Orthodontic Finishing:

Ten Steps to Success

Mucha JN. Orthodontic finishing: Ten steps to success. APOS Trends Orthod 2018;8:184-99.

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 FINISHING DETAILING

 last step, before active treatment is  It is the achievement of

discontinued, ensuring that the the ideal positions of every
teeth and related structures are tooth in the vertical and
positioned in such a way as will horizontal planes with
lead to a better stability of results,
enhancement of esthetics,
particular reference to the
optimised functions of the stomato- individual in-out, rotation,
gnathic system and an tip and torque
improvement of the health of the adjustments.
periodontium.

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Evolution of the concept of finishing

• Angle - worked out by nature

• Tweed - relied primarily on placement of the lower incisors over basal bone. He also
stressed the importance of artistic bends in the arch-wire.

• Begg's and merrifield philosophy overcorrection of all aspects of the malocclusion

• Bench- natural forces of eruption

• Andrews-6 keys of occlusion

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Define your goals

• Skeletal and dental treatment objectives must be developed to address a

patient's diagnostic problems and chief concern.

• The treatment plan should be designed to meet the treatment objectives.

• Determining treatment objectives requires an understanding of the

evidence regarding skeletal and dental changes with growth, as well as
craniofacial and dental norms
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Treatment Goals

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 Condyle’s in a seated
position- in centric relation
 Root resorption Root parallelism

Periodontal health

Dental caries
 Ideal functional movements-
a mutually protected occlusion
Relaxed healthy
musculature
Aesthetics
A ‘six keys’ class I occlusion
 Inappropriate treatment objectives

• Skeletal and dental treatment objectives must be developed to address a

patient's diagnostic problems and chief concern.

• The treatment plan should be designed to meet the treatment objectives.

• Determining treatment objectives requires an understanding of the

evidence regarding skeletal and dental changes with growth, as well as
craniofacial and dental norms
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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
Have a checklist

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Improve bracket placement

• (a) upper second molars;

• (b) lower first premolars;
• (c) upper second premolars and first molars;
• (d) third molars
• (e) according to malocclusion.

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 Improve bracket placement

• (a) upper second molars;

• (b) lower first premolars;
• (c) upper second premolars and first molars;
• (d) third molars
• (e) according to malocclusion.

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 Improve bracket placement

• (a) upper second molars;

• (b) lower first premolars;
• (c) upper second premolars and first molars;
• (d) third molars
• (e) according to malocclusion.

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 Improve bracket placement

(a) upper second molars;

(b) lower first premolars;
(c) upper second premolars and first molars;
(d) third molars
(e) according to malocclusion.

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Repositioning of brackets

• Armstrong et al. performed a research to compare the accuracy in

bracket positioning between two techniques:
Localizing the center of the clinical crown and measuring the
distance from the incisal edge.

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Repositioning of brackets

The goals in leveling and alignments. There

are many reasons
why perfect bonding is not enough in
unleveled and rotated teeth as follows:

 Play between the archwire and slot

 Force diminution - reduction

in force produced by an archwire, deflected
within its elastic limits, as it
returns to its original shape.

 Brackets away from the center of

resistance.

 Action and reaction

 Repositioning of brackets

A typical case of repositioning of brackets. Congenital absence of laterals teeth.

(a) Spaces were closed. (b) Brackets removed. (c) Reshaped teeth. (d) Reposition of brackets
The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Make adjustments in the archwires

• Scholz state Sachdeva affirms and illustrates that it is necessary to bend archwires
to achieve the desired alignment

• Joch et al. verify that the accuracy of the manufacturers dimension and concluded
a perfect finishing still requires correction bends put in by the orthodontist

• Hence, to improve the occlusal contacts, an orthodontist has to reposition brackets

or adjust the orthodontic wires,or even do both to improve alignments

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 Make adjustments in the archwires

In some cases will be necessary increase or decrease

bend in archwires to get better teeth alignments

Incisor and canine will often be necessary to

incorporate or increase the offsets of the canines in
the archwires 31
Make adjustments in the archwires

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Look at the face, teeth and smile, not the
appliance

Premolar extractions can be beneficial to facial profile. (a)

The goal in the lower face profile. (a) Before treatment. (b) After Before treatment. (b) After treatment and (c) close view of the
treatment. (c) “S” line with excellent relationship between nose, upper lip, face profile
lower lip, and chin, with agreeable curves

Improvements in the lower face profile. (a) Before treatment.

(b) After treatment. (c) Excellent relationship between nose, upper lip, lower
lip, and chin, with agreeable curves 34
 Look at the face, teeth and smile, not the
appliance

Lips at rest: From 15 to 30 years of age, lips at rest should be expose from 3 to 5 mm
i.Incisal edges of upper teeth‑smile arch.
ii. Gingival outline and exposure:
iii. Incisors display on smiling: 10–12 mm
iv. Proportional shapes, positions, and sizes
v. View in esthetic proportions: Decreasing from anterior to posterior horizontally

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 Look at the face, teeth and smile, not the
appliance

Lips at rest: From 15 to 30 years of age, lips at rest should be expose from 3 to 5 mm
i.Incisal edges of upper teeth‑smile arch.
ii. Gingival outline and exposure:
iii. Incisors display on smiling: 10–12 mm
iv. Proportional shapes, positions, and sizes
v. View in esthetic proportions: Decreasing from anterior to posterior horizontally

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 Look at the face, teeth and smile, not the
appliance

Lips at rest: From 15 to 30 years of age, lips at rest should be expose from 3 to 5 mm
i.Incisal edges of upper teeth‑smile arch.
ii. Gingival outline and exposure:
iii. Incisors display on smiling: 10–12 mm
iv. Proportional shapes, positions, and sizes
v. View in esthetic proportions: Decreasing from anterior to posterior horizontally

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 Look at the face, teeth and smile, not the
appliance

Lips at rest: From 15 to 30 years of age, lips at rest should be expose from 3 to 5 mm
i.Incisal edges of upper teeth‑smile arch.
ii. Gingival outline and exposure:
iii. Incisors display on smiling: 10–12 mm
iv. Proportional shapes, positions, and sizes
v. View in esthetic proportions: Decreasing from anterior to posterior horizontally

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Improve the functional occlusion

Occlusal view:
1. Correct contact points
2. Absence of rotations
3. Leveling of marginal ridges

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 Improve the functional occlusion

Lateral view:
From posterior to anterior:
1. Molar relationship
2. Occlusal relationship
3. Occlusal contacts
4. Anterior torque
5. Occlusal plane

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 Improve the functional occlusion

Lateral view:
From posterior to anterior:
1. Molar relationship
2. Occlusal relationship
3. Occlusal contacts
4. Anterior torque
5. Occlusal plane

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 Improve the functional occlusion

• The goals are :

• a. Centric relation = Maximum intercuspidation (no slide)
• b. Anterior guidance, protrusive. (overjet and overbite: 2–3 mm)
• c. Canine guidance:(no posterior interference)
• d. Healthy TMJ: (symptom‑free).

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 Improve the functional occlusion

Lateral view:
From posterior to anterior:
1. Molar relationship
2. Occlusal relationship
3. Occlusal contacts
4. Anterior torque
5. Occlusal plane

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 Improve the functional occlusion

Lateral view:
From posterior to anterior:
1. Molar relationship
2. Occlusal relationship
3. Occlusal contacts
4. Anterior torque
5. Occlusal plane

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 Improve the functional occlusion

Anterior view:
1. Upper anterior mesial‑distal inclinations.
2. Lower incisors mesial‑distal inclinations
3. Midline: Upper and lower dental midlines coincident
4. Posterior upper torque‑en mass
5.Posterior lower torque‑progressive.

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 Improve the functional occlusion

Anterior view:
1. Upper anterior mesial‑distal inclinations.
2. Lower incisors mesial‑distal inclinations
3. Midline: Upper and lower dental midlines coincident
4. Posterior upper torque‑en mass
(a) Posterior upper torque en mass with canines,
5.Posterior lower torque‑progressive. premolars
and molars with the same inclination, or molars
slightly more.
(b) 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.
(c) Progressive posterior lower torque. A
straight edge should contact the buccal cusps of
contralateral mandibular molars. The lingual
cusps should be within 1 mm of the surface of
the straight edge

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Reshape teeth anatomically

• Incisal edges and embrasures

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Plan the retention

• The signsof instability are clinically recognizable as follows:

hypermobility; excessive wear; and migration or relapse

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 Plan the retention
• No retention, temporary retention, and permanent retention.

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The ten steps are as follows:
1. Define your goals
2. Have a checklist
3. Improve bracket placement
4. Repositioning of brackets
5. Make adjustments in the archwires
6. Look at the face, teeth and smile, not the appliance
7. Improve the functional occlusion
8. Reshape teeth anatomically
9. Plan the retention
10. Plan the appliance removal.
 Plan the appliance removal.

• Total appliance removal in one session. If you decide to let one arch (upper or
lower) until the next appointment, you will lose the natural adjustment of the
occlusal contacts that occur taken advantage of increased thickening of the
periodontal ligament
• Occlusal prematurities

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DISCUSSION

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CONCLUSION

• To achieve great results, it is crucial to keep in mind that in clinical orthodontic

practice, it is important to clearly define your goals, to know the basics
(foundations), have technical domain (training and repetition) and implement the
plan. All those combined, the result will be inevitable:Success.

• Wendell Wylie, one of great teachers in orthodontics, once said: “A good

orthodontist who knows the basis can treat well with barbed wire if need be; a
poorly trained orthodontist will never treat well, even with the most sophisticated
appliance.”

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