Dr Sanjeed Kabeer

3rd year Ortho

JSSDCH
 When a new orthodontic case is begun, it is essential to have a vision to obtain
optimal results and this is obtained right at the beginning during the diagnosis and
treatment planning stage. Planning correct treatment mechanics will ensure good
results.

 The objective of any orthodontic treatment depends on the end goal

 In the finishing and detailing stage we continue to focus on these goals, the
foundation established by the background in the fundamentals of occlusion.
 Chung et al. concluded in his study that the ABO examiners continue to see
problems in cases presentation including lack of attention to finishing details and
inappropriate treatment objectives, among other details.
 So let’s define our goals in orthodontic treatment:
1. Oral health
2. Esthetics
3. Occlusion
4. Function
5. Stability.
 Oral health: This means maintainable health of the teeth, the supporting structures,
and all the other components of the masticatory system

 Esthetics: Pleasing esthetics of the face, teeth, and

especially the smile
Occlusion: The goal is an anatomic harmony. This means that all the interrelated parts
of the masticatory system are in a structural equilibrium. This requires a harmony of
form:
 Between the teeth and the face- appropriate teeth positions providing an
esthetically pleasing face, teeth, and smile
 Between the lower teeth and the upper teeth
 Between the posterior teeth, the cheeks, and the tongue
 Between the anterior teeth, the lips, and the tongue
 Between the condyle, the disc, the musculature, and the teeth.
 Function: The goal is to obtain a
functional harmony. The preferred
type of functional occlusion is
named “mutually protected
occlusion.”
 The posterior occlusal contacted
teeth protect in centric occlusion
relation and the anterior teeth
protect the eccentric occlusion
(anterior guidance), without
interference of the posterior teeth
in the mandibular movement.
 For this, it is necessary that this
dentition is in a neutral zone
between the tongue and the
perioral muscles
 Stability: If each tooth remains without mobility, it does not wear excessively
and stays in its proper position, the occlusion can be considered stable.
The signs of instability are clinically recognizable as follows
 Hypermobility
 excessive wear
 migration or relapse
 The finishing procedures are considered from the beginning stages of treatment, as
a part of the total scheme of treatment. A clear-cut vision of end goals should set
the objectives of any orthodontic treatment sequence.

 In contemporary orthodontics: finishing can be defined as "The correction of errors

made before finishing and detailing, over correction as needed and settling of case.”

 It is the last step, before active treatment is discontinued, ensuring that the
teeth and related structures are positioned in such a way that will lead to a
better stability, enhancement of esthetics, optimised functions of the
stomatognathic system and improvement of the health of the periodontium.
The concept of finishing has changed from that of the earlier authors who primarily
relied on nature to achieve final finishing in each individual case.

ANGLE- “The best the orthodontist can do is to secure normal relations of the teeth
and correct the general form of the arch, leaving the finer adjustments to individual
form to be worked out by nature”.

TWEED relied primarily on placement of the lower incisors upright on the basal bone.

 He also stressed the importance of second order bends in the archwire.

RICKETTS: laid emphasis on the importance of arch form & the placement of lower
incisors in relation to the A-Pog line.

BEGG: emphasised the routine over-movement and overcorrection of all aspects of

malocclusion so that teeth would settle into proper positions after tissue rebound.

MERRIFIELD: stresses on overcorrecting major problems so that changes seen during

denture recovery would move occlusion towards ideal.

BENCH et al: Natural forces of eruption and natural forces of occlusion combine with
those of physiology and growth to settle teeth functionally into the best position for
each individuals characteristics

 It appears that many orthodontists and clinicians felt that a mere reliance on
mother nature to achieve final positioning of the treated case was inadequate.
ANDREWS(1972): six keys to normal occlusion
His study established normal values for in-out, tip and torque for each individual
tooth which were then built into the edgewise brackets for the straight wire
appliance. this gave the necessary impetus for precise detailing procedure to be
taken up.

ROTH: added the goals of gnathologic finishing as part of orthodontic treatment. He

also supported the concept of overcorrection.
 GNATHOLOGICAL PRINCIPLES

(IN FINISHING A CASE)

I- Centric occlusion

II- Mutually Protected occlusion

III- Cusp Embrasure occlusion

IV- Tooth Structure, Tooth position and occlusal form

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 GNATHOLOGICAL PRINCIPLES IN FINISHING A CASE

I- Centric occlusion or maximum

intercuspation of the teeth should

occur with the mandible in

centric relation, in which the

condyles are centered transversely

and seated against the articulator disks at the poster-superior slopes

of the eminence.

13
 II- Mutually protective occlusion
Occlusal force during closure should be of equal magnitude for all posterior
teeth and the stress should be directed along the long axis of the teeth and
the lower incisors should not be in contact with the lingual surface of upper
incisors and should have a clearance of 0.005 inch
(by transmitting all the occlusal forces, the centric stops of the posterior
teeth will protect the anterior teeth from lateral stress).

14
According to Okeson and Roth:
Patients should be treated to a “ mutually protected occlusion”.

Centric occlusion

Anterior teeth Posterior teeth

No contact and Equal and even contact

0.005” of clearance

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In a "mutually protective" occlusion:

•The anterior teeth protect the posterior teeth from lateral stress during
protrusive movement and

The posterior teeth protect the anterior teeth from lateral stress during
closure into centric occlusion

•So in a mutually protective occlusion, the mandible can execute its total
range or envelope of motion without interference from the teeth & during
closure the teeth will direct and maintain centricity of the condyles in the
fossae

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Anterior guidance / incisal guidance
•In straight protrusion, the anterior teeth should serve as a gentle glide path
to disocclude the posterior teeth.
•To have such anterior guidance, there should be minimal but sufficient
anterior overbite.
•In the absence of anterior guidance,
excessive lateral stress on the
cuspids may cause lingual movement No stress
of the lower cuspids and resultant
lower anterior crowding, and/or
labial movement of the maxillary
cuspids and affects post treatment
stability.

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Canine guidance / canine rise: In lateral excursions the maxillary cuspids
should act as guiding inclines to disocclude the teeth on the balancing or non-
functioning side and to disocclude the teeth on the working or functioning
side after approximately 0.5mm of group contact.

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III -Tooth-to-two-teeth or cusp-embrasure occlusion

During maximum intercuspation, there should should be Tooth-to-two-teeth or

cusp-embrasure occlusion between the upper and lower teeth, because this
make the lateral and protrusive movements with proper cuspid and incisor
contact.

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 IV- Tooth structure, tooth position and occlusal form should correlate perfectly
with mandibular border movements.
Check tooth detailing for
 1. Torque of upper incisors.
 2. Artistic tip of upper incisors and cuspids.
 3. Overbite and overjet.
 4. Flatness of curve of Spee.
 5. Second molar positions.
 6. Look for anterior group function, posterior clearance (minimal), cuspid guidance,
and balancing interferences.
 The first real effort to present a structured assessment of the treatment result was
made by Andrews. In 1972.

 His "six keys to normal occlusion" constituted specific variables that could be
measured in the finished orthodontic result.
 Molar interarch relationship

 Mesiodistal Crown Angulation

 Labiolingual Crown Inclination

 Absence of Rotations

 Tight Contacts

 Curve of Spee
DOUGHERTY’S FACTORS IN FINISHING

Doherty in 1976 gave 17 factors for finishing and detailing:

1. Correction and Overcorrection of the A-P Jaw Relationship.

2. Establishing Correct Tip of the Upper and Lower Anterior Teeth.
3. Establishing Correct Torque of the Upper and Lower Anterior Teeth.
4. Coordinating Arch Widths and Archform.
5. Establishing Correct Posterior Crown Torque.
6. Establishing Marginal Ridge Relationships and Contact Points
7. Correction of Midline Discrepancies.
8. Establishing the Interdigitation of Teeth
9. Checking Cephalometric Objectives.
10. Checking the Parallelism of Roots.
11. Maintaining the Closure of All Spaces
12. Evaluating Facial and Profile Esthetics.
13. Checking for TMJ Dysfunctions such as Clicking and Locking.
14. Checking Functional Movements.
15. Determining if All Habits Have Been Corrected.
16. Correction of Rotations and Overcorrection Where Needed.
17. Establishing a Relatively Flat Plane of Occlusion
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.
Tip

Lower Ant. Tip Upper Ant. Tip

Author 1 2 3 1 2 3

Roth +2 +2 +5 +5 +9 +11to+13

Hilgers 0 0 +5 +5 +8 +10

Rickett’s 0 0 0 0 +8 +5

Alexander 0 0 +6 +5 +8 +10

Andrews +2 +2 +5 +5 +9 +11

MBT 0 0 3 4 8 8
torque
Lower Ant. Torque Upper Ant. Torque

Author 1 2 3 1 2 3

Roth -1 -1 -11 +12 +8 -2

Hilgers -1 -1 +7 +14 + 2 2 +7

Rickett’s 0 0 +7 +22 +14 +7

Alexande
-5 -5 +7 +14 +7 -3
r
Andrews -1 -1 -11 +7 +3 -7

MBT -6 -6 -6,0,+6 +17 +10 +7,0,-7

Vertical considerations :
-Correct crown lengths
-marginal ridge relations and contact points.
-Final management of curve of spee.

Transverse considerations :
-Arch form
-Transverse overcorrection
Dynamic considerations :
- Establishing centric relation and checking functional
movements.

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:
analyzed by sitting or standing in front of the
patient.
-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.
 PAR index was developed British Orthodontic Standard
Working Party in 1987 over a series of six meetings.
 A scoring system was invented and a ruler was customized to perform model analysis
in approximately 2 min. The overall score is calculated by summing the individual
scores alloted for the components of alignment and occlusion. Thus score Zero
means perfect alignment and occlusion and greater scores (beyond 50 in rare cases)
indicate increasing level of teeth irregularities.
 The index is used to evaluate both at the start and the end of treatment in study
models and the change in the total score mirrors treatment success in creating
overall alignment and occlusion
conclusion
Have a checklist
 It is recommended to use a checklist,
especially to all whom are starting in clinic
orthodontics. This checklist consists of a
hierarchical sequence of seven major items
 Oral health
 Esthetics
 Occlusion
 Function
 Stability
 General considerations about the
treatment and
 Conclusions about the case.
 The American Board of Orthodontics is constantly striving to make the phase III
clinical examination a fair, accurate, and meaningful experience for candidates.
 In an effort to enhance the reliability of the examiners and provide the candidates
with a tool to assess the adequacy of their finished orthodontic results, the Board
has established an Objective Grading System to evaluate the final dental casts and
panoramic radiographs.
 This scoring system has been developed systematically through a series of four field
tests over a period of 5 years.
 The Board instituted the model and radiographic portions of the Model Grading
System, and it has been used to grade these portions of the examinees’ clinical case
reports since 1999.
 In an effort to assist examinees with the selection of their cases, the Board is
making this Model Grading System available to all examinees.
 The Board encourages examinees to score their own case reports with this scoring
system to determine if they meet Board standards.
 In 1994, The American Board of Orthodontics began investigating methods of making
the clinical examination more objective.
 In the past, several indices have been used to evaluate the outcome of orthodontic
treatment. Generally, these indices compare pretreatment and post treatment
records to determine the quality of the final result. However, these indices are not
precise, and the validity and reliability of these indices has not been established.
 The Occlusal Index has also been used to determine treatment quality. However, this
method is tedious, and the system is more appropriate for scoring pretreatment
rather than posttreatment records.
 In 1987, the PAR Index (Peer Assessment Rating) was developed to assess an
occlusion at any stage of development. Over 200 dental casts representing various
pretreatment and post treatment stages of occlusion were used to establish this
index.
 The PAR Index has good reliability and validity, however this measuring system is not
precise enough to discriminate between the minor inadequacies of tooth position
that are found in ABO case reports.
 Therefore, an ABO committee was formed in 1994, to begin field testing precise
methods of objectively evaluating post treatment dental casts and panoramic
radiographs.
 From 1995 to 1998 – four field tests were done, once every year
 1995 – 100 cases – 15 criteria – 85 % of inadequacy was found in 7 out of 15 criteria
(alignment, marginal ridges, buccolingual inclination, overjet, occlusal relationships, occlusal contacts,
root angulation)
 1996 – 300 cases – same 7 out of 15 criteria showed majority of inadequacies
 1997 – 832 casts and radiographs – total criteria 8 – (interproximal contact) - In addition,
modifications were made in the measuring instrument to improve measuring
accuracy among Directors.
 1998- The new and improved measuring instrument was used. An extensive training
and calibration session was performed prior to the actual examination. The major
objectives of this final field test were to refine the measuring and calibration
process, and to gather enough data on general performance to establish the validity
or cut-off for passing this portion of the clinical examination.
 Based upon the collective and cumulative results of these extensive field tests, the
Board decided to officially initiate the use of this Model Grading System for
examinees at the February 1999, ABO clinical examination in St. Louis.
 The Board encourages examinees to score their own dental casts and panoramic
radiographs during their preparation for the clinical examination in order to select
cases that will successfully pass the ABO Model Grading System.
 The ABO Model Grading System for scoring dental casts and panoramic radiographs
contains eight criteria.
These are:
 Alignment
 marginal ridges
 buccolingual inclination
 occlusal relationships
 occlusal contacts
 Overjet
 interproximal contacts
 root angulation.
 A. 1 mm in width and measures discrepancies in alignment, overjet, occlusal contact,
interproximal contact, and occlusal relationships;
 B. steps measure 1 mm in height and are used to determine discrepancies in
mandibular posterior buccolingual inclination;
 C. steps measure 1 mm in height and are used to determine discrepancies in marginal
ridges
 D. steps measure 1 mm in height and are used to determine discrepancies in maxillary
posterior buccolingual inclination.
 Alignment - is usually a fundamental objective of any orthodontic treatment plan.
Therefore, it seems reasonable that any assessment of quality of orthodontic result
must contain an assessment of tooth alignment.
 In the anterior region, the incisal edges and lingual surfaces of the maxillary
anterior teeth and the incisal edges and labial incisal surfaces of the mandibular
anterior teeth were chosen as the guide to assess anterior alignment.
 These are not only the functioning areas of these teeth, but they also influence
esthetics if they are not arranged in proper relationship.
 In the maxillary posterior region, the mesiodistal central groove of the premolars
and molars is used to assess adequacy of alignment.
 In the mandibular arch, the buccal cusps of the premolars and molars are used to
assess proper alignment.
 These areas were chosen since they represent easily identifiable points on the
teeth, and represent the functioning areas of the posterior teeth.
 If the mesial or distal alignment at any of the contact points is 0.50 mm to 1 mm
deviated from proper alignment, 1 point shall be scored for the tooth that is out of
alignment. If adjacent teeth are out of alignment, then 1 point should be scored for
each tooth.
 If the discrepancy in alignment of a tooth at the contact point is greater than 1 mm,
then 2 points shall be scored for that tooth. No more than 2 points shall be scored
for any tooth.
 MARGINAL RIDGES
 In both maxillary and mandibular arches, marginal ridges of adjacent posterior teeth
shall be at the same level, or within 0.50 mm of the same level.
 In scoring, do not include the canine-premolar contact; and do not include the
distal of lower 1st premolar.
 If adjacent marginal ridges deviate from 0.50 to 1 mm, then 1 point is scored for
that interproximal contact.
 If the marginal ridge discrepancy is greater than 1 mm, then 2 points shall be scored
for that interproximal contact.
 No more than 2 points will be scored for any contact point.
 The marginal ridge will be considered as the most occlusal point that is within 1 mm
of the contact at the occlusal surface of adjacent teeth.
 BUCCOLINGUAL INCLINATION
 The buccolingual inclination of the maxillary and mandibular posterior teeth shall be
assessed by using a flat surface that is extended between the occlusal surfaces of
the right and left posterior teeth.
 When positioned in this manner, the straight edge should contact the buccal cusps of
contralateral mandibular molars and premolars. The lingual cusps should be within 1
mm of the surface of the straight edge.
 In the maxillary arch, the straight edge should contact the lingual cusps of the
maxillary molars and premolars. The buccal cusps should be within 1 mm of the
surface of the straight edge
 Do not score the mandibular 1st premolars nor the distal cusps of the second
molars.
 If the mandibular lingual cusps or maxillary buccal cusps are more than 1 mm, but
less than 2 mm from the straight edge surface, 1 point shall be scored for that
tooth.
 If the discrepancy is greater than 2 mm, then 2 points are scored for that tooth.
 No more than 2 points shall be scored for any tooth.
OCCLUSAL CONTACTS
 This section of the evaluation determines the adequacy of occlusal contact of the
premolars and molars. The buccal cusps of the mandibular premolars and molars and
the lingual cusps of the maxillary premolars and molars should be contacting the
occlusal surfaces of the opposing teeth.
 If the distolingual cusp is short or diminutive, it should not be considered in the
evaluation.

 If this cusp is prominent, but does not contact with the opposing arch, then points
may be scored. If the cusps are in contact with the opposing arch, no points are
scored.
 Do not score diminutive distolingual cusps of the maxillary 1st and 2nd molars, nor
lingual cusps of the mandibular first premolars.
 If a cusp is out of contact with the opposing arch, and the distance is 1 mm or less,
then 1 point is scored for that tooth.

 If the cusp is out of contact and the distance is greater than 1 mm, then 2 points are
scored for that tooth. No more than 2 points are scored for each tooth.
OCCLUSAL RELATIONSHIP
 This section of the evaluation determines whether the occlusion has been finished in
an Angle Class I relationship.
 Ideally, the maxillary canine cusp tip should align with (or within 1 mm of) the
embrasure or contact between the mandibular canine and adjacent premolar.
 The buccal cusps of the maxillary premolars should align with (or be within 1 mm of)
the embrasures or contacts between the mandibular premolars and first molar.
 The mesiobuccal cusps of the maxillary molars should align with (or be within 1 mm
of) the buccal grooves of the mandibular molars.
 If the maxillary buccal cusps deviate between 1 and 2 mm from the aforementioned
positions (fig. 19), then 1 point shall be scored for that maxillary tooth.

 If the buccal cusps of the maxillary premolars or molars deviate by more than 2 mm
from ideal position (fig. 20), then 2 points shall be scored for each maxillary tooth
that deviates.

 No more than 2 points shall be scored for each maxillary tooth.

 In some situations, the posterior occlusion may be finished in either an Angle Class II
or Class III relationship, depending upon the type of tooth extraction in the maxillary
or mandibular arches.
 In a Class II situation, the buccal cusp of the maxillary first molar should align with
the embrasure or interproximal contact between the mandibular second premolar
and first molar. The buccal cusp of the maxillary second molar should align with the
embrasure or interproximal contact between the mandibular first and second
molars.
 If the final occlusion is finished in a Class III relationship (when mandibular
premolars are extracted), the buccal cusp of the maxillary second premolar should
align with the buccal groove of the mandibular first molar. The remaining occlusion
distal to the maxillary second premolar and mandibular first molar are adjusted
accordingly.
OVERJET
 The overjet is evaluated by articulating the models and viewing the labiolingual
relationship of the maxillary arch relative to the mandibular arch.
 In order to determine the proper relationship of the casts, the examiner must rely
on the trimming of the backs of the bases of the models.
 The models are set flat on their backs, in order to determine this assessment
 If the models are mounted on an articulator, then the articulated mounting shall
determine the proper maxillary and mandibular model relationship.
 If the proper overjet has been established, then the buccal cusps of the mandibular
molars and premolars will contact in the center of the occlusal surfaces,
buccolingually, of the maxillary premolars and molars.

 In the anterior region, the mandibular canines

and incisors will contact the lingual surfaces
of the maxillary canines and incisors.

 If this relationship exists, no points are scored.

 If the mandibular buccal cusps deviate 1 mm or less from the
center of the opposing tooth (fig. 26), 1 point is scored for
that tooth.

 If the position of the mandibular buccal cusps deviates more

than 1 mm from the center of the opposing tooth (fig. 27),
two points are scored for that tooth.

 No more than 2 points are scored for any tooth.

 In the anterior region, if the mandibular canines or incisors
are not contacting lingual surfaces of the maxillary canines
and incisors, and the distance is 1 mm or less, then 1 point
is scored for each maxillary tooth.

 If the discrepancy is greater than 1 mm, then 2 points are

scored for each maxillary tooth.
INTERPROXIMAL CONTACTS
 This assessment is made by viewing the maxillary and mandibular dental casts from
an occlusal perspective.
 The mesial and distal surfaces of the teeth should be in contact with one another.

 If 0.50 mm or less interproximal space exists, then no points are scored.

 If greater than 0.50 to 1 mm of interproximal space
exists between two adjacent teeth, then 1 point is
scored for that interproximal contact.

 If more than 1 mm of space is present between two

teeth, then 2 points are scored for that interproximal
contact.

 No more than 2 points are scored for any contact that

deviates from ideal.
ROOT ANGULATION
 The relative angulation of the roots of the maxillary and mandibular teeth is
assessed on the panoramic radiograph.
 Although this is not ideal, it gives a reasonably good assessment of root position.
 Generally, the roots of the maxillary and mandibular teeth should be parallel to one
another and oriented perpendicular to the occlusal plane. If this situation exists,
then no points are scored.
 The ABO acknowledges the distortion that frequently occurs within panoramic
radiographs. The Board has recommended the following:
 Omit scoring the canine relationship with adjacent tooth root when using a final
panoramic radiograph.

• If a root is angled to the mesial or distal (not

parallel) and is close to, but not touching, the
adjacent tooth root, then 1 point is scored for each
discrepancy (anterior, premolar, and/or molar areas.

• If the root is angled to the mesial or distal and is

contacting the adjacent tooth root, then 2 points
are scored for that tooth.
 The Board’s decision to evaluate an individual case as Complete or Incomplete is based
upon multiple factors. Record quality and the ability to finish a case are important, but
they are not the only aspects that are considered in the evaluation.
 Case management, a sound understanding of diagnosis, treatment planning and
mechanotherapy are equally important and are discussed during the actual interview
when cases are reviewed with the examinee.
 A score corresponding to Complete in the Cast-Radiograph Evaluation and Case
Management are determined at every clinical examination during a pre-exam calibration
session of all examiners.
 Therefore, scores for cases evaluated as Complete will vary from exam to exam and may
range from:
27 or less for C-R Eval
7 or less for CMF
And, case meets DI and case criteria
 High scores on individual segments, or combinations of individual segments, may cause a
case to become Incomplete. From time to time, however, a successful interview may
result in an overturn of an otherwise Incomplete case.
 During the 1997 and 1998 field tests, both subjective and objective methods of
scoring the dental casts and panoramic radiographs were used by the directors.
 Based on a comparison of these two methods, a passing score was established.
 In general, a case report that loses more than 30 points will fail. A case report that
loses less than 20 points will generally pass that portion of the phase III
examination.
 However, this figure only represents a part of the overall score for each case report.
 The quality of the records, appropriateness of the treatment plan, and objectives
for positioning of the maxilla, mandible, maxillary dentition, mandibular dentition,
and facial profile are also carefully scrutinized.
 The Board is presently field testing objective methods for grading these other
aspects of the phase III examination.
 The Cast-Radiograph Evaluation is a measure of the results of treatment based on
analysis of the final dental casts and dental radiographs.
 The most common deficiencies found in the Cast-Radiograph Evaluation are
alignment, buccolingual inclination inadequacies, marginal ridge discrepancies, and
root angulation problems.
 Lateral incisors and second molars most often lack adequate alignment.
 The Case Management Form is a measure of the treatment changes in the skeletal,
dental, and facial soft-tissue aspects of the case.
 This analysis also documents how well the treatment objectives were met.
 The skeletal, dental, and facial analyses must have relevance to the stated
treatment objectives listed on the Written Case Report. If they differ, the examinee
should be prepared to explain what happened or why the goals were not achieved.
 Cephalometric tracing errors are common when the occipital area and the stable
areas of the skull (planum sphenoidum, greater wing of the sphenoid, and cribiform
plate) are not included or clearly depicted.
 The maxilla and the mandible should also be traced with the appropriate landmarks.
Constructed gonion, as demonstrated on the ABO Web site, should be used to
measure the mandibular plane angle.
 Superimposition errors are common when proper landmarks are ignored.
 Proclination of lower incisors resulting from treatment is another situation to which
the examinee needs to pay close attention.
 Although in certain instances based upon the diagnosis, sound treatment planning,
and profile considerations, incisor proclination might be appropriate.
 However excessive advancement and proclination of lower incisors should be
avoided because thismight be detrimental to periodontal health, and could result in
a protruded lower lip and an unaesthetic profile.
 Most orthodontists prefer a particular bracket system.
 It is important to know the system used in case treatment and why it was chosen.
Be ready to explain what appliance modifications were used to address unusual
circumstances.
 The American Board of Orthodontics has existed since 1929 as an independent peer
review institution, supported by the American Association of Orthodontists.
 Recently, several national Orthodontic Board examinations have been introduced.
For example, the European Orthodontic Society set up the international European
Board of Orthodontists (EBO) examination, with the first EBO examination being
held in 1997.
 One aim of these examinations is to encourage orthodontic specialists to participate
in voluntary peer review, thereby acting as stimulus leading to an improvement in
the quality of treatment.
 EBO (European Board),
 BFO (France),
 IBO (Italy),
 ABO (Austria) and
 ABO (USA, American Board Clinical Part III)
 The Board’s examination committee is a sub-group of the professional organization
with executive powers and, in many cases, it is fully independent of its parent body.
 The American Board, for instance, is fully independent in both its constitution, and
its rules and regulations.
 However, the European Board is dependent for its regulations on the European
Orthodontic Society. The EOS decides on matters such as the general set-up of the
examination, but does not interfere with the actual examination or the evaluation
of candidates.
 The Italian organization SIDO has set-up the IBO, but the board is absolutely
independent of the parent body.
 The Directors of the different Board of Orthodontics have spent countless hours
developing this system for assessing the occlusal and radiographic results of
orthodontic treatment.
 The usefulness of this system depends not only on its objectivity, but more
importantly on the validity and reliability of the measurements.
 Diplomates may use this scoring system at anytime in their orthodontic career to
determine if they are producing “Board quality” results.
 The Board hopes that this method of self-evaluation will help to elevate the quality
of orthodontic care in the future.
 Contemporary Orthodontics- Proffit W.R
 Systemised treatment mechanics- McLaughlin, Bennet and Trevisi
 Biomechanics and esthetics strategy in clinical orthodontics – ravindra nanda
 Richmond, S., Shaw, W, et al. The development of the PAR Index (Peer Assessment Rating):
reliability and validity, Europ J Orthod, 14:125-139, 1992.
 Summers, C The occlusal index: a system for identifying and scoring occlusal disorders, Am J
Orthod, 59:552-566, 1971
 Andrews LF. The six keys to normal occlusion. Am J Orthod 1972;62:296-309
 Broderson SP. Anterior guidance: the key to successful occlusal treatment. J Prosthet Dent
1978;39:396-400
 Finishing and detailing with PEA- McLaughlin and Bennet- seminars in orthodontics- 2003
 Common errors in preparing for and completing the American Board of Orthodontics clinical
examination Am J Orthod Dentofacial Orthop 2011;139:136-7
 The development of PAR index Eur J of Orth 14 (1992) 125-139