Finishing Stage Part1

Finishing stage
Part 1
By
Osama Atef Ezz El Regal
Part 1
Outline
1. Introduction
2. Intraoral Objectives
A.intra- arch (objectives & Adjustments)
a)Individual Tooth Positions
b)first order
c)Second order ,Radiographs
d)Third order
B.inter-arch (objectives & Adjustments)
a)Tooth size discrepancy
b)Midline Discrepancies
c)Excessive Overbite
d)Anterior Open Bite
Introduction
• Finishing is the last phase of “active” treatment

1. Levelling and aligning
2. over bite correction
3. spaces are closure
4. the final stage of treatment is to get the details correct.
• heavily dependent upon the previous stages of treatment.

• It is extremely difficult to achieve an acceptable end result when the
treatment objectives and proper mechanics have not been met
Introduction
• CONTEMPORARY EDGEWISE TECHNIQUES

• much less treatment remains
• individual tooth positions adjustment in order to get
1. precise in–out positions of teeth
2. marginal ridges level
3. minor root movements
4. overcome any discrepancies by (errors in bracket positioning or
appliance prescription)
5. the vertical relationship of incisors, as in (moderately excessive deep
bite or a mild anterior open bite) cases.
Introduction
A logical sequence of archwires for

continuous arch edgewise technique
based on :
1- that the most efficient archwires
should be used, so as to minimize
clinical adjustments and chair time
2- that it is necessary to fill (or nearly
fill) the bracket slot in the finishing
stage with appropriately flexible
wires to take full advantage of the
modern appliance.
Introduction
That means that at finishing stage the wires should be :

• 17 × 25 st.st. in 18-slot brackets
• 21 × 25 TMA or m-niti in 22-slot brackets
Intraoral Objectives
Intra-Arch (objectives & Adjustments)
Adjustment of Individual Tooth Positions
• At the finishing stage
• Unnecessary if appliance prescription and bracket positioning
were perfect
• But due to the variations in
(tooth anatomy and bracket placement) some tooth position
adjustment may be needed
if bracket is poorly positioned

1. Rebond the bracket
2. Placing compensating bends in archwires
1- Rebond the bracket

• after bracket rebonding
• a flexible wire must be placed to bring the tooth to the correct position.

• Arch wires for tooth positioning in finishing stage:
Appliance 18-slot 22-slot
Arch wire
The next-to-last 17 × 25 beta-titanium (beta-ti) 21 × 25 martensitic nickel–
wire satisfactory titanium (m-niti) best choice
(for step bends)
The final wire 17 × 25 steel (stiffer) 21 × 25 beta-ti (stiffer)
(for torque)

2- Step Bends
a) They must be placed in a flexible full-dimension wire
• (the next-to-last wire)
b) Any bend placed Must be repeated in the final wire that is used for
torque
c) the position of step bend is not a critical in determining its effect
• like the position of a V-bend relative to the adjacent brackets.
The first order (in-out / rotation )

Should follow
• Tight interproximal contacts
• No rotations.
• Allowing the perfect arch form.
The first order
Occlusal mirror to
• identify minor rotations
• buccolingual displacement outside the
perfect arch form
The first order
The upper first molar

• Mesiobuccal cusp makes mesial out
rotation of the is considered to be ideal.
• the buccal surface of the upper first molar
should be parallel to the palatal suture
The second order ( mesio-distal / tipping)
• evaluate the root parallelism and marginal

ridges.
1. (Clinically) The marginal ridges

should be at the same level especially buccal segments.
2. (Radiograph)root parallelism
important for retention and stability.
The second order

In the the edgewise appliance
• During space closure phase

• the goal is to achieve bodily tooth movement
• and preventing the crowns from tipping toward each other.
The second order

In the the edgewise appliance
In case of a small amount of tipping will occur after space closure

• some degree of root paralleling at extraction sites often will be necessary.
In case of improper bracket positioning

• root separation or paralleling may be needed in non extraction cases
• (this is most likely on maxillary lateral incisors and premolars).
The second order

In standard edgewise brackets
• Similar to begg and tip edge
technique
• That use springs
• For controlling root tipping
The second order

In standard edgewise brackets
• may includes a vertical slot behind the

edgewise bracket
• allows root tipping
• using springs that inserted and hooked
• beneath the main st.st. arch wire.
The second order

In preadjusted edgewise brackets
• No Up righting springs and vertical slots

• Angulated bracket slots
• Allow proper root paralleling
• when a flexible full-dimension rectangular wire
is placed.
The second order

With the 18-slot appliance
To correct mild tipping

• finishing arch wire is (17 × 22 or 17 × 25) st.st.
• flexible and produce the necessary root paralleling moments.
The second order

To correct greater degree of tipping

• more flexible rectangular arch wire is needed.
To correct more severe tipping

• 17 × 25 beta-Ti (TMA)
• 17 × 25 nickel–titanium (M-NiTi)
The second order

With 22-slot brackets
• if teeth have tipped even slightly into an extraction
space or if other root-positioning is needed
Under most circumstances

• 21 × 25 beta-Ti wire is
if significant root positioning is needed

• 21 × 25 M-NiTi should be used first.
The second order

With 22-slot brackets
If greater range of action is needed (severely tipped tooth)

• A-NiTi wire initially, then M-NiTi.
We can’t use for tipping

• 19 × 25 st.st. ( too stiff )
The second order

A root-paralleling moment
• a crown-separating moment .
• When a full-dimension rectangular wire is
placed in maxillary arch.
• spaces are likely to open between the incisors
in non-extraction as well as extraction cases.
The second order

So
• The teeth must be tied together
• The entire archwire must be tied back against
the molars
• to prevent spaces from opening.
• Teeth at extraction sites and maxillary incisors
must be protected
The second order

Root parallelism is important for three reasons:
1. to transmit occlusal load of the forces across the longitudinal axis of
the tooth.
2. A greater potential for relapse If only the crown has been tipped and
the root is not in its proper position.
3. A greater potential for periodontal problems due to root proximity.
Radiographic Objectives
Panoramic Radiograph
• Recommended before starting the finishing
stage
1. to evaluate root position ,angulation
and root parallelism.
2. Evaluating root resorption If observed,
that might dictate ending treatment
early or taking a break from the final
active treatment for 3 to 4 months to
allow cementum to heal.
3. Evaluation of periodontal health

4. Evaluation of eruption angle of the third molars.
5. Evaluation of position and the eruption pattern of the
second molars
if eruption was delayed or when orthodontic treatment
was finished before complete eruption
• Problems of second-order
angulation are commonly
found in
1. the upper lateral incisors
2. lower premolars
3. teeth adjacent to the
extraction sites.
• Problems might be related to
1. abnormal tooth morphology
2. bracketing errors
Periapical radiographs
• Indicated only when any significant findings is observed in the panoramic
radiograph
• to obtain a more detailed view
such as:
1. extensive root resorption
2. Evidence of periodontal bone loss
3. root parallelism between teeth adjacent to an implant site
The third order (labiolingual – torque)

• Affect
1. the esthetics of the smile (an extraoral category).
2. the inter-arch objectives (the occlusal relationship)
• The third order

• inclination of buccal segment
a small curve of Monson
• At buccal segments to allow proper occlusal function
• (i.e. adequate intercuspation without balancing
interferences).
An accentuated curve of Monson
• Cause balancing interferences, especially in the second
molar area
• Found in adults after the dental correction of buccal
crossbites
• without expansion of the basal bone/palatal suture
The third order

inclination with anterior teeth
• important for good occlusion
• important for good esthetics of the smile
(extraoral category)
inclination of upper canine and first premolar

• the buccal surfaces should be close to parallel to
the mid sagittal facial line in an ideal smile.
The third order

• Are difficult and time consuming.
• Need extensive bone remodeling
Controlling third order can be done by
1. maintaining a proper moment/force ratio during the retraction phase in extraction
cases.
The third order

2. To allow only root correction and prevent incisors from flaring.
a) 3rd order bend for anterior teeth
b) cinching the arch wires
c) lacing the entire arch.
• Mesial migration of upper molar (rowboat effect) can be generated
• So use of Class II elastics is recommended to prevent it.
3. Auxiliary torquing springs

• a mild bowing of the anterior segment is expected
The third order

Lingual Root Torque of Incisors
• If incisors tipped lingually more than desired while retraction

• Lingual root torque may be required as a finishing procedure.
The third order

In the Begg technique
• If the incisors tipped back during retraction
• lingual root torque is a part of the finishing stage
• this was accomplished with
1. an auxiliary appliance “piggyback arch”
2. over the main or base arch wire.
The third order

The torquing auxiliary is a “piggyback arch”
• contacts the labial surface of the incisors near the gingival margin
• creating the necessary couple with a moment arm of 4 to 5 mm .
• can be used in edgewise technique in the same way
The third order

the basic principle of torquing auxiliary :
1. the auxiliary arch
2. Initially shaped into a tight circle
3. when it is partially straightened out to normal arch form
4. It exerts a force against the roots of the teeth
The third order
The torquing
auxiliary
“piggyback arch”
In a patient with a Class II malocclusion

• Anchorage reinforcement is required to maintain overjet correction
• During torqueing upper incisor roots lingually.
• So Class II elastics are necessary
The third order

With a modern edgewise appliance
• only moderate additional incisor torque may be needed during the finishing
stage.
• a 17 × 25 st.st. arch wire
Built-in torque in the bracket slot
• There is no need to place torquing bends in the arch wire
• making the accomplishment of torque
• as a finishing procedure relatively straightforward.
The third order

With 22-slot brackets with built-in torque
• Tipping of incisors can be prevented during retraction and space closure.

• full-dimension M-NiTi or beta-Ti arch wires can be used
• (torque built in) reduce the need for auxiliary arches.
• for 22-slot edgewise torquing auxiliaries have almost disappeared from
contemporary use
except
• when upright incisors are to be corrected by tipping the crowns facially.
• The auxiliaries are probably the best way to do this.
The third order

With 22-slot brackets with built-in torque
• full-dimension st.st. rectangular wires are too stiff for effective

torquing
• Not effective For correcting ligually tipped incisors
• to place a rectangular steel arch wire only
• depending on bracket torque-prescription
• because the wire creates too much torsional force and has a very
limited range.
The third order

With 22-slot brackets Without built-in torque
• before titanium archwires were available
• torquing auxiliaries were commonly used
The third order

IN Class II division 2 malocclusion
• If maxillary central incisors are severely tipped

lingually
• require torquing movement
• while the lateral incisors need little torque.
• Burstone torquing arch is the most effective torquing
auxiliary
• Because of the long lever arm,
• It is equally effective with the 18- or 22-slot
appliance.
The third order

IN Class II division 2 malocclusion
• With all four incisors need considerable torque
• use of a wire spanning from the molar auxiliary tube to
the incisors,
• with a V-bend so that the incisor segment receives the
greater moment,
• is a highly efficient approach.
The third order

Three factors determine the amount of torque that will be expressed by
any rectangular arch wire in a rectangular slot:
1. the torsional stiffness of the wire
2. the inclination of the bracket slot relative to the archwire
3. the tightness of the fit between the archwire and the bracket.
The third order

what finishing wires are intended For full expression of the torque
built into brackets in the 22-slot appliance,
A. 21 × 25 beta-Ti wires
• usually the best
• This wire’s torsional stiffness is less than that of 17 × 25 steel
• but the shorter inter-bracket distances with 22-slot twin brackets bring its
performance in torsion close to that of the smaller steel wire.
The third order
B. Braided rectangular steel wires

• are available in a variety of stiffnesses
• the stiffest of these in 21 × 25 dimension also can be useful in 22-slot
finishing.
The third order
C. A solid 21 × 25 steel wire

• not recommended
• because of
1. its stiffness
2. the resulting extremely high forces
3. short range of action.
• used for surgical stabilization
• and should be preceded by 21 × 25 beta-Ti.
The third order
Buccal Root Torque of Premolars and Molars
• Can affect smile esthetics
• It is common that at the end of fixed appliance treatment,
• maxillary canines and premolars Roots are tipped facially and crowns
lingually
• because the prescription in many modern brackets provides negative
torque
The third order

• (lingual crown torque) for these teeth.
• this negatively affects smile esthetics
• by making the canines less prominent
• and causing the first premolars to almost disappear on smile.
• especially in patients with narrow and tapered arch forms
The third order

To obtain a broader and more pleasing
smile,
• the solution is not to expand across the
premolars
• but to use buccal crown torque so that
the crowns are uprighted
• This gives the appearance of a broader
smile
• without the risk of relapse that
accompanies arch expansion.
The third order

It is important in dental esthetics to
• Research into what patients see
• Do not deal with this subtle effect as it can change the patient perceptions
about the appearance of his teeth.
• some people may noticed it
• and the majority simply had no idea what they were looking at.
The third order

Orthodontists
• appreciate the esthetic effect of this uprighting
• may also provide better interdigitation of first premolar lingual cusps.
Inter-Arch Analysis (objectives & Adjustments)
Upper and lower Arch interocclusal relationship

1. Evaluated from intraoral frontal and buccal occlusion views.
2. the canines into a Class I relationship (ant.-Post.)
3. canine-guided functional occlusion is to be achieved
4. the first molars interocclusal relationship (ant.-Post.)
5. Normal intercuspation (cusp to fossa / cusp to embrasure )
6. Normal incisors overjet (ant.-Post.)
7. Normal incisors overbite (vertical)
8. Coordination of inter-canine and intermolar widths (transverse).
9. Coordination The premolar area (transversely).
Ideal interocclusal relationship is difficult to achieve with :

1. Tooth size discrepancy
2. Midline Discrepancies
3. Excessive Overbite
4. Anterior Open Bite
Tooth Size Discrepancies

A significant tooth size discrepancy
exists between the dental arches
(i.e. a Bolton discrepancy).
Example:
• upper lateral incisors
• lower second premolars

• Correction or compensation for it must be part of the initial
treatment plan
As a general guideline
• from Bolton analysis the threshold for clinical significance of
tooth size discrepancy is 2 mm.
• So more than 2mm discrepancy will necessitate steps to deal
with it during treatment. And not be delayed at the finishing
stage

Discrepancies due to excess tooth size
• Interproximal enamel reduction (IPR).
Discrepancies due to tooth size deficiency

• leave space between the diffident teeth
• Finally will be closed by restorations.

IPR
1. bonded appliance allows IPR at any time.
2. When IPR is part of the original treatment plan
3. most of reduction should be done initially
4. but final reduction can be deferred until the finishing stage.
5. This allows direct observation of the occlusal relationships before the
final tooth size adjustments.
6. A topical fluoride treatment recommended immediately after IPR.

deficient maxillary lateral incisors.
Treatment options can be as the following

1. composite buildup
2. Laminate veneer
3. Delaying restoration
4. Leaving the space

deficient maxillary lateral incisors.
1- composite buildup
• The best plan
• Should be done during the finishing stage for easier and Precise finishing
• The lateral incisor root should be close to ideal position before buildup
• because change in root position after buildup will change contact points and
embrasure relationships leading to bad esthetics .
2- Laminate veneers
• should be delayed because bonding and debonding may damage the it’s surface

Dificient maxillary lateral incisors.
3- Delaying restoration
• The main reason for waiting until after the orthodontic appliance has been removed.
• would be to allow any gingival inflammation to resolve itself.
• So the restoration should be done during retention phase.
• initial retainer to hold the space
• new retainer immediately after the restoration is completed.
4- Leaving the space

• distal to the lateral incisor can be esthetically and functionally acceptable

More generalized small deficiencies
It is also possible to compensate by
1. third-order bends
2. slightly tipping teeth
3. finishing the ortho. treatment with mildly excessive overbite
4. finishing the ortho. treatment with mildly excessive overjet

1- third-order bends
can be masked by altering incisor inclination by third-order bends in the
finishing archwires
large upper incisors
• Torque of the upper incisors can be used To a limited extent
• by leaving the incisors slightly more upright
• to take less room relative to the lower arch.
small upper incisors
• slightly excessive torque can partially compensate

2- slightly tipping teeth
Decrease any excess space in the anterior
region
• Small adjustments in the second-order
angulation of the anterior teeth (i.e.
accentuating the distal tip)
Midline Discrepancies
• Midlines should be coincident.
• Affect interocclusal relationships in how the posterior teeth fit together
• >2 mm discrepancy should be treated in the early phases of treatment.
• If not 1–2 mm or more discrepancy between the midlines will result in
• an improper interocclusal relationship, at least in one of the buccal
segments
• The midline objectives should be evaluated in the intraoral and extraoral
finishing category ( specially the upper arch ).
• it is undesirable esthetically to displace the maxillary midline, bringing it
around to meet a displaced mandibular midline.
• Minor midline discrepancies
not a great problem
• Large midline discrepancies

it is quite difficult to correct
specially after extraction spaces have been closed and occlusal
relationships have been nearly established.
• This can result from
1. Improper planning or mechanics
2. Dental Cause
3. Skeletal Cause
4. Mandibular shift
5. Incisal Cant.
Can Result from
1- Improper planning or mechanics
a) a preexisting midline discrepancy that was not
completely resolved at an earlier stage of treatment
b) asymmetric closure of spaces within the arch.
Can result from
2- Skeletal Cause
• Skeletal asymmetry
• it may be impossible to correct it orthodontically
• the treatment should be camouflage or surgical correction
3- Dental Cause
• usually not severe
• caused only by lateral displacements of maxillary or
mandibular teeth
• that accompanied by a mild Class II or Class III relationship
on one side.
3- Dentally
can be corrected by (1 - 2mm)
• the range of correction for each arch is approximately 1 mm to
each side.
• Tipping is the major type of tooth movement that can be used
to correct midlines
• Treated by anterior cross elastics.
• Or a combination of Class II elastics on one side and Class III
on the other can be used.
Class II or Class III and anterior cross elastic
should be reserved for small discrepancies
long term use side effect occur in the vertical and transverse planes
• the vertical component of the anterior cross elastic force cause canting of the
occlusal planes
• In The Transverse plane, rotation of the dental arches around the y axis with the use
of Class II/Class III elastics may result in a crossbite tendency on one buccal segment
and a Brodie bite tendency on the other
CIII CII
Midline Discrepancies ELASTICS ELASTICS
4- Mandibular shift
• Arise easily if a slight discrepancy in the transverse position of
posterior teeth is present.
Example 1.
• A narrow maxillary right posterior segment
• can lead to a shift of the mandible to the left on final closure,
creating the midline discrepancy.
Can be treated by
• by correcting the transverse arch relationships
• by (careful coordination of the maxillary and mandibular
archwires, reinforced by a posterior cross-elastic).
Example 2.
• If the entire maxillary arch is slightly displaced transversely relative
to the mandibular arch
• so the teeth are in excellent relationships in occlusion, but there is a
lateral shift to reach that position.
The treatment
• involve posterior cross-elastics but in a parallel pattern
• (i.e., from maxillary lingual to mandibular buccal on one side and the
reverse on the other side).
5- Incisal Cant. can Affect midline
Excessive Overbite & Anterior Open Bite

• If the first two stages have been accomplished perfectly
• no change in the vertical relationship of incisors will be needed at the
finishing stage.
• anterior open bite is more likely to be a problem than residual excessive
overbite.
Excessive Overbite
• Before correction
• why the problem exists ?
• evaluate two things:
1. The vertical relationship between the upper lip and maxillary incisors
2. Anterior face height.
Excessive Overbite
1- The vertical relationship between the upper lip and maxillary incisors
If Appropriate maxillary incisors display of the on smile

• Maintain this relationship
• Make any overbite correction by repositioning the lower incisors.
If Excessive maxillary incisors display of the on smile

• intrusion of the upper incisors would be indicated.
Excessive Overbite
2- Anterior face height.
With Short facial height
• elongating the posterior teeth slightly (the lower posterior teeth)
would be acceptable
With Long facial height
• intrusion of incisors would be needed.
Excessive Overbite
For example:
1. a stabilizing trans-palatal arch needed
2. cutting the rectangular finishing arch wire distal to the lateral
incisors
3. Making two segment anterior segment and buccal segment
4. install an auxiliary intrusion arch
5. That is tied to this Anterior segment in the appropriate place
Excessive Overbite
Lingual arch or TPA
1. is to controls transverse relationships prevent excessive distal
tipping of the maxillary molars
2. The greater the vertical change in incisor position needed
3. The more important to have a stabilizing lingual arch in place and
vice versa.
4. Small corrections do not require a lingual arch or TPA.
Excessive Overbite
if slight elongation of the posterior teeth is indicated
1. step bends in a flexible arch wire would be satisfactory.
2. The arch wire before the final finishing arch wire is used for
these step bends
3. (17 × 25 TMA with the 18-slot appliance, 21 × 25 M-NiTi
with the 22-slot appliance).
Excessive Overbite
or
1. An auxiliary depressing arch for
overbite correction can be effective
2. The continuous base arch wire is
should be a relatively small round wire
3. not preferred approach for a slight
overbite correction.
Anterior Open Bite

• why the problem exists ?
1. excessive eruption of posterior teeth
2. a poor growth pattern
3. excessive use of inter arch elastics can be very
difficult to correct
• Evaluate two things:

1. The vertical relationship between the upper lip and
maxillary incisors
2. Anterior face height.
Anterior Open Bite

With severe long face growth pattern.
• intrusion of posterior teeth
• By Using skeletal anchorage to be more effective.
• Placing miniplates or palatal anchors
Anterior Open Bite

A mild open bite with no facial growth pattern problems
1. This may be due to an excessively leveled lower arch.
2. This is managed by elongating the lower incisors
3. creating a slight curve of Spee in the lower arch.
4. use vertical elastics to deepen the bite
5. flexible lower arch wire, a stabilizing stiffer upper wire
Anterior Open Bite

Inadequate upper incisors display
1. This indicate elongation of upper incisors to close the bite
2. the same approach with the flexible or stabilizing arch wires reversed would
be indicated.
Anterior Open Bite

keep in mind when vertical repositioning of incisors is
planned
A- Elongating the lower incisors to close a moderate
anterior open bite
• is a quite stable procedure.
B- Elongating the upper incisors
• is less stable
• compromises facial esthetics if it makes them too
prominent.
• Anterior Open Bite
References:
1. Contemporary Orthodontics ,6ed (2019)
2. Biomechanics and Esthetic Strategies in Clinical Orthodontics ,1ed
(2005)
Finishing stage
Part 2
By
Osama Atef Ezz El Regal
Part 2
Outline
3. Extraoral Objectives
A. Smile arc
B. Incisor display
C. Gingival display
D. Buccal corridors
E. Incisal cant.
F. Midlines
G. Third-order inclination (torque)
H. Tooth morphology in the esthetic zone.
Extraoral Objectives
• Based on facial and smile esthetics
Factors needed to be evaluated within the smile:
1. Smile arc
2. Incisor display
3. Gingival display
4. Buccal corridors
5. Incisal cant.
6. Midlines
7. Third-order inclination (torque)
8. Tooth morphology in the esthetic zone.
1- Smile Arc
• The ideal smile arc (incisal edge follow lip line
curvature).
In the finishing stage
• little can be done to affect the smile arc.
• Only small finishing bends
can differentially extrude or intrude the anterior teeth
The problem with wire bends is
• the potential for antagonistic effects
on the interocclusal finishing objectives.
An example
• A perfect overbite is and the teeth need to
be extruded to achieve an ideal smile arc.
• A choice is needed between achieving
1. an esthetic objective (ideal smile arc)
2. an occlusal objective (ideal overbite).
• A compromise might be the best decision.

• The amount of compromise is limited for
each characteristic i.e.
1. avoid finishing with >50% overbite
2. avoid a flat or reverse smile arc
2- Incisor Display
• females show 2–3 mm of incisor at rest and Males show 1 mm less.
• A plan is made for correction of any deviation During diagnosis and
treatment planning phases
• So at finishing phase of treatment
1. the vertical incisor objectives should have already
been accomplished.
2. Detailing is limited to proper alignment and leveling
of the incisal edges (providing no restorations are
needed).
3. Attempting to significantly intrude or extrude the
incisors may complicate and prolong treatment.
Open bite malocclusions with (moderate / excessive) incisor display :
1. they are difficult to correct.
2. It is usual to find an open bite tendency still present at finishing phase
Correction :
• done by extruding the lower anterior teeth
• and accentuating the lower curve of Spee
• If no additional upper incisor display is desired
3- Gingival Display
• females show 1 mm of gingiva when smiling Males
show 0-1 mm
• The amount and characteristics of the gingival display
Important to Evaluate
1. symmetry in the gingiva
2. Gingival height relationships of adjacent upper teeth.
Can be corrected
• by selective intrusion or extrusion of any of the anterior
teeth.
• within a narrow range of approximately 1 mm
• Limited by The overbite
If incisal wear is not present
• the incisal edges will reflect gingival height asymmetries
• incisal edges will determine the vertical finishing movements
of the anterior teeth
If incisal wear is present

• the gingival height relationship
• will determine the vertical finishing movements of the
anterior teeth
If there is significant incisal wear
The final incisal edge position is determined by
1. proper tooth proportions
2. gingival heights
3. relationship to the upper lip
4. crown/root ratio
5. overbite
6. Periodontal procedures should be considered as an
adjunct to the esthetic objectives after finishing in
patients with an excessive gingival display or
asymmetric gingival heights.
The periodontal procedures that can be considered are
• gingivectomy or crown lengthening
• (depending on the alveolar bone level) (Fig. 17-14).
may be combined with prosthetic alternatives in
patients with
• worn incisal edges,
• abnormally shaped incisors (i.e. peg laterals).
A common unesthetic result
• after gingivectomies or crown lengthening
• (performed exclusively in the anterior segment)
• the transition area from the canine to the premolars.
• Ideally, there should be a 1 mm step down in gingival height
between these teeth.
• When gingivectomies are not carried to the premolars,
• excess gingiva remains more pronounced in the corners of
the smile (Fig. 17-15).
the gingival height & Symmetry at the lower
incisors and the canines .
• In the literature little attention has been given
to it
• They are important factors
• in individuals over 30 years of age
• as the lower gingival margin is more visible.
• a discrepancy in gingival heights between the
lower incisors and the canines may be found,
• particularly in deep bite patients (Fig. 17-16).
In young patients,
• the gingival margin follows the incisal edges of
the lower anterior teeth.
• This problem is corrected during the initial
phases of orthodontic treatment
• When the canines and central incisors are
leveled.
In the adult,
• Incisal wear complicate the determination of proper
gingival heights.
• when the incisors with incisal wear supra-erupt,
• a good incisal edge relationship with the canines will
exist,
• but a significant discrepancy in the gingival height will
develop.
To correct this discrepancy:
A. Gingivectomy/Crown lengthening to match
gingival heights with no restorations
B. Gingivectomy/Crown lengthening and
restorations (composites or veneers or
crowns)
C. Intrusion of the four anterior teeth to level
the gingival heights (no surgery) and
restorations (composites or veneers or
crowns).
A very important factor in deciding
between these alternatives is the
crown/root ratio.
A. Any osseous resective periodontal
procedure (crown lengthening)
increases this ratio
B. therefore, a good assessment of the
remaining root structure is required
4- Buccal Corridors
• Ideally if there is wide dental arches the
buccal corridors should be narrow
• This should have been corrected before the
finishing stage.
• Any type of arch expansion during the
finishing stages
• is difficult to achieve
• and unstable in the long term.
5- Incisal Cant
Examined From the frontal
view
This cant may be limited to
1. the incisor segment
2. the entire maxillary arch.
The incisal cant can be the result of
1. incorrect bracket positioning
2. asymmetric mechanics
3. a true maxillary skeletal cant
which was undetected during diagnosis
due to dental compensations.
References:
1. Contemporary Orthodontics ,6ed (2019)
2. Biomechanics and Esthetic Strategies in Clinical Orthodontics ,1ed
(2005)

Finishing Stage Part1

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Finishing Stage Part1

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Finishing stage

• Finishing is the last phase of “active” treatment

• heavily dependent upon the previous stages of treatment.

• CONTEMPORARY EDGEWISE TECHNIQUES

A logical sequence of archwires for

That means that at finishing stage the wires should be :

Adjustment of Individual Tooth Positions

if bracket is poorly positioned

1- Rebond the bracket

Adjustment of Individual Tooth Positions

Adjustment of Individual Tooth Positions

The first order (in-out / rotation )

The first order

The first order

The upper first molar

The second order ( mesio-distal / tipping)

• evaluate the root parallelism and marginal

1. (Clinically) The marginal ridges

The second order

• During space closure phase

The second order

In case of a small amount of tipping will occur after space closure

In case of improper bracket positioning

The second order

The second order

• may includes a vertical slot behind the

The second order

• No Up righting springs and vertical slots

The second order

To correct mild tipping

The second order

To correct greater degree of tipping

To correct more severe tipping

The second order

Under most circumstances

if significant root position­ing is needed

The second order

If greater range of action is needed (severely tipped tooth)

We can’t use for tipping

The second order

The second order

The second order

3. Evaluation of periodontal health

The third order (labiolingual – torque)

• The third order

The third order

inclination of upper canine and first premolar

The third order

The third order

3. Auxiliary torquing springs

The third order

• If incisors tipped lingually more than desired while retraction

The third order

The third order

The third order

The third order

In a patient with a Class II malocclusion

The third order

The third order

• Tipping of incisors can be prevented during retraction and space closure.

The third order

• full-dimension st.st. rectangular wires are too stiff for effective

The third order

if significant root positioning is needed