FINISHING AND DETAILING IN
DR JASMINE ARNEJA
Dougherty’s factors in finishing
Factors affecting the finishing phase
Esthetic procedures in finishing
Periodontal procedures in finishing
Finishing to ABO requirements
Positioners for finishing
Man has always tried to attain perfection in all his endeavours. In recent
times, great deal of emphasis is placed on achieving perfect finishing of
the orthodontic treatment so that the results are pleasing to the eye
and hopefully are more stable and conducive to an improved
function and health.
Although, the earlier authors like Tweed did mention finishing of a case,
the impetus to this concept was given by Andrews, who expressed his
dissatisfaction with the hundreds of completed cases that he saw at
various meetings and which he felt were lacking in perfect occlusion. His
own study of 120 non-orthodontic models led him to formulate the "six
keys to normal occlusion ".
Finishing is considered to be very difficult and time consuming in
Conventional Begg therapy. But the same has become very easy with
the PEA systems. If the tip, torque and in-out compensation built into the
appliance is accurately suited to the patients dentition, and if the
brackets are properly positioned, then only minimal wire bending should
be required to complete the treatment.
Finishing : It 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, optimised functions of the stomato-
gnathic system and an improvement of the health of the
Detailing : It is the achievement of the ideal positions of every
tooth in the vertical and horizontal planes with particular reference
to the individual in-out, rotation, tip and torque adjustments.
Evolution of the concept of finishing
The concept of finishing has changed from that of the earlier authors
who primarily relied on nature to achieve final finishing in each
According to Angle, "the best the orthodontist can do is to secure
normal relations of the teeth and correct the general forms of the
arch, leaving the finer adjustment to individual type form to be
worked out by nature, which must, in any event, finally triumph".
Tweed relied primarily on placement of the lower incisors over
basal bone. He also stressed the importance of artistic (second
order) bends in the archwire.
Begg's philosophy on finishing emphasized the routine over
movement and overcorrection of all aspects of the malocclusion
(e.g. Deep-bites were finished in edge to edge or slight open bite,
class II cases were finished in super class I, class III). So that teeth
would settle into proper positions after tissue rebound.
Merrifield belief of finishing also plans stress on overcorrecting
major problems so that changes seen during denture recovery would
move occlusion towards ideal.
According to Bench et al “The natural forces of eruption and natural
forces of occlusion combine with those of physiology and growth to
settle teeth functionally into the best position for each individual's
Andrew's in 1972 went against this belief and published six keys
to normal occlusion. This study established normal values for in
out, tip and torque for each individual tooth which were then built into
the edge wise brackets for the straight wire appliance.
DOUGHERTY’S FACTORS IN FINISHING
In 1976, Dougherty described 17 factors that should be considered
in the finishing and detailing stage of orthodontic treatment.
1)Correction and overcorrection of A.P. jaw relationship
Proffit and Rickett’s recommends over treatment of Class II and
Class III malocclusion to overcome rebound of 1-2 mm.
Zachrisson overcorrects rotations and labiolingual displacements of
individual teeth to 1/10th overmovement.
McLaughlin and Bennett contend that Class II case with deep bites
benefit from overcorrection to an end-to-end position, and
maintenance of that position with night time Class II elastics for six
to eight weeks, which is followed by settling into an ideal Class I
2) Establishing correct tip of upper and lower
AlOuabandi et al reposrted 6-7degree of lower
incisor flaring when simply leveling the curve of
Raleigh Williams states that lower incisor apices
should be spread distally to the crowns and the
apices of the lower lateral incisor must be spread
more than those of the centrall incisor. The apex
of the lower cuspid should be positioned distal to
According to MBT (40’ upper anterior, 6’ lower
anterior) the 34 degree of additional tip helps in
overjet maintenance and better fit
3) Establishing correct torque of upper and lower anterior teeth
Torque is frequently lost during the retraction phase of treatment,
especially in class II div 1 cases. Thus anterior teeth must be torqued to
maintain the correct overjet and overbite and to establish stability
4) Coordinating arch widths and archform
Arch form coordination prevents development of a cross bite.
McLaughlin and Bennett prefer widening the archform in the
bicuspid area, so that mesial of lower bicuspid contacts distal of
upper cuspids and therefore the lower eight most anterior teeth
make contact with upper six most anterior teeth during protrusive
Cross-elastics in cuspid areas
used to compensate for
archform (symmetrical arch
indicated by dashed line).
Modified upper archform
(dotted line): archwire
canted in direction opposite
5) Establishing correct posterior crown torque and crown tip
Mclaughlin and Bennett state that correct posterior crown torque is
essential to prevent posterior interferences from developing and to
allow seating of centric cusps.
In normal situation, the lingual cusp of the mandibular posterior teeth
should be at the same level or a milimeter of the buccal cusp. This
relationship makes the occlusal table of posteriors relatively flat tereby
promoting a better contact between the maxillary lingual cusp with
“Rolling in” is a common phenomena seen in mandibular posterior
teeth. In the maxillary arch, the palatal cusps of 1st molar and second
premolar tend to be longer than the buccal cusp, thus disturbing proper
Therefore flattening the CURVE OF WILSON results in improvement in
interdigitation of maxillary and mandibular teeth.
6) Establishing marginal ridge relationship and contact points
Marginal ridges are a key to achieve relative vertical positioning of
posterior teeth. This will position the cusp and fossae of adjascent
teeth at the same level. Thereby the CEJ will also be at the same
level, producing equal and suffient bone support and healthier
Contact surfaces of teeth are generally located in the occlusal 1/3 of the
proximal walls, slightly buccal to the central fossa in the molar and premolar
area with the exception of maxillary 1st and 2nd molars.
The contact point between max incisors is located between the most incisal
1/3 having the perception of a vertical line
From CI To Canines, contact points gradually move from incisal to gingival
Contact points must be taken into good consideration to provide adequate
post treatment stability and healthy periodontium.
7) Correction of midline discrepancies
It is important to establish the origin of the discrepancy in order to
Upto 3 mm of mildline discrepancy can be corrected in this phase
Usually elastics are enough for midline correction but at times
asymmetric stripping may be required
8) Establishing the interdigitation of teeth
Different authors use different configuration of elastics for final
seating of occlusion. The elastics are worn after rectangular
arches are changed to light round wires so that teeth can settle more
Alexander also recommends chewing sugarless gum to get good
interdigitation of teeth.
Proffit describes 3 ways to settle the occlusion:
◦ Replacing rectangular wires by round light wires with some
freedom of movement and using light vertical elastics
◦ Using laced posterior vertical elastics after removing the posterior
◦ Tooth positioner
◦ Cuspids labially displ. – extend sectional wire in upper ant. seg to
hold them in postn.
◦ Diastemas – areas tied lightly with elastic thread or ligature
◦ Teeth extracted. – figure of 8 ties –across extraction. 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
Serpentine wires:- 1 week before appliance removal U&L arch wires
are removed ,ligated together in a serpentine fashion from PM to PM
with ligature wire--- occlusion to settle without any interdental
spacing– (in minimal discrepancies of tooth position)
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
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
Settling elastics with class II pull:- 2oz elastic started over L2M
&U1Molar twisted and engaged over next 2 teeth and repeated to
the UCi on X side
Settling elastics with class III pull:-starts from U2&L 1 M and extends to
the Ci. on X side
9) Checking cephalometric objectives
McLaughlin and Bennett recommend that progress headfilms
should be taken about halfway through treatment to allow time for
reassessment of anchorage and possible changes in division of
treatment time. They prefer to take final cephalogram three or four
months before debonding
Important factors to evaluate with progress and final cephalometric
◦ AP posn. of the incisors
◦ incisor angulations,
◦ changes in the occlusal plane,
◦ the degree to which vertical dev.iation occurred or restricted, &
◦ the success of the correction of horizontal and skeletal
components of the case.
10) Checking the parallelism of roots
A panoramic X-ray should be taken before
debonding to evaluate root parallelism.
Parallel roots provide adequate bone support around
each tooth thereby preventing tooth tipping to any side
A v bend can be created in the midline to avoid root
tipping while retraction.
In earlier treatment prescriptions, root uprighting was a
definite stage in the treatment. With the advent of sliding
mechanics and PEA, nedd for root uprighting has
Fuller wires (0.021 x 0.025 for 0.022” slots and 0.017 x
0.025 for 0.018” slots) are preferred. In case evident root
tiping needs to be done, beta ti vires are recommended)
11) Maintaining the closure of all spaces
McLaughlin and Bennett prefer passive tiebacks in finishing
stage especially in extraction cases to maintain space closure. Also
lacebacks are routinely used.
12) Evaluating facial and profile esthetics
Roth suggests that the tip of upper incisors should be 2-2.5mm
below the lip embrasure of the upper and lower lips and 1mm of
attached gingiva should be showing on full smile.
Artistic positioning of the upper anterior teeth has been
recommended by Tweed, Mollenhauer and recently by Sheridan.
13) Checking for TMJ dysfunctions such as clicking & locking
14) Checking functional movements
Coincidence of centric relation with centric occlusion is a goal for
lower eight most anterior teeth make contact with the upper six most
anterior teeth during protrusive movements.
Teeth should not prevent mandible from entering into or leaving any
In lateral excursion, the canines should provide a glide path with no
interference on the balancing side
15) Determining if all habits have been corrected :
Habits such as tongue thrusting will usually correct before finishing
16) Correction of rotations and overcorrections where needed:
Rubber rotation wedges under rectangular wire.
Steiner rotation wedges.
17) Establishing a relatively flat plane of occlusion
◦ Fixed prosthodontics is treatment of
◦ In case of implants. 6.5 mm of space is
required between adjascent roots to
place a standard 3 mm wide implant
◦ Gingival zenith lies distal to long axis of
crown of CI and Canine and coincides
with long axis of LI
The buccolingual inclination of the
maxillary and mandibular posterior teeth
shall be assessed by using a flat surface
that is extended between the occlusal
surfaces of the right and left posterior
teeth. When positioned in this manner,
the straight edge should contact the
buccal cusps of contralateral mandibular
molars and premolars. The lingual
cusps should be within 1 mm of the
surface of the straight edge (fig. 9). 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 edge00