excellence in finishing orthodontic treatment orthodontics

1. OPTIMIZING ORTHODONTIC
TREATMENT & EXCELLENCE IN
FINISHING
BY
SHADY M.AKRAM
MSC.ORTHODONTICS CAIRO UNIVERSITY

2. IN SEARCH OF EXCELLENCE
• Considering the present appliance systems and available
prescriptions, no single prescription is ideal for all, since there
are a lot of variations in the morphological characteristics of
the patient population.
• The built in features of the preadjusted edgewise appliances
do not adapt to individual needs , hence the finishing stage is
still present to account for variation.

3. HIGH-QUALITY ORTHODONTIC CARE
• Begin with end in mind , Goal &
Result should be identical
• Definitive treatment plan , strict
sequence & monitoring
• Proper Timing of intervention to
the right patient
• Shortest treatment duration
• Least side effects & damage to
hard & soft tissue
• Non compliance therapy
• Minimal Chair time
• Optimum facial esthetics
• Goals achieved for patients of any
age
• Patient centered goals
• Appliance selection & mechanics
engineered to meet patient
requirements .
• Elimination of abnormal habits
• Evidence based practice
• Optimal bracket positioning

4. PRECISE BRACKET POSITIONING
• critical determinant of efficient, predictable tooth
movement and high-quality case finish
• If not placed at the correct location, the
prescription values built into the bracket will not
be properly expressed and the final tooth
positions will be compromised.
• Less finishing bends , less settling effort
• Better finish & post treatment stability
• Better occlusal outcome & less interferences
• Individual tooth morphology will clearly have an
impact on the first-order movement
• The correction of tooth positions with faulty
bracket placement tends to be extrusive in
nature.
• This is because, orthodontic extrusion of teeth
seems to occur significantly more easily than any
other direction, therefore, lowest bracketed tooth

5. BRACKET POSITIONING
• Abnormal tooth morphology either congenital or
as a result of wear or trauma the functional parts
of the crown should be used as primary
references.
• Marginal ridges and/or interproximal contact
points are primary references while the incisal
edges or maxillary buccal cusps as secondary
references.
• It is good practice not to compensate for dental
deep or open bites, as it requires compensating
wire bends to avoid teeth irregularities.
• Direct bonding of brackets must be followed by
firmly pressing the bracket on to the tooth to
minimize bracket drift, maximize bond strength,
minimize resin excess, maintain bracket in-out
relations and minimize rotation errors.

6. BRACKET POSITIONING
• Indirect bonding can be very beneficial in achieving a good bracket placement ,
however difficulties like excess composite , Bonding failure rates & increased
time for setup & increased cost increase difficulty .
• Use of a positioning chart & gauge drastically increases vertical accuracy &
treatment outcome
• A mirror is essential to asses bracket placement at FA point & tip .
• Lower cuspid can be placed slightly mesial to achieve good contact
• Upper bicuspid can be bonded slightly towards mesial to achieve good contact
• When finishing class 2 molar relationships use tubes of opposite side and arch
• Inverting brackets in teeth with dental crossbites will drastically improve
aesthetic outcome

7. EXCESS COMPOSITE MATERIAL REMOVAL
• Excess adhesive causes food impaction
• Subsequent gingival inflammation
• Gradual worsening of oral hygiene
• Localized plaque induced gingivitis
• Microfine brush can be helpful in adhesive removal

8. EXCELLENT FINISHING = EXCELLENT
OCCLUSION
• Preadjusted edgewise appliances in their current variations
probably represent the biggest step up the orthodontic
evolutionary ladder and provide great benefits to orthodontists
in all stages of treatment, especially during finishing and
detailing.
• Most important parameters are occlusal, periodontal and
aesthetic parameters
• stability of orthodontic treatment results partially depends on
the way cases have been finished

9. WHAT ARE YOUR fiNISHING
GOALS ?
WHAT ARE THE APPROPRIATE
TREATMENT MECHANICS FOR
OPTIMAL AESTHETICS,
FUNCTION AND STABILITY ?
WHEN CAN YOU DEBOND ?
HOW CAN YOU JUDGE YOUR
WORK ?

11. ACCEPTED TREATMENT GOALS
• 1. Normal static occlusal relationships—Class I/II/III occlusion
• 2. Normal functional movements—a mutually protected occlusion
• 3. Condyles in a seated position—in centric relation
• 4. Relaxed healthy musculature
• 5. Normal periodontal health
• 6. Optimal aesthetics
• 7. Long-term stability of post-treatment tooth positions

12. 6 KEYS OF OCCLUSSION

13. FINISHING & DETAILING
• 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 periodontium.
• 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.

15. THE AMERICAN BOARD OF
ORTHODONTICS (ABO)
• Established guidelines and objective grading system for scoring dental casts and panoramic
radiographs containing eight parameters.
• Alignment
• Marginal ridges
• Buccolingual inclination
• Occlusal relationships
• Occlusal contacts
• Overjet
• Interproximal contacts
• Root angulation

16. #1 ALIGNMENT 1ST ORDER /IN & OUT
If the mesial or distal alignment at any of the
contact
Less than 0.5 mm 0 point
0.5-1 mm 1 point
More than 1 mm 2 points
The degree of rotational control of teeth is
dependant on the mesiodistal width of the
bracket.
The greater the width the greater the
rotational control. This is achieved,
however, at the expense of reducing the
interbracket distance
The alignment of teeth, irrespective of the
treatment technique, is carried out during
the initial phase of treatment before
correction of major elements of
malocclusion.
It is not considered to be complete until
finishing archwires become passive in the
brackets.

17. ANTERIOR SEGMENT ALIGNMENT
ASSESSMENT
alignment of the incisal edges and lingual
incisal surfaces of the maxillary incisors
and canines
the incisal edges and labial incisal
surfaces of the mandibular incisors and
canines

18. POSTERIOR SEGMENT ALIGMENT
In the maxillary arch,
the central grooves (mesio-distal) should all
be in the same plane or alignment
In the mandibular Arch,
the mesiobuccal and distobuccal cusps of the
molars and premolars should be in the same
mesiodistal alignment.

19. MOLAR OFFSET DESIRABLE OR NOT ?
15° distal offset:
1.the tooth morphology requires some offset for a linear
archwire.
2.the archwire leads away from the tooth mesiodistally,
and the tube's built-in rotation must be neutral to allow
proper rotation.

20. AIDS IN ALIGNMENT

21. ROTATION CONTROL

22. . The levelled marginal ridges will
position the cusps and fossae of the
teeth at the same level, thereby
promoting proper occlusal contacts
#2 MARGINAL RIDGES / 2ND ORDER /
TIP
In both maxillary and mandibular
arches, marginal ridges of adjacent
posterior teeth shall be at the same
level, or within 0.50 mm of the same
level
In scoring, do not include the canine-
premolar contact; and do not include
the distal of lower 1st premolar.
If adjacent marginal ridges deviate
from 0.50 to 1 mm 1 point is scored
for that interproximal contact.
greater than 1mm then 2 points shall
be scored for that interproximal
contact.
No more than 2 points will be scored
for any contact point.

23. MARGINAL RIDGES
According to Casko et al once the marginal
ridges of the posterior teeth are positioned at
the same relative level, then the
cementoenamel junctions are also at the same
relative level.
This will lead to the bone levels between the
adjacent teeth being flat, producing a much
healthier periodontal situation for the patient.
ABO noted that the most common
mistakes in marginal ridge alignment
were between the maxillary first and
the second molars and between the
mandibular first and the second
molars

24. MARGINAL RIDGES
The lack of distal root tip in the maxillary
second bicuspids, expressed during the
finishing stage, leads to discrepancy in
the marginal ridge matching between
these teeth
and the first molar.
This also leads to a lack of occlusal
contact in the posteriors.
The maxillary bicuspids should have
mesioaxial angulation with the second
bicuspid exhibiting distal root tip to promote
marginal ridge matching between these teeth
and the first molar and for better
interocclusal contact

25. MARGINAL RIDGES
The precise bracket placement, especially in the
vertical plane, has been generally acknowledged to
be the critical element in establishing marginal ridge
relationships.
If there is an error in vertical bracket placement, it
will be expressed as abnormal crown position after
the initial levelling.
At this stage, the bracket should be precisely
repositioned to level marginal ridges and to ensure
better stability.
If this is not performed during the initial phase of
treatment, these corrections can be done during the
finishing stage of treatment by incorporating some
bends in the finishing archwire.
The vertical bracket height affects the torque and in–
out and height of the tooth and, therefore, holds the
key to proper vertical crown positioning, marginal
ridge relationships and contact points.

26. #3 BUCCOLINGUAL INCLINATION
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 edge
Do not score the mandibular
1st premolars nor the distal
cusps of the second molars.

27. #4 OCCLUSAL CONTACTS
If the distolingual cusp is short or diminutive
it should not be considered in the evaluation.
If this cusp is prominent, but does not contact
with the opposing arch, then points may be
scored.
If the cusps are in contact with the opposing
arch, no points are scored.
Do not score diminutive distolingual cusps of
the maxillary 1st and 2nd molars,
nor lingual cusps of the mandibular first
premolars.
The buccal cusps of the mandibular
premolars and molars and the lingual
cusps of the maxillary premolars and
molars should be contacting the
occlusal surfaces of the opposing
teeth
The maxillary premolars have one functional
lingual cusp. However, the maxillary molars
may have only a mesiolingual functional cusp.
Each mandibular premolar has one functional cusp.
Each mandibular molar has two functional buccal
cusps

28. ARCH FORM COORDINATION
• 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 movements.
• Cross-elastics in cuspid areas used to compensate
for asymmetrical upper archform
• Archwire canted in direction opposite to
asymmetry.

29. OCCLUSAL RELATIONSHIPS
occlusion has been finished in an Angle Class I
relationship.
the maxillary canine cusp tip should align the
embrasure or contact between the mandibular
canine and adjacent premolar
The buccal cusps of the maxillary premolars
should align with the embrasures or contacts
between the mandibular premolars and first molar
The mesiobuccal cusps of the maxillary molars
should align with the buccal grooves of the

30. OCCLUSAL RELATIONSHIPS
In a Class II situation
the buccal cusp of the
maxillary first molar should
align with the embrasure or
interproximal contact
between the mandibular
second premolar and first
molar.
The buccal cusp of the
maxillary second molar
should align with the
embrasure or interproximal
in a Class III relationship (when
mandibular premolars are
extracted)
the buccal cusp of the maxillary
second premolar should align
with the buccal groove of the
mandibular first molar
The remaining occlusion distal to
the maxillary second premolar
and mandibular first molar are

31. SETTLING
• Transition from rectangular wires to light wires as rectangular are restrictive.
• Different elastics configuration for occlusal seating
• Alexander recommended chewing sugarless gum to get good interdigitation
• Profit recommends using light wires & light vertical elastics & cutting wire
distal to canine as well as positioner therapy
• If the arch wire is cut terminal to canine , lacebacks should be perfomed for
settling segment
• 0.014 & 0.016 round wires coordinated to patients arch form are used
• Multistranded rectangular wire can be used as well

32. SETTLING & FINAL OCCLUSAL RESULT
• In the posterior segment, teeth are generally held away from one another in
vertical plane due to full-size rectangular steel finishing arch wires.
• The vertical settling of maxillary and mandibular teeth to achieve maximum
intercuspation is done by using different configurations of vertical elastics
• The more precise the placement of brackets and tubes, the easier it is to
settle the teeth and the less elastics need to be used in this way
• Ricketts suggested that without third molars, 16–24 occlusal stops or centric
stops on each side are adequate for a good balanced occlusion
• In the maxillary buccal segments, the palatal cusps of the first and second
molars are generally slightly longer and extend slightly more occlusal than the
buccal cusp.
• With the common use of expansion treatment often using overexpanded,
commercial arch blanks or limited amount of maxillary posterior expressed
buccal root torque, palatal cusps extend occlusally beyond their normal limits.
• This leads to inappropriate interdigitation between maxillary and mandibular
posterior teeth.

33. MIDLINE DISCREPANCIES
• It is important to establish
the origin of the
discrepancy in order to
correct it
• Up to 3 mm of midline
discrepancy can be
corrected in this phase
• Usually elastics are
enough for midline
correction but at times
asymmetric stripping may
be required

34. ELASTIC CONFIGURATIONS

35. OVERJET
If the proper overjet has
been established, then the
buccal cusps of the
mandibular molars and
premolars will contact in the
center of the occlusal
surfaces, buccolingually, of
the maxillary premolars and
molars
In the anterior region,
the mandibular
canines and incisors
will contact the
lingual surfaces of the
maxillary canines and
If this relationship
exists, no points are
scored.

36. OVERJET
mandibular buccal cusps deviate 1 mm or less from
the center of the opposing tooth 1 point is scored
for that tooth.
More than 1 mm from the center of the opposing
tooth
two points are scored for that tooth.
No more than 2 points are scored for any tooth.

37. OVERJET
In the anterior region, if the mandibular canines or
incisors are not contacting lingual surfaces of the
maxillary canines and incisors, and the distance is 1
mm or less then 1 point is scored for each maxillary
tooth. If the discrepancy is greater than 1 mm then
2 points are scored for each maxillary tooth.
extremely acute inter-
incisal angles and/or
significant overlap of incisal
edges may be scored an
additional point.
2.5 mm overjet– overbite relationship; however, it
should be proportional to the height of cusps of
posterior teeth.

38. OVER JET KEYS
• Torque Tip
• Torque
• Tooth Size
• Inclination
AlQabandi et al reported 6–7° of lower incisor
flaring when simply levelling the curve of Spee with
fixed appliances
The lower incisor flaring, if not controlled during the
initial stage of treatment, would require increased
labial crown torque of the maxillary incisors to
maintain appropriate overjet and overbite
. This results into bimaxillary protrusion impairing
the facial aesthetics.
Growth direction, aesthetics and overbite should
also be considered in determining ideal torque in the
maxillary and mandibular arch

39. SUSPECT BOLTON’S DISCREPANCY
• Where posterior space closure is difficult in the upper arch
while maintaining correct amount of overjet 3-4 mm
• Cases where overjet is correct but buccal segment is in class II
• Complete space closure is difficult while maintaining overjet
• In patients with large upper incisors
• In some class III cases where upper incisors are proclined
forward and lower incisors are retroclined

40. INTERPROXIMAL CONTACTS
This assessment is made by viewing the maxillary
and mandibular dental casts from an occlusal
perspective.
The mesial and distal surfaces of the teeth should be
in contact with one another
If 0.50 mm or less interproximal space exists, then
no points are scored.
0.50 to 1 mm of interproximal space exists between
two adjacent teeth then 1 point is scored
0.5 to 2 mm then 2 points are scored for that
interproximal contact.
No more than 2 points are scored for any contact
that deviates from ideal.

41. INTERPROXIMAL CONTACTS
• The importance of proper
contact points between the
teeth in preventing food
impaction and stability of
the dental arches after
orthodontic treatment has
been well understood by all
specialists. Interproximal
contacts are also used to
determine, if all spaces
within the dental arch have
been closed

42. ROOT ANGULATIONS
this is not ideal, it gives a reasonably good assessment of root position.
Generally, the roots of the maxillary and mandibular teeth should be
parallel to one another and oriented perpendicular to the occlusal plane
If this situation exists, then no points are scored
Omit scoring the canine relationship with adjacent tooth root when
using a final panoramic radiograph.
close to, but not touching, the adjacent tooth root,
then 1 point is scored for each discrepancy
If the root is angled to the mesial or distal
and is contacting the adjacent tooth root then
2 points are scored for that tooth

43. LOWER ANTERIOR ROOT ANGULATION
Raleigh Williams suggested certain guidelines to
optimally position mandibular incisors and canines
for long-term stability
The lower incisor root apices should be spread
distally to the crowns, and the apices of the lower
lateral incisor must be spread more than those of
the central incisors
Other factors being normal, if the roots are parallel
to one another, 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.
In extraction cases, it is important to
maintain the closure of extraction
spaces during the finishing stage of
treatment with the roots of the
adjacent teeth parallel to each other.
This eliminates the troublesome
problem of spaces reopening

44. SUCCESSFUL ABO CASE • 27 or less points for C-R Evaluation

45. LATERAL CEPHALOMETRIC RADIOGRAPH
IN FINISHING
• Mid-treatment lateral cephalogram may be obtained and analyzed to see the key indicators of treatment
success
• Interincisal angle
• A-POG
• Disoclussion angle
• Mandibular plane angle
• ANB angle
• Nasolabial angle
• SNB angle
• Occlusal plane
• Posterior facial height to anterior facial height ratio

46. INTERINCISAL ANGLE IMPORTANCE
• The overall inclination of the maxillary and
mandibular anterior teeth
• The interincisal angle plays an important role in
aesthetics, function and stability and should
not be based on averages.
• Growth direction, aesthetics and overbite
should also be considered in determining ideal
torque in the maxillary and mandibular arch.

47. A-POG
The mandibular incisors should be aligned contact
point-to-contact point with the roots in the same
labiolingual
They should be positioned at the cephalometric
goal of 11 to A-Po.

48. DISOCLUSSION ANGLE
The ideal angle of disclusion in protrusive is
thought to be 5° greater than the condylar disclusive
angle , paramount importance to avoid protrusive
interferences & TMD.

49. MANDIBULAR PLANE ANGLE
32 +- 4
• In high-angle patients,
successful treatment is
associated with a favorable
counter-clockwise rotation of the
mandible by a reduction of
mandibular plane angle.
• in low-angle patients, good
treatment is determined by a
favorable clockwise rotation of
the mandible by an increase in
mandibular plane angle.

50. SNB 80 +-2
• The SNB angle indicates the
mandibular response.
• An improvement in SNB angle is
an indication of better
mandibular response,
suggesting a successful
treatment.

51. OCCLUSAL PLANE
• Occlusal plane indicates the
control of treatment.
• As extrusion and tipping are
relatively easy movements,
orthodontic treatment is often
associated with the extrusion of
molars and flaring of the
mandibular incisors, causing the
occlusal plane to tip forward.
• This is an indication of poor
control of treatment. Successful
treatment is associated with a
flattening of the occlusal plane

52. ANB ANGLE 2 +-1
• The ANB angle is an indicator
of a skeletal discrepancy
correction.
• A successful orthodontic
treatment is associated with an
improvement in existing ANB
discrepancy.

53. NASOLABIAL ANGLE 85-105
• In most situations, the
nasolabial angle indicates the
dentoalveolar and soft-tissue
profile response.
• A successful treatment is
associated with an improvement
in the soft-tissue balance and
harmony and reduction in the
dentoalveolar protrusion.
• Females show more obtuse

54. POSTERIOR FACIAL HEIGHT : ANTERIOR
FACIAL HEIGHT
• Posterior facial height to
anterior facial height ratio is
an indicator of the mandibular
response.
• In most clinical situations,
successful treatment is
associated with an increase in
posterior facial height than
the anterior facial height,
leading to an increase in this
ratio.

55. AESTHETIC PARAMETERS IN FINISHING
• Crown width discrepancy
• Illusion
• Aesthetic recontouring
• Post debonding restoration of enamel surface
• Enamel decalcification
• Tooth whitening
• Gingival architecture
• Gingival depigmentation

56. CROWN WIDTH DISCREPANCY
• Size of the teeth is one of the most important elements of anterior dental aesthetic
• peg-shaped lateral incisors
• a diagnostic wax-up is an important step to visualize the final result
• Vincent Kokich provided certain guidelines to optimally position malformed lateral incisors for best results. One must remember that the contour of the
mesial surfaces of lateral and central incisors is relatively flat. If the lateral incisor is positioned too close to the canine, its mesial surface should be
overcontoured to establish normal crown width. Therefore, as far as the mesiodistal position of peg-shaped lateral incisor is concerned, it should be
positioned nearer the central incisor for optimal aesthetic result
• The labiolingual position of the malformed lateral incisor will depend on the type of the subsequent permanent restoration used to restore the appropriate
rown width.
• This restoration could be either a porcelain crown or a porcelain veneer.
• If it is a porcelain crown, the orthodontic treatment should be directed to position the peg-shaped lateral incisor in the centre of the alveolar ridge
labiolingually, with approximately 0.50–0.75 mm overjet.
• This will eliminate the need for additional tooth preparation on the lingual aspect of the lateral. However, if the subsequent restoration is going to be the
porcelain veneer, the malformed lateral incisor should be positioned lingually to be in contact with the mandibular incisors. This lingual position should be
in proportion with the thickness of the porcelain veneer.
• During the finishing stage of treatment, it is important to evaluate the gingivoincisal position of the lateral incisor. Ideally, the incisal edges and the
gingival margins should be aligned with the contralateral lateral incisor. Orthodontic intrusion or forced eruption will position the peg-shaped lateral
incisor at the appropriate level, which in turn will help restore proper length of the tooth.
golden proportion, This ratio is an
ideal ratio that can be mathematically
defined as 1:1.618

57. ILLUSION
• Role of ‘Illusion’ The size and shape of anterior
teeth, particularly their length and width, as a
result of disproportion, may appear aesthetically
compromised.
• If this disproportion is not very severe, it can be
addressed by using optical concepts to create
optical illusions of size and shape
• l perception is possible because of the contrast in
shape, lines and colour of objects.
• Therefore, the perception of size and shape is
dependant on the reflection or deflection of light
from different surface areas of objects.
• By controlling the phenomenon of light reflection
and by altering the surface of a tooth, it is
possible to establish proportions because ‘our
vision is often fooled by optical illusive effects’
• Increases light reflection increases visibility
• Increased light deflection decreases visibility
• increased contrast increases visibility
• The key factor here is to control the light
reflection or deflection by contouring the tooth
surface.
• Tooth contouring should be limited to mesial
and distal inclines, incisal edges, gingival
inclines, natural grooves, angles, etc.
• In case of a wider tooth mesiodistally
proportions can be re-established by applying
the principles of narrowing illusion. This can be
accomplished by adjusting the lateral
prominences toward the centre, increasing the
curvature of the central prominence

58. ESTHETIC RECONTOURING/
ENAMELOPLASTY
• Proper incisor display upon smiling is a key factor
• irregular incisal edges, abnormal tooth morphology or attrided
anterior teeth interfere with the aesthetic outcome of orthodontic
treatment
• it should not be used as a substitute for incomplete orthodontic
treatment
• guidelines that are specific to the feminine and masculine smiles.52
The characteristic features of youthful, feminine smiles are rounded
incisal edges, open incisal and facial embrasures and softened facial
line angles. However, the masculine smile is typically characterized
by more closed incisal embrasures and prominent incisal angles.

59. POST DEBONDING ENAMEL SURFACE CARE
• proper removal of various orthodontic attachments and the residual composite from the
teeth
• Incomplete removal of the residual adhesive from the tooth surface after debonding
leads to staining and plaque accumulation, demineralization or caries formation and
gingival inflammation from contact with rough surface.
• quite difficult to remove the residual adhesive due to its colour similarity with the enamel.
• The important step is to identify the residual adhesive sites
• ultrafine diamond bur leaves a very rough surface
• dome-tapered tungsten carbide bur in a contraangle handpiece at approximately 30,000
rpm
• aluminium oxide polishing points and rubber cups for the removal of last traces,
followed by enamel polishing with pumice as the best way to restore the enamel surface
to its pretreatment surface quality.

60. ENAMEL DECALCIFICATION
• white spots or areas of enamel demineralization of varying degrees
due to noncompliance with oral hygiene instructions
• Almost half of the patients undergoing orthodontic treatment with
multibonded appliances exhibit the areas of enamel decalcification,
with the highest incidence in the maxillary incisors, especially the
laterals
• proper tooth-brushing, daily rinsing with dilute (0.05%) sodium
fluoride solution along with a regular use of a fluoride dentifrice is
recommended as a routine procedure for orthodontic patients
• Fluoride varnish application at bracket / tooth interface significantly
decrased wsl.

61. GINGIVAL ARCHITECTURE
• Colour, contour and health of the gingival
tissues provide the framework and backdrop for
the pleasing smile.
• loss of papilla, asymmetrical pattern or
excessive display upon smile leads to a poor
result
• The presence of a papilla between the
maxillary central incisors is a key element in
anterior aesthetics.
• While evaluating the aesthetics related to
gingival tissues, it is important to consider two
key factors: (1) gingival levels and (2) gingival
contour or gingival zenith.
• The most apical point of the labial gingival
contour, called the gingival zenith, is located
just distal of the long axis of the central
incisors and cuspids, whereas the gingival
zenith for the lateral incisors coincides with
their long axis

62. ANTERIOR AESTHETIC GINGIVAL
DEPIGMENTATION
SCALPEL VS LASER• Exposure of maxillary gingiva of approximately 1–2 mm
upon smile is generally considered part of the aesthetic
smile
• ‘gummy smile’ major concerns for large number of
patients seeking orthodontic treatment & is aggravated in
patients with gingival hyperpigmentation, expressed as
‘dark gums’ leading to compromised gingival aesthetics
• Aesthetic periodontal plastic surgery ‘depigmentation’ is
rewarding
• Melanin, a brown pigment, is the most common cause of
endogenous pigmentation of gingiva
• Gingival depigmentation procedure using scalpels involves
surgical removal of gingival epithelium along with a layer
of the underlying connective tissue to heal by secondary
intention. The newly formed epithelium is devoid of
melanin pigmentation
• Laser depigmentation is associated with less pain & less
bleeding vs. scalpel

63. NEGATIVE SPACES
• As the smile approaches a laugh, the jaws
separate and a dark space develops between
the maxillary and mandibular teeth. This well-
formed dark space, called the negative space
lends attractiveness to the smile and enhances
the appearance of the oral region
• The perfect smile occurs when the maxillary
anterior dentition is in line with the curvature
of the lower lip, the corners of the lips are
elevated to the same height (symmetry), and
bilateral negative spaces separate the teeth
from the corners of the lips

64. ANTERIOR TEETH CONSIDERATIONS
• The maxillary central
and lateral incisors in
their final positions
should have no more
than 0.5 mm height
differential
• 5° and 9° mesioaxial
angulation,
respectively, and they
should be adequately
torqued
5 ° 9°

65. LIP – INCISOR RELATION
• The incisal edges should be 2–2.5 mm
below the lip embrasure of the upper
and lower lips, when the lips are closed
with no lip strain. Raleigh Williams29
• Smile arch should follow lower lip
curvature

66. THANK YOU

67. REFRENCES
• 1. Ashok Karad. Excellence in finishing: current concepts, goals and mechanics. J Ind Orthod Soc 2006; 39:126–138.
• 2. Ronald H Roth. Functional occlusion for the orthodontist. JCO 1981; 1:32–50.
• 3. Richard P McLaughlin, John C Bennett. Finishing with the preadjusted orthodontic appliance. Semin Orthod 2003; 9:165–183.
• 4. Andrews LF. Straight wire – the concept and the appliance. In: Valleau J, Olfe JT, eds. Straight wire. Los Angeles: Wells; 1989:32–33.
• 5. Casko J, VadenJ, Kokich V et al. American Board of Orthodontics objective grading system for dental casts and panoramic radiographs. Am J Orthod Dentofacial Orthop 2000; 114:530–532.
• 6. Angle EH. Malocclusion of the teeth. 7th edn. Philadelphia: S.S. White; 1907.
• 7. Andrews LF. The six keys to normal occlusion. Am J Orthod 1972; 63:296–309.
• 8. Broomell IN. Anatomy and physiology of the mouth and teeth. 2nd edn. Philadelphia: P. Blakiston’s Son; 1902:99.
• 9. Chuck GC. Ideal archform. Angle Orthod 1934; 4:312–327.
• 10. Hawley CA. Determination of the normal arch and its application to orthodontia. Dental Cosmos 1905; 47:541–552.
• 11. White LW. Individualized ideal arches. J Clin Ortho 1978; 12: 779–787.
• 12. Brader AC. Dental arch form related to intraoral forces: PR5C. Am J Orthod 1972; 61:541–561.
• 13. Felton MJ, Sinclair PM, Jones DL, et al. A computerized analysis of the shape and stability of mandibular archform. AmJ Orthod 1987; 92:478–483.
• 14. Burke SP, Silveira AM, Goldsmith LJ, et al. Meta-analysis of mandibular intercanine width in treatment and postretention. Angle Orthod 1998; 68(1):53–60.
• 15. Gardner SD. Posttreatment and postretention changes following orthodontic therapy. Angle Orthod 1976; 46:151–161.
• 16. Richard P McLaughlin, John C Bennett. Finishing with the preadjusted orthodontic appliance. Semin Orthod 2003; 9:165–183.