Finishing and Detailing.

Definition : Finishing in contemporary orthodontics can be defined as

The correction of errors made before finishing and detailing , over correction
as needed, and settling of the case.

Goals of Treatment:

During the final stage of finishing and Detailing, it is

important to focus on treatment goals,

These goals are:

• Condyles in a seated position- in centric relation.

• Relaxed healthy musculature.

• A six keys class I occlusion with 3mm of overjet and overbite.

• Ideal functional movements- a mutually protected occlusion.

• Good Periodontal health.

• Best possible esthetics.

• Goals according to American board of orthodontics (July 2000)

ABO clarified and quantified the goals of static

• occlusion by providing a grading system for study casts and panoramic

radiographs

• Emphasis was placed on self assessment of seven features of dental

casts,

• these features include

• 1.Tooth alignment (Incisal edges of anterior teeth , mesiobuccal and

• distobuccal cusps of mandibular posterior teeth and central fossae of

maxillary posterior teeth should be well aligned).
2.Marginal ridges (Marginal ridges of adjacent teeth should be at the same
vertical level or within 0.5 mm of the same level.

Radiographically

• the CEJ should be at the same relative height, resulting in a flat bone
level between adjacent teeth)

3.Bucco lingual inclinations (There should not be significant difference

between the buccal and lingual cusps of maxillary and mandibular premolars
and molars with all cusps within 1mm of straight edge)

4. Occlusal relation ship: The mesiobuccal cusp of maxillary first molar

must coincide with in 1mm of buccal groove of the mandibular 1st

molar and buccal cusps of maxillary molars ,premolars , and canines must
align within 1mm of the interproximal embrasures of mandibular
posterior teeth.

5.Occlusal contacts: Maximum intercuspation should be established

• between the buccal cusps of mandibular posterior teeth and lingual

cusps of maxillary posterior teeth .Each functional cusp should be in
contact with the opposing arch.

6.Overjet: Posteriorly ,the mandibular buccal cusps and the maxillary

• lingual cusps are used to determine proper position within the fossa of

• the opposing arch. Anteriorly , the Incisal surfaces should lightly

• contact the lingual surfaces of maxillary anterior teeth.

7. Interproximal contacts: All the spaces within the dental arches

• should be closed.

8.Root angulation: Generally the roots of maxillary and mandibular

teeth should be parallel to each other and perpendicular to the Occlusal

plane,as viewed in panoramic radiograph.

• If roots are properly angulated sufficient bone will be present between

• adjacent roots ,an important consideration in periodontal health.

 • Andrews six keys to normal occlusion :

• Key I : Molar relationship: Distal surface of the distobuccal cusp

• of the upper first permanent molar occluded with the mesial

• surface of the mesiobuccal cusp of the lower second molar.

• The closer the distal surface of distobuccal surface approaches the

• the mesial surface of mesiobuccal cusp of lower second molar

• the better opportunity for normal occlusion.

Key II. Crown angulation (tip). The gingival portion of the long axis of all
crowns was more distal than the incisal portion.

crown tip is expressed in degrees, plus or minus.

The degree of crown tip is the angle between the long axis of the crown (as
viewed from the labial or buccal surface) and a line bearing 90 degrees from the
occlusal plane.

A "plus reading" is awarded when the gingival portion of the long axis of the
crown is distal to the incisal portion. A "minus reading" is assigned when the
gingival portion of the long axis of the crown is mesial to the incisal portion.
Key III : Crown inclination (labiolingual or buccolingual inclination). The third
key to normal occlusion is crown inclination

crown inclination is expressed in plus or minus degrees, representing the angle

formed by a line which bears 90 degrees to the occlusal plane and a line that is
tangent to the bracket site (which is in the middle of the labial or buccal long
axis of the clinical crown, as viewed from the mesial or distal).

A plus reading is given if the gingival portion of the tangent line (or of the
crown) is lingual to the incisal portion,

A minus reading is recorded when the gingival portion of the tangent line (or of
the crown) is labial to the incisal portion.

Anterior teeth has positive crown inclination where as posterior teeth has
negative crown inclination.

Key IV :Rotations. The fourth key to normal occlusion is that the teeth

should be free of undesirable rotations.

Key V: The contact points should be tight (no spaces)

Key VI: Occlusal plane : Occlusal plane should be flat Intercuspation of the
teeth is best when the plane of occlusion is flat.

Factors to be considered in finishing and detailing:

Doughtry ( 1976) outlined 17 factors to be considered in finishing and

detailing.

1.Correction and over correction of antero posterior jaw relation ship.

2.Establish correct tip of upper and lower anterior teeth.

3.Establish correct torque of upper and lower anterior teeth.

4.Coordinating arch forms and arch widths.

5.Establish correct posterior crown torque.

6.Establishing marginal ridge relation and contact points.

7.Correction of midline discrepancies.

8.Establishing interdigitation of teeth.

9.Checking cephelometric objectives.

10.Checking root parallelism .

11.Maintaining closure of all spaces.

12.Evaluating profile and facial esthetics.

13.Checking for TMJ dysfunction's like clicking and locking.

14.Checking functional movements .

15.Determining of all habits have been corrected.

16.Correction of rotations and overcorrection when needed.

17.Establishing flat occlusal plane.

Two rules in finishing treatment :

1.Inter arch elastics and head gear should be discontinued , and the rebound
from their use allowed to express itself ,4-8 weeks before the orthodontic
appliances are removed.

2.Teeth to be brought into solid occlusal relationship without heavy arch wires.

During closing stages of treatment attention is given to following

considerations:

• Horizontal

• vertical.

• Transverse

• Dynamic
Cephelometric and Esthetic

Horizontal considerations :

• Coordination of teeth fit.

• Establishing correct tip of the anterior and posterior teeth.

• Providing adequate incisor torque.

• Establishing correct posterior torque.

• Management of tooth size discrepancy.

• Controlling rotations.

• Maintaining closure of all spaces.

• Horizontal over correction.

• Horizontal considerations:

These include,

• a)Coordination of tooth fit :

• A major finishing consideration is coordination of tooth fit in anterior and

posterior areas.

• It was found that In approximately 20% cases anterior and posterior

teeth fit well with little or no adjustment.

• In approx 60% of cases there is mandibular anterior tooth excess.

• In remaining 20% show excess of maxillary anterior tooth material

• excess and patient shows some excessive overjet when posterior

• segments are in a class I relationship.

• B) Establishing correct tip of anterior and posterior teeth:

Tip is one of the strengths of PEA, especially when twin

• brackets of adequate width are used.

With the PEA if proper mechanics with light forces are used
• there should be little need to modify the tip measurements as obtained

• by Andrews non-orthodontic study models.

• Bracket tip is one of the main factor that influence the amount of space

• occupied by each tooth ,

• A tooth which is tipped occupies more space relative to the tooth which

• is upright.

• When using anterior brackets with original Andrews tip measurements

• a total of 40 deg tip is placed in upper anterior segment and only a

• 6 deg of tip in the lower anterior segment , the resulting 34 deg of tip

• differential helps to increase the upper anterior segment and decrease

• the size of lower anterior segment, this helps to achieve improved

• fit in 60% of cases having increased lower mandibular anterior excess.

Increased tip requires additional space

 Tipping incisors which are Triangular or barrel shaped will have little

effect on arch length occupied.

C) Providing adequate incisor torque:

Torque is the weakness of PEA since approximately 1mm segment of

rectangular steel wire is placed in bracket of about same dimension is required
to carry out tooth movement involving movement of entire portion of root
through alveolar bone.

A full size wire is normally not used because such wires do not slide effectively
through posterior bracket slots.

Because majority patients are either classI or class II the general tendency to
place additional palatal root torque in the upper incisor

brackets and additional labial root torque in the lower incisor brackets.

It is frequently necessary to add palatal root torque( upto 20 deg)

in upper arch wire and 10-15 deg of labial root torque to the

lower arch wire.

In overjet reduction in moderate to severe class II torque is lost in

upper anterior segment and lowers are angulated forward , additional

torque is needed in arch wires to correct incisor angulation.

Anterior inclination:

Relative inclination of maxillary and mandibular incisors:

Maxillary and mandibular central and lateral incisors

should be in same relative plane compared with one another.

If they are in different planes may cause relapse .

During finishing this can be evaluated using 4 criteria.

1.Incisal edges.

2.Clinical crown length of contralateral teeth ( in unworn dentition)

3.Root prominence.

4.Occlusal prospective (cingulum more prominent on improperly inclined

incisor.)

D)Establishing correct posterior torque:

Correct posterior torque is essential in preventing

posterior interference's and allowing for seating of centric cusps.

There is often a tendency for upper palatal overhanging cusps , requiring

posterior buccal root torque.

In lower arch 1st and 2nd molar can show undesirable lingual tipping and it
may be necessary to add buccal crown torque.
Additional buccal root torque needed to adjust upper molars during finishing

Posterior inclination:

In 1999 ,casko and codirectors of ABO defined the

relationships between buccal and lingual cusps of maxillary and mandibular

premolars and molars.

According to them , Mandibular lingual cusp should be at the same level

or within a millimeter of the same level as mandibular buccal cusps.

This permits flat occlusal plane and good cusp fossae relation ship of posterior
teeth.

In maxillary posterior teeth ,palatal cusps of the first and second molars

are generally slightly longer and extend slightly more occlusally

than buccal cusps , this is regarded by ABO as normal, however maxillary

palatal cusps should not extend beyond 1mm since it is difficult to achieve
proper occlusal contact between maxillary and mandibular posterior teeth with
out producing cross arch balancing interferences in

lateral mandibular excursions.

E) Management of tooth size discrepancy :

Tooth size is actually the seventh key to normal occlusion.

Tooth size discrepancy may be corrected either by

reducing tooth mass in one arch with interproximal enamel reduction (usually
lower incisors) or by addition of tooth mass with restorative material in the
opposing arch.
It is more common to find an excess tooth substance in lower arch. If the
Bolton analysis confirms this ,it is often advisable to carry out

interproximal stripping in the lower anterior region in initial stages of

treatment, as finishing stage is approached the relative tooth mass in

upper anterior segment is evaluated and interproximal reduction is

carried on if necessary .

Controlling rotations:

Rotation control is an important aspect of

finishing and detailing .

The in out compensation built into PEA combined

with correct bracket positioning is most effective in controlling

rotations.

Gingival surgery (preferably CSF procedure) is indicated in patients

who has severe anterior rotations.

CSF procedures are carried 1-4 months before appliance removal after

their alignment.

Maintaining the closure of all spaces:

In extraction cases during settling stage figure 8

ligature wires should be placed across the extraction site to keep them

closed.
Maintaining space closure using

passive tie backs

Figure 8 ligation across premolar

extraction site during settling stage

to prevent space reopening.

Figure 8 ligation to maintain

diastema closure

Horizontal over correction:

It is often necessary to consider horizontal over correction

of class II and class III cases.During finishing stages of treatment it is

important to fully correct the anteroposterior position of dentition using

class II elastics or class III elastics or headgear.

Immediately after debonding with buccal segment override

Final functional settling of teeth 2 weeks post treatment.

Alignment:

Proper alignment should be a fundamental objective of any

orthodontic treatment plan.

American Board of orthodontics established guidelines and objective

parameters for assessing anterior and posterior dental alignment.

In mandibular anterior sextant Labioincisal edges of the mandibular

incisors and canines are used to establish proper alignment

This surface was considered since it is the functioning surface of mandibular

teeth and these teeth look best esthetically if there labioincisal edges are aligned
properly.

In maxillary anterior region lingual surfaces of maxillary incisors and

canines are used to assess proper alignment.

This surface was chose since it is the functioning surface of the maxillary

anterior teeth.If these surfaces align properly maxillary incisors appear

to be in proper esthetic relation ship.

Alignment: Upper anterior palatal surfaces and lower labioincisal surface

are used to establish proper alignment.

Posterior alignment:

In mandibular posterior sextant , the buccal cusps

of the mandibular premolars and molars are used to determine

proper tooth position.

This was chosen since it represents the functioning surface of mandibular

posterior teeth and easy to visualize intraorally .

In maxillary posterior sextant central grooves of the

maxillary premolars and molars are used to assess proper alignment.

This landmark was chosen since it represents the functioning surfaces

of maxillary posterior teeth and easy to observe intraorally.

Vertical considerations :

• Correct crown lengths ,marginal ridge relations and contact points.

• Final management of curve of spee.

• Correction of vertical crown positions , marginal

 • relationships and contact points should be completed during rectangular

• stage of treatment, if these are not done then it should be done in

• finishing and detailing stage of treatment.

• It is often necessary to correct these early in treatment than during

• finishing stage for better stability.

• Therefore correct bracket placement is essential for achieving these

relations.

Curve of spee:

In low angle cases it is beneficial to level the entire curve of spee since excess
curve of spee makes it difficult or impossible to complete final space closure
in upper arch and to keep these spaces closed.

In high angle cases it is important to leave some curve of spee at the

back of the arch to prevent the risk of open bite

Early banding of second molars greatly aids in bite opening

and leveling curve of spee in deep bite low angle cases.

Marginal ridges : Marginal ridges are used to assess the proper

vertical relationships of maxillary and mandibular posterior teeth.

If the marginal ridges of adjacent posterior teeth are

positioned at the same level then the cusps of those teeth are also at the same
level and even the fossae are positioned at same level.

If the marginal ridges are at the same relative level then CEJ
are at same relative level and bone levels between adjacent teeth are flat and
this produces a much healthier periodontal situation for the patient.

These are true in cases of non worn ,non restored and non
periodontically involved adolescent dentition.

But in adult patients with periodontal problems ,tooth abrasion and

existing restorations , the marginal ridges are not a good guide for

posterior vertical tooth position.

In these situations one should rely on bone levels between the teeth

to determine the correct vertical position of adjacent teeth.

It is advantageous to erupt the tooth with bone loss during orthodontics ,

this will level the bone and reduce pocket depth eliminate the

hemiseptal defect, followed by compensatory occlusal reduction

Alignment of lower incisors with significant bone loss

In these cases it is best to maintain the level of bone

and equilibrate the incisal edges.

Transverse considerations :
 • Arch form

• Transverse overcorrection

• Transpalatal elastics.

• Arch coordination:

• Upper and lower arches should be coordinated

• right from the early stages of treatment, this helps to eliminate the

• occurrence of troublesome crossbites in finishing stage..

• In general this is achieved by adjusting the upper arch wire so that

• it is 3mm wider anteriorly and posteriorly than the lower archwire.

• This helps to establish the correct 3mm of overjet anteriorly and

posteriorly .

Upper and lower arches are 3mm separated in all dimensions

The cases showing narrow maxillary arches should be over expanded

and held in over expanded position for an extended period of time.

If the expansion is carried at the beginning of

orthodontic treatment, a palatal bar should be placed after the expansion
procedures and can remain in position until the rectangular stainless steel wires
in place,

Additional buccal root torque in the arch wire is beneficial to allow

posterior segments to settle properly

Trans palatal elastics ( Buffalo elastics) :

These elastics are some times used for coordination of

the arches at the end of treatment.

These elastics are used to constrict the maxillary arch by producing

trans palatal force on maxillary arch.

These are attached to ball hooks on the maxillary first premolar

bands.

They are prescribed for night time wear as they interfere with speech.

Dynamic considerations :

Establishing centric relation and checking functional movements:

It is necessary to monitor and to reevaluate the

centric relation position of the mandible and additional corrections done

prior to finishing of the case ( using inter maxillary elastics).

Patients should be checked for Interferences in protrusive and lateral

excursions.

During protrusive movement lower most anterior teeth make contact with the
upper six most anterior teeth with no posterior contact.

During lateral excursions the patient should experience cuspid rise with
slight anterior contact and disocclusion of posterior teeth on both working and
balancing sides.

Protrusive, working, and balancing excursions in a mutually protected

occlusion. Note absence of posterior contact on all excursions.

Final stage of finishing :

During closing stages of treatment much lighter wires

are used since rectangular stainless steel wires are

restrictive for settling of teeth in closing stages of treatment.

Typically .014 or.016 heat activated Ni-Ti is used in the lower arch

coordinated with upper arch.

In the upper arch a .014 round sectional arch can be placed from

lateral incisor to lateral incisor( if canines are displaced labially then extended
up to canines) . These wires can be accompanied by the use of vertical
triangular elastics when settling needs to occur.

The better the bracket placement the less elastics need to be used.

It is beneficial to retain all bands and brackets on the teeth during settling so
that if any unwanted changes occur these can be corrected.

Serpentine wiring :

This is done about one week prior to appliance

removable.

Purpose : For settling of occlusion without any interdental spacing

Method: Upper and lower arch wires are removed but the TPA and

molar bands are left in place, teeth are ligated in a serpentine fashion
from second premolar to second premolar with standard ligature wire.

The patient is instructed to chew gum as much as possible .

This method is ideal if there are only minimal discrepancies remaining

in tooth position.

Indication : class II div 2 malocclusion.

Serpentine wires from second premolar to second premolar.

Vertical Spaghetti elastics:

These are used one week before appliance removal ,

Maxillary and mandibular arch wires are removed, 0.016 ss wire is placed in
mandibular arch and no arch wire is placed in the upper arch brackets.

Using elastics of 3/16 , 2-3.5 ounce elastics a series of triangular

elastics are placed between the two dental arches

Patient is instructed to wear the spaghetti elastics on almost full time basis for a
week before appliance removal.

These elastics are useful in patients whom there is difficulty in closing the bite
whether anteriorly or posteriorly,

Contraindicated in malocclusions presented originally presented with deep bite (

Class II div2).
Settling Elastics:

Elastics with class II pull:

Elastics with class III pull :

Cephelometric and esthetic considerations:

The most important factors to be evaluated with the

cephelometric head films taken approximately 3-4 months before debonding

these are

A)soft tissue profile.

B)Antero posterior position of incisors.

C) Torque of incisors

D)Changes in mandibular plane.

 E)Success in correcting the horizontal skeletal and dental components .

Evaluation of esthetic Factors of anterior teeth:

These are analyzed by sit0vting or standing in front

of the patient.

Theses are

• Crown lengths of maxillary and mandibular incisors.

• Incisal edge contours

• Axial inclination of all maxillary and mandibular incisors.

• Midlines( upper ,lower.facial and labial)

• Crown torques.

• Smile line ( rest position and full smile)

• Right -left symmetry of crown shapes and sizes of gingival marginal

levels.

• Crown width :

• Maxillary lateral incisors are the most variable teeth

• in size and shape.

• If malformation is unilateral or mesio distal width

discrepancy is significant, esthetics and occlusion could be adversely

• affected if the malformed tooth are ignored.

• Therefore during orthodontic treatment space

should be maintained or created to built the crown and restore it to
normal size and shape.
Gingival levels:

The relationship of the gingival margins of six

maxillary anterior teeth plays an important role in esthetic appearance of

the crowns.

Four characteristics contribute to ideal gingival form .

A)Free gingival margin of the two central incisors should be at the same level.

B)Gingival margins of central incisors should be positioned more apically then

laterals and at the same level as canines.

C)The contour of labial gingival margins should mimic the CEJ of teeth.

D)There should be a papilla between each tooth and the height of

tip of the papilla is usually halfway between Incisal edges and labial

gingival height of contour over the center of each anterior tooth

Gingival marginal discrepancies between the adjacent teeth could be

caused by abrasion of Incisal edges or delayed migration of gingival

levels.

These gingival marginal discrepancies can be corrected either by

orthodontic tooth movement or surgical correction of gingival

margin discrepancy.
Four criteria to make correct decision :

1.Patients lip line when the patient smiles ( if smile line is below the free

margin then requires no correction)

2.Labial sulcular depth :If the shorter tooth has a deep sulcus, excisional

Gingivectomy may be appreciated to move the gingival margins of shorter

tooth apically.

3.Evaluate the relationship between shortest central incisor and adjacent

lateral incisor: If the short central incisor is longer than laterals then it is

possible to extrude the Longer tooth and equilibrate the incisal edge.

4.If the incisal edges are attrited and tooth had supra erupted , then

the best method to correct the gingival discrepancy is to intrude the

short central incisor and building restoration of incisal edges

Gingival form :

The presence of papilla between the maxillary central

incisors is a key esthetic factor in any individual.

Occasionally adults will have open gingival embrasures or black

triangles spaces above contact areas that look unesthetic .

This spaces is usually due to

1.Tooth shape.

2.Root angulation.

3.Periodontal bone loss.

In case of periodontal bone loss and papilla is receded extrusion of

selected teeth and equilibration and align the roots.

If triangular tooth shape is the cause then flatten the incisal contact

and closing the space.

If the roots are angulation is divergent causing excessive space

they should be corrected to descend the papilla down and overcome

the dark triangular spaces.

Implication of bracket selection and Bracket placement on finishing

Details:

Selection of buccal tubes : It is desirable to place mandibular first molar

buccal tube with out distal offset since that seems to deliver proper
contact relationship between the mandibular first and second molar.

Torque value on maxillary molars :

It is advisable to have buccal tubes

with more buccal root torque on maxillary second molars than maxillary

first molars to prevent undesirable extension of lingual cusps of second

molars into occlusal plane creating balancing interferences resulting

in inadequate settling of posterior occlusion.

Implications of vertical placement on expressed torque:

There is a definite impact on expressed torque with

vertical position of bracket.

The intensity of expressed torque on the vertical position of bracket

depends on the degree of convexity of the labial surface of the teeth.

Therefore maxillary central incisor which has mild degree of convexity

on the labial surface ,the change in vertical bracket positioning results in

change in vertical position of tooth relative to archwire but only a

Slight change in expressed torque.

Whereas maxillary canine which has greater degree of convexity of

labial surface ,even a slight change in vertical bracket positioning results

in extrusion and marked degree of labial root torque is expressed.

Therefore it is important to place brackets at correct vertical position,

in cases of attrition of cusps of canines the bracket should be

placed considering the amount of attrition .

Correction of midline discrepancies

Bilateral Class II component: double Class II elastics on right side, single Class
II elastic on left.

Case with Class II molar relationship on right side and Class I on left: single
Class II elastic on rightside
Class II molar relationship on right side and Class III on left:

Class I dental relationship on right side and Class III on left: single Class III
elastic on left side

Discrepancy primarily in anterior segment: anterior cross elastic

Occlusal check list in Finishing : ( Bio progressive therapy)

An occlusal check list including eight areas

in each arch is used in establishing the ideal finishing arch configuration

and individualized tooth rotation in our over treated orthodontic

finishing occlusion. This check list procedure is used in gaining the

final completed details necessary in accomplishing the desired

finishing objectives.

MAXILLARY ARCH :

1. Width across first and second molars.

2. Distal rotation of first molar so that line drawn through

distobuccal and mesiolingual cusps points to the distal third

of the opposite side cuspid ( in extraction case mesial of canine)

3. Mesial offset (large) on molar.

4. Mesial rotation of lingual cusp of first bicuspid to seat in

distal fossa of lower first bicuspid.

5. Premolar offset (2-3mm) to avoid first area of prematurity.

6. Cuspid brought into contact with lower cuspid and premolar

to establish cuspid rise.

7. Lateral incisor left labial (until retainer) to allow overtreatment

of buccal segments; then tucked in.

8. Smooth arc across incisors.

Check list for maxillary arch :

1.Arch width : Arch width should be checked at first and

second molar region. They should be well expanded to compensate
narrowness present at the beginning of treatment This width increase is
necessary to allow and encourage an improved torque and function.

2. Upper first molar rotation: A line drawn from the tip of

the distal buccal cusp extended through the mesiolingual cusp tip should pass
through the canine of the opposite side. The upper first molar should be distally
rotated until its distal buccal cusp can contact the mesial buccal cusp of the
lower second molar.

Maxillary first molars

The upper first molar is rotated 15 ° distally, so that a line drawn through its
distobuccal cusp would point at the distal of the opposite cuspid

3.Upper second bicuspid:

This is considered the key to finishing

because the lower 1st molar and the upper 1st molar both must be

correct before its proper position can be attained.

Care should be exercised to make certain the distal margin

of the upper bicuspid is well occlusal to the marginal ridge

of the upper first molar.

The upper second bicuspid may appear to be slightly inclined mesially.

The upper first bicuspid :

It should be parallel to the occlusal plane

buccolingually. It may also appear to be slightly distally inclined

because the mesial marginal ridge is lower than the

distal marginal ridge.

Maxillary bicuspids
As with the maxillary first molar, buccal root torque assures that the roots can
be slightly to the lingual and supported by the dense cortical bone of the
palate— particularly when expansion is part of the treatment mechanics. A
mesial root tip of -5° in extraction cases facilitates root paralleling.

Maxillary canines :

Another key tooth in finishing is the upper canine.

The tooth is overtreated in the finishing stages

of Class I and Class II malocclusion corrections.

It should be reversed and overtreated forward toward the Class II side in

Class Ill malocclusions.

Maxillary Canines :

Consistent with a 134° intercanine angle, the upper cuspid should be torqued
slightly to the lingual.The torque differential between the upper laterals and
canines (14° to 7°) should be kept to a minimum to maintain integrity of the
labial surface contours.

Lateral incisors :

The upper lateral incisor is kept labially. Overtreatment of the

upper buccal segment and the labial position of the lower lateral

requires that the upper lateral not be stepped lingually.

A gingival step of ½ to 1 mm would be required to clear the longer

cusp of the lower cuspid in excursions of the mandible.

The upper lateral would therefore have to be depressed excessively or

else placed forward in its final position. This forward position is

preferred to the intruded position by the patient because of the esthetics

Finally the upper central's contacts are considered.

Upper and lower midlines should be coincided and the tooth size and

mass can be checked for their final settling potential.

The roots are torqued to a 134° interincisal angle and the long axis is

aligned to closely parallel the cephalometric facial axis.

Maxillary incisors
Lingual root torque with interincisal angle of 134 deg.

With full arch wire engaged active torque brings all upper roots into support
by dense lingual cortical bone of palate.

MANDIBULAR ARCH:

1. Arch width across second molars.

2. Distal of first molar rotated lingually until the distobuccal

cusp approximates mesial sluice way on second molar.

3. Large buccal offset at mesial of first molar.

4. Check inter-bicuspid width for necessary expansion.

5. Proper buccal arch form and contour.

6. Premolar offset to bring it in contact with distal lingual

incline of upper canine (2-3mm).

7. Mesial of cuspid tucked slightly behind lateral incisor

distal of the cuspid buccal.

8. Over-rotation of incisors; smooth arc.

Finishing check list in lower arch :

1.Second molar : Molar width at Lower second molar and check for
uprightness and any rotations.

The lower second molar should be tipped (5 deg )distally during treatment

because it will settle mesially as the distobuccal cusp of the upper first molar
settles into

the lower first and second molar embrasure.Rotated distally(12 deg) and have
labial root torque
Mandibular First molar :

First molar distal contact should be at least 1/3

inward from the buccal on the marginal edge of the second molar.

The lower first molar is checked for uprightness and the mesial is

slightly outward in preparation to accommodate the distal incline

of the upper second bicuspid

In an ideal final position, the mandibular first molar has 5 degree distal crown
tip and rotated distally(12 deg )

3.Second premolar:

Distal contact of the lower second bicuspid

would appear to be slightly depressed for the preparation

of the seat for the upper second bicuspid.

Each tooth in the lower arch is progressively narrowed

in a smooth catenary curve.

The lower second bicuspid should have buccal root torque

symmetrical with the lower first and second molars,

because their main cortical bone support is through

the external oblique ridge. And with zero degree tip, but in extraction cases 5
deg mesial

tip for root paralleling.

4.First premolar : The lower first premolar is very critical.

This tooth should appear to be buccal to the lower canine and should

be well elevated. The mesial contact should be to the buccal.

This will serve as a point of relation for canine contact.

If this tooth is not far enough to the buccal, a tendency for

prematurity will be experienced in occlusion with the upper 1st bicuspid

The buccal cusp seats in the distal fossa of the upper first bicuspid, allowing the
lower first bicuspid to act as a posterior tooth and to function as a masticator.

5.Canine : Canine is critical in mechanical and proprioceptive function.

This tooth is principally to change arch shape.

The typical position produced is a smooth corner of the catenary curve.

In wide arches, a cuspid eminence is present, but in tapered arches this

tooth is held inwardly on the mesial contact of the lower first bicuspid,

which may rotate forward

Has 5 degree tip and seven degree torque and 0.5 mm lingual to lateral incisor.

6. Incisors :

In finishing, we overlap the lateral incisor distal

contact slightly to the labial of the mesial contact point of the canine.

This lapping permits adjustment of canine labiolingually and vertically

in finishing and locks the lower anterior segment and stabilizes

the lateral incisor.

The ideal torque of the lower incisor— as with the upper incisor— varies with
facial type. However, a torque of -1° allows enough flexibility for increase or
decrease in torque as required by dolichofacial or brachyfacial types.

Settling of teeth :

Final step of finishing is called settling,

Purpose : Bring all teeth into solid occlusal relationship before

teeth patient the patient is placed in retention.

How to settle the occlusion : There are 3 ways to settle the

occlusion.

1.By replacing rectangular wires at the very end of treatment with

with light round arch wires that provide some freedom for

movement of teeth.

2.With laced vertical elastics after removal of posterior segments

of the arch wires .

3.With the use of tooth positioner.

Using light round wires Replacing rectangular wires :

This was the original method for settling ,recommended

by Tweed in 1940.

According to him : These light wires must have first and second order
bends as used in rectangular wires.These light arch wires will quickly

settle the teeth into final occlusion and should remain in place for

only a few weeks at most.

vertical elastics are used only if needed.

Disadvantages : Precise control of anterior teeth is lost by using

light continuous round wires .

Latter in 1980s the above method was replaced with Removing only

the posterior part of rectangular wire ,leaving the rectangular wire in

anterior segment ( Typically canine to canine or premolar to premolars).

Using laced elastics to bring posterior teeth into tight contact.

Disadvantage : Since this method do not have control over posterior teeth
therefore should not be used in patients having major rotations or posterior cross
bites.

Elastics : Elastics for settling are laced around tubes and brackets .

A typical arrangement is to use light 1/4 -inch elastics with

class II or class III depending on whether slightly more correction

is desired.

These elastics should not remain in place for more than 2 weeks, one

week is usually enough to accomplish desired settling.

Finishing Elastics in case with open bite :

Triangular elastics aid in improving class I cuspid intercuspation and closing

minor open bites of 0.5 to 1mm.

Anterior vertical elastics with class II pull with class III pull

Positioners for finishing :

An alternative to segmental elastics or light

round arch wires for settling is a rubber or plastic tooth positioner.

Advantages :

• It allows the fixed appliance to be removed somewhat quickly than

otherwise would have been, therefore some finishing that could have
been done with final arch wires can be left to positioner.

• It serves not only to reposition the teeth but also to massage the gingiva
and promote the inflamed gingiva to rapid return to normal gingival
contours.

• Advantage if the initial problem is an open bite.

Disadvantages: Increased lab work, Expensive, Needs good patient cooperation

• Positioner tends to increase the overbite more than when compared to

settling with light elastics so cannot be used in patients with initial deep
bite.

• Cannot maintain the correction of rotations(ie minor rotations recur)

• Positioners :

• Indications : 1.Gingival condition with more than usual degree of

• inflammation and swelling at the end of active orthodontics.

• 2.Cases with an open bite tendency ,so that settling by mild

depression rather than elongation of posterior teeth is needed.

• Contraindications :Severe malalignment and rotated teeth.

• Deep bite tendency

• Uncooperative patient.

• Duration of wear:

• Positioner should be worn at least 4 hours during day

time and during sleep.

• Positioner in a cooperative patient will produce any

changes it is capable of with in 3 weeks, beyond that time it serves as a
retaining devise than a finishing device.

Finishing and detailing in Refined Begg :

Finishing with Begg appliance is difficult but

not impossible.

Difficulties in finishing with Begg appliance arose

because of use of round arch wires in the Begg bracket.This

combination is efficient in first order (rotational)detailing

and adjust the vertical levels of the teeth but lacks the

second order(mesio-distal) control and third order(torque) control

which are vital ingredients of finishing and detailing.

Hence during finishing one must provide these missing ingredients

by a continued use of the third stage auxiliaries or use a

rectangular (ribbon or square) finishing wire for torque control.

Rectangular wire finishing has added advantage of

being able to apply torque to any or all posterior teeth

Round Finishing arch wires :

0.020’’ stage III wires can be used for finishing

unless large vertical displacements of teeth are required for settling

of teeth.

If large vertical movement (more than 0.5 mm) then 0.018’’ can be

used which provides greater freedom for vertical movement and

more wire flexibility.

If the entire segment of the teeth to be moved significantly vertically

(as in closing an open bite) ,in this case 0.020’’wire can be sectioned

either in upper or lower arch , and appropriate elastics are applied.

Some additional first and second order bends may be required in

the arch wires.

First order adjustments :

1.Proper labio-lingual position of upper lateral incisors,

.Upper laterals are slightly tucked lingually with horizontal

offsets to compensate for difference in then labiolingual thick ness

of central and lateral incisors. This provides proper alignment and occludes

well with labio-incisal edges of the four lower incisors.

2.Canine off set for upper canine prominence.

3.Offset between premolar and molars to compensate for different

buccal contours is continued in finishing stage.

4.Toe-in for Upper first molar for distolingual rotation in order to

obtain good class I molar relationship.

5. Curvature between upper canines and molars is flattened if the

upper premolars are expanded more than required.

6.In cases of severe lower anterior crowding the canines are tucked in

by inset between lower lateral incisors and canines and offset between

canines and premolars.

Second order adjustments :

1. Upper laterals are shorter than central incisors and canines , vertical

arch wire steps may be required if the bracket height is not correct.

2.The molar section of the arch wire is given a mild occlusal (tip down)

bend since a slight mesial angulation of upper first molar for seating

its distobuccal cusp against mesiobuccal cusp of corresponding second

molar according to Andrews.

3. Upper canines are slightly more mesially angulated to make their

 cusp tips occlude with distal half of labial surface of lower canine,

not in the embrasure between lower canine and premolar.

4.Levels of lower canines and lateral incisors are to be adjusted if

necessary , by a step in the arch wire between them.

It is necessary to over tip and over torque by 10-15%

so that they settle to their correct tip and torque during finishing.

Rectangular finishing wires in refined Begg :

Rectangular molar tubes can be used from beginning

using combination tubes or they can replace round tubes during

finishing stage.

It is preferable to use alpha-titanium 0.022’’ x 0.018’’ ribbon wire

for finishing due to following reasons :

It is possible to build the precise degree of torque in the anterior

segment and because of slight play of the wire in the bracket

mild over torque is built in the wire compared to the actually required

torque.

Its vertical dimension 0.022’’ gives enough clearance in

the 0.040’’ Begg vertical slot for vertical settling of the teeth.
Finishing time :

Actual amount of Finishing and detailing time

can be increased in situations like :

1. Variations in the shape and size of the patient's teeth relative to the average
measurements used for the pre adjusted appliance.

2. Inaccuracies or shortcomings in appliance design relative to its measurement

goals (in other words, whether the three-dimensional forces delivered by the
appliance correspond to the measurements used in its design).

3. Utilization of force levels that "overpower" the selected appliance design.

4. Inaccuracies in appliance placement relative to the design of the appliance.

5. Failure to allow sufficient time for the bracket system to express itself.
(Leaving the appliance in place for an additional three months after major
corrections are complete, and retying at monthly intervals, will often produce
further favorable tooth movements.)

Conclusion:

The concept of occlusion requires detailed study of stomatognathic function

such as mastication ,speech ,deglutition, as well as careful investigation of inter
relation ship of morphology of a particular stomatognathic organ and
resultantfunction of overall stomatognathic system. When in harmony these two
elements can produce both a pleasing appearance and ongoing optimal health of
component parts of system.