The Final Stage Of Finishing Settling The Case

Rectangular stainless steel working wires are required for overbite control, A/P correction, and space closure, but they are somewhat restrictive for settling of the teeth in the closing stages of the treatment. Much lighter wires are therefore used. Typically, a .014 or .016 round 1IANT wire is used in the lower arch, coordinated to the IAF for the patient. In the upper arch, a .014 round sectional wire can be placed from lateral incisor to lateral incisor. These wires can be accompanied by the use of vertical triangular elastics where settling needs to occur. The belter the bracket placement, the less elastics need to be used in this way. It is beneficial to keep all bands and brackets on ihe teeth during settling, so that if unwanted changes occur, these can be corrected.

Managing the case in this manner allows teeth to individually settle into their final positions before appliance removal. Patients can be seen at approximately 2-week intervals during the settling phase. Elastics can be worn full time for the first 2 weeks, then at night for a period of 2 weeks, if settling is adequate. Debanding can then be scheduled.

Fig. 10.20 Light vertical triangular elastics can be used where settling needs to occur. Fewer elastics of this type will be required if bracket placement has been accurate.

Some variations to this general settling technique are as follows:

• If cuspids were labially displaced in the upper arch, the sectional wire in the upper anterior segment can be extended to the cuspids to hold them in position.

• If diastemas were present in the upper and lower anterior segments, these areas should be tied together lightly with elastic thread or ligature wires (Fig. 10.21).

• If teeth have been extracted, ligure-8 ligature wires should be placed across the extraction sites to hold them closed.

• If palatal expansion was carried out, a small removable palatal plate, with .018 wires extending inter-proximally in the gingival areas, can be used to maintain expansion during the settling phase (Fig. 10.22).

• When finishing moderate to severe Class II/l malocclusions, it is not wise to use a small sectional wire for the upper anterior segment, because some return of the overjet can be expected. In this situation, a full upper .014 archwire can be used in settling (Case DO, p. 210) and this wire can be bent back behind the most distal molars. This controls the overjet, but inhibits settling of the posterior teeth somewhat. Archwire bends may therefore be placed where individual teeth need to settle.

• If it is intended that settling may take longer than approximately 6 weeks, it is beneficial to leave the lower rectangular steel wire in position during this extended settling phase. This will help to maintain lower arch form. An example of this might be a difficult posterior open bite that will require a more extended period of time for settling. When it is anticipated that only 4 to 6 weeks of treatment is remaining, a normal lower .014 steel or .016 heat-activated wire can be placed.

Occasionally, settling does not proceed as expected and it may be necessary to return to the rectangular stainless steel wires. On occasion, it may be necessary to reposition some brackets to allow the arches to re-level and settle properly. This, of course, should have been accomplished at an earlier stage of treatment, but occasionally it is necessary. Once the orthodontist is satisfied that teeth have settled into a satisfactory position, retainer impressions can be taken and the patient scheduled for debanding procedures.

Fig. 10.21 During settling it is necessary to lightly tie incisors together if a diastema was present at the start of treatment.

Fig. 10.21 During settling it is necessary to lightly tie incisors together if a diastema was present at the start of treatment.

Fig. 10.22 A removable palatal plate can be used during settling to maintain upper arch expansion.

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