EXCELLENCE IN FINISHING

Prepared by:
Divine Macaranas, DMD
Seminar and Conferences III
Manila Central University, MSD Orthodontics
 INTRODUCTION
• It has been recognized for many years that the stability of
orthodontic treatment results at least partially depends on the
way cases have been finished.

• Orthodontic finishing still remains a continual challenge for the

Orthodontist.

• Proper finishing is of critical importance in achieving an excellent

occlusal result after orthodontic appliance removal, and it has
been widely recognized for many years.
 OBJECTIVE
To inform the orthodontic clinician of the importance
of occlusal, periodontal and esthetic parameters, to
finish orthodontic cases to the highest standards.
 COMMONLY ACCEPTED
ORTHODONTIC TREATMENT GOALS
1 2 3 4 5 6 7

Normal 2. Normal 3. Condyles in 4. Relaxed 5. Normal 6. Optimal 7. Long-term

static functional a seated healthy periodontal aesthetics stability of
occlusal movements position musculature health posttreatment
tooth positions
relationships

– a mutually – in centric
– Class I protected relation
occlusion occlusion
with ‘six
keys’,
-3 mm of
overjet and
overbite
 I. Occlusal parameters
– both static and
dynamic

REDEFINED II. Optimal aesthetics

ORTHODONTIC
FINISHING
GOALS III. Periodontal health

IV. Long-term stability

I. OCCLUSAL
PARAMETERS B. Functional
– BOTH A. Static occlusal
goals – as observed
occlusion goals – as
observed during
STATIC AND on dental casts or
intraorally
various mandibular
movements
DYNAMIC
 I. OCCLUSAL PARAMETERS -STATIC
1. ALIGNMENT

-incisal edges and lingual surfaces of

anterior teeth establish anterior
alignment

-functioning surfaces of the posterior

teeth should be at optimum position

-finishing arch wires are passive in the

brackets
I. OCCLUSAL
PARAMETERS -STATIC
2. ARCH FORM COORDINATION
-Coordinate well to the patient’s original arch
form
-Whatever changes are done during the initial
and transitional stages of treatment, they
should be maintained during the finishing stage
- Before making any alterations in the chosen
arch form for desired treatment changes, it is
critical to identify the areas for potential
relapse
I. OCCLUSAL PARAMETERS -STATIC
3. ESTABLISHING MARGINAL RIDGE
RELATIONSHIPS
-marginal ridges of the posterior teeth are
positioned at the same relative level, then
the cementoenamel junctions are also at
the same relative level

-precise bracket positions and finishing

bends

-if errors have been made, corrections

can be done during the finishing stage of
treatment by incorporating some bends
in the finishing archwire
 I. OCCLUSAL
PARAMETERS -STATIC
4. CONTACT POINTS
-prevent food impaction and stability of the dental
arches
a. Contact points in the maxillary anterior teeth
progress from incisal to cervical and from central
incisor to canine.
b. Contact points in the maxillary posterior segment
when viewed from the occlusal aspect.
c. Contact points when viewed from the buccal
aspect.
d. Another patient showing normal contact
relationship between the mandibular first and
second molars pretreatment.
e. Abnormal position of contact points between the
first and second molars due to built-in offsets in the
first molar attachments.
 I. OCCLUSAL PARAMETERS -STATIC
5. MOLAR RELATIONSHIP

-evaluate the buccolingual inclination of the posterior teeth to

achieve good intercuspation and prevent interferences during
mandibular movements
-evaluate the relationship between the buccal and the lingual
cusps of the maxillary and mandibular premolars and molars –
called the curve of Wilson
-The maxillary second premolar should have a normal contact
relation with the mesial incline of the lower first molar which
produces an interlocking into the corresponding interspaces of
premolars.
-extreme amount of mandibular posterior lingual crown torque
found in many preadjusted appliance prescriptions results in
‘rolled-in’ mandibular posterior teeth as a result of expressed
torque
-The mandibular molars should be uprighted and progressively
torqued with no rotations and spaces.
 I. OCCLUSAL PARAMETERS -DYNAMIC
-Angle, Andrews, other workers like Williamson, Aubrey, Ricketts", and Roth have all
expanded the area of knowledge in occlusion to include the neuromuscular and bony
structures of the TMJ in establishing orthodontic treatment objectives

-Intercuspal position and retruded contact position the mandible should be situated in the
same sagittal lane, the distance between the two positions being less than 1mm.

-There should be harmonious glide path of anterior teeth. These teeth should work against
one another to separate or disclude the posterior segments as soon as the mandible
moves out of centric closure.

-The proper overbite and overjet established after orthodontic treatment should allow for a
gentle glide path.
a. PRE TREATMENT EXTRA-ORAL
b. PRE TREATMENT INTRA-ORAL
c. MANDIBULAR RIGHT LATERAL
EXCURSION
d. PROTRUSIVE MANDIBULAR
MOVEMENT
e. MANDIBULAR LEFT LATERAL
EXCURSION
 I. OCCLUSAL PARAMETERS -DYNAMIC

-The canines should provide the main gliding inclines for lateral excursions, with no
interferences on the balancing side.

-The six mandibular anterior teeth and mandibular first bicuspids should articulate with
the maxillary six anteriors during mandibular protrusive excursion. In this way, a protrusive
load is spread over fourteen anterior teeth with no interferences in the posterior region.

-The lingual discluding surface the upper seems to reflect the anatomical angle or
discluding pathway of the mandibular condyles. The ideal anterior disclosure angle is
greater than or equal to 5 degrees than the condylar disclosure angle
Post treatment Photographs
II. Optimal
Esthetics
1. CROWN- WIDTH DISCREPANCY
2. REPLACEMENT OF MISSING TOOTH
3. GINGIVAL ARCHITECTURE
 III. Periodontal Health and
IV. Long Term Stability
-If the roots are parallel to each other,
then there will be sufficient bone
between the roots of teeth

-It is considered that more

interproximal bone will provide
greater resistance to periodontal
bone loss if the patient develops
periodontal disease in the future
 III. Periodontal Health and
IV. Long Term Stability
-During the finishing stage, if the teeth
are not properly uprighted, especially
when the second bicuspids or first
molars are extracted /missing and the
posterior teeth are drifted into that
space; then the marginal ridges will not
be level, proximal contacts will be
faulty, with angular bony defects on
the mesial aspects of the mesially
tipped teeth.
Reference
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