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Conventional begg's stage 3 in orthodontics /certified fixed orthodontic courses by Indian dental academy

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Conventional begg's stage 3 in orthodontics /certified fixed orthodontic courses by Indian dental academy

  1. 1. The Begg Appliance and Technique Stage III
  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  3. 3. Outline ► Introduction ► Tooth Relationships at start of Stage III ► Bending of Main Arch Wires for Stage III ► Auxiliaries used during Stage III - Uprighting Springs - Torqueing Auxiliaries ► Application of third stage arch wires and auxiliaries to teeth ► Additions and modifications in stage III mechanics
  4. 4. Introduction ► The third stage of treatment should be commenced only after the completion of all the objectives of preceding stages. ► Objectives of stage III 1.Maintaining all the corrections achieved during first and second stages. 2.Achieve desired axial inclinations of all the teeth.
  5. 5. Tooth Relationships at start of Stage III ► The teeth of a four bicuspid extraction case should appear as shown in the fig. ► Bicuspids in good occlusion and the anterior teeth slightly apart. ► Anterior teeth lingually inclined, and bicuspids and cuspids need root paralleling.
  6. 6. Bending of main arch wires for Stage III ► To maintain proper dental arch form and bite-opening achieved during treatment, new heavier arch wires are used. ► Maxillary arch wire bent from 0.020 inch round arch wire material and slightly constricted in its distal bends to counteract the widening effects of the maxillary torqueing auxiliary. Proper arch form of stage III 0.020 arch wire.
  7. 7. ► The upper arch wire is passive (vertically) in the molar tubes. ► It has a slight gingival bend distal to the cuspid bracket area to counteract the occlusal vectors of force created by all anterior lingual root torqueing auxiliaries. Maxillary 0.020 inch arch wire as viewed from the buccal. Anterior portion is offset gingivally to counteract the incisal force generated by most torqueing auxiliaries.
  8. 8. ► The mandibular arch wire used is 0.020 inch round wire. ► Expansion incorporated (slight). ► Anchor bend continued, but it is not as pronounced as that present during stage II. Proper mandibular arch form for stage III made from 0.020 inch wire.
  9. 9. ► A mild bend placed distal to the mandibular cuspid bracket area to reduce any tendency for recurrence of an anterior overbite during stage III. ► A slight vertical step in the anchor bend area. Buccal view of stage III arch wire. Note the slight anchor bend and a bend to depress the anterior teeth.
  10. 10. Auxiliaries used during stage III ► The two main auxiliaries : ► Individual Root Springs or Mesio distal uprighting Springs. ► Torqueing auxiliaries.
  11. 11. Uprighting Springs ► 1. 2. ► 1. 2. Original Spring. Smaller & fewer coils. A longer lever arm. Refinement of original spring. Larger more resilient coils. Short lever arm.
  12. 12. ► 1. 2. Advantages of Short Springs: They are Selfretaining. Being short they do not interfere with springs on adjacent teeth.
  13. 13. Spring - Pin ► A problem inherent in all uprighting springs is that, when engaged and under tension, the coil presses against the gingival edge of the beacket. ► If arch wire is not safely tied into the slot of the bracket, this force from the coils can cause the bracket to move away from the arch wire, with a subsequent elongation of the tooth.
  14. 14. ► As a solution to this problem authors have invented, Spring Pin. ► A Combination of a Lock Pin and an Uprighting Spring. ► The leg of the pin portion passes lingual to the arch wire and the tail fits labial to it in the space in the bracket that normaly accepts the lock pin.
  15. 15. ► The arch wire is so held securely( yet loose) in the bracket slot, and the tooth is free to upright mesiodistally with no danger of its being elongated.
  16. 16. Torqueing Auxiliaries ► To torque roots of the maxillary anterior teeth lingually. ► Torqueing is nearly always necessary (especially with upper incisors) in mild discrepancy cases that require extraction of the four first premolars i,e in cases having only a mild excess of tooth substance relative to jaw size. ► This is because crowns of the incisors tipped back a long way lingually to close the extraction spaces.
  17. 17. ► It is usually unnecessary to torque incisor roots lingually in four first premolar extraction cases that have considerable excess of tooth substance relative to the jaw size. ► The extraction spaces are more prone to close quickly than in mild discrepancy cases. ► Therefore, the extraction spaces close before the crowns of the incisors are able to tip very far back.
  18. 18. ► It is always necessary to torque the incisor roots lingually, usually both the upper and the lower incisor roots, in severest discrepancy cases. ► This is because it is necessary to extract eight teeth in these most severe discrepancy cases i,e 4 first PM’s & 4 first permanent M’s. ► The extraction of these eight teeth leaves a large amount of space that needs to be closed by the tipping of the incisors and in the process they would have moved a long way lingually.
  19. 19. ► It is sometimes necessary to torque the roots lingually in non extraction cases also, especially in those that have an excess of jaw substance relative to tooth size. ► In most of the patients, by the end of the second stage of treatment (and sometimes before this time), it becomes quite obvious that whether it is necessary to torque incisor roots lingually or not.
  20. 20. ► Originally spurs, to rest against the labial surfaces of the upper centrals and the laterals, were bent into the main maxillary arch wire i,e 0.016 inch arch wire material. ► The torque force was transmitted in a spiral manner along the main arch wire to the anchor molars. ► Effect was to move the molars buccally and rotate them distobuccaly. ► By employing a heavier main upper arch wire in conjunction with the torqueing auxiliaries bent from lighter material( 0.014 to 0.016 inch), it is possible to prevent undesired movement of the maxillary anchor molars.
  21. 21. ► At present, there are many different designs for anterior root torqueing auxiliaries. ► Probably the most popular is the original four- spur type. Four spur torqeing auxiliary. Applied gingival to the main arch wire. Left in place until the upper anterior teeth are overtorqued.
  22. 22. Bending the four-spur auxiliary ► Root torqueing spurs, when used to move to roots of anterior teeth, are formed in such positions that they will exert force as close to the centers of labial surfaces of the tooth crowns as possible.
  23. 23. ► Bend the auxiliary using 0.014 or 0.016 inch diameter arch wire material, working from left to right. ► The novices can cut the wire and straight a 6 inch length of wire. ► Place the straightened wire in the central incisor brackets, centered by eye, and the ends pulled incisally.
  24. 24. ► This automatically begins the bends for the mesial legs of both central incisor spurs. ► These spurs are completed, bending them so that they lean slightly towards the midline. ► The wire is then returned to the mouth and grasped by light wire pliers.
  25. 25. ► After being removed from the mouth, the mesial leg of the left lateral incisor spur is formed by bending the wire around the pliers. ► The spur is completed, bending it with the same mesial inclination as given to the central incisor spur.
  26. 26. ► The wire is returned to the mouth, placed in the brackets and the right lateral incisor spur is bent following the same procedure as was done for the left one. ► The auxiliary which now has four torqueing spurs, is placed again in the mouth and the distal ends are cut off midway between the cuspid and the second bicuspid brackets. ► Ends are curled back on themselves, as a protective measure.
  27. 27. Activating the four spur auxiliary ► Using the light wire pliers, the auxiliary is formed into an arc smaller than that of the anterior portion of the patient’s dental arch, with the spurs in a nearly horizontal position. ► This constricted arch form of the auxiliary counteracts the reciprocal forces applied to the arch wire when the auxiliary is engaged, which tend to widen the dental arch. It also guarantees that the maximum amount of torque force is derived from each auxiliary.
  28. 28. ► If it is found that the auxiliary needs to be formed into a smaller arc, the original bends at the base of the distal legs of each spur can be increased. ► Another method is to place a slight “V” bend midway between the spurs. ► Both measures will cause the distal ends of the auxiliary to move together.
  29. 29. ► The final modification in the torqueing auxiliary is the bending of the “Cuspid-Curve” in the distal arms. ► In the passive state this curve will cause the arms to appear to drop below the level of the main arch wire. ► When the torqueing auxiliary is applied, these distal arms will be rotated by the spurs striking the labial surfaces of the anterior teeth. ► This curve will then follow that of the main arch below.
  30. 30. Pre-Wound Torqueing Auxiliary ► This Pre-Wound (Rat-Trap type) auxiliary was originally devised by one of the author (P. R. Begg) in the early 1950’s. ► Graduated sizes are available to fit varying mesiodistal widths of the teeth. ► It is simpler to apply and is capable of delivering a greater force through a greater range of movement than other type of auxiliaries – regardless of the size of wire used in its construction.
  31. 31. ► 0.014/0.016 inch round wire. ► A small incisal offset or “V” bend, in the midline of the main arch wire acts as a reciprocating stop for the auxiliary. ► Since this type of auxiliary is activated by meeting the resistance of the stop in the midline of the arch wire, it is more effective in torqueing when only central incisors require torqueing.
  32. 32. ► When the maxillary lateral incisors need their roots to be brought labially, as is usually the case if these teeth were displaced lingually, prior to treatment, the pre-wound auxiliary can be modified. ► The lateral torque bars are overwound so that they fall in a plane approximately 90 to the plane of the central incisors torque bars.
  33. 33. Application of the third stage arch wires and the auxiliaries to the teeth ► Place the upper and lower arch wires in the mouth. The lower arch wire is pinned in place. ► Place the proper springpins in the brackets of all the mandibular teeth requiring mesiodistal uprighting and in the maxillary second premolar brackets.
  34. 34. ► The proportion of the uprighting force delivered to each tooth is related to its proximity to the point of engagement of the arm of the spring and to the flexibility of the arch wire. ► The use of heavier arch wires has reduced any ill effects from the reciprocal forces delivered by the uprighting springs or torqueing auxiliaries. ► Normally, in a case requiring pretreatment extraction of first premolars, the lower canines require the greatest amount of mesiodistal uprighting.
  35. 35. ► 1. 2. 3. 4. 5. 6. The order of descending need of the remaining teeth to be uprighted: Lower canines Upper canines Lower second premolars Upper second premolars Upper lateral incisors The lower lateral incisors ( requiring the least amount of force)
  36. 36. ► ► 1. 2. 3. 4. The forces on the teeth can be varied by using springs fashioned from different sizes of wires and having either two or three coils. The following types of springs, or spring-pins, deliver the amounts of forces that are required in a four first premolar extraction case during stage III. Upper and Lower Canines- 0.016/0.018 inch & 2-coils Upper and Lower Second Premolars- 0.016 inch & 2-coils Upper Lateral incisors-0.014 inch & 2-coils Lower Lateral incisors-0.014 inch & 3-coils.
  37. 37. ► Pin the upper torqueing auxiliary in one of the maxillary central incisors brackets. The distal ends of the auxiliary wire then pinned into the canine brackets gingival to the main arch wire with spring-pins.
  38. 38. ► Spring –pins are then placed on the upper lateral incisors, which usually require their roots to be torqued distally, and on the upper second premolars. ► Normally the centrals do not require mesiodistal uprighting and are pinned to the arch wire with stage III lock pins.
  39. 39. ► In order to prevent the creation of the spaces in the dental arches due to pressures on the teeth from the anterior root torqueing auxiliaries and individual uprighting springs, the ends of the arch wires are bent around the distal of the molar tubes. ► The upper arch wire can be bent so that it rests against the molar band occlusally to the molar tube.
  40. 40. ► This gives an increased axial inclination control in the bucco-lingual direction, and also helps prevent maxillary molar flaring during stage III. ► When bending the end of the arch wire, care should taken to prevent the beaks of the pliers from resting against the distal surfaces of the tubes. ► This can set up a Camming Action that results in the arch wire being drawn distally through the molar tube with such force during bending that the arch wire can be permanently distorted in the maxillary hook area.
  41. 41. Additions and modifications in stage III Mechanics ► If the maxillary or mandibular anchor molars show signs of rotating distobuccaly, tie with 0.012 inch diameter ligature wire from the lingual of the molar to the lingual button on the cuspid. ► This tie helps to control the rotations of the molars.
  42. 42. ► Some times it is not desirable to torque the roots of all four maxillary anterior teeth lingually. ► If it is felt that only the central incisors are to be torqued, an auxiliary with two spurs is used. ► Maxillary laterals often displaced bodily to the lingual prior to treatment. During stage I & II, the crowns of these teeth are tipped labially, leaving their roots too far lingual. ► Assuming that the central incisors require the usual lingual torque, an auxiliary shown below (on right side) can be used.
  43. 43. ► Another lingual root torqueing auxiliary that can be easily applied and removed has been invented by Dr. Jhon Kichton. ► It can be made to include both the centrals and laterals, or shortened to torque centrals only. • This type of auxiliary is capable of exerting a great amount force, especially when fashoined from 0.016 inch wire and used in conjuction with 0.020 main arch wire.
  44. 44. ► The use of a torqueing auxiliary (0.016 inch) in conjunction with a heavy base arch wire (0.020 inch) with a vertical spur in the midline. ► Vertical spur in the midline bent into the main arch wire, acts as a point of resistance against center section of auxiliary.
  45. 45. ► Maxillary arch wire with a gingivally directed stop bent in the midline being used in conjunction with a 0.014 or 0.016 inch auxiliary to torque the roots of the lateral incisors labially.
  46. 46. Reverse Torqueing auxiliary ► In a properly treated four first bicuspid extraction case, the anchor molars( entire dental arches) are brought farther forward during the third stage than during previous stages. ► In the severe tooth mass discrepancy cases, the mandibular dental arch may assume its desired mesiodistal positioning on basal bone before stage III is compelted. ► In order to retard further anterior movement of the lower dental arch and to upright the mandibular incisors, which usually becoming labially inclined, A Reverse Torqueing Auxiliary is applied.
  47. 47. ► The vertical spurs exert labial pressure against the lingual surface of the main arch wire, while the horizontal sections press lingually against the labial surface of the four incisors. ► This causes the roots of these teeth to move labially and their crowns to attempt to move lingually.
  48. 48. ► Since there are no spaces left between the crowns of the teeth in the third stage, lingual movement of the crowns is not possible. ► The force is passed on distally through the contact points between the teeth to the mandibular molars. ► This reverse torqueing thus becomes an excellent source of intraoral anchorage duing stage III.
  49. 49. The Begg Appliance and Technique Stage III
  50. 50. Outline ► Objectives of stage III ► How Objectives are achieved ► Problems and their remedies of stage III ► Causes of loss of anchorage in stage III ► Positions of teeth at the end of stage Three ► Stage III models ► Conclusion
  51. 51. Objectives of Stage III Maintaining all the corrections achieved during first and second stages. 2. Achieve desired axial inclinations of all the teeth. 1.
  52. 52. How Objectives are achieved 1. Maintaining all the corrections achieved during stages I & II.   Mesiodistal molar relationship maintained through the wearing of class II or class III elastics as required. Original spaces between anterior teeth are prevented from recurring by tying intermaxillry circles to the cuspid brackets with steel ligature wire.
  53. 53.    Over corrections of cuspids are maintained by engaging the brackets which have been offset on the teeth. Over corrections of bicuspids are held by replacing elastic threads with steel ligature ties. Over corrections of central and lateral incisors are maintained through the continued use of bayonet bends in the arch wires.
  54. 54.     Opening of a deep anterior overbite is maintained through the continued use of biteopening bends and class II or class III elastics. The correction of posterior crossbites is maintained by modifying the archwire or by wearing of cross elastics as necessary. Posterior spaces kept closed by bending the distal ends of the arch wire around the buccal tubes. Arch form and overbite correction maintained by using heavier (0.018 to 0.025) main archwire.
  55. 55. 2. Achieve desired axial inclinations of the teeth.   Changes in the mesiodistal inclinations of teeth are accomplished by the use of individual root-tipping springs. Lingual or labial root torque is applied to anterior teeth through the application of torqueing auxilaries.
  56. 56. Problems that may be encountered during the third stage and their remedies 1. Maxilary molar widening: Cause Remedy A. Anchor bends A. present in maxillary wire. Remove the maxillary arch wire and eliminate or reduce the anchor bends so that arch wire does not exert excessive gingival force on the maxillary molars.
  57. 57. 1. Maxilary molar widening: Cause Remedy B. Too much bite A. Remove the arch wire and lessen the degree of bend. A. Construct a new arch wire from hard 0.020 inch round wire. opening bend between cuspid and bicuspid. C. Maxillary arch wire too flexible ; i,e too small in diameter.
  58. 58. 1. Maxillary molar widening: Cause Remedy D. Maxillary arch wire too A. Remove and modify the arch wire. A. Remove auxiliary and modify – narrow in posterior or shorten so that it ends between cuspid and bicuspids. wide . E. Torqueing auxiliary not constricted adequately or extended too far distally.
  59. 59. 2. Mandibular molars narrowing: Cause Remedy A. Lower arch wire not wide enough. A. B. Class II elastics A. exerting too much force. Remove and widen distal ends of arch wire. Use lighter elastics ( 2 to 2 1/2 ounces ).
  60. 60. 2. Mandibular molars narrowing: Cause: Remedy: A. Presence of steel ligature tie from the lingual of the mandibular cuspid to the lingual of the mandibular molar. A. Remove the lingual tie. Hold the spaces closed by bending the arch wire around the distal of the buccal tube.
  61. 61. 2. Mandibular molars narrowing: Cause: Remedy: A. Lack of support A. through the occlusal contact with the maxillary molars. Use posterior cross elastics and check symmetry of both arch wires.
  62. 62. 3. Anterior bite opening: Cause: Remedy: A. Too much power in A. the torqueing auxiliary. Less activation in auxiliary, or make auxiliary from smaller size wire.
  63. 63. 3. Anterior bite opening: Cause: Remedy: B. Maxillary arch wire too A. thin. Use heavier main third stage arch wire. C. Patient not wearing A. Educate patient. A. Remove all torqueing mechanisms ; return to stage I. class II elastics. D. Bite not open at beginning of stage 3.
  64. 64. 4. Teeth not uprighting mesiodistally: Cause: Remedy: A. A. Springs not active. Arch wire caught on the edge of the bracket. Remove and activate spring. B. A. Use spring with more reseliency. A.Tighten spring-pin to draw arch wire in bracket.
  65. 65. 4. Teeth not uprighting mesiodistally: Cause: Remedy: A. Springs placed in backwards. A. Remove and replace properly. B. Occlusal A. Remove band and move bracket incisally to cause leveling of teeth. interferences caused by an elevated tooth.
  66. 66. 5.Maxillary anterior teeth not torqueing palatally. Cause: Remedy: A. Not enough force A. Remove and reactivate. from maxillary torqueing auxiliary. B. Maxillary incisal B. Make a new auxiliary from heavier wire. A. Open the bite by arch wire modification or by placing anterior brackets farthe to the incisal. edges caught lingual to lower anterior teeth.
  67. 67. 6. Lower anterior teeth labially inclined: Cause: Remedy: A. Normal mesial A. If near the end of stage III, do nothing. B. If in the middle of stage III, place reverse torqueing auxiliary to upright lower anterior teeth. migration of teeth during third stage.
  68. 68. 7. Rotation of teeth other than molars Cause: Remedy: A. Lack of complete A. Seat arch wire completely in the bracket slot, using a spring pin or steel ligature. A. Recement band with bracket in proper location. bracket engagement. B. Bracket off center of labial surface of teeth.
  69. 69. Causes of loss anchorage ► If class II elastics are not worn during the third stage, the upper dental arch as a whole will move too forward while the roots of the teeth of both dental arches are being uprighted. ► Use of rectangular arch wires during third stage to torque tooth roots instead of using root torqueing spurs formed from light round arch wires.
  70. 70. Positions of teeth at the end of stage III End of Stage III with perfect parallelism of canine and premolar roots.
  71. 71. Stage III Models 1. Basically for teaching purposes 2. To check the arch width and the contour 3. Self-discipline to complete the third stage 4. To check the inclination of the upper and lower anterior teeth – the impression should be deep to appreciate 5. To see as to how anchorage was maintained in treatment 6. It is certainly a visual aid for the patient and parents
  72. 72. Conclusion The Begg Stage III treatment phase is more complex than for the previous once, involving the application of many auxiliaries. The careful understanding and practicing of Begg Technique helps us to provide an optimum treatment to the patient. The good beginning brings the good end & the good end should always depict what it meant to be at the beginning….
  73. 73. Leader in continuing dental education

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