FINISHING AND DETAILING

Contents
Introduction
Objectives in finishing
Andrew’s 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.
There is a significant range of opinions
within the profession regarding both the
appearance (esthetic) and function of the
treatment results.
During early 1970’s Andrew’s definition of
the 'Six Keys to Normal Occlusion'
constituted the first real effort to tabulate
specific variables that could be measured
in the finished orthodontic result.
Roth has provided much information about
gnathologic concepts of finishing in
orthodontics which takes TMJ health into
account.

Other important consideration of esthetic

and periodontal health during orthodontic
finishing are highlighted by Kokich.
 Andrew’s six keys to normal
occlusion
During a period of four years (1960 to 1964), Andrew
selected 120 non-orthodontic normal models
Models selected were of teeth which
(1) had never had orthodontic treatment,
(2) were straight and pleasing in appearance,
(3) had a bite which looked generally correct, and
(4) in his judgment would not benefit from orthodontic
treatment.
The crowns of these models were then
studied intensively to ascertain which
characteristics, if any, would be found
consistently.

Tentative conclusions were reached, and

six characteristics were formulated in
general terms as “six keys”
First key : inter-arch relationship
1. Molar relationship.
- The mesiobuccal cusp of the upper first
permanent molar fall within the groove between
the mesial and middle cusps of the lower first
permanent molar. (Angle’s key of occlusion)

- The distal surface of the distobuccal cusp of

upper first permanent molar occlude with the
mesial surface of the mesiobuccal cusp of
lower second molar.
- Distal marginal ridge of maxillary first
molar occlude with mesial marginal ridge
of mandibular second molar.

- Mesiolingual cusp of maxillary first molar

occlude in central fossa of mandibular first
molar
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
2nd key :crown angulation / Mesiodistal
(Tip)

The term crown angulation refers to

angulation of the long axis of the crown,
not to angulation of the long axis of the
entire tooth.

.
Crown angulation (tip)— long
axis of crown measured from
line 90 degrees to occlusal
plane.

"plus reading" is given when

the gingival portion of the
long axis of the crown is
distal to the incisal portion.

"minus reading" is assigned

when the gingival portion of
the long axis of the crown is
mesial to the incisal portion. + 5 degree tip
 Maxilla

1 2 3 4 5 6 7
+5 + 9 +11 + 2 +2 + 5 +5

Mandible

1 2 3 4 5 6 7
+2 +2 + 5 + 2 + 2 + 2 +2
3rd key : Crown inclination (labiolingual
or buccolingual inclination).

Crown inclination refers to the labiolingual

or buccolingual inclination of the long axis
of the crown, not to the inclination of the
long axis of the entire tooth.
Crown inclination is determined by
the resulting angle between a line
90 degrees to the occlusal plane
and a line tangent to the middle of
the labial or buccal clinical crown.

plus reading is given if the gingival

portion of the tangent line is lingual
to the incisal portion,
minus reading is recorded when
the gingival portion of the tangent
line is labial to the incisal portion,
Crown inclination of
central and lateral
incisors :

Definite +ve crown

inclination of upper
incisors allow proper
occlusion of the
posterior teeth.
Improperly inclined anterior
crowns result in improper Spaces resulting from normally occluded
occlusion. posterior teeth and insufficiently inclined
anterior teeth.
Upper posterior teeth (canines through
molars ):
A lingual crown inclination exist in the
upper posterior crowns.

It is constant and similar from the canines

through the second premolars but is
slightly more pronounced in the molars.
A lingual crown inclination
generally occurs in
normally occluded upper
posterior crowns.
The inclination is constant
and similar from the
canines through the
second premolars and
slightly more pronounced
in the molars. 3 4 5 6 7
-7 -7 -7 -9 -9
Lower posterior
(canines through
molars )
The lingual crown
inclination in the lower
posterior teeth
progressively
increase from the
canines through the 3 4 5 6 7
second molars. - 11 - 17 - 22 - 30 - 33
4th key : Rotations.
There should not
be any rotations.

A rotated molar
occupies more
mesiodistal space,
creating a situation
unreceptive to normal
occlusion.
5th key : Spaces.
There should not be any spaces; tight
contact

6th key : Occlusal plane.

The plane of occlusion varies from
generally flat to a slight curve of Spee.
A, deep curve of Spee
results slippage of the
upper teeth progressively
mesially and distally.

B, flat plane of occlusion is

most receptive to normal
occlusion.

C, reverse curve of Spee

results in excessive room
for the upper teeth.
Possible 7th key of occlusion
Inter-arch tooth mass harmony

It seems Andrew’s normal occlusion

sample did not have any tooth mass
disharmony
Gnathological / functional 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)

.
The second objective is to have a harmonious
glide path of anterior teeth working against each
other to separate or disclude the posterior teeth
immediately, but gently, as soon as the mandible
moves out of centric closure.
(Mutually protected occlusion)
 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.
Centric occlusion (CO)

Mandibular position dictated by maximum

and habitual intercuspation of the
maxillary and mandibular teeth.
It is a dentally determined position,
independent of condylar position.
Ideally, centric relation and centric
occlusion of the teeth should be
coinciding.
Maximum intercuspation of the teeth
should occur when the mandible is in
centric relation.

However, a CR-CO discrepancy of 1 – 1.5

mm is acceptable.
Shift from CR to CR may be in horizontal
or vertical direction.

Horizontal shift occur because of

inadequate intercuspation of posterior
teeth (end on buccal segment
relationship) or anterior interference which
force the mandible to move antero
posteriorly for proper intercuspation.
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.
In cases with a short ramus and/or short
posterior facial dimension (vertical growth
pattern), care should be taken not to drive
molars distally and wedge the mandible
into a molar fulcrum.
 Mutually protected occlusion
In Mutually protected occlusion :
- All centric stops of posterior teeth should hit
equally and simultaneously and the stress
should be directed as nearly as possible along
the long axes of the posterior teeth.
There should be no actual contact of the anterior
teeth in centric closure (.0005" clearance).
- Cuspids should provide the main gliding
inclines for lateral excursion

- Maxillary anterior teeth should articulate

with the mandibular anterior teeth during
protrusive movement
It’s very critical that
cuspid incline
provided by upper
canine should be in
harmony with path
followed by condyle.

Diagram of effect of side-shift on the

lingual concavity of the maxillary
cuspids.
During protrusive movements, anterior
teeth should protect posterior teeth by
dis-occluding them.
Two important factors which contribute to
this function are :
Overjet. ( Horizontal overlap of incisors)
Overbite ( Vertical overlap of incisors)
Overjet (The horizontal overlap)

The key feature during protrusion is contact of

mandibular incisor edges with concavity
provided by lingual surfaces of upper incisors.

If overjet is large, there will be trauma to

posterior teeth by the time anteriors start
discluding them.
Overbite (vertical overlap) will be dictated
primarily by :
 Cusp height and fossa depth of
posteriors
 Steepness of articular eminence
 Cant of occlusion plane
Cusp height and
fossa depth of
posterior teeth is the
first and single most
important
determinant in
establishing vertical Maximal fossa depth or
overlap (overbite) cuspal height + 1mm =
optimal overbite
The vertically incline
of articular
eminence is the
second factor of
consideration in
establishing the
proper vertical
overlap
Steeper the eminence, more
vertical overlap
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.
Occlusion plane divergent
from the angle of the
eminence

more posterior tooth

separation occurs during
mandibular protraction and

therefore overbite is not as

critical as in previous case
 Mutually protected occlusion.
A, Centric occlusion.
B, canine guidance during lateral excursion
C protrusive excursion, separating posterior
teeth
In this way, a "mutually protective"
occlusal scheme is established where the
anterior teeth protect the posterior
teeth from lateral stress during excursive
movement and the posterior teeth
protect the anterior teeth from stress
during closure into centric relation
occlusion.
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.
Whether or not close root proximity
enhances interproximal bone destruction
is not clear ( Kokich, Osterberg, Artun
1986,1987)
However, at the end of orthodontic
treatment, roots of all teeth should be
parallel to each other especially in
extraction cases where properly placed
roots enhance stability by preventing
opening of extraction space.
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.
In posterior segment, angular bony defects
are very common with mesial migration of
molars.

Uprighting of these teeth will eliminate

bony defects.
 Patient with missing mandibular
left second premolar.

A) First molar had tipped mesially

and undergone periodontal
breakdown, producing 8mm
pocket with significant bone
loss.
B,C) During uprighting, molar
was substantially extruded and
occlusal surface was
equilibrated.
C. Bony defect get eliminated
interproximally between first
premolar and first molar.

D,E). After appliance removal.

F) Four years later.

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 :
Where should the lateral incisor be
positioned mesiodistally relative to the
central incisor and canine?

Where should lateral incisor be positioned

incisogingivally?
If the lateral incisor is positioned too close
to the canine, the mesial surface of the
lateral must be over-contoured to achieve
the appropriate crown width. The result
could be unaesthetic.
Therefore, the peg-shaped lateral incisor
should be positioned nearer the central
incisor than the canine during orthodontic
treatment.
Vertical (inciso-gingival) relationship is
determined by the relative positions of the
gingival margins.

Gingival margins of the peg-shaped lateral should

be aligned with the contra-lateral lateral incisor.
Incisal edges will be leveled by restorative
material.
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.
- Gingival margins of the lateral incisors
should be positioned more coronally than
the central incisors and the canines.

- The contour of the gingival margins should

mimic the cementoenamel junctions of the
teeth.
 When gingival margin discrepancies exist,
two possible remedies are :
- surgical correction of gingival margin
discrepancies.
- orthodontic movement to reposition the
gingival margins
If tooth has a
deeper sulcus
(pseudo pocket),
excisional
gingivectomy is
treatment of
choice.
When Sulcus depth is normal, the problem
is due to supra-eruption of teeth which
carry gingival margin along with them.

Such discrepancies are best treated with

orthodontic and restorative approach.
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.
This space can be due to :
Periodontal factor - Deficient papilla due to
periodontal bone loss
Dental factors
- abnormal root angulation
- abnormal tooth shape (triangular shape)
If deficient papilla is the problem, the
cause is lack of bone support due to an
underlying periodontal disease.

These case should be treated with

periodontal therapy.
If the root
angulation is
divergent, then
the brackets
should be
repositioned so
the root position
can be corrected.
 If shape of the tooth is problem, two
possibilities are :
- restore the open gingival embrasure.
- reshape the tooth, by flattening the incisal
contact and closing the space.
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
Typical overcorrection in transverse plane
Finishing with standard
Edgewise Appliance
Angle’s “latest and best” appliance which
he introduced in 1928 is still best in
achieving any 3-dimensional tooth
movement with appropriate wire bending.

Rectangular wire (edgewise mode) in

rectangular slot provide excellent control
of tooth movement.
All brackets are practically identical to each other
except for mesiodistal width.

During finishing stage, various bends are placed

in following order :
First order bends
Second order bends
Artistic positioning bends
Third order bends
First-order bends (Offsets,
In-out bends)

Labiolingual or Vertical
step bends in the
archwire to accommodate
variations in the
prominence and vertical
discrepancies of
individual teeth.
These bends do not
change the angulation
of teeth
Typical first-order bends
are :
- lateral incisors
(insets),
- canines (offsets) and
- first molars (bayonet
bends, toe in).
Second-order bends
(Tip bends)

Offsets in the archwire

in the vertical plane,
to change the
angulation
(mesiodistal tip).
Typically, wire should cross the bracket at an
angle to be effective for changing the angulation
of tooth.

With more flexible wire, 2nd order bend can be

placed without any loop.

But in case of stiff rectangular wire, loops should

be placed to increase flexibility of wire.
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 second-
order 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, it’s 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
The torquing activation is mainly felt by the
tooth immediately distal to the bend.

The teeth lying more posteriorly along the

archwire will feel minimal torquing
activation until the inclination of the tooth
distal to the bend has actually changed as
a result of the torque.
Progressive posterior torque

A gradually progressing torquing

activation placed over the entire
buccal segment.

This is performed by holding the

archwire with plier close to the end
of the wire and twisting
appropriately with the fingers
placed distal to the canine bracket.
Tip and torque relationship

As the anterior portion of an upper

rectangular arch wire is lingually torqued,
a proportional amount of tip for the
incisors is lost. (undesirable)
The wagon wheel
effect.

Anterior arch wire

torque negates arch
wire tip in a ratio of
four to one.
Finishing with Pre-adjusted
Edgewise Appliance
Andrew in early 1970’s tried to simplify wire
bending procedure by incorporating
various 1st, 2nd and 3rd order prescription in
brackets and molar tubes.

Acc. to original straight wire concept, this

will eliminate wire bending during finishing.
 First order control Second order control

Third order control

Standard edgewise appliance on extracted
teeth with full size rectangular archwire in
place (no bends other than arch form)
showing inherent tip and torque errors.
Straight-Wire Appliance on extracted teeth
with full size rectangular archwire in place
(no bends other than arch form) showing
inherent appliance positioning of maxillary
teeth.
Hence, the single most important factor in
finishing with PEA is selection and
placement of these attachments.

‘Selection’ of different attachments

depending on treatment needs has been
used by ‘wick’ Alexander in his “Vari-
Simplex” technique.
Brackets and molar tubes placement

Though some techniques (MBT etc.) have

come up with bracket placement guides
for operator’s convenience, but still
Andrew’s FA (Facial Axis) point on crown
is recommended.
FA is a point along the long axis of clinical
crown which is exactly midway of :
mesiodistal dimension
occlusogingival dimension
Except molars, long axis of all other teeth
is considered along the most prominent
ridge on labial surface.

For molars, long axis is considered along

the most prominent developmental groove
(mesiobuccal groove)
Acc. to ‘straight wire’
concept, once brackets
are placed at exact
point (FA), a well
coordinated U/L
rectangular wire will
control all types of tooth
movement with no
additional finishing bend
required.
 But invariably, some wire bending is required in all
cases. This may be due to:

- As a compensation for abnormal bracket

positioning

- inadequate expression of bracket prescription

(with undersize wire)

- Different type of malocclusion

First order control

The in-out compensation built into the

preadjusted appliance, combined with
correct positioning of attachments , is
reasonably effective in controlling rotations
and contact points.
But some wire bending is required in
following two common conditions :
- Abnormal tooth morphology
- Class II molar finish
Any buccolingual
thickness variation will
necessitate wire
bending to establish
proper contact point
relationship
Maxillary-first-premolar extraction case in which molars are finished in Class II
relationship. Maxillary first molars should be rotated mesially in to produce
better contact with mandibular second premolars.
Second order (tip) control

Tip is the strengths of preadjusted appliance,

especially when twin brackets with adequate
width are used.

Hence unless bracket is improperly placed, there

is no need for 2nd order wire bending.
Nearly full expression
of the bracket tip is
achieved with
relatively little play
once rectangular steel
wires are placed.
Third order (torque) control
Torque control is weakness of the preadjusted
appliance system. This is due to the following
reasons :

- Approximately 1 mm segment of rectangular steel

wire is placed in a bracket to carry out a rather
difficult tooth movement, which involves moving
an entire portion of the root through alveolar
bone.
- A full size wire is normally
not used routinely.

For example 0.019 x

0.025 wire is often
selected for the 0.022 slot
and 0.0175 x 0.025 is
often selected for the
0.018 slot

This reduces the

effectiveness of torque
expression because of
large play
- Even a slight variation
in bracket placement
changes torque
prescription rapidly
especially on teeth
with convex labial
surfaces.
- Different malocclusions require different
torque of incisors.

3rd order bend are most common bend

required during finishing especially in
following two situations :
 Maxillary lateral incisor that was in
lingual crossbite prior to orthodontics
 If the crown is moved into proper position
but the torque is not adjusted to bring the
root into its proper position, then the
stability will be affected.

Two options are:

- 3rd order wire bending
- inversion of bracket
 Upper-bicuspid-extraction with class II
molar finish

- Usually the lower incisors will be at a

greater inclination than ideal before
treatment.

- Lower incisors will further procline during

leveling curve of Spee
- During retraction of upper incisor with
undersize wire ( e.g 0.019 x0.025 in 0.22
slot), there will some torque loss.

All these factors warrant some additional

torque to be placed in wire to achieve
good occlusion.
A. Moderate-to-severe Class II case before treatment.
B. After overjet reduction, torque has been lost in upper
anterior segment and lower incisors are angulated
forward.
C. Additional torque needed in archwires to recover correct
incisor angulation.
Additional buccal root
torque needed to
adjust upper molars
during finishing stage
to correct hanging
palatal cusp.
 Correction of curve of Spee

Typical reverse curve of

Spee is placed in lower
arch wire and curve of
Spee in upper arch for
leveling.
Overbite control is enhanced by
including lower second molars.
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.
 Methods of elastic wear to
correct minor midline
discrepancies during finishing
stage.
A. Case with bilateral Class II
component: double Class II
elastics on right side, single
Class II elastic on left.
B. Case with Class II molar
relationship on right side and
Class I on left: single Class II
elastic on right side.
C. Case with Class II molar
relationship on right side and
Class III on left.
(continued on next page)
D. Case with Class I dental
relationship on right side and
Class III on left: single Class III
elastic on left side.

E. Case with discrepancy

primarily in anterior segment:
anterior cross-elastic.
 Arch asymmetry

Asymmetric lower Mirror image asymmetry

arch placed in arch wire
Settling

Vertical triangular
elastics used in
settling phase before
debonding.
A. Patient before treatment.
B. Round archwires and elastics in
place after 22 months of treatment.
C. After 10 days of settling.
D. Patient after debonding, four
months later.
Finishing with Begg appliance
Compared to PEA, finishing with the Begg
appliance is difficult but not impossible.

Difficulties in the finishing stage using the

classic Begg appliance arise because of
the use of round archwires in the Begg
bracket.
While this combination (round archwires in
the Begg bracket) is efficient in the first
order detailing (bucco-lingual or rotational
correction), it lacks the second order tip
and third order torque control, which are
vital ingredients of finishing and detailing.
2nd order tooth movements are achieved
with uprighting springs

3rd order tooth movements are achieved with

torquing auxiliaries, or by using
rectangular (ribbon or square) finishing
wire.
Rectangular finishing has the added
advantage of being able to apply torque to
posterior teeth.

Posterior root torque of individual teeth is

possible with Begg auxiliaries, but torquing
all the posterior teeth is more difficult
using a round base wire.
ROUND FINISHING ARCHWIRES
First order adjustments
- Upper laterals are slightly tucked lingually
with horizontal offsets to compensate for
the difference in the labio-lingual
thickness compared to upper central
incisors.
- The difference in the crown thickness of
the lower canine in relation to the lower
lateral usually pushes the crown of the
canine slightly lingually.
Lateral inset is placed in lower arch to
compensate for this dimension.
A. Difference in
labiolingual
thickness between
lower lateral Incisor
and lower cuspid.
B If brackets have
same thickness
lower cuspids are
excessively inset.
- On account of difference in the labio-
lingual thickness between the upper lateral
incisor and canine, an offset (canine
contour) is required in the archwire to
compensate for this canine prominence
- An offset between the
premolars and the
molars, to
compensate for the
different buccal
contours.
2nd order adjustment
Uprighting springs are used to achieve
desired tip of dentition.

3rd order adjustments

various torquing auxiliaries are used to
gain torque of anteriors and posteriors.
RECTANGULAR FINISHING WIRES

Rectangular ribbon molar tubes should be

provided from the beginning by using
combination tubes, or else, round molar
tubes are replaced with rectangular tubes
at the time of starting the finishing stage.
 alpha-titanium 0.018" x 0.022" ribbon
wires are recommended for finishing
because :
1. Employing this wire, it is possible to build
the precise degree of torque in the anterior
segment using a 0.022" torquing turret, in
which the wire is held in the ribbon mode.
2.The wire is relatively soft while shaping,
and hence easy to bend.
It becomes harder in the mouth by
absorption of hydrogen atoms.
3. Its vertical 0.022" dimension gives
enough clearance in the 0.040" Begg
vertical slot for vertical settling of the teeth.
The upper and lower
archwires are shaped
as described for the
round wires in an
ideal form
incorporating first,
second order bends
and required anterior
and posterior torque.
Settling
Final settling elastics
can be used during
finishing just like as in
Preadjusted
Edgewise Appliance.
Finishing with other appliances which use
Begg philosophy for major tooth
movement but have additional pre-
adjusted edgewise slot (e.g CAT) is
exactly similarly to PEA.
 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.
Both static and functional occlusion
objectives should be fulfilled because they
have intimate relationship especially with
regard to stability.

All tooth movements should be

overcorrected because some amount of
biologic rebound is inevitable.
Esthetic factors should also be considered
because these are the features which are
most important from patient’s point of
view.

In adult patients, it’s important to keep

restorative objectives in mind during
finishing.
 References
Andrews, L. F. The Six Keys to Normal Occlusion, Sept.
1972, AJO.

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