A METHOD OF FINISHING

THE OCCLUSION
REBECCA POLING
AJODO 1999
INTRODUCTION

• The preadjusted orthodontic appliance has improved the efficiency and effectiveness of the
orthodontist in achieving good final results for patients.
• limited in achieving excellent final results.
• This article presents a comprehensive system of evaluation of the individual patient to be used
during the finishing stage of treatment and a written system of notation that can guide the
orthodontist in producing an excellent finished result for each patient.
• considers multiple aspects of esthetics, occlusion and function, periodontal health, root
alignment, and stability.
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D E TA I L I N G F O R M

6 Sections

3 for examination findings

3 for wire changes notations

and procedure to be done.
 T H E F I N A L D E TA I L I N G A P P O I N T M E N T

• Orthodontist thoroughly examines the patient and records findings on the Detailing Form.
• Helps in integrated plan changes.
• About 4 to 7 months before the removal of the appliances, the patient is scheduled for the 45
minute Final Detailing appointment. And checked for Angles class 1 occlusion and space
closures.
 M A R K I N G O F T H E D E TA I L W I R E S

• Black – maxillary arch wire

• Red- mandibular arch wire.
• Wide midline mark and small interproximal markings
• Bold markings on right end to differentiate quadrants.
• changes to be made in the wire, it is best to use a 19 *25 titanium molybdenum finishing wire
in a 0.022 slot
• Or 17*25 on 0.018 slot.
• TMA wire is brittle and can break easily if one places too many bends.
• tends to collapse with strong closing mechanics and may not hold arch form as well as a
stainless steel wire.
• 0.019 * 0.025 stainless steel wire in a 0.022 slot is usually too heavy to make very many
adjustments and still be able to engage into brackets.
E X A M I N AT I O N O F T H E PA N O R A M I C R A D I O G R A P H F O R R O O T A N G L E B E N D S

• Check for root parallelism.

• “V” bend in the maxillary wire would bring excessively divergent roots together
• “V” bend in the wire to upright the central incisors.
• adjacent roots are too close
• together, a “tent” bend is made to move them apart.
• common problem area is in root angulation of maxillary second premolars and maxillary first molars.
• distal marginal ridge of the second premolar is much more gingival than the mesial marginal ridge of
the first molar.
• noted that there is too much mesial root angulation of the maxillary second premolar due to improper
position of brackets on partially erupted pm.
• root and occlusal table relationship would result in a marginal ridge discrepancy.
• be corrected by a root angle bend of the second premolar moving the root distally
E X A M I N AT I O N O F T H E PAT I E N T ’ S FA C I A L F O R M , I N C I S O R D I S P L AY, A N D
G I N G I VA L C O N TO U R S

• Any asymmetries,
• Over all dental changes to be done and then note for individual tooth.
• Periodontal and gingivectomy for scalloping to improve incisal show are noted.
E VA L U AT I O N O F C O I N C I D E N C E O F FA C I A L M I D L I N E S W I T H D E N TA L
MIDLINES AND OCCLUSAL PLANE

• Correct canting and slanting of occlusal plane.

• Wire changes are noted in the chard which to be done later.
E VA L U AT I O N O F F U N C T I O N A L H A B I T S

• Note in the first section if patient has any history of habits or playing instruments using mouth
that affects the stability of the treatment for selection of retainers.
E VA L U AT I O N O F T H E T E M P O R O M A N D I B U L A R J O I N T S A N D F U N C T I O N

• evaluate interincisal opening, sounds, range of motion, and deviation of the path of opening.
• should check if centric relation is coincident with centric occlusion and note in TMJ evaluation
section.
• initial points of contact, slides, or shifts tooth guidance in excursions and balancing
interferences.
• If any adjustments to be made that has to be mentioned in wire changes section.
 E VA L U AT E A N G L E C L A S S I F I C AT I O N A N D O V E R J E T

• if it is not Class I, then it should be noted in the third section of the Detailing Form how many
millimeters Class II or Class III.
• Note the need for elastic wear, interproximal reduction for tooth size, restorative needs as with
small maxillary laterals.
• Noted in the fifth section of the Detailing Form.
 E VA L U AT E P O S T E R I O R T R A N S V E R S E C O N C E R N S

• evaluate posterior transverse relationships, posterior crossbite tendencies, or buccal position of

individual teeth, especially maxillary second molars are noted in third section of the form.
E VA L U AT E V E RT I C A L R E L AT I O N S H I P S

• curve of Spee.
• overbite in millimetres and percentage.
• the third section
E VA L U AT E S PA C I N G A N D TO O T H S I Z E
R E L AT I O N S H I P S

• spacing and determine the best method to correct any concerns.

• If need for restorative therapy mention in fifth section.
E VA L U AT I O N O F M A X I L L A RY A N T E R I O R TO O T H
POSITIONS

• overall view of root positions, function, and the occlusion, specific positions of the teeth are
evaluated.
• Starting with the maxillary anteriors check that the central incisors are even and equilibrate the
incisal edges(if length adjustments to be made restorativel mention in 5th section)
• Check for root angles and black triangular spaces and if present correct by root angle
bends,stripping and restore.
• Torque should be same for all incisors for better stability.
• For palatally placed laterals high torque is needed to improve stability and prevent relapse.
• maxillary lateral incisor edges should be slightly higher than the central incisor edges.
• canines should be slightly longer than the maxillary central incisors for the best canine
guidance in lateral excursions.
E VA L U AT I O N O F M A X I L L A RY R I G H T P O S T E R I O R S E G M E N T A N D T H E
M A X I L L A RY L E F T P O S T E R I O R S E G M E N T

• “Ideal” crown torque of the canine should be checked.

• Evaluate crown torque and the parallel contours of the facial surfaces of the premolars and
molars.
• The facial cusp lengths of all the facial cusps should be even and of the same length except that
the maxillary canine.
• flatness of the occlusal table as examined from the occlusal should be checked with special
attention on second molar area.
• check the alignment of the central fossae and the alignment of the functional lingual cusps.
• second premolar is smaller faciolingually and have to compromise in aligning the facial surface
of the tooth or in the position of the functional lingual cusp of this second premolar.
• Noted in wire changes section.
• Same for mandible.
 E VA L U AT I O N O F T H E M A N D I B U L A R A N T E R I O R S E G M E N T

• The mandibular anteriors canine to canine are evaluated for even height of the four incisors,
long axis of the crowns, and normal triangular embrasures, rotations, and ideal torque.
• Torque of all four incisors should be the same to prevent relapse.
• The mandibular canines are little for the best canine disclusion.
• mandibular canine may be rotated out slightly on the mesial for the most stable contact with the
mandibular lateral to resist the tendency for lingual collapse and relapse.
• wire changes section.
 E VA L U AT I O N O F T H E M A N D I B U L A R R I G H T A N D M A N D I B U L A R L E F T
POSTERIOR SEGMENTS

• checking for parallel contours of the facial surfaces

• need for torque changes for improvement in buccolingual inclination, alignment of the
functional buccal cusps, and cusp tip height
 I N T R A O R A L E VA L U AT I O N O F A L I G N M E N T A N D
I N T E R D I G I TAT I O N O F T H E O C C L U S I O N

• supine position
• correction of rotations especially in the upper premolar, positioning the maxillary functional
lingual cusps to articulate into the distal fossae of the mandibular premolars.
• Check torque of the incisors with a mirror.
• final evaluation and the most important step is to view the occlusion with a mirror looking up
under the buccal cusp tips and incisal edges of the maxillary teeth.
• If any doubts on cusp to foaas relationship check with horseshe articulating paper
 B E N D I N G A N D I N S E RT I O N O F T H E “ D E TA I L ” W I R E

• Decide whether to bend immediately or during nonpatient time.

• Use AEZ arch bending plier. Wire most not have morethan 10 adjustment bends.
• First- root angle
• Second- vertical and in-out bends
• Finally-torque changes.
• If both wires are being inserted at the Final Detailing appointment, finishing bends are made
first in the maxillary wire and coordinated with the mandibular wire.
F O L L O W- U P D E B A N D C H E C K A P P O I N T M E N T

• After 4-6weeks untie the wire ,check for adjustments and mark the findings.
• If no adjustments are required debond the appliance.
P R O C E D U R E S A F T E R R E M O VA L O F T H E
APPLIANCES

• After debonding check for centric contacts wit articulating papers and equilibrate the occlusal
contacts and remove any balancing interferences and adjust incisal edges for better esthetics
and function.
 DISCUSSION

• esthetics,
• occlusion and function,
• periodontal health and root alignment, and
• stability.
 ESTHETICS

• First, in the area of esthetics, the orthodontist must make decisions regarding facial form and
harmony, smile line characteristics, gingival display, incisor display, arch form, dental
alignment and inclination, and individual tooth characteristics.
• Mack in a review of facial esthetics and treatment planning noted that a comprehensive
evaluation that relates the facial soft tissues to underlying skeletal form is necessary in planning
correction of deficient facial proportion and integumental form.
• Lombardi states that orthodontist selects a very broad square arch form, the first premolar may
be a key tooth in a natural transition from anterior to posterior.
• If the maxillary first premolar has excessive labial crown torque or too short gingivally will be
unesthetic.
• Lombardi further discusses the impact of “negative” space in the composition of the “positive”
space. One should evaluate the smile focusing on the negative space created at the
commissures of the lips as well as between the arches.
• Treatment of the interarch negative space can impart age, sex, and personality characteristics.
For instance, straight, flat, incisal edges with sharp corners can give the illusion of an older
worn dentition.
OCCLUSION AND FUNCTION

• The second major area the orthodontist must consider in finishing is the final occlusion of the
patient and acceptability of function.
• the orthodontist must decide what specific characteristics the occlusion will have in three areas:

• temporomandibular joints, centric relation, and centric occlusion,

• final occlusal pattern of maximum intercuspation or achievement of the six keys of a normal
occlusion and
• functional pattern of canine disclusion or group function.
• In the first occlusion area, current literature reveals very limited interaction of morphologic and
functional occlusal factors with temporomandibular dysfunction.
• a harmonious relationship between the occlusion and the temporomandibular joints should
exist.(Buhner WA. The gestalt of occlusion: a clinical appraisal. J Prosthet Dent 1980;44:545-51.)
• The second occlusion area to be evaluated and planned is the final occlusal pattern achieved in
centric occlusion.
• the orthodontist may prefer to follow the principles of the “six keys to a normal occlusion” as
presented by Andrews.
• In achievement of this final occlusal pattern, the orthodontist would focus on the interdigitation
of the maxillary first molar distobuccal cusp into the mandibular second molar mesial marginal
ridge.
• The third occlusion area to examine is the functional pattern of occlusion.The orthodontist
must decide the most ideal functional pattern for each patient, be it
• canine disclusion in lateral excursions,
• “group function” in lateral excursions and the extent of the teeth involved in group function,
and
• positions of the incisors for anterior guidance.
P E R I O D O N TA L H E A LT H A N D R O O T A L I G N M E N T

• A third major area.

• The orthodontist should evaluate root proximities, interproximal alveolar bone crest and
cementoenamel junction alignment, vertical bone defects, open triangular gingival embrasures
or “black triangles,” gingival recession, gingival contours and ideal scalloping,
pseudopocketing and gingival display, and fibrous frenula.
• incisor root position has not been shown to have long-term deleterious effects on periodontal
health,more ideal esthetics, function, and stability are enhanced through good root alignment.
(Artun J, Osterberg SK, Kokich VG. Long-term effect of thin interdental alveolar bone on periodontal health after orthodontic treatment. J
Periodont 1986;57:341-6.)

• periodontal procedures such as frenectomies, gingivectomies,1 and circumferential

fiberotomies should be considered to improve esthetics and stability. (Kokich V. Esthetics: The
orthodontic-periodontic restorative connection. Semin Orthod 1996;2:21-30.)
 S TA B I L I T Y

• The final major area for consideration

• Stability is affected by the decisions made during treatment planning, such as extraction of
teeth, alteration of arch form, expansion of intercanine width, and treatment mechanics.
• expand arch form and intercanine width to enhance esthetics but less stable.
• To prevent use fixed retainers.
• Over correction of rotated tooth
• Splint retainer for a patient with bruxism habit.