profile (OR = 5.706, p = 0.006) and high-angle pattern (OR = 4.234, p = 0.015) specifically increased relapse risk in Class II patients, whereas female sex (OR = 0.101, p = 0.003) was most protective in Class III patients.

Conclusions

​​ Convex facial profile and high-angle pattern indicated increased relapse risk, particularly in Class II patients. Female sex (especially in Class III patients) and extraction treatment showed protective effects. ​​High retainer adherence (full-time wear and prolonged use) was the most critical stability factor.​​ Clinical practice calls for personalized retention strategies based on individual risk profiles.