FINISHING

ORTHODONTICS

Sotiropoulos G., D.D.S., M.S.

Lasagabaster T., D.D.S.

“ Better finishes need great
beginnings”

“Think ahead”
 FINISHING OBJECTIVES

1. Occlusal objectives: Occlusal

relationships.
2. Periodontal objectives: Periodontal
health.
3. Esthetic objectives: Esthetic satisfaction.
OCCLUSAL OBJECTIVES

1. Alignment.
2. Marginal ridges.
3. Anterior torque.
4. Posterior torque.
5. Overjet and Overbite.
6. Lateral excursion.
7. Occlusal relationships.
8. Interproximal spacing.
 1. ALIGNMENT

Look for minor rotations.

Most errors because of bad bracket position.

Check from every direction.

Directly and with mirror.
From the front and from the back.
 Alignment checks:

Max ants: Linguo-incisal surfaces (functioning

surfaces)
Mand ants: Labio-lingual surfaces (functioning
and esthetics surfaces)
 Alignment checks:

Max posts: central grooves.

(Functioning surfaces)

Mand posts: Buccal cusps.

(Functioning surfaces)
Alignment checks:

Alignment of interproximal contacts.

 Most common error in the mandibular dental
alignment:

• Contact between Lateral Incisor and Canine

due to bracket position.
• To correct change bracket from beginning or
cuspid offset.
Rotated cusp Nice cusp
 Alignment-rotational control with bracket
position:

• Middle of the crown mesio-distally.

• Draw on crown if necessary.
• Cusps will help you for bracket position in
bicuspids,cuspids and molars.
 2. MARGINAL RIDGES

Alignment of the marginal ridges will facilitate

root parallelism and good intercuspation.

Unaligned marginal ridge

 Alignment of marginal ridges depends on
“perfect” bracket position

Bracket axis should be parallel to long axis of the

tooth and to the mesial and distal secants of
the crown (Heiser and Schendell, 2001)
 Bicuspids bracket position for alignment of
marginal ridges

Same height as bracket of molar

to avoid opening of posterior
segments.

If bracket to occlusal: reposition(early in

treatment) or Step down finishing wire
and use vertical elastics.
 Bicuspids bracket position for alignment of
marginal ridges.

Bracket slot and occlusal margin should be

parallel to marginal ridges of bicuspids.

Draw on tooth if necessary.

Check from labial and lingual.

Check from occlusal

 To correct unaligned marginal ridges:

Change bracket as early in treatment as possible

Artistic bend in finishing wire

Uprighting spring
(tip-edge or edgewise bracket
with round wire)

Artistic bend +Uprighting spring

 First molar band or bracket position

Middle of the crown mesio-distally

Distal and mesial-occlusal margins of

the band should be at the level of the
gingival margins.
 First molar band or bracket position

Bracket and occlusal margin of the band

should be parallel to occlusal plane of the
molar.

Labial-distal and mesial cusps of

the molar should been shown in
equally amount through the
occlusal margin of the band.
 First molar band or bracket position

• Make sure that the upper molar is not hitting on

the lower molar bracket, when patient bites.
• This could create interferences, open the bite or
cause abrasion of upper molar cusps.

• When it happens, try to reposition

the mandibular bracket or band
more gingivally.
• Or grind the bracket wings.
 Second molar band or bracket position

Open
Deep bite tendency
or normal bite:orsame
avoidheight
impaction ofmolar
as first 8s:
maintain
and parallelcurve of Spee plane
to occlusal by positioning
of secondthe bracket
molar.
of 2 nd
*This willmolar parallel
extrude to first
distal cusp,molar
help bracket
to open and more
the bite
occlusally.
level curve of Spee and gingival margins of molars.
 3. ANTERIOR CROWN TORQUE

Upper and lower crown

torque: affect overbite,
overjet, posterior
occlusion
and can result in spaces
often falsely blamed on
tooth size discrepancy (3rd
key of occlusion of
Andrews).
“Pay extra attention in extraction cases”.
 Torquing mechanics: Straightwire

• Built in bracket slot. .018 slot: .017x .025

• Fill bracket with rectangular .022 slot: .021x .025
wires to express torque.

For extra torque or Edgewise appliances:

• Bend torque in ss. or TMA rectangular wires.
• Torquing auxiliaries on rectangular wires.
• Torquing auxiliaries on round wires.
 Torquing mechanics: Straightwire

Torquing auxiliaries on rectangular wires.

 Torquing auxiliaries:Begg or Tip-Edge

Very important part of their final finishing stage.

 4. POSTERIOR CROWN TORQUE

Lingual crown torque(4th Key of Andrews)

Insufficient torque
 5. OVERJET AND
OVERBITE

Overjet: 2 (+or –1mm) Overbite:

males: 45%(+or-25%)
females: 36%(+or-16%)

Excessive overjet
6. LATERAL EXCURSION
 7. OCCLUSAL
RELATIONSHIPS
Molar relationship: the distal surface of the
distobuccal cusps of the upper 1 st permanent
molar occlude with the mesial surface of the
mesiobuccal cusp of the lower 2nd molar
(1st Key of Andrews).
 Conditional occlusal relationships

Class II finishing Class III finishing

 Mechanics to “settle” occlusion

1. Replace rectangular wires at the very end by light

round or braided wires. Artistic bends and up-down
elastics as necessary.
 Mechanics to “settle” occlusion ”

2. Cut posterior segment of rectangular wire,

keeping 3-3, and laced elastics during 1
week.
*Not recommended when patient used to have major
posterior rotations of crossbite.
 Mechanics to “settle” occlusion ”

3. Let teeth settle down by themselves.

4. Tooth positioner.
 8. INTERPROXIMAL SPACING

• In extraction cases, diastema or generalized

spacing, make sure to maintain the spaces closed
after closing stage during the rest of treatment.
• With ss. figure 8 ligatures, light power chains,
tied back wires.
PERIODONTAL OBJECTIVES

1. Root parallelism.
2. Bone Level.
3. Mucogingival considerations.
 1. ROOT PARALLELISM

• Important for:
1. Stability of orthodontic treatment.
2. Periodontal health.
• Extra attention to extraction sites.
Panoramic Rx to check root parallelism and
bone level:

Root apices should not approach.

Panoramic Rx to check root parallelism and
bone level:

Take periodical panoramic Rxs to check

bracket position, correct root angulation and
root resoption.
 2. BONE LEVEL
Infrabony defect:
• With active periodontal disease, should be periodontally
treated before ortho treatment.
• When inflammation does not exist, it should be
eliminated by:
1. Periodontal surgery before-during ortho
treatment.
2. Extrusion of the tooth, bone level would follow.
3. Bodily movement of tooth into the defect.
 Elimination of the infrabony defect by
movement of the tooth into it. “Light forces”
 BONE LEVEL CONT.

Movement of tooth into edentulous space with

reduced alveolar bone height is possible:
1. if tooth has healthy periodontal support.
2. With light orthodontic forces and good oral
hygiene.
Periodontal support will follow increasing the
bone level of the alveolar ridge.
Movement of a tooth into an edentulous space
 3. MUCOGINGIVAL
CONSIDERATIONS
In presence of a mucogingival recession,
the gingival augmentation can be
postpone after ortho if:
1.Active periodontal disease does not
exist.
2.Gingival thickness is equal or more
than 2 mm.
3.Not buccal tipping or intrusive forces
are going to be used.
 ESTHETIC
OBJECTIVES
1. Smile line.
2. Gummy display.
3. Gingival margin alignment.
4. Missing papilla (black triangles).
5. Midlines.
 1. SMILE LINE

The incisal curve should be parallel

to the inner contour of the lower lip.

With age: max. incisors display decreases and

mand. incisors display increases.

Females: show more max incisors and less mand

incisors than males.
Select intrusion-extrusion mechanics based on
finishing objectives.

By extruding the maxillary incisors of a

woman you can make her look younger.
 Central and lateral incisal edges height respect
to smile line.

Individualize: Lateral incisor bracket should be

positioned from 0 to1mm more incisally than
central incisor bracket, depending on each case.

Usually, the lateral incisal edge should be

slightly higher, to follow smile line.
 Central and lateral incisors incisal edges
height respect to smile line.

When the lateral incisal edge is

too high, an unaesthetic black
spot appears in the smile.

When the lateral and central

incisal edges are at the same
height, the patient has a more
masculine look.
 2. GUMMY
DISPLAY
1-2mm of gummy display is considered
normal.
Above 3mm, general dentists notice.
Above 5mm, lay persons notice.
 Gummy smile treatment depends on its
etiology

1. Excessive maxillary growth:

posterior and anterior gummy display.
Surgical impaction of the maxilla.
 Gummy smile treatment depends on its
etiology

2. Delayed apical migration of gingival margin:

3 to4 mm of sulcular depth in absence of
inflammation.
Gingival surgery.
 Gummy smile treatment depends on its
etiology

3. Tooth malposition:
Normal sulcular depth of one 1mm.
Intrusion mechanics.

Intrusion arch +
HPHG Leveling arches
 3. GINGIVAL MARGIN
ALIGNMENT
1. Both centrals should be at same level.
2. Centrals more apical than laterals.
3. Canines same level than centrals
 4 Criteria for correction of gingival margin
discrepancies

1. If it is not seen while smiling, no correction is

needed
2. If shorter tooth has deeper sulcular depth,
gingivectomy.
3. If shorter tooth has 1 mm of sulcular depth and
abrasion of incisal edge, intrude and restore it.
4. If shorter tooth has 1mm of sulcular depth and no
abrasion, extrude long tooth and enameloplasty
 4. MISSING PAPILLA
(BLACK TRIANGLE)

Very common in adults, with overlapped

centrals in the beginning of ortho treatment.
 Missing papilla treatment depends on its
etiology

1. Divergent root of centrals due to improper

bracket position.
2. Abnormal tooth shape. Recontour mesial
surfaces of centrals and consolidate.
3. Advanced periodontal disease.
 5. MIDLINE ALIGNMENT

Class II-Class III elastics.

Ant Cross elastics

Tip crown of anterior teeth

towards side we want midline
on.
Any questions?