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Traditional begg technique stage 1 and stage 2

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Traditional begg technique stage 1 and stage 2

  1. 1.
  2. 2. Dr. P. Raymond Begg was graduated in dentistry from the University of Melbourne, Australia in 1923. He became interested in orthodontics almost immediately and attended Dr. Edward H. Angle's courses in Pasadena, California from March 1924 to November 1925. Dr. Begg returned to Adelaide and started a practice of orthodontics utilizing the edgewise technique. Some time after 1927 Dr. Begg broke away from his Angle background. He began to extract teeth as an integral concept of the treatment of malocclusions and he discarded the edgewise mechanism in favor of the light round archwire technique which he developed. His technique has changed the ideas and beliefs of many practitioners all over the world about orthodontics and dentistry. History:
  3. 3. He knew from experience and his appreciation of the role, attrition is meant to play in the development of man’s dentition that seeks reduction was often necessary to permit the proper repositioning of the teeth to enhance Function, Stability & Esthetics. Dr.Begg realized that edgewise mechanism was not designed to rapidly close extraction spaces and for quickly reducing deep overbites. To facilitate such changes, he began using .020inch round platinized gold rather than rectangular arch wire in 1929. In 1931/32 he started using .018inch round stainless steel wire bending the vertical loops, intermaxillary circles right into the arch wire. However he soon realizes that if round arch wires were engaged in edgewise brackets, indiscriminate and often undesired root moving forces could be created. History:
  4. 4. Dr.Begg described a treatment approach based on the following hypotheses which were backed to some extent by his own researches. They were: 1.Theory of attritional occlusion 2.Theory of differential forces 3.The employment of a modified form of ribbon arch bracket and light gauge round archwire. Begg’s Philosophy:
  5. 5. Dr. Begg founded the concept of correct occlusion based on his studies on the skulls of australian aboriginals.. He found that the dentitions displayed a considerable amount of attrition ,both occlusally and interproximally. The dento - alveolar height was maintained by continuous eruption and proximal contact by mesial tooth migration facilitated by cuspal wear. The incisor relationship became edge to edge thereby reducing the chance of lower incisor imbrications through overbite obstruction… The total reduction in arch length resulting from attrition amounted approximately to one bicuspid width either side of both dental arches by the time the aboriginal was 20 years of age… These findings accord with the studies of miss Corisande smyth with her study of Anglo-Saxon skulls… According to sir Arthur keith, in bronze-age Britain, skulls showed edge-to- edge incisor relationship was common.. Theory of Attritional Occlusion:
  6. 6. But in the present age, due to the refined and pre-cooked food, less dental attrition was observed. The absence of attrition along with the presence of mesial tooth migration does not relieve the dental overcrowding ,particularly in the lower incisor region where the modern overbite prevents their escape into edge-to-edge relationship with the uppers. Dr.Begg used the findings from his study of australian aboriginal occlusions as a justification to extraction. He argues that if in this present era tooth material is not lost through attrition ,it would be reasonable to cause a commensurate reduction artificially through extraction. However, care should be taken to restrict the employment of extraction within logical limits.. Thus the extraction approach in orthodontic treatment came into existence . Surely, there will be exceptions to the extraction approach just as there were to the non-extraction approach
  7. 7. Normal occlusion in young adult of present day Normal occlusion in primitive times.
  8. 8. The theory of differential forces in it’s original form was described by Dr.Begg in an article AJO{1956} his observation was based to a large extent on the work of Storey and Smith. The range of light pressures which would cause the teeth to move at an optimum rate with minimal disturbance of the supporting tissues. Pressures below this range would produce a slow rate of response while those above incurred a reaction within the bone support, referred as “undermining resorption”. Applying these principles to the Begg technique, the force of the intermaxillary elastics used inn stage I of treatment ,was kept light so that the upper labial segment was retracted while the lower anchor molars has negligible mesial movement. later, if it was required that the residual extraction spaces should be closed largely by the mesial movement of the posterior teeth, the elastic forces are increased so that the anterior segment with their relatively small root area received an excess of force sufficient to delay their movement, while the posteriors moved forward. Theory of differential forces
  9. 9. Judo principle in orthodontics: Judo is based on “using the opponents greater strength and weight to his disadvantage” Since root tipping is a high resistance movement and crown tipping encounter less resistance, if root tipping force is applied, the roots tend to tip in one direction and the crowns tend to tip in the other. Movements include Net distal movement of the molars Net distal movement of mesially inclined lower second molar Braking springs for up righting excessively tipped molars Braking springs in cuspids in lower cuspids and premolars in non extraction cases Braking springs on one or more teeth An auxiliary wire incorporating torque loops to rest against one or more teeth double back arch wire the udder arch
  10. 10. Advantages of Begg’s appliance: Efficiency of treatment , because many corrective tooth movements occur simultaneously with relative little appliance adjustment Minimal patient discomfort and minimal trauma to the hard and soft tissues as a result of the use the light and continuous force Rapid esthetic improvement, achieved by early reduction of overjet and alignment of anterior teeth Early correction and overcorrection of rotations, possibly reducing relapse after treatment Short treatment time resulting from the rapidity of the tooth movement
  11. 11. Patient cooperation is critical for successful treatment with Begg technique Distortion of the light arch wires by mastication of tough foods or biting hard objects Difficulty may be encountered in accomplishing detailed finishing procedure Auxiliary used in stage III constitute a hazard to maintenance of oral hygiene Tissue trauma is thought to occur ot the alveolar crest as a result of tipping & root resorption from excessive tipping of the apices of maxillary incisors Steepening of an existing high mandibular plane angle may occur as a result of Class II intermaxillary traction The Begg technique does not lend itself to the intrusion of maxillary incisors when a deep overbite is associated with over eruption of the maxillary incisors Unpleasing flattening of the lips may occur during Stage I and Stage II Lack of understanding of the complex dynamics of force Disadvantages:
  12. 12. Difference between Begg and Edge wise Appliance: In an Edge wise when the rectangular arch wire is held to each tooth by being engaged in its bracket that accurately fits the arch wire, force is immediately exerted that moves the ROOT of each tooth It is impossible to tip crowns when the rectangular arch wires either Ribbon arch or Edgewise arch, engage their brackets The light wire differential force technique employs forces which are most physiologically acceptable to the tissues and move teeth most rapidly The excessive force delivered by edgewise limits tooth moving efficiency In edgewise there is simultaneous movement of the anchor & the teeth to be moved. Periodontal tissues resist high forces; therefore the distance a teeth can be torqued is relatively small with edgewise mechanism there is considerable anterior movement of the dental arch as a whole because of greater mesio distal dimension of the bracket. In Begg the small mesio distal dimension of the bracket freely permits mesial or distal tipping of tooth crowns with less mesial or distal force on the roots
  13. 13. When the arch wire is engaged in an edgewise bracket with wide mesiodistal slot, force is transmitted to the root of the tooth
  14. 14. In the Edgewise arch wire appliance the need for extra oral anchorage is great in order to counteract the tooth root-moving forces that cause anterior movement of the dental arches The light arch wire technique has eliminated the need for extraoral anchorage
  15. 15. Synergism in Begg appliances:
  16. 16. Case selection criteria for selection of Begg case: The tooth movements required are such as to demand the forms of control given by banded appliances and cannot be achieved an adequate standard The ultimate stability of treated occlusion is in doubt, unless root movements accompany repositioning of crowns The patients interest in his personal appearance and health Patient interest matches with practical ability to attend regularly at prescribed intervals over the treatment period The parent and patient have been given to understand precisely the nature and duration of proposed treatment and what is required if success is to be achieved Clinically: Low mandibular plane angle Not excessive incisal show Adequate thickness of labial cortical
  17. 17. Arch wire material: A.J.Wilcock after years of experimentation developed a wire which is most suitable for light arch wire technique The arch wire is a round austenitic stainless steel wire of 0.016” diameter which is heat treated & cold drawn from a round wire of larger diameter The wires are highly resilient so that they can produce force for a longer duration without frequent reactivation.
  18. 18. Bands: Pinched or preformed bands preformed bans with prewelded brackets Do not use preformed band with prewelded bracket unless the gingival slot is set at a constant height from the incisal edges or the tips of the buccal cusps and band is fully seated Preformed bands without attached brackets
  19. 19. Brackets : The high flange brackets are preferred over the taper flange because high flange possess a wider wedding surface which makes them less liable to distortion. The brackets are manufactured to accept 0.016” diameter arch wire
  20. 20. LOCKPINS: 1.One-point safety lockpin:  first stage of treatment with .016 inch archwire. Shoulder on labial surface of the head strikes bracket to prevent impingement of pin and the archwire. Beveled undersurface of head leaves adequate space for tipping. 2.Second stage lockpin: Safety shoulder prevents binding on archwires . The body of the pin is dimensioned to open 256-500 bracket slot to 0.020 inch to accept larger archwires during stage II. 3.Hook lockpin: Used on all teeth that do not require mesiodistal up righting during stage III.
  21. 21. Buccal tube: Flat oval buccal tubes are used with double back round arch wires than rectangular tubes Flat oval and double back arch wire is used when second permanent molar is used as the anchor and also when the lower premolar is missing Interchangeable type of molar tube permits switching from a double arch wire to a straight back arch wire without losing mechanical advantages
  22. 22. Elastics: Elastics (latex or rubber) is used which will exert a force of 60 to 70 gm when they are new and first placed. Elastic tie material is used to provide force rotate or erupt teeth. Elastic thread or elastomeric filament is used for extreme light forces In clinical practice, elastic force should signify measured force for the individual patient E.g.: Class II elastic force 21/2 ounce Extraction cases class II horizontal, vertical and cross bite elastics average 2 to 4 ounce Non extraction cases class II horizontal elastics 11/2 to 21/2 ounce Size of elastics Larger diameter for molar extraction cases small Class Ii elastics in bicuspid extractions Small horizontal elastics in Stage
  23. 23. Types of Elastics: Anterior Elastics Used in conjugation with a plain arch wire for closing spaces between anterior teeth. If Teeth Protrusive Elastic not placed at the commencement of treatment. Elastic force is 1 to 2 ounce. Criss cross Elastics Diagonal Elastics Zigzag Elastics Used in Stage II, premolar extraction case, Closure of extraction space Cross Palate Elastics Used in Stage III Class III Elastics In Class III cases treatment and in overcorrected class II in Stage III to eliminate edge to edge relationship
  24. 24. Horizontal or intramaxillary elastics in position Elastic thread tied in figure of ‘8’ pattern
  25. 25. Stage I: (Usually 4 to 8 months) Objectives: Correction of Anterior spaces Correction of crowding Overcorrection of rotation of anterior teeth Overcorrection of Over jet to an edge to edge incisor relation Overcorrection of Overbite to an edge to edge incisor relation Correction of Cross bites Correction of molar relation Beginning of correction of premolars Overcorrection of disto occlusion of the buccal segments Partial correction of midline discrepancies Correction of Axial inclination of mandibular incisors
  27. 27. Bracket Placement: Brackets are centered mesio distally on the labial or buccal surface with the base of the arch wire slot 4mm from the incisal edge of cusp tips. Only exception is maxillary lateral incisor where 3.5mm from the incisal edge is placed.
  28. 28. Lingual Button: Placed directly opposite to to the areas of engagement of the archwire on the opposite side of the teeth. This is to permit free mesio distal tipping or uprighting of the teeth. If the lingual button is placed incisal or occlusal to the level of base of arch wire the steel ligature would loosen or tighten during mesio distal uprighting.
  29. 29. Buccal Tube: Molar tubes should be parallel to the occlusal surface when viewed from buccal and parallel with a line bisecting the occlusal surface mesiodistally.
  30. 30. Arch wire: Different diameter of wire is available but the most commonly used one is 0.016” wire 0.016” special - Looped arch wire in any case 0.016” special - Plain arch wire in extraction cases or in which 1st and 2nd premolars are extracted 0.018” - Plain arch wire in molar extraction cases Initial Arch wire: The basic shape of the initial archwire depends upon the shape of malocclusion and although it is similar it isn seldom identical. The archwire shape is proportional to the width, the form and symmetry of dental arch. There may be localized modifications of archwire in the vertical and horizontal plane and these are called Offset bends.
  31. 31. Offset bends: In Anterior segment Vertical offset - To Intrude or Extrude Horizontal offset - to Expand, contract and rotate In posterior segment Gingival offset - to avoid occlusal distortion and interference with bicuspids
  32. 32. Shape of Anterior segment: The anterior curve of the initial arch wire is usually a compromise between the shape of the malocclusion and that of normal occlusion. E.g.: If anterior segment is narrow and protrusive the arch wire is made slightly broader in the cuspid region and flatter opposite to central incisors.
  33. 33. Intermaxillary Hooks: Routinely bent into the arch wire for both the upper and lower arches and are positioned 1mm mesial to the cuspid brackets. The coil Pattern is usually a small helical loop 2 to 2.5mm of outside diameter. The helical Intermaxillary hook two primary and two secondary advantages Archwire is stiffer and aids in overbite correction Wire is stiffer in horizontal plane and aids in correction of arch form, width and symmetry Helical hook can be formed quickly Helical hook is seldom distorted or broken If Boot shaped loops are used they are angulated buccaly away the vertical in order to avoid any possibility if wedging of distal arm of loop into slot.
  34. 34. Vertical Loops: Used to supply local increased arch flexibility or used for space opening or closing, stops, rotation or root torque. The most vertical loops to allign six anterior teeth are five, one in each interproximal area. Generally loops are made 6 to 8mm long but greater the length of the loop, the more gentle the force on the tooth . The Loop between the maxillary central incisors should be avoided, when indicated the loop is made shorter because 1) Avoid irritation to the labial frenum 2) Loop in midline causes arch wire to assume “V” shape when contracted by placement in the molar tube
  35. 35. Horizontal bracket area for severly lingually placed tooth is bent 1mm further gingivally than plane of arch wire to prevent elongation of tooth as it tips labially Contraction Loop in midline with incisor stops to tip crowns of upper centrals Vertical loops bent in case of high frenum attachment
  36. 36. Molar anchorage bends: Placed immediately posterior to the 2nd premolar bracket Bent opposite so that when inserted into the buccal tubes the anterior section of the archwire lies in the buccal sulci Amount of bend varies from case to case The leverage force incorporated on the incisors should be around 65mg Greater force tend to eventually cause lingual rolling and distal tilting of molars Increase of excessive leverage the mesial marginal ridge of the molars are is seen to raise above the occlusal level the purpose of anchor bend in upper arch is to prevent mesial migration of the molars; In lower is to supply bodily control of the lower molars as these are moved forward by action of Class II elastics
  37. 37. Anchorage bend opposite to molar premolar contact point Labial portion lying in buccal sulci
  38. 38. Bayonet bends: It is inadvisable to use bayonet bends for active correction, because of the tendency for round archwire to rotate within bracket slots causing the bayonet bend to become ineffective or supply movement in wrong plane Commonly used passively to retain overrotation brought about via previously looped arch. They should be small and offset section is 5 degrees to the line of main arch.
  39. 39. Pinning and ligation of arch wires: The pins used in the opening stages of treatment should be safety lock design which will automatically obviate friction between pinhead and archwire. In the StageI of treatment of ClassII all the teeth are pinned except The second premolars Teeth initially so far displaced Upper laterals which are lingual to centrals Rotated Buccal teeth.
  40. 40. Placement of Elastics: It is impossible for the arch wire to function properly without the proper elastics. In order to determine the size of the elastics the tension gauge is used. The Class II elastics are engaged around the distal ends of the molar tubes or molar hooks and stretched anteriorly to engage the maxillary Intermaxillary hook mesial to the maxillary cuspid. In Class III elastics are worn from the maxillary molars to the intermaxillary hook mesial to the mandibular cuspid bracket. No horizontal (intramaxillary) elastics are applied during stage I
  41. 41. Class II elastics pulling 2 to 3 ounce at the beginning Class III elastics Horizontal (intramaxillay) elastic
  42. 42. Check list for stage I: Check for desired movements Overbite and over jet improvement Anterior alignment progressing Dental arch width particularly the molar width Dental arch form being maintained Antero - posterior relation of cuspids and molars being maintained Individual molar positions being maintained Check for undesired movements or manifestations Failure to wear elastics at all times Poor hygiene Vertical loops impinging on tooth or tissues Arch wire distortion contraction or expansion of arch width
  43. 43. Problems encountered during the first stage: 1) Bite not opening Patients not wearing elastics Patient biting out bite opening bends Failure to place proper amount of bite opening bends when arches were placed Anchor molars out of occlusion Loose molar band Improper angulations of buccal tube or entire band 2) Molar width narrowing (usually mandibular molars) Vertical component of Class II elastic force Prolonged wearing of posterior cross elastics to widen opposing molars Distolingually rotated cuspids Bicuspid rotational elastic tie on the lingual from the bicuspid to the molar Rolling of distal ends of archwire, causing anchor bend to turn into rotational force on molar 3) Adverse tipping of anchor molars No anchor bends Too much anchor bend Proper amount of anchor bends, but in place for too long
  44. 44. Loose molar band Excessive elastic force Improper placement of elastics on tooth Oversize arch wire 4) No appreciable changes Not wearing elastics Arch wires bent out of shape Oral habits present that counteract force of appliances Patient seen too soon 5) Vertical loops buried in gingiva Original Looped arch wire left in the mouth too long Maladjustment in the proper direction of vertical loops when the arch wire was placed 6) Elastics which break or do not stay on May just be an excuse for not wearing elastics Elastic will not stay in Intermaxillary circle Distal end archwire too short or imbedded in the gingiva 7) Lock pin lost occlusal incisal forces If missing randomly throughout the mouth, probably patient is picking at them
  45. 45. 8) Extremely mobile molars Clenching of teeth Intermittent wearing of elastics Pathology Excessive force applied to molar No apparent cause 9) Lower anterior teeth tipping labially May be an optical illusion with the roots actually moving lingually Binding of the archwire in bicuspid brackets binding of ends arch wire inside distal ends of buccal tube 10) Anterior Open bite not Closing Patient not wearing anterior vertical elastics Persistent Tongue-thrust or adverse habbits Too much anchor bends 11) Tooth not rotating Not enough space Not enough activation in bracket area of arch wire Elastic threads slipping over the top of the tooth 12) Midline discrepancy Asymmetrical tipping of anterior teeth
  46. 46. Stage II: ( usually 1 to 4 months) Completion of extraction space closure 1. By continuing retraction of anterior teeth 2. Correction of premolar rotations Completion of correction of midline discrepancies Maintenance of all anterior and posterior overcorrection achieved in stage I Continued correction of Open Bite
  47. 47. Arch wire: The Archwire pattern is basically that of Stage I treatment 0.016” gauge of wire is used 0.018” is used when there is frequent arch wire distortions or unilateral space closure Anchor bend is made 1mm mesial to the molar, premolar contact point. The pressure supplied by the anchor bends to the molars and incisors is slightly reduced from that employed during Stage I Because Intermaxillary elastics tend to rotate molars slight toe in bends are made in the molar areas to prevent molar rotation Intermaxillary hooks are incorporated in both archwire immediately mesial to the cuspid brackets and in contact or very near contact with them The hooks in upper arch has to bear two elastics which is somewhat difficult for ring pattern. A ‘Z’ shaped hook makes it easier for the patient to apply two rubbers to the hook The 2nd premolar is bypassed from pinning as in Stage I, The wire is held in position by bypass clamp or steel ligature
  48. 48. The bypass clamp in position of the bracket in premolar Slight horizontal offsets are formed distal to canines to maintain correct buccolingual position of the premolars and canines
  49. 49. Inter & Intramaxillary elastics: Lateral Cephalogram is taken and from cephalometric evaluation it is determined whether the anteriors are to be retracted or posteriors are moved for closure of space. The Space – closing elastic ( esp. the maxillary) stretching from the Intermaxillary hook to the molar hook against molar lies against the gingiva and irritates the gingiva, to overcome this elastic is twisted one half turn when it is placed
  50. 50. Wearing of horizontal elastics try to rotate the molars distobuccaly and this should be counteracted by the toe – in bends of the arch wire. If rotation aggravates after giving toe in bends the elastics can be engaged on the lingual hooks. Care should be taken of the second premolar so it doesn’t tip when elastic crosses it occlusally.
  51. 51. Correction of Midline discrepancy: Midline must be determined by reference to the center of face, whether the discrepancy is confined to one arch or in both If one arch is involved shifts more than 2mm is major; lesst han 2mm is a minor problem. The application of intramaxillary elastic will complete closure on the side to which midline is shifted; The intramaxillary elastic on the side which closes first can be discontinued Minor discrepancies are self correcting Diagonal elastics for correction of midline in both the arches Correction by movement of individual units or small group after distal tipping of canine
  52. 52. Auxiliaries in stage II: The auxiliaries used are passive mesio distal root uprighting springs on the mandibular canines and the lower anterior braking arches. The function of of these types of auxiliaries is to establish two point contact between teeth and archwire and prevent free tipping movement of the anteriors. Lower braking auxiliary on the four Anteriors
  53. 53. Check list for stage II: Check the teeth and appliances berfore treatment progress for Loosened bands Loosened brackets Patient co-operation in elastic wearing Compare the positions of the teeth on the second stage model with those in mouth Check for desired movements Check for undesired movements or manifestations such as Failure to wear elastics at all times Poor oral hygiene Arch wire projecting out and causing impingement Contraction or expansion of the arch Asymmetry of dental arch Molars rotating mesiolingually due to use of single elastic on the buccal Anterior class III relation developing Excessive anterior open bite Anchorage bend coming into close proximity Midline is
  54. 54. Problems encountered during stage II: 1) Anterior bite opening Not enough bite opening bends placed in the arch Bite opening bends bitten out or arch wires distorted Patient not wearing Intermaxillary elastics Anchor molars out of occlusion 2) Anterior teeth assuming Class III relationship Excessive wearing of class II elastics Determine if anterior bite is truly open 3) Spaces developing between anterior teeth Failure to tie with steel ligature from Intermaxillary hook distal to cuspids Intermaxillary circles formed too apart 4) Anchor molars rotating distobuccaly Toe – out on arch wire Too much force from horizontal
  55. 55. 5) Cuspid roots bulging on labial plate of alveolar bone Normal distal tipping Poor arch form Poor bracket placement 6) Posterior spaces not closed Patient not wearing elastics Arch wire not free to slide through the buccal tube Arch wire pinned or caught in bicuspid bracket slot Patient placing tongue or pencil in space Occlusal interference Anterior teeth not free to tip distally Anteriors cannot tip distally owing to tongue habits 7) Second premolars tipping mesially in extraction caseof 1st premolar Slight expected mesial movement of anchor molars Abnormal loss of anchorage, if second premolars are tipping excessively
  56. 56. 8) Mandibular anterior teeth achieving desired lingual inclination before posterior spaces are closed completely Inexperienced orthodontic skill Careful preservation of anchorage Excess space at beginning of treatment
  57. 57. CONCLUSION: The development of Begg’s different way of orthodontic therapy was not the result of a single discovery but rather ,the product of a long tedious ,well-organized trial and error process. When correctly applied, his light archwire technique can produce universal tooth movement with light optimum forces, least discomfort to patients ,minimum loosening of teeth and least injury to tooth investing tissues. Dr.Begg theory does not depend upon cephalometrics to establish angulations nor does it require complicated engineering formulae for moving teeth. Because the Begg technique, requires shorter time, it does not mean that it is a “snap” method requiring less orthodontic skill or
  58. 58. References: The Begg orthodontic theory and technique – Kesling 3rd edition Begg appliance and technique – Fletcher Current orthodontic concepts and technique – Graber and Swain New vistas of orthodontics – Lysle E Johnston AJO 1975 may volume 67 – George R Cadman AJO 1973 Jan volume 63 – Doyle W Baldbridge AJO 1963 oct volume 49 – George V Newman
  59. 59.

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