Finishing and Detailing in Orthodontics
Finishing and Detailing in Orthodontics
Finishing and Detailing in Orthodontics
Contents
Introduction
Objectives in finishing
Andrews six keys to normal occlusion (static occlusion)
Gnathologic occlusion concept
(functional occlusion)
Periodontal factors
Esthetic factors
Overcorrection
How to achieve these finishing objectives
In standard Edgewise appliance system
In Pre-Adjusted Edgewise appliance system
In Begg appliance system
Conclusion
References
Introduction
Finishing can be defined as The final
stage of fixed appliance orthodontic
treatment, during which final detailing
takes place to idealize individual tooth
position .
Orthodontic finished occlusion is the
occlusion that is desired at the time of
active appliance removal.
1, Improper molar
relationship.
2, Improved molar
relationship.
3, More improved molar
relationship.
4, Proper molar
relationship.
2 premolar relationship
- buccal cusp of maxillary premolars have
cusp-embrasure relationship with
mandibular premolars
- lingual cusp of maxillary premolars have
cusp-fossa relationship with mandibular
premolars
3 Canine relationship
Maxillary canine has cusp-embrasure
relationship with mandibular canine and
first premolar, but cusp tip is slightly
mesial to embrasure.
4 Incisor relationship
Maxillary incisors overlap mandibular
incisors and midlines are matching.
Inter-arch relationship
+ 5 degree tip
Maxilla
+5
+ 9 +11 + 2 +2
+ 5 +5
Mandible
2
+2
+2 + 5 + 2 + 2 + 2 +2
Crown inclination of
central and lateral
incisors :
Definite +ve crown
inclination of upper
incisors allow proper
occlusion of the
posterior teeth.
-7
-7
-7
-9
-9
Lower posterior
(canines through
molars )
The lingual crown
inclination in the lower
posterior teeth
progressively
increase from the
3
4
5 6
7
canines through the
second molars.
- 11 - 17 - 22 - 30 - 33
A rotated molar
occupies more
mesiodistal space,
creating a situation
unreceptive to normal
occlusion.
Gnathological Objectives
The first objective of a gnathological occlusion
is to obtain a stable centric relation of the
mandible and have the teeth intercusp
maximally at this mandibular position.
(no CR-CO discrepancy)
.
CR-CO harmony
Centric relation (CR)
A gnathological term that designate the
relation of the mandible to the maxilla
when the condyles are in a
physiologically stable position,
independent of tooth contacts.
Horizontal discrepancy
from centric relation.
Vertical shift
Most common cause for Vertical shift is
molar fulcrum created during treatment
which try to draw the condyle out of fossa.
Fulcrum effect
produces
A. an anterior open
bite or
B. posterior and
interior
displacement of the
condyle
Vertical discrepancy
from centric.
Occlusion plane
Occlusion plane nearly
parallel to angle of the
eminence
less posterior tooth
separation occurs during
mandibular protraction
sufficient overbite is critical to
obtain posterior disclusion.
Periodontal Factors
Root Angulation
In theory, if the roots of adjacent teeth are
perpendicular to the occlusal plane and
parallel with one another, there will be
sufficient supporting bone between them.
Bone Level
If adult patient has horizontal bone loss, it
is best to align the bone levels rather than
adjacent teeth.
Incisal edges are equilibrated to establish
correct incisal edge position, occlusion,
and crown-to-root ratio.
Esthetic Factors
Crown Width
Gingival Levels
Gingival Form
Crown Width
Occasionally, one or both lateral incisors are
narrower than normal which need restoration
after orthodontic therapy.
When space is created for restoration on these
small teeth, following factors should be
considered :
Gingival Levels
During orthodontic finishing, following
factors should be taken into consideration
regarding gingival levels of anterior teeth :
- Gingival margins of the two central incisors
and canines should be at the same level.
If tooth has a
deeper sulcus
(pseudo pocket),
excisional
gingivectomy is
treatment of
choice.
Gingival Form:
Presence of interdental papilla between
maxillary incisors is a key esthetic factor.
Occasionally, adults have open gingival
embrasures or black triangles between the
incisors.
If the root
angulation is
divergent, then
the brackets
should be
repositioned so
the root position
can be corrected.
Overcorrection
To counteract any rebound tendency of biologic
system, all treatment procedures should be
done towards overcorrection.
Both inter-arch and intra-arch overcorrections
are necessary to compensate for inevitable
relapse.
Overcorrection in
class II case
Overcorrection
in class III case
Second-order bends
(Tip bends)
Offsets in the archwire
in the vertical plane,
to change the
angulation
(mesiodistal tip).
Asymmetric height of
anterior and posterior
legs of loop provide
desired angulation
Artistic bends
(Esthetic bends)
Bends to position
anterior teeth for
optimal esthetic
appeal. (Usually
referring to secondorder bends on
anterior teeth).
Third-order bends
(Torquing bends)
Twists in a rectangular
archwire to change
buccolingual or
labiolingual inclination
of teeth.
Anterior torque
Before placing torque
in wire, its important
to separate incisors
from posterior
segment by placing a
v bend between
lateral incisor and
canine.
Posterior torque
Continuous posterior
torque
A torquing activation
placed at one point on the
archwire for the entire
buccal segment.
This is performed by
holding the archwire with
two pairs of pliers very
close to each other, and
twisting appropriately
Any buccolingual
thickness variation will
necessitate wire
bending to establish
proper contact point
relationship
Midline correction
Best time for midline correction is during space
closure by using differential space closure.
However, mild midline correction can be
achieved during finishing by using diagonal
elastics with or without simultaneous use of
asymmetric class II and class III elastics.
Arch asymmetry
Asymmetric lower
arch
Settling
Vertical triangular
elastics used in
settling phase before
debonding.
A. Difference in
labiolingual
thickness between
lower lateral Incisor
and lower cuspid.
B If brackets have
same thickness
lower cuspids are
excessively inset.
Settling
Final settling elastics
can be used during
finishing just like as in
Preadjusted
Edgewise Appliance.
Conclusion
Orthodontist should keep finishing objectives in
his mind during treatment planning and setting
up of appliance.
Bracket positioning is most important point to
considered with any technique especially with
PEA.
References
Andrews, L. F. The Six Keys to Normal Occlusion, Sept.
1972, AJO.
Roth, R. H.: Temporomandibular Pain-Dysfunction and
Occlusal Relationships, The Angle Orthodontist, April
1973.
A Gnathologic Approach to Orthodontic Finishing, JCO
1975 Jul (405-417)
L. COLIN RESS : A Finishing Technique for the StraightWire Appliance , JCO 1988 Jan (29-31)
RICHARD P. McLaughlin, JOHN C. BENNETT : Finishing
and Detailing with a Preadjusted Appliance System, JCO
1991 Apr (251-264)
Systemized orthodontic treatment mechanics - RICHARD
P. McLaughlin, JOHN C. BENNETT , Hugo J Trevesi
(2001)