Finishing And Detailing In Orthodontics Pdf
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- [Finishing and detailing, stability and harmony]
- Contemporary Finishing Techniques
- Finishing & Detailing In Orthodontics
Over the last 10 years, technology and orthodontic techniques have harmoniously come together to pave the way for a new era in the end smile result. A desirable smile now includes an ideal occlusion, arch width, a smile arc, incisor display, full lips with vermilion curl, and properly torqued teeth.
Correspondence Address : Dr. Finishing is perhaps one of the most deceiving and difficult phases of orthodontic treatment. The finishing procedures are considered from the beginning stages of the treatment as a part of total scheme of treatment. The great deal of emphasis is placed on achieving perfect finishing and detailing of the orthodontic treatment, so that the results are pleasing to the eye and are more stable and conducive to improved function and health. Thus, the aim of this article is to provide comprehensive knowledge about different criteria about finishing and detailing in orthodontics.
[Finishing and detailing, stability and harmony]
Treatment then becomes inefficient and results are disappointing. However, if treatment goals are kept constantly in mind, results become much more consistent, and when minor compromises must occur, the reasons for these can be understood, and many of them can be avoided in the future.
The goals of treatment for the authors are listed below. They hope the reader will keep these in mind when reading the text, to provide greater insight into their intent. It is hoped that in that way it will have more meaning. This book was originally planned as a second edition of the first Bennett and McLaughlin text, entitled Orthodontic Treatment Mechanics and the Preadjusted Appliance, published in However, there have been so many technological changes and improvements over the past 8 years that an entirely next text became necessary, supplementing the general message of the first.
A second Bennett and Mclaughlin text, entitled Orthodontic K4anagemenl of the Dentition with the Preadjusted Appliance, was published in This devoted a chapter to each tooth in the dentition, emphasizing clinical situations relating to each tooth. It evolved into a far more extensive project than initially intended, and required a substantial manuscript to cover the wide range of material. With this third textbook, the intention is to return to a concise format somewhat similar in scope to the first.
Its primary focus is on orthodontic treatment mechanics, in particular intra-arch considerations, or the maneuvers involved in alignment and maintenance of the dentition in each individual arch.
These factors are dealt with in Chapter 5 Anchorage control during tooth leveling and aligning', Chapter 6 'Arch leveling and overbite control', Chapter 9 'Space closure and sliding mechanics', and Chapter 10 'Finishing the case'. Inter-arch considerations, or the coordination of the upper and lower arches in three planes of space within the facial complex, are also given a slightly greater emphasis than previously; in particular, Chapter 7 and 8 deal with Class II treatment and Class III treatment, respectively.
These are extensive subjects, but an attempt has been made to present a concise and up-to-date perspective on the general management of these two categories of case. The text discusses both extraction and non-extraction treatments.
Greater emphasis is placed on extraction treatment, because the mechanics of these cases are more complex. This is not to infer that the authors treat more cases on an extraction basis; in general, every effort is made to treat on a non-extraction basis wherever possible, and the authors treat a much higher percentage of cases in this manner.
Chapter 2 on appliance specification deals with the rationale behind the changes made in the appliance system. Emphasis is placed on the new variations, as well as on the versatility of the appliance comparisons are restricted to the original SWA and do not refer to other orthodontic appliances. A bracket placement chart, developed in , has been most valuable in the important area of bracket placement.
The text discusses recent developments in bracket-placement techniques -renewed interest in indirect bonding, for instance, has occurred because of improved materials, such as adhesive systems and tray materials. An overview of this subject is provided.
Archwire technology has improved dramatically over the past 8 years. The use of heat-activated nickel-titanium wires I IANT has become a vital part of the treatment system, and, consequently, modifications to the treatment mechanics have occurred. Information on HANT wires, along with a discussion of archwire sequencing, is presented in Chapter 5 'Anchorage control during tooth leveling and aligning'.
Since its introduction in the s, attempts have been made with the preadjusted appliance to select and use a single arch form on most patients.
Even using the most frequently observed arch form in the orthodontic population, the authors observed numerous cases that were either too narrow or over-expanded. Therefore, Chapter 4 is dedicated to the subject of arch form, and presents efficient techniques for managing arch form selection and archwire coordination.
Chapler 11 is dedicated to retention protocol, which is a new subject for this text. It gives an overview of the protocol, as well as describing the methods most frequently used by the authors.
DrTrevisi has provided a number of important insights into the technique, and therefore a decision was made to introduce him as a third author of the text, thus reinforcing its international perspective, and bringing together the best ideas from three continents. The success of a project of this scope and complexity depends on the commitment of many individuals. The authors acknowledge and appreciate the documentation skills and extra photography carried out by the assistants in each of the authors' practices.
Text and illustrations were assembled in London, and production and publication were handled by the Mosby team in Edinburgh. On behalf of the publishers, Barbara Simmons, project development manager, and her colleagues contributed unfailing energy' and enthusiasm to this project.
Their professionalism and respect of the authors' sometimes unconventional work patterns helped make the publishing process both efficient and enjoyable. The authors freely acknowledge the valuable help and advice given by Michael Parkinson, commissioning editor. They also wish to make particular mention of the contribulion of Graham Birnie, who laboriously checked and edited the original text, and of ludith Wright, who was responsible for the design.
Looking ahead, there are plans for at least 12 foreign co-editions, and the authors are grateful to Ilona Turniak for her work on diis important aspect of publication.
Chapters 7 and 8 include information on the diagnostic methods of Dr Bill Arnett, who gave considerable time and assistance, and made important material available for Chapter 8. The authors are also grateful for Dr Fredrik Bergstrand's advice on bonding, and for the photograph.
The authors' work has benefited over the course of many years from the input of international colleagues -although space constraints make it impossible to acknowledge each individually, their friendship, enthusiasm and support does not go unrecognized. The following technical production information may be of interest. The original text was generated in Apple Works 5. Line drawings were created in Apple Freehand 8.
The color photographs were mainly originaled in Kodachrome No digital enhancement of clinical material took place. Apart from the removal of red-eye on some of the facial photographs, il has been published directly from the original Kodachrome slides.
Finally, the authors would like to thank 3M Unitek for its efforts in designing the new appliance, as well as for support in the other areas of the treatment system, such as bracketplacement gauges and charts.
However, soon after the introduction of the preadjusted appliance, it became clear that the bracket system required a whole new program of treatment mechanics and force levels lo fully realize its potential.
In turn, the new treatment mechanics and force levels brought about a need for modifications to the bracket system. Ultimately, it has become the mechanics and force levels that have determined the appliance design, and not vice versa. This chapter reviews the evolution of orthodontic treatment mechanics since the early s the start of the modern era , and goes on to review the principles of the method currently used.
Appliance design and treatment mechanics are closely inter-related. To some extent, bracket design can be scientific and based on research, so that bracket designs can be produced in a matter of months. However, development and refinement of appropriate treatment mechanics take years, and have to be based on experience with numerous treated cases. Consequently, the information on treatment mechanics is often anecdotal, and based on recommendations from experienced clinicians.
If a balanced combination of these elements is used, efficient and systemized treatment can be achieved. However, variation in one for example archwire selection can substantially influence the other elements and can undermine the effectiveness of the treatment approach. Andrews' paper was based on the measurement of nonorthodontic normal cases. He then used the data as a basis to design a bracket system. Although the SWA was radically new, traditional heavy edgewise forces continued to be used.
No special anchorage control measures, such as second order archwire bends, were employed. This may have been due to his clinical experience as an edgewise orthodontist and the force levels that were used. He also emphasized the 'wagon wheel effect' where tip was lost as torque was added. Hence, he chose to add additional tip to the anterior brackets.
Bracket positioning was based on the center of the clinical crown. Because less wire bending was needed with the new appliance, there was also a trend to standardize arch form. As a result of Roth's influence, there was a general movement toward a broad or square arch form, although Andrews continued to use the basal bone of the mandible as an arch form reference. Various arch forms were used because no clear direction was available.
Difficulties were encountered with treatment mechanics in the early years, clue to the heavy forces and possibly due to the increased tip in the anterior brackets. Consequently, deepening of the anterior bite, with creation of a lateral open bite, was seen in many cases, and this became known as the 'roller coaster' effect Figs 1. For example, he determined that for extraction cases, canine brackets with anti-tip, anti-rotation and power arms were needed Fig.
He also recommended the use of three different sets of incisor brackets, with varying degrees of torque for different clinical situations.
Whereas Andrews, with the first generation of preadjusted brackets, was recommending a large range of bracket specifications, Roth was anxious to avoid the inventory difficulties of a multiple bracket system. He therefore recommended a single appliance system, consisting primarily of minimum extraction series brackets, which he felt would allow him to manage both extraction and non-extraction cases.
This has been described as the second generation of preadjusted brackets, and Roth's recommendations were widely accepted by clinicians, some of whom had experienced similar difficulties in treatment mechanics and were confused by the wide variety of available brackets. The appliance prescriptions developed by Andrews and Roth were based on the overall treatment mechanics used in their practices.
The Roth treatment approach emphasized the use of articulators for diagnostic records, for early splint construction, and for the construction of gnathological positioners at the end of treatment Fig. This approach was used to aid in establishing correct condyle position.
He used the center of the clinical crown for bracket positioning, as advocaieciby Andrews. As stated above, his arch form was wider than Andrews' in order to avoid damage to canine lips during treatment and to assist in obtaining good protrusive function.
Instead of initially modifying the basic bracket design, for more than 15 years they developed and refined treatment mechanics based on sliding mechanics and continuous light forces, mainly using standard SWA brackets.
These mechanics were published initially as a series of papers in the early s' 1,51 ' and then as a book in ' pig i9 ant nave seen widespread acceptance. Their treatment mechanics recommendations included accurate brackei positioning, and lacebacks and bendbacks for early anchorage control, with light archwire forces Fig. Sliding mechanics were recommended on. They used the middle of the clinical crown for bracket positioning during this development period.
Contemporary Finishing Techniques
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Finishing & Detailing In Orthodontics
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Finishing procedures in Orthodontics: dental dimensions and proportions microesthetics. The content is limited to microesthetics, which comprises the concept of ideal dental dimensions and proportions white esthetics and its correlation with the periodontium pink esthetics. Standards of normality are described both in their real dimensions dental height and width , and in those effectively perceived by the observer, the virtual dimensions.
The finishing and detailing phase, the last stage of active orthodontic treatment, makes it possible to perfect the occlusion, by adhering to criteria defined by various authors and to improve the esthetic result, while achieving the treatment objectives made during the pre-planning phase. The reliability of end of treatment results cannot be ensured without an initial individualized analysis of the risk factors for relapse specific to each patient. It is only after this analysis, that the orthodontist will be able to determine how to comply with these criteria for stability, common in any treatment, and to individually choose and implement reliable procedures. When planning for stability as the treatment objective, orthodontic patients are able to achieve stable alignment. This course of action is the necessary process to help ensure equilibrium and alignment. Eight different methods of alignment, already frequently discussed in the literature, will be described and analyzed in this paper. Abstract The finishing and detailing phase, the last stage of active orthodontic treatment, makes it possible to perfect the occlusion, by adhering to criteria defined by various authors and to improve the esthetic result, while achieving the treatment objectives made during the pre-planning phase.