Finishing consists of managing a number of dental and skeletal factors in the sagittal, vertical and traverse dimensions. Two critical factors that become very important at the end of treatment are bracket placement and the features built in to the pre-adjusted appliance. Pre-adjusted brackets are designed based on values measured at the center of the clinical crown (Andrews). While there are some modifications to this location, in most cases this is the ideal position. After initial placement and leveling, bracket position is greatly enhanced by …

Photos 1-5
Patient’s initial records. 11.6 year old male shows a slight Class II malocclusion with a deep anterior overbite. Patient was treated on a non‐extraction basis.

The patient was re-bracketed in May 2009 with upper Opal Avex Cxi and Lower 5×5 Opal Avex brackets.

Photos 6-7
Case in settling stage of treatment, prior to debanding. Notice accurate tip, torque and in/out values.

Final records.

Surgical treatment plan consisted of a maxillary advancement and mandibular set back.

“I recently had the opportunity to teach the orthodontic residents at Saint Louis University. They have a very large program and a beautiful facility. My thanks to Dr. Rolf Behrents, Orthodontic Program Director, for allowing me to be part of his excellent program.”

In the upper and lower posterior segments, the goal in orthodontic treatment is to level the marginal ridges, align the central fossae, and level the curve of Wilson. One of the most difficult areas to achieve this key three dimensional relationship is in the lower second bicuspid-lower first molar area.
The average occlusal – gingival height of the lower second bicuspid is 7 mm, and that of the first molar is 5 mm. The center of the clinical crown, where bracket slots are normally placed, is then 3.5 mm below the …