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Finishing and detailing /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Finishing and detailing /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Introduction Finishing and detailing is the last stage of treatment . The finishing procedures are considered ,from the beginning stages of treatment , as a part of total scheme of treatment The objective of any orthodontic treatment depends on the end goal In the finishing and detailing stage we continue to focus on these goals, the foundation established by the background in the fundamentals of occlusion
  3. 3. Goals of Orthodontic Treatment Healthy and functionally stable occlusion Incorporate andrews six keys Stable jaw relationships Correlation between Cr and Co Facial esthetics Depends on the patient and the community in which he leaves Stability of results Natural occlusion before trmnt was stable and any change in be another position must
  4. 4. Finishing is the last step, before active treatment is discontinued, of ensuring that the teeth and related structures are positioned in such a way as will lead to a better stability of results, enhancement of esthetics ,optimized functions of the stomato-gnathic system and an improvement of the health of the periodontium. Detailing is the achievement of the ideal positions of every tooth in the vtl and hzl planes with particular reference to the individual in out, rotation , tip and torque adjustments
  5. 5. Concept Earlier relied on nature to achieve final finishing in individual case. “The best the orthodontist can do is to secure normal relations of the teeth and correct the general form of the arch , leaving the finer adjustments to individual type and form to be worked out by the nature, which must, in any event finally triump ( Angle ) LI upright over basal bone and artistic or 2nd order bends in arch wire (Tweed) Arch form and placement of LI in reln to the A-Pog line. ( Ricketts) Overcorrecting major problems so that the changes during denture recovery would move towards ideal occlusion (Merryfield)
  6. 6. The natural forces of eruption and occlusion combine with those of physiology and growth to settle teeth functionally into the best position for each individual characteristics . (Bench-et al) Many felt that a mere reliance on mother nature to achieve final positioning of teeth in treated case was inadequate. 1972- Andrews 6 keys- nl values of in out,tip and torque for individual teeth- built in to the SWA- gave necessary impetus for precise orthodontic treatment Roth added the goals of gnathologic finishing as part of orthodontic treatment ,found Andrews brackets well suited to achieve these goals and built over treatment in his appliance to neutralize the relapse tendency.
  7. 7. Roth adds his functional req to the Six Keys to normal occlusion 1. Lower incisors at the +1 to A-Po; for facial esthetics, for planning anchorage control, and for selection of mechanotherapy. 2. Tips of the upper incisors 2-2.5mm below the lip embrasure of the upper and lower lips, when the lips are closed with no lip strain. 3. No more than 1 mm of attached gingiva showing upon a full smile.
  8. 8. 4. App. 2.5mm overjet-overbite relationship (.0005" clearance with the lingual surface of the upper incisor.) 5. A flat occlusal plane, at the end of therapy that would return to a 1 to 1.5mm curve, at its deepest point, after appliance removal and settling of the occlusion 6. A curve of Wilson that would allow seating of centric cusps, but clearance upon excursions.
  9. 9. 7. Lower incisors aligned contact point-tocontact point with the roots in the same plane, when observed from the occlusal, and a mesioaxial inclination of 2 degrees. 8. L- 3 crowns angulated mesially 5 degrees, with the incisal tip 1mm higher than the incisal edge of, the lateral incisors. The lower cuspids should have a slightly exaggerated mesial rotation in extraction cases.
  10. 10. 9. The lower bicuspids should be uprighted 1 degree from their normal mesial inclination and should have a slight distal rotation (more so on an extraction case). The contact point should be adjacent to the contact point on the lower cuspid distal surface. 10. The lower molars should be uprighted 1 degree from their normal 2-degree mesial inclination, and should have a slight distal rotation.
  11. 11. 11. The lower buccal segment should have progressive torque close to Andrews' measurements for establishing the curve of Wilson, and there should be no rotations or spaces. 12. The upper 1st molars should have sufficient distal rotation, mesioaxial inclination, and buccal root torque, so as to fit with the lower 1st molars,. The same would follow for the upper 2 nd molars. (14 degrees torque and 0 degrees tip).
  12. 12. 13. The upper bicuspids should be uprighted to 0 degrees from their normal 2-degree mesial inclination, with no rotation. 14. The U-3 must have its contact points adjacent to the contact points of the upper bicuspid and lateral incisor, to establish proper length for cuspid guidance. ( +11 to +13 degrees of mesial crown tip)
  13. 13. 15. The U-2 & U-1 should be almost equal in incisal edge length, with no more than 0.5mm height differential. 16. There should be no rotations or spaces in the upper arch, and the buccal segments from the cuspids distally should have 14 degrees non progressive buccal root torque.
  14. 14. 17. The arch form should be a modified catenary curve consisting of five separate radii — one for the front of the arch form, one for each cuspid-bicuspid area and one for each buccal segment from the first bicuspid distally. The widest point of the lower arch would be at the mesiobuccal cusp of the mandibular first molars and at the first bicuspids. The widest point of the maxillary arch would be at the mesiobuccal cusps of the first molars.
  15. 15. Roth's sequence of finishing To finish lower arch before the upper arch L anteriors at or slightly lingual to the cephalometric goal LI should have divergent roots L canines positioned in mesio-axial inclination with distal root positioning 4. Canine tip 1 mm higher than incisal edge of LI 5. Canine crowns lingually inclined , long axes labio-axially inclined 6. L posteriors uprighted 30 distal from nl mesio-axial position of 20 7. L posteriors rotated slightly distally 8. Levelled curve of spee Sequentially from antr to postr. Sets lower arch to receive the upper teeth. 1. 2. 3.
  16. 16. Upper arch 1. Max 6 to have distal rotation with suff: buccal root torque to lift the palatal cusp (supporting) 2. Positioning of 6 determines that of 7 from a rotational standpoint since both are trapezoidal in shape 3. This facilitates the PM to seat in a class I reln 4. U canines should have sufficient mesio-axial inclination so that their tips ride on the disto-incisal inclines of L canine- canine guided occlusion 5. UI positioned to close the space and occupy sufficient space within their reach Finishing the upper arch prior to lower makes it impossible to finish case properly ,for when the lower arch is corrected one has to move all upper teeth to get proper relationship of upper arch to lower arch.
  17. 17. Dougherty – 1976. outlined 17 factors to be considered in finishing and detailing. Correction and Overcorrection of the A-P Jaw Relationship The tip and torque of anterior brackets place demand for anchorage, - upper arch, Total anchorage for anteroposterior correction is about the same for all appliances. Overcorrection of the Class II case is the greatest challenge in this area. Some class II show relapse with the OJ returning and DB deepening– overcorrection to end to end position and maintain it with class II elastics for 6-8 wks followed by settling into ideal class II relnp.
  18. 18. Establishing Correct Tip of the Upper and Lower Anterior Teeth Tip in face- eliminates the need for 2nd-order bends - treatment more efficient. Wire bending reqiured when: improper bracket placement relative to the vertical reference lines of the anterior teeth irregularly shaped anterior teeth -peg-shape LI present.
  19. 19. Establishing Correct Torque of the Upper and Lower Anterior Teeth The anterior torquing needs of patients vary - no single set of bracket torque values can meet the needs of all the cases . Adjust the torque in the upper and lower anterior segments at various stages of treatment . Eg: over jet correction of the moderate-to-severe Class II case – T frequently lost in U antrs and the LI angulated forward, so lingual root T in U arch wire and labial root T in L arch wire . Ideally these compensations to be done in early stages of OJ correction and space closure
  20. 20. Start MO End of OJ redn T lost in U antrs LI angulated forward T needed to be added to recover correct I angulation
  21. 21. Coordinating Arch Widths and Arch form Coordination of archwires - from beginning through the rectangular wire phase -prevent crossbites from developing.  In asymmetry cases -distorted anterior arch forms, (cuspid regions). To correct - during the finishing stage, • cross-elastics in cuspid areas, • archwires canted in the direction opposite to the asymmetry.
  22. 22. Cross-elastics in cuspid areas used to compensate for asymmetrical upper archform (symmetrical arch indicated by dashed line). Modified upper archform (dotted line): archwire canted in direction opposite to asymmetry.
  23. 23. Establishing Correct Posterior Crown Torque Built in torque- preadjusted posterior brackets -eliminates wire bending. a tendency for upper palatal cusps to be situated below the occlusal planeposterior buccal root torque - rectangular finishing wires. In the lower arch, 1st & 2nd molars- undesirable lingual tipping, buccal crown torque to the rectangular archwires.
  24. 24.
  25. 25. Establishing Marginal Ridge Relationships and Contact Points Proper marginal ridge relationships - finishing stage - function of bracket height. Incorrect bracket height - apparent early . effective to reposition brackets as early as possible. An .014" round wire can be used to step any improperly positioned brackets.
  26. 26. Upper central incisor with incorrect bracket height and compensating step in . 014" archwire. Bracket repositioned at next appointment, with .016" archwire.
  27. 27. Correction of Midline Discrepancies minor discrepancies -3mm or less 5 methods of elastic wear A single Class II elastic on one side and a double Class II elastic on the other, for cases with a bilateral Class II component A single Class II elastic on one side only, when the overjet results in a slight Class II relationship on that side and the opposite side is in a Class I position.
  28. 28.
  29. 29. Class III elastics on one side and Class II elastics on the other, for cases with the corresponding dental relationships. A single Class III elastic on one side only, when that side is in a Class III position and the opposite side has a Class I dental relationship . An anterior cross-elastic, when the discrepancy occurs primarily segments. in the anterior
  30. 30.
  31. 31.  Establishing the Interdigitation of Teeth rectangular wires - the teeth unable to settle . Settling before debonding - L/.014" & U/ .014" round sectional wire from Li to Li & vertical triangular elastics . Adv. - establish an individual archform within certain limits
  32. 32. Checking Cephalometric Objectives Progress headfilms - halfway through treatment reassessment of anchorage & changes in the division of treatment time. final cephalometric headfilms- 3 or 4 months before debonding. Evaluate the success or failure of trmnt ,no adv for pat if after debonding
  33. 33. Important factors to evaluate with progress and final cephalometric x-rays include  AP posn. of the incisors incisor angulations, changes in the occlusal plane,  the degree to which vertical dev. - occurred or restricted, & the success of the correction of horizontal and skeletal components of the case.
  34. 34. Checking the Parallelism of Roots The tip built into preadjusted brackets - proper root paralleling. A panoramic x-ray - before debanding to evaluate root parallelism. If crown-root angulation is beyond normal standards, bracket repositioning or archwire bending may be required to modify the root positions.
  35. 35. Maintaining the Closure of All Spaces space closure be maintained - extraction cases passive tiebacks , lacebaks ,in the finishing stage to prevent relapse
  36. 36.  Evaluating Facial and Profile Esthetics Esthetic evaluation - ongoing process during all stages of orthodontic treatment. A projection of esthetic goals - made as part of the treatment plan and is monitored clinically and cephalometrically Determining if All Habits Have Been Corrected Habits such as tongue thrusting - been corrected before the finishing stage . because as the patient grows, airway size increases and the tongue can assume a more postr position. Orthodontically improved oral env:- normal fn.
  37. 37. Checking for TMJ Dysfunctions such as Clicking and Locking Document - TMJ dysfunction prior to treatment, Monitor - TMJ dysfunction during treatment. Problems – if managed before the development of true internal derangement, - joint function - re-established without permanent damage. Monitor the patient for symptoms of TMJ dysfunction during retention.
  38. 38. Checking Functional Movements Before debonding, - checked for interferences during protrusive movements and lateral excursions. lower eight most anterior teeth make contact with the upper six most anterior teeth during protrusive movements. requires - slight widening of archform - bicuspid area, mesial of the lower bicuspids contacts the distal of the upper cuspids.
  39. 39.  Correction of Rotations and Overcorrection Where Needed Most rotations - eliminated before finishing stage. Any remaining rotations can be corrected during finishing by one of three methods: Rubber rotation wedges under the rectangular archwire. Steiner rotation wedges— these are useful because they can be placed after the archwire is in position. Lingual elastics—the most effective method.
  40. 40. Establishing a Relatively Flat Plane of Occlusion Reasons for completing cases to a relatively flat occlusal plane, according to Andrews, proper fit of the upper dentition against the lower dentition. Curve of spee left in lower arch the – L teeth occupy less room and OJ. Overcorrected in deep bite cases to prevent relapse
  41. 41. According to McLaughlin, Bennet & Trevisi, attention should be given to the following considerations during the finishing stages of treatment. Horizontal Vertical Transverse Dynamic Cephalometric & esthetic.
  42. 42. Horizontal Considerations Coordination of tooth fit. A major consideration in HP is coordination of tooth fit in ant. and post. areas. Ant. & post. teeth fit well Crowns of upper ant. teeth do not occupy enough space relative to the lower ant. Teeth – 20% of cases. 60% of cases. Excess of upper ant. tooth substance – 20% of cases.
  43. 43. Mandibular excess in 60% cases will be evidenced by Post. space closure – difficult in upper arch – maintaining correct overjet. Overjet is correct, buccal segments – mild to moderate class II. Ant. space closure – upper arch – difficult while maintaining the correct overjet. Horizontal plane  difficulty relates primarily to factors of tip in the ant. teeth, incisor torque & tooth size.
  44. 44. Establishing the correct tip of the anterior & posterior teeth. Main factor that influence amount of space occupied by each tooth. Andrew’s prescription – 40° tip- upper ant. seg, 6° tip – lower ant. seg. 34° tip differential - size of upper ant. seg. & lower. improved tooth fit – 60% disc. cases. Shape of incisor crowns: • Barrel or  shaped – tipping – little effect
  45. 45.
  46. 46.  Providing adequate incisor torque Torque control – weakness of PAE.  Approx. 1mm seg. of rect. wire – in a bracket slot – same dimension to carry out difficult root movement.  Full size wires – not used, to permit sliding.  effectiveness relative to torque control.  U/L torque needs vary greatly. Additional palatal root torque– upper incisor br. Addnl. labial root torque – lower incisor br.
  47. 47. Management of tooth size discrepancies. Tooth size – ‘seventh key’ – normal Occlusion. Common – lack of tooth mass – u/ant. seg. Relative to l/ant. seg. Corrected by either reducing tooth mass in one arch or by adding to the opposite one Excess tooth mass – L/ ant. seg – adv. to carry tooth redcn. – initial stages of trt. Minimal amt reduced from upper arch in initial stages for it may lead to spacing in the arch
  48. 48. Controlling rotations. In out compensation built into br. + correct br. positioning is effective in controlling rotns. Beneficial in class I & Cl. II cases to place Pm br. 0.5 mm to mesial  buccal cusps rotate distally to class I, palatal cusps – mesially – occlude Accurately into the fossae of lower arch. Lower canine br slightly mesially  Labial rotn. of mesial aspect – better contact with distal aspect of lower laterals.
  49. 49. MO characterized by severe antr crowding and rotation – circumferential supracrestal fiberotomy carried out 1-4 months before appliance removal Contraindicated in :-Poor oral hygiene ,Active Pdl disease,Gingival recession ,Lack of attached gingiva Imp aspects of long term stability of corrected rotations  Under corrections -compare with pretreatment plaster cast  Broken contact points- starting pts for later crowding, reshaping is necessary  Placing 2-2 outside 3-3- particularly imp when distal of 2 lingually placed at the start of treatment  Early correction- derotation just after emergence in the mouth implies corrections before transeptal fiber arrangement has been established
  50. 50. Maintaining closure of all spaces. Passive wire tie backs when rect wires in place, Lacebacks – molar – cuspids – when light wires used. In extn. cases – figure of 8 liagature ties –across extn. site – to keep it closed.
  51. 51. Horizontal overcorrection. Cl II & Cl III cases – consider overcorrection. Fully correct the A/P position of dentition – using elastics, head gear etc. After correction – these methods discontinued/ worn part time – 6-8 weeks. If stable – appl. removed. Relapse – horizontally overcorrected.
  52. 52. Vertical Considerations Correct crown lengths, marginal ridge relationships and contact points. Correction should be completed during rect. NiTi stage of trt. If not done early, in finishing stage – minor archwire bends. Does not ensure stability. These relns. to be corrected 1-2 yrs, before br. removal. Teeth with cusp height which vary from norm or with abnormal marginal ridges, br.position is modified to accommodate the difference.
  53. 53. Final management of the Curve of spee. Low angle cases: Beneficial to level the entire curve of spee.This include banding 2nd molars. If not corrected, the LI will be positioned more gingivally on palatal surface of UI , difficult to complete space closure or maintain the closed space. Upper bite plate retainers given in cases showing a tendency for bite deepening during retention. High – angle cases: High angle cases with open bite tendencies its impt. to leave some curve of Spee at the back of the
  54. 54. Vertical overcorrection – deep bite and open bite cases: Br. On ant. teeth – 0.5 mm more gingival – open bite. - 0.5 mm more incisally – deep bite. Bite opening curves used in cases resistant to bite opening Overbite cases -Towards end of trt. – 1-2mm over bite, settle to 3-4mm. Openbite cases – impt. to evaluate – tongue position & tongue habits. In some cases it may reassert itself despite the best efforts of pat and orthodontist
  55. 55. Excessive overbite:- rectified at this stage by  Auxillary intrusion arch  Auxillary intrusion spring  Increased curve of spee in round ss wire UI moved in vtl direction that improves their relationship to resting lip position and the tooth to lip position monitored through out trt: Other than in gummy smile cases active intrusion of UI is undesirable. LI are intruded using double tubes on L molars and continuous or segmented utility arches.
  56. 56. Transverse Considerations. Arch form. Single arch form for every patient – efficiency in arch form management, accuracy or stability is not achieved. Key to good arch form management :- balance b/w efficiency & accuracy Arch form system consist of  3 std. Templates( square, tapered & ovoid) – to establish arch form used from early stages of trt.  Use of a wax template compressed over br. in lower arch, before placement of rect. SS wire. Shape of rect wire based on this template---- IAF  Allowing to settle with light wire – last trt. procedure.
  57. 57. Archwire Coordination. U & L archwire coordinated from early stages to prevent troublesome cross bites in final stage In all wire sizes – lower arch form established and Upper coordinated with lower wire, 3mm wider ant. & post. than the lower wire- 3mm OJ A & Prtly Post. Torque considerations – beneficial to widen upper arch – post. Segments – 5mm. Minor maxillary narowing in finishing stages of trt. ‘Jockey wire’. – 0.045 arch wire coordinated – upper arch, widened 6mm/side,secured to headgear tubes.
  58. 58.  Establishing posterior torque. Progressive buccal crown torque designed in to appliance system– lower post. Seg. Rect SS wire in br: L post– upright position ------Slight widening tendency in the lower arch. The L postr root move lingually than crown buccally. Upper molars are provided with additional buccal root torque. Due to their anatomy its important to have adequate width in maxillary bone so that the buccal roots are not compressed against the cortical plate.-----impossible to establish correct buccal root torque
  59. 59. Transverse overcorrection Cases with narrowing in maxilla overexpanded and held in that position for an extended period of time. Maxilla expanded – palatal cusps of upper arch are in contact with buccal cusps of lower arch. If carried out in early stages, a palatal bar should be placed after expansion procedures until rect ss wire is placed. Torque in post. Br. + torque in arch wire – allow post. seg. to settle. Trans palatal or buffalo elastics Used to constrict the maxillary arch by producing a trans palatal force in the maxilla. They extend across the palate and attach to ball hooks on max. PM bands. Worn in the night- constriction in few months.
  60. 60. Dynamic Considerations  Establishing centric relation and checking functional movements. Evaluate orthodontic cases in CR at beginning of trt. Re-evaluate mandibular posn. as finishing stage of trt. commences. Patients are checked for interference in protrusive & lateral excursions. Protrusion – lower eight most ant. teeth make contact with upper six most ant. teeth. Lateral excursions – cuspid rise with slight ant. contact, disclusion of post. teeth on both working & balancing sides.
  61. 61. Checking for TMJ dysfunction. Document any evidence of TMJ dysfunction prior to trt. Muscular imbalance/ pain/ CR not accurately recorded ---- splint therapy / physical therapy prior to trmnt Monitor during ortho trt. if any symptoms develop. Normal TMJ fn. reestablished – if managed prior to true int. derangement. Seated & reasonably centred condyle position – most beneficial posn. during ortho trt.
  62. 62. Cephalometric & Esthetic Considerations Cephalograms – taken half way through assess – anchorage factors- help revisions in trt. planning as trt. progress. Super imposed to determine changes occured Ceph. film – 3-4 months before debonding –evaluateAP position of incisors. Torque of incisors Changes in the mandibular plane Vertical dev. Success in correcting horizontal, sk. & dental components of the problem. Soft tissue profile
  63. 63. Evaluation of esthetic factors involved in Anterior Tooth Display and Smile Factors analyzed from the front of the patient 1. Crown length of U/L incisors 2. Incisal edge contours 3. Axial inclinations of U/L incisors 4. Midlines (U,L, labial, facial) 5. Crown torques 6. Smile line (rest and full) 7. R/L symmetry of crown shapes and sizes and gngvl marginal levels After studying these any required finishing bends or esthetic procedures is done.
  64. 64. Max CI – even , equilibrate incisal edges and length of crown if necessary with restorations Root angles balanced Torque should be similar for all Is’ for best stability and allignment LI edges above that of CI to clear the lower canine tips in protrusive movement. Max Cn slightly longer than Ci for best canine guidance in lateral excursions Max Incisal curve II to that of the inner contour of L lip Achieved by positioning CI .5-1 mm longer than LI
  65. 65. Settling the Case Rect. Ss wires restrictive for settling of teeth in the closing stages of trt. 0.014 or 0.016 round wire in lower arch coordinated to the IAF 0..014 round sectional wire – LI to LI in upper arch. Vertical  elastics used where settling needs to occur. Full time wear for first 2 weeks, then night wear for next 2 weeks, if adequate- debonding.
  66. 66. Variations: Cuspids labially displ. – extend sectional wire in upper ant. seg to hold them in postn. Diastemas – areas tied lightly with elastic thread or ligature wires. Teeth extd. – figure of 8 ties –across extn. sites. Palatal expansion cases -a small removable palatal plate – maintain expansion during settling phase Moderate to severe Cl II/I, full upper arch wire is used with wire bend back distally- controls OJ Settling longer than 6weeks –leave lower rect. wire in positn –maintain L arch form. eg: difficult postr OB
  67. 67. Serpentine wires:- 1 week before appliance removal U&L arch wires are removed ,ligated together in a serpentine fashion from PM to PM with std: ligature wire--- occlusion to settle without any interdental spacing– (in minimal discrepancies of tooth position)
  68. 68. Vertical spaghetti elastics:1 week before appliance removal U&L arch wires are removed . 0.16” ss wire secured in L arch with light steel ligatures and no arch wire in upper arch. Series of triangular elastics placed btwn two arches. 3 arms of elastic include distal br. wing of one max tooth ,mesial br. wing of the postr tooth and the entire br. of mand tooth closest to it. In CI region two elastics placed in midline. Wear full time – rapid settling of occlusion Contraindicated in cases originally characterized by deep bite (Class II div 2) :- serpentine wires used
  69. 69.
  70. 70.  Settling elastics with class II pull:- 2oz elastic started over L1M &U2M twisted and engaged over next 2 teeth and repeated to the UCi on X side  Settling elastics with class III pull:-starts from U&L 2 M and extends to the Ci. on X side
  71. 71. ABO Criteria-1998- evaluating dental casts and panoramic radiograph 1. Alignment:- attn paid to incisal edges and lingual surface of UI and labioincisal surface of LI. Central groove of U PM &M and buccal cusp of L PM &M used to assess adequacy of alignment 2. Marginal ridges:- of adjacent teeth at same level or within .5 mm of same level. R/G : cej at same level Flat bone level btwn adj: teeth. 3. Buccolingual inclination:-assessed using a flat surface extended btwn occlsl surface of R&L postrs. Buccal and lingual cusp of all teeth within 1 mm of the straight edge
  72. 72. 4. Occlusal relnp:- mb cusp of U 1 M coincide within 1 mm of buccal groove of L1 M and buccal cusp of U PM,M, Cn align within 1mm of interproximal embrasure of mandibular postr teeth. 5. Occlusal cts:-Max: intercuspation btwn buccal cusp of U postrs and Lingual cusps of L postrs. 6. Overjet:- LI edges slightly ct lingual surface of UI. 7. Interproximal cts:- All spaces within the arch should be closed. 8. Root angulation:-parallel to each other and perpendicular to the occlusal plane.
  73. 73. Duration of finishing and detailing affected by Variation in shape and size of patients teeth relative to average measurements Inaccuracies in appliance design Inaccuracies in appliance placement Failure to allow sufficient time for the bracket to express itself Use of force levels that overpower the appliance design
  74. 74. Wires Used 0.018” slot 0.02” slot Finishing - 0.017”x 0.025”ss 0.019”x 0.025”ss Detailing - 0.016”x 0.022” Bss 0.014”ss 0.017”x 0.025”Bss 0.016”ss Torque assessment Eff t = Designated t + T in the arch wire t play Eff t by T play. Done by filling slot completely with rect wire of larger dimension
  75. 75. Conclusion With the built in features of the PEA and the correct bracket placement, moving teeth to their finished positions begins as soon as the brs: have been placed and the first archwires tied in. There is a gradual flow towards the finishing rather than an abrupt , clearly defined treatment stage. The real value of PEA becomes apparent in finishing, the more accurate the appliance, the less time and effort required in this stage. Even though not required in initial stages ,in most cases some wire bending is required in finishing stage to precisely position teeth. PEA let redefine finishing & detailing as “the correction of errors made prior to finishing & detailing, over correction as needed and settling of the case.”
  76. 76.