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Begg’s philosophy and technique

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Begg’s philosophy and technique

  1. 1. BEGG’S PHILOSOPHYBEGG’S PHILOSOPHY AND TECHNIQUEAND TECHNIQUE Presented byPresented by Susna PaulSusna Paul
  2. 2. CONTENTSCONTENTS • EVOLUTION OF BEGGS TECHNIQUEEVOLUTION OF BEGGS TECHNIQUE • BEGGS PHILOSOPHYBEGGS PHILOSOPHY • BEGGS TECHNIQUEBEGGS TECHNIQUE • COMPONENTSCOMPONENTS • STAGE ISTAGE I • STAGE IISTAGE II • STAGE IIISTAGE III
  3. 3. DEVELOPMENT OFDEVELOPMENT OF LIGHT WIRELIGHT WIRE TECHNIQUETECHNIQUE
  4. 4. • Dr. Percival Raymond BeggDr. Percival Raymond Begg was born in 1898 in awas born in 1898 in a small, gold mining town Coolgardie, west Australiasmall, gold mining town Coolgardie, west Australia.. • Grew up in south Australia.Grew up in south Australia.
  5. 5. • In his early twenties he worked in a sheep and cattle station inIn his early twenties he worked in a sheep and cattle station in New south Australia, looking after both cattle and sheepNew south Australia, looking after both cattle and sheep.. • As a boy he saw the sketch of Australia aborginal and noticedAs a boy he saw the sketch of Australia aborginal and noticed their teeth were worn flat, no one thought to tell himtheir teeth were worn flat, no one thought to tell him why or how it happened.why or how it happened. • He noticed many people with crooked teeth and saw manyHe noticed many people with crooked teeth and saw many feeble attempts at correction of these problems with manyfeeble attempts at correction of these problems with many treatment failures and few successestreatment failures and few successes..
  6. 6. • As he wanted to help such people he enrolled in theAs he wanted to help such people he enrolled in the dental course at the University of Melbourne instead ofdental course at the University of Melbourne instead of taking the medical course, as he originally intended.taking the medical course, as he originally intended. • At the commencement of third year of training, Dr BeggAt the commencement of third year of training, Dr Begg decided to practice orthodontics after graduating indecided to practice orthodontics after graduating in dentistry.dentistry.
  7. 7. • Dr Begg graduated in 1923 with B.D.Sc Degree.Dr Begg graduated in 1923 with B.D.Sc Degree. • His introduction to Dr. Angle’s work led him to travel toHis introduction to Dr. Angle’s work led him to travel to Pasadena, California in 1924 to study with Dr. Angle..Pasadena, California in 1924 to study with Dr. Angle..
  8. 8. - Coincidentally with Begg’s arrival in California Dr.Coincidentally with Begg’s arrival in California Dr. Angle was developing he Edgewise arch mechanisms,Angle was developing he Edgewise arch mechanisms, which he felt was a vast improvement over the Ribbonwhich he felt was a vast improvement over the Ribbon arch Appliancearch Appliance - Angle instructed Dr. Begg and Fred Ishii of Japan in theAngle instructed Dr. Begg and Fred Ishii of Japan in the use of the Edgewise mechanism, before it was revealeduse of the Edgewise mechanism, before it was revealed to the profession. Since Dr. Angle was ill, it was theyto the profession. Since Dr. Angle was ill, it was they who first treated patients with Edge wise Appliancewho first treated patients with Edge wise Appliance
  9. 9. • During Dr. Begg’s stay Dr.Angle wrote, and read for theDuring Dr. Begg’s stay Dr.Angle wrote, and read for the first time, his paper entitled.“ The latest and Best infirst time, his paper entitled.“ The latest and Best in orthodontic Mechanism” ( published in Dent. Cosmosorthodontic Mechanism” ( published in Dent. Cosmos 1928 and 1929 ). It disclosed the use of edge wise1928 and 1929 ). It disclosed the use of edge wise Mechanism.Mechanism. • In November, 1925 Dr. Begg sailed back to Australia. InIn November, 1925 Dr. Begg sailed back to Australia. In December of the same year he began practicingDecember of the same year he began practicing Orthodonics in Adelaide, south Australia.Orthodonics in Adelaide, south Australia.
  10. 10. • Begg was the only orthodontist in Adelaide in 1926 practicedBegg was the only orthodontist in Adelaide in 1926 practiced Edgewise non extraction, technique.Edgewise non extraction, technique. • He was appointed Lecturer in Orthodontics at the universityHe was appointed Lecturer in Orthodontics at the university of Adelaide, a position he held until the university’sof Adelaide, a position he held until the university’s retirement age. ( Retirement in 1964).retirement age. ( Retirement in 1964). • For two years, Dr. Begg faithfully followed Dr. Angle’sFor two years, Dr. Begg faithfully followed Dr. Angle’s teaching of retaining the full compliment of teeth.teaching of retaining the full compliment of teeth.
  11. 11. •However in many of his patients he wasn’t satisfied withHowever in many of his patients he wasn’t satisfied with post treatment profiles and there was the seriouspost treatment profiles and there was the serious problem of relapses.problem of relapses. •In February of 1928 he began to routinely remove teethIn February of 1928 he began to routinely remove teeth or reduce tooth widths by mesio - distal stripping inor reduce tooth widths by mesio - distal stripping in patients with excess tooth substance.patients with excess tooth substance.
  12. 12. • He learnt from experience and his ever – growingHe learnt from experience and his ever – growing appreciation of the role ofappreciation of the role of attritional occlusionattritional occlusion in thein the development of man’s dentition..development of man’s dentition.. • Initially he faced opposition from other dentists..Initially he faced opposition from other dentists.. • He retreated many patients who had relapse due toHe retreated many patients who had relapse due to retention of excessive tooth material.retention of excessive tooth material.
  13. 13. CHANGING THE MECHANICSCHANGING THE MECHANICS - Dr. Begg began to realize the Edgewise mechanism wasDr. Begg began to realize the Edgewise mechanism was not designed to rapidly close extraction space ornot designed to rapidly close extraction space or quickly reduce deep overbites.quickly reduce deep overbites. - To facilitate such changes he began using 0.20’’ roundTo facilitate such changes he began using 0.20’’ round platinized gold, rather than rectangular, arch wire inplatinized gold, rather than rectangular, arch wire in 1929. In 1931 he started using .018’’ round stainless1929. In 1931 he started using .018’’ round stainless steel wire, bending the now popular vertical loops andsteel wire, bending the now popular vertical loops and intermaxillary hooks right into the arch wires.intermaxillary hooks right into the arch wires.
  14. 14. - He soon realized that if round arch wire were engagedHe soon realized that if round arch wire were engaged in edgewise brackets..in edgewise brackets.. - In 1933, about 3 years after switching from rectangularIn 1933, about 3 years after switching from rectangular to round arch wire material, he began treating someto round arch wire material, he began treating some cases using S.S.White ribbon arch brackets, to which hecases using S.S.White ribbon arch brackets, to which he had been exposed during his stay with Dr.Angle.had been exposed during his stay with Dr.Angle. - He realized that these relatively narrow brackets withHe realized that these relatively narrow brackets with vertically facing slots allowed the teeth to move undervertically facing slots allowed the teeth to move under much lighter forces.much lighter forces.
  15. 15. • To improve rotation tooth control with the use ofTo improve rotation tooth control with the use of smaller round wires in the Ribbon Arch Brackets, Dr.smaller round wires in the Ribbon Arch Brackets, Dr. Begg filed their bases before soldering them to theBegg filed their bases before soldering them to the bands.This reduced the widths of the arch wire slots.bands.This reduced the widths of the arch wire slots.
  16. 16. A NEW WIRE!A NEW WIRE! • In the early 1940’s Dr. Begg met Arthur J.Wilcock, director ofIn the early 1940’s Dr. Begg met Arthur J.Wilcock, director of metallurgical research projects at the University of Melbourne.metallurgical research projects at the University of Melbourne. • After many years of research Wilcock produced a cold drawn heatAfter many years of research Wilcock produced a cold drawn heat treated wire that combined the balance between hardness andtreated wire that combined the balance between hardness and resilience with the unique property of zero stress relaxation thatresilience with the unique property of zero stress relaxation that Dr.Begg was seeking.Dr.Begg was seeking. • This unusual wire permitted to open anterior over bites, whileThis unusual wire permitted to open anterior over bites, while controlling arch form and providing molar stability.controlling arch form and providing molar stability.
  17. 17. • He also produced the modified Ribbon arch brackets, lockHe also produced the modified Ribbon arch brackets, lock pins and special buccal tubes to meet Dr.Begg’s ever-pins and special buccal tubes to meet Dr.Begg’s ever- changing requirements in these experimental yearschanging requirements in these experimental years • In 1952 Dr Begg began to use 0.016’’ round stainless steelIn 1952 Dr Begg began to use 0.016’’ round stainless steel wires instead of 0.018’’ permitting to open anterior overbiteswires instead of 0.018’’ permitting to open anterior overbites quickly.quickly.
  18. 18. • In 1954 Dr.Begg published paper entitled,“Stone AgeIn 1954 Dr.Begg published paper entitled,“Stone Age Man’s dentition”Man’s dentition” • At the end of his article he disclosed a new techniqueAt the end of his article he disclosed a new technique which he referred to as the “round wire technique”,which he referred to as the “round wire technique”, advocating at that time the use of 0.018” diameteradvocating at that time the use of 0.018” diameter stainless steel arch wires in modified Ribbon Archstainless steel arch wires in modified Ribbon Arch brackets.brackets.
  19. 19. • The technique describe in this 1954 article was muchThe technique describe in this 1954 article was much different from what it is today..different from what it is today.. • Even so, it drew relatively large response includingEven so, it drew relatively large response including correspondance from three prominent orthodontist whocorrespondance from three prominent orthodontist who expressed an interest in the treatment methodexpressed an interest in the treatment method disclosed – his found from the Angle school, Dr.disclosed – his found from the Angle school, Dr. Spencer Atkinson; Dr. Robert strang and Dr.Spencer Atkinson; Dr. Robert strang and Dr. CharlesTweed.CharlesTweed.
  20. 20. • In 1956 Dr. Begg had another article published entitledIn 1956 Dr. Begg had another article published entitled,, Differential Force in orthodontic Treatment.Differential Force in orthodontic Treatment. • While he did not specifically define differential force inWhile he did not specifically define differential force in so many words, its operation was explained.so many words, its operation was explained.
  21. 21. • As a result of reading this article severalAs a result of reading this article several orthodontists visited Dr.Begg in Adelaide, Southorthodontists visited Dr.Begg in Adelaide, South Australia.Australia. • In 1957 Dr.H.D. Kesling and Dr. George DisshamIn 1957 Dr.H.D. Kesling and Dr. George Dissham came from the United states..came from the United states..
  22. 22. INTRODUCTION OF BEGG TECHNIQUE IN THE UNITEDINTRODUCTION OF BEGG TECHNIQUE IN THE UNITED STATESSTATES • Upon Kesling’s return from Adelaide,he had plans toUpon Kesling’s return from Adelaide,he had plans to implement his new technique in his practice along withimplement his new technique in his practice along with Dr.R. A. Rocke not just to selected patients, but everyDr.R. A. Rocke not just to selected patients, but every patient.patient. • In 1959 the Kesling and Rocke Orthodontic groupIn 1959 the Kesling and Rocke Orthodontic group invited over 150 orthodontist from across the unitedinvited over 150 orthodontist from across the united states, to assess the results of their results of their 100states, to assess the results of their results of their 100 consecutively – treated cases by Begg technique.consecutively – treated cases by Begg technique.
  23. 23. • Dr .H.D. Kesling, firstDr .H.D. Kesling, first orthodontist in the Unitedorthodontist in the United States to practice theStates to practice the Begg Technique, and theBegg Technique, and the one most responsible forone most responsible for popularizing its usepopularizing its use through showings andthrough showings and coursescourses
  24. 24. • While the results were not of the quality of the resultsWhile the results were not of the quality of the results achieved today, they demonstrated the ability of the Beggachieved today, they demonstrated the ability of the Begg technique totechnique to quickly open deep anterior bitesquickly open deep anterior bites.Treatment.Treatment time was relativelytime was relatively shortshort, and the number of, and the number of adjustmentsadjustments were fewwere few. As a result there arose a demand for training in. As a result there arose a demand for training in this new technique.this new technique. • First course in Begg Technique had 31 students, was held inFirst course in Begg Technique had 31 students, was held in the new orthodontic center in Westville, Indiana in June 1959the new orthodontic center in Westville, Indiana in June 1959 (1week course).The brackets used were the new Double -(1week course).The brackets used were the new Double - Tab type.Tab type.
  25. 25. • However, the use of the double tab bracket provedHowever, the use of the double tab bracket proved difficult, as arch wires weredifficult, as arch wires were unnecessarilyunnecessarily complicatedcomplicated to permit desired tooth movement.to permit desired tooth movement. • Also, itAlso, it lackedlacked the ability tothe ability to overcorrectovercorrect the teeththe teeth which is so necessary to reduce the tendency forwhich is so necessary to reduce the tendency for relapse.relapse.
  26. 26. • Dr Begg realized that, he had to finish his cases withDr Begg realized that, he had to finish his cases with more precision.more precision. • Dr. Begg was mainly concerned with repositioningDr. Begg was mainly concerned with repositioning the teeth in stable positions over basal bone.Thethe teeth in stable positions over basal bone.The final settling of teeth he left to the forces of occlusion,final settling of teeth he left to the forces of occlusion, guided when necessary by an upper retainer withguided when necessary by an upper retainer with circumferential wire.circumferential wire.
  27. 27. • Also he realized the growing demand for training in hisAlso he realized the growing demand for training in his new technique required that the treatment be organisednew technique required that the treatment be organised in some manner to facilitate both teaching andin some manner to facilitate both teaching and learninglearning..
  28. 28. • The result was that in April of 1960, as Dr. Begg beganThe result was that in April of 1960, as Dr. Begg began unpacking his models (which he had brought as part ofunpacking his models (which he had brought as part of his presentation before the American Association ofhis presentation before the American Association of Orthodontist), members of the Kesling and Rocke groupOrthodontist), members of the Kesling and Rocke group were stunned by his quality of treatment . Hours afterwere stunned by his quality of treatment . Hours after seeing the quality of results achieved by Dr.Begg withseeing the quality of results achieved by Dr.Begg with modified Ribbon Arch brackets, Dr.Kesling made themodified Ribbon Arch brackets, Dr.Kesling made the decision to scrap his double- tab brackets.decision to scrap his double- tab brackets.
  29. 29. In the years between Dr.Kesling’s first visit in 1957 and his trip to theIn the years between Dr.Kesling’s first visit in 1957 and his trip to the United states in the spring of 1960, Dr.Begg did the following:United states in the spring of 1960, Dr.Begg did the following: 1.Finished his cases with such1.Finished his cases with such detail and precisiondetail and precision that they could notthat they could not be discerned from similar cases treated with Edgewise mechanism.be discerned from similar cases treated with Edgewise mechanism. 2. Separated the technique into2. Separated the technique into three distinct stagesthree distinct stages and establishedand established objectives for each stage.objectives for each stage. 3.Developed3.Developed root torqueing auxiliariesroot torqueing auxiliaries separate from the main archseparate from the main arch wire.wire. 4.Introduced mesiodistal4.Introduced mesiodistal uprighting springuprighting spring.. 5. Emphasized the importance of5. Emphasized the importance of free tippingfree tipping of tooth crowns in theof tooth crowns in the early stages of treatment.early stages of treatment. 6. Suggested taking6. Suggested taking stage modelsstage models to discipline the orthodontist.to discipline the orthodontist.
  30. 30. BEGG’S PHILOSOPHYBEGG’S PHILOSOPHY
  31. 31. They were:They were: 1.Theory of attritional occlusion1.Theory of attritional occlusion 2.Theory of differential forces2.Theory of differential forces
  32. 32. ATTRITIONAL OCCLUSIONATTRITIONAL OCCLUSION • In 1939 Dr.Begg wrote his doctoral thesis “ TheIn 1939 Dr.Begg wrote his doctoral thesis “ The Evolutionary Reduction and degenaration of Man’sEvolutionary Reduction and degenaration of Man’s Jaws and teeth’’.Jaws and teeth’’. • In 1954 Dr.Begg published paper entitled,“StoneIn 1954 Dr.Begg published paper entitled,“Stone Age Man’s dentition”Age Man’s dentition”
  33. 33. • Concept of normal occlusion------- ANATOMICALLYConcept of normal occlusion------- ANATOMICALLY CORRECT OCCLUSIONCORRECT OCCLUSION • Stone age man’s dentitionStone age man’s dentition • This occlusion was far more efficient and healthy thanThis occlusion was far more efficient and healthy than “textbook normal occlusion”.“textbook normal occlusion”.
  34. 34. Dr. Begg noticed that the teeth of Aborigines.They had:Dr. Begg noticed that the teeth of Aborigines.They had: 1.1.not only had extensive occlusal and interproximal wearnot only had extensive occlusal and interproximal wear 2.2.total lack of :total lack of : I.I. CariesCaries II.II. periodontal diseaseperiodontal disease III.III. tooth crowding.tooth crowding.
  35. 35. • Hard, coarse and grittyHard, coarse and gritty food quickly causesfood quickly causes incisal and occlusal wear.incisal and occlusal wear. • Initially the incisal wear isInitially the incisal wear is oblique.oblique. • The lower incisors tipThe lower incisors tip labially, while the upperlabially, while the upper incisors become moreincisors become more upright until they assumeupright until they assume an edge to edgean edge to edge relationship.relationship.
  36. 36. • This restraint the natural tendency for the lower incisorThis restraint the natural tendency for the lower incisor to become more procumbent, also encourages furtherto become more procumbent, also encourages further crowding of these teeth.crowding of these teeth. • Persistence of anterior overbite also locks the maxillaryPersistence of anterior overbite also locks the maxillary incisors in an anatomically and functionally abnormalincisors in an anatomically and functionally abnormal labial location.labial location.
  37. 37. Attrition causes continual changes in the shapes andAttrition causes continual changes in the shapes and sizes of the teeth.sizes of the teeth. Mesial migration and vertical eruption in theMesial migration and vertical eruption in the presence of attrition result in their movingpresence of attrition result in their moving occlusomesially in the jawsocclusomesially in the jaws
  38. 38. GINGIVAL RECESSION AND VERTICALGINGIVAL RECESSION AND VERTICAL ERUPTIONERUPTION • The physiologic process of continualThe physiologic process of continual tooth eruptiontooth eruption hashas evolved to compensate for occlusal attrition. It persists inevolved to compensate for occlusal attrition. It persists in modern man, even in the absence of attrition.modern man, even in the absence of attrition. • As a result of this, there is often continual increase in theAs a result of this, there is often continual increase in the vertical dimension between maxilla and mandible.vertical dimension between maxilla and mandible. Consequently civilized man’s face grows ‘longer’ with age.Consequently civilized man’s face grows ‘longer’ with age.
  39. 39. • This eruption is often clinically misinterpreted asThis eruption is often clinically misinterpreted as gingival recession, when in fact it is the teeth that aregingival recession, when in fact it is the teeth that are erupting, and the gingival margin that is remainingerupting, and the gingival margin that is remaining relatively stationary.relatively stationary.
  40. 40. • In primitive man theIn primitive man the excessive occlusal forcesexcessive occlusal forces of mastication retard thisof mastication retard this eruption to a rateeruption to a rate harmonious with theharmonious with the progression of attritionalprogression of attritional wear..wear..
  41. 41. LACK OF CARIESLACK OF CARIES • Pits and fissures are quickly reduced by occlusalPits and fissures are quickly reduced by occlusal wear, thereby eliminating the focus of most caries.wear, thereby eliminating the focus of most caries. • The diet itself is of low in carbohydrates and itsThe diet itself is of low in carbohydrates and its coarseness plus high volume prevents thecoarseness plus high volume prevents the accumulation of dental plaque, without which thereaccumulation of dental plaque, without which there can be no dental decay.can be no dental decay.
  42. 42. PROXIMAL WEARPROXIMAL WEAR • Gingival embrassure areas (black triangles) inGingival embrassure areas (black triangles) in civilized man become larger with age, due to lack ofcivilized man become larger with age, due to lack of proximal wear.proximal wear.
  43. 43. NO proximal wear Surface Spongy and nonkeratinized Bacterial Stagnation and invasion Gingival trough deepens PERIODONTAL disease
  44. 44. INCIDENCE OF CROWDINGINCIDENCE OF CROWDING • Eruption of FIRST PERMANENT MOLARSEruption of FIRST PERMANENT MOLARS • Eruption of SUCCEDANEOUS TEETHEruption of SUCCEDANEOUS TEETH • Eruption of THIRD MOLARSEruption of THIRD MOLARS
  45. 45. ERUPTION OF FIRST PERMANENT MOLARSERUPTION OF FIRST PERMANENT MOLARS The edge to edge anterior tooth relationshipThe edge to edge anterior tooth relationship lower teeth being further forward in relation to the upper teethlower teeth being further forward in relation to the upper teeth the mandibular second deciduous molars are mesial to the maxillarythe mandibular second deciduous molars are mesial to the maxillary decidous second molars.decidous second molars. The lower first permanent molar is then able to erupt in a more mesialThe lower first permanent molar is then able to erupt in a more mesial position and proper initial relationship with the maxillary first permanentposition and proper initial relationship with the maxillary first permanent molar is achieved.molar is achieved.
  46. 46. ERUPTION OF SUCCEDANEOUSERUPTION OF SUCCEDANEOUS TEETHTEETH.. • Attrition brings about enough reduction inAttrition brings about enough reduction in mesiodistal dimensions of teeth to allow adequatemesiodistal dimensions of teeth to allow adequate space for the erupting permanent canines.space for the erupting permanent canines. • In the absence of attrition there is often not enoughIn the absence of attrition there is often not enough space for the caninespace for the canine
  47. 47. ERUPTION OF THIRD MOLARSERUPTION OF THIRD MOLARS • In civilized man as no proximal wear occursIn civilized man as no proximal wear occurs causes inadequate room distal to the second molarscauses inadequate room distal to the second molars for normal eruption of third molars which leads tofor normal eruption of third molars which leads to delayed eruption and complete impaction.delayed eruption and complete impaction.
  48. 48. • Since attrition especially interproximallly causes aSince attrition especially interproximallly causes a continoual reduction in mesiodistal tooth widths, thecontinoual reduction in mesiodistal tooth widths, the incidence of tooth crowding is relatively low inincidence of tooth crowding is relatively low in primitive man.primitive man.
  49. 49. PHENOMENON TO SUPPORTPHENOMENON TO SUPPORT ATTRITIONAL OCCLUSIONATTRITIONAL OCCLUSION • Third molars- only teeth that have their rootThird molars- only teeth that have their root formation completed before eruption in civilizedformation completed before eruption in civilized man’s non attritional dentition.man’s non attritional dentition. • At the age of 12 to 13 years the third molar begin toAt the age of 12 to 13 years the third molar begin to erupt in attritional occlusion.erupt in attritional occlusion.
  50. 50. CHANGE IN CURVE OF WILSONCHANGE IN CURVE OF WILSON • As the permanent molars eruptAs the permanent molars erupt the bucco– lingual plane isthe bucco– lingual plane is oblique. As wear progress, theoblique. As wear progress, the plane becomes horizontal, thenplane becomes horizontal, then begins to slant downwards andbegins to slant downwards and cusp of carabelli serves tocusp of carabelli serves to increase overall occlusalincrease overall occlusal surface areasurface area.. • In civilized man theIn civilized man the buccolingual plane is obliquebuccolingual plane is oblique throughout life.throughout life.
  51. 51. SECONDARY DENTINE AND PULPAL PAINSECONDARY DENTINE AND PULPAL PAIN • Value of pulpal pain is not to warn of caries, but toValue of pulpal pain is not to warn of caries, but to warn of atttrition approaching the pulp faster thanwarn of atttrition approaching the pulp faster than secondary dentin can be laid down.secondary dentin can be laid down.
  52. 52. • Teeth continually erupt vertically, migrate mesially, andTeeth continually erupt vertically, migrate mesially, and usually are collectively too large to be accommodatedusually are collectively too large to be accommodated in the jaws without a reduction of tooth mass.in the jaws without a reduction of tooth mass. • This reduction, which occurs naturally in primitive manThis reduction, which occurs naturally in primitive man from attrition, can be replaced in civilized man byfrom attrition, can be replaced in civilized man by planned mesiodistal stripping and / or toothplanned mesiodistal stripping and / or tooth extractions.extractions.
  53. 53. DIFFERENTIAL FORCEDIFFERENTIAL FORCE • In 1956 Dr Begg introduced the concept ofIn 1956 Dr Begg introduced the concept of Differential forceDifferential force • His observations was based on the work of StoreyHis observations was based on the work of Storey and Smith and their experiments on toothand Smith and their experiments on tooth movement response to different pressuremovement response to different pressure applications.applications.
  54. 54. • IT IS DEFINED AS A FORCE THAT RESULTS IN AIT IS DEFINED AS A FORCE THAT RESULTS IN A DIFFERENT RATE OR TOOTH MOVEMENT AT ONEDIFFERENT RATE OR TOOTH MOVEMENT AT ONE END THAN THE OTHER.END THAN THE OTHER.
  55. 55. • A range of light pressures which would cause teethA range of light pressures which would cause teeth to move at an optimum rate and with minimalto move at an optimum rate and with minimal disturbance of the supportive tissues -disturbance of the supportive tissues - optimumoptimum orthodontic forceorthodontic force.. • Pressures below slow rate of responsePressures below slow rate of response above undermining resorptionabove undermining resorption retarding tooth movement.retarding tooth movement.
  56. 56. WHENWHEN LIGHTLIGHT FORCES ARE USEDFORCES ARE USED ANCHOR UNITANCHOR UNIT STABLESTABLE ANTERIORSANTERIORS TIPTIP
  57. 57. WHEN HEAVY FORCES ARE USED ANCHOR UNITANCHOR UNIT MOVEMOVE ANTERIORSANTERIORS STABLESTABLE
  58. 58. • The significance of this concept is enhanced by theThe significance of this concept is enhanced by the ability to choose mechanicsability to choose mechanics that promote free tippingthat promote free tipping where the greatest movement is desired and preventwhere the greatest movement is desired and prevent free tipping where stability or anchorage is indicated.free tipping where stability or anchorage is indicated.
  59. 59. • A goal of Begg’s treatment is over correction of the teeth toA goal of Begg’s treatment is over correction of the teeth to allow for the natural tendency for relapse that occurs whenallow for the natural tendency for relapse that occurs when orthodontic appliance removed.orthodontic appliance removed. • The differential force technique is designed to permit teethThe differential force technique is designed to permit teeth to move towards their anatomically correct positions in theto move towards their anatomically correct positions in the jaw under the influence of very light forces – as would occurjaw under the influence of very light forces – as would occur naturally in the presence of attrition.naturally in the presence of attrition. ..
  60. 60. • The light intra oral forces of Begg Technique do notThe light intra oral forces of Begg Technique do not place undue strain on the anchor molars.place undue strain on the anchor molars. • The appliance is designed to permit the teeth to moveThe appliance is designed to permit the teeth to move independently of one anotherindependently of one another – whether tipping freely– whether tipping freely in the early stages or during detailed root positioning inin the early stages or during detailed root positioning in the final stage.the final stage.
  61. 61. • The movement of all teeth is due to the synergisticThe movement of all teeth is due to the synergistic effect of the forces and appliances working together ineffect of the forces and appliances working together in the presence of proper diagnosis.the presence of proper diagnosis. • The begg synergistic arch graphically demonstratesThe begg synergistic arch graphically demonstrates and emphasizes the importance of the combination ofand emphasizes the importance of the combination of various components comprising the Begg theory andvarious components comprising the Begg theory and technique.technique.
  62. 62. SEVEN SYNERGISTIC COMPONENTSSEVEN SYNERGISTIC COMPONENTS 1. A1. A diagnosis and treatment plandiagnosis and treatment plan that recognizes the persistence ofthat recognizes the persistence of hereditary forces of mesial migration and vertical eruption of teeth and hashereditary forces of mesial migration and vertical eruption of teeth and has its objectives the over correction of malrelationships of both teeth and jaws.its objectives the over correction of malrelationships of both teeth and jaws. 2. The2. The simultaneous movementsimultaneous movement of all teeth. From the beginning ofof all teeth. From the beginning of treatment each tooth is directed towards its final position in the dental arch.treatment each tooth is directed towards its final position in the dental arch. 3. The total separation of3. The total separation of root moving forcesroot moving forces from arch wire forces duringfrom arch wire forces during the final third stage of treatment.the final third stage of treatment. 4.The application of proper elastic forces to create the4.The application of proper elastic forces to create the desired differentialdesired differential movement of the teeth.movement of the teeth.
  63. 63. 5.The use of5.The use of light round continuous arch wireslight round continuous arch wires bent from thebent from the hardest wire possible – Not only must the wire be of highest quality,hardest wire possible – Not only must the wire be of highest quality, but the arch wire have proper form, including bite opening bends, tobut the arch wire have proper form, including bite opening bends, to control the vertical dimension.control the vertical dimension. 6. The use of6. The use of molar attachmentsmolar attachments that prevent free mesiodistalthat prevent free mesiodistal tipping and yet permit the arch wire to slide freely mesio distally.tipping and yet permit the arch wire to slide freely mesio distally. This permits the rapid retraction of the anterior teeth.This permits the rapid retraction of the anterior teeth. 7. The use of7. The use of attachments on all teethattachments on all teeth, except anchor molars, that, except anchor molars, that control rotations yet permit free tipping in the desired direction andcontrol rotations yet permit free tipping in the desired direction and free sliding along arch wires.free sliding along arch wires.
  64. 64. A diagnosis and treatment plan that recognizes the persistence of hereditary forces of mesial migration and vertical eruption of teeth and has its objectives of over correction of malrelationships of both teeth and jaws 11 The simultaneous movement of all teeth. From the beginning of treatment each tooth is directed towards its final position in the dental arch. 22 The total separation of root moving forces from arch wire forces during the final third stage of treatment. 33 The application of proper elastic forces to create the desired differential movement of the teeth. 4455 The use of light round continuous arch wires bent from the hardest wire possible – Not only must the wire be of highest quality, but the arch wire have proper form, including bite opening bends, to control the vertical dimension. 66The use of molar attachments that prevent free mesiodistal tipping and yet permit the arch wire to slide freely mesio distally. This permits the rapid retraction of the anterior teeth. 77 The use of attachments on all teeth, except anchor molars, that control rotations yet permit free tipping in the desired direction and free sliding along arch wires. ““ SYNERGISTIC ARCHSYNERGISTIC ARCH ””
  65. 65. BEGG’S TECHNIQUEBEGG’S TECHNIQUE
  66. 66. • An orthodontic technique may be defined as aAn orthodontic technique may be defined as a systematic sequence of definite procedures to achievesystematic sequence of definite procedures to achieve the correction of malocclusion with a specific type ofthe correction of malocclusion with a specific type of appliance or with a combination of appliances.appliance or with a combination of appliances.
  67. 67. • The method consist essentially ofThe method consist essentially of tipping movementstipping movements of the teethof the teeth.Two successive tipping movements are.Two successive tipping movements are required to achieve bodily movement.The first torequired to achieve bodily movement.The first to position the tooth crowns and second to position theposition the tooth crowns and second to position the tooth roots. As a result of these tipping movements,tooth roots. As a result of these tipping movements, complemented by intrusion, extrusion and rotation ofcomplemented by intrusion, extrusion and rotation of teeth whenever required, optimal occlusion, axialteeth whenever required, optimal occlusion, axial positioning and alignment of the teeth are secured.positioning and alignment of the teeth are secured.
  68. 68. COMPONENTS OF BEGG APPLIANCECOMPONENTS OF BEGG APPLIANCE • ARCH WIRE MATERIALARCH WIRE MATERIAL -Round austenitic stainless steel-Round austenitic stainless steel wire of 0.016 inch diameterwire of 0.016 inch diameter -heat treated and cold drawn-heat treated and cold drawn down to its proper diameter, indown to its proper diameter, in order to give it the requiredorder to give it the required properties of resiliency,properties of resiliency, toughness and tensile strength.toughness and tensile strength. ––produce force for a longerproduce force for a longer duration without frequentduration without frequent reactivation, over long distance.reactivation, over long distance.
  69. 69. SIX TYPES OF AUSTRALIAN WIRESIX TYPES OF AUSTRALIAN WIRE 1. REGULAR GRADE:1. REGULAR GRADE: -- Lowest grade – easy to bendLowest grade – easy to bend - Used for practice bending and forming auxillaries.- Used for practice bending and forming auxillaries. 2. REGULAR PLUS:2. REGULAR PLUS: -- Easy to form, more resilient than regular gradeEasy to form, more resilient than regular grade - Used for auxiliaries and arch wires when more- Used for auxiliaries and arch wires when more pressure and resistance to deformation as desired.pressure and resistance to deformation as desired. 3. SPECIAL GRADE:3. SPECIAL GRADE: -- Highly resilient yet can be formed into shape.Highly resilient yet can be formed into shape.
  70. 70. 4. SPECIAL PLUS GRADE:4. SPECIAL PLUS GRADE: -- Hardness and resiliency of 0.016” wire, is excellent forHardness and resiliency of 0.016” wire, is excellent for supporting anchorage, and reducing deep overbites.supporting anchorage, and reducing deep overbites. - Must be bent with care.- Must be bent with care. 5. EXTRA SP ECIAL PLUS GRADE :5. EXTRA SP ECIAL PLUS GRADE : -- Also called premium plusAlso called premium plus - This grade is unequalled in resiliency and- This grade is unequalled in resiliency and hardness.hardness. - More difficult to bend and more subjected to- More difficult to bend and more subjected to fracture.fracture.
  71. 71. 6. SUPREME GRADE:6. SUPREME GRADE: -- It is ultra light tensile fine round stainless steelIt is ultra light tensile fine round stainless steel wire.wire. - It was initially introduce in 0.010” diameter- It was initially introduce in 0.010” diameter and then further reduced to 0.009 diameter.and then further reduced to 0.009 diameter. -It is primarily used in the early treatment for-It is primarily used in the early treatment for rotation. Alignment and leveling.rotation. Alignment and leveling. - Although supreme exceeds the yield strength- Although supreme exceeds the yield strength of E.S.P, it is intended for use in either short sectionof E.S.P, it is intended for use in either short section or full arches where sharp bends are not required.or full arches where sharp bends are not required.
  72. 72. PRECAUTION TAKEN WHILE BENDING THE WIREPRECAUTION TAKEN WHILE BENDING THE WIRE • When the wire is bent around the round beak of the pliers,When the wire is bent around the round beak of the pliers, the stress on the crystalline structure is confined to a smallthe stress on the crystalline structure is confined to a small area, which may cause the wire to breakarea, which may cause the wire to break When bending the wire around the square beak theWhen bending the wire around the square beak the points of stress are offset, providing more area for crystallinepoints of stress are offset, providing more area for crystalline adjustment and there fore less chance fracture.adjustment and there fore less chance fracture.
  73. 73. MODIFIED RIBBON ARCH BRACKET ( TPMODIFIED RIBBON ARCH BRACKET ( TP -256- 500)-256- 500) By changing the lock pins, the size of the arch wire slotBy changing the lock pins, the size of the arch wire slot can be changed to accept properly either a 0.016can be changed to accept properly either a 0.016 inch or a 0.020 inch arch wireinch or a 0.020 inch arch wire
  74. 74. REQUIREMENTS FOR A LIGHT WIREREQUIREMENTS FOR A LIGHT WIRE BRACKETSBRACKETS • Ease of arch wire engagementEase of arch wire engagement • A means to guide both the tail and head of lock pinA means to guide both the tail and head of lock pin during lockingduring locking • Positive retention of arch wire in all 3 stagesPositive retention of arch wire in all 3 stages • Free tipping and sliding on arch wireFree tipping and sliding on arch wire • Ability to effect and hold rotationAbility to effect and hold rotation • Ability to prevent accidental tipping in stage III.Ability to prevent accidental tipping in stage III.
  75. 75. TYPESTYPES 1. Full flange1. Full flange 2.Half flange2.Half flange 1. Bondable1. Bondable 2.Weldable2.Weldable Full flange brackets will have more friction with arch wire andFull flange brackets will have more friction with arch wire and hence hindrance to smooth tipping movement of anteriors.hence hindrance to smooth tipping movement of anteriors. In half flange brackets, contact of the flange with archIn half flange brackets, contact of the flange with arch wire is minimal , thus friction is also minimal.wire is minimal , thus friction is also minimal. The high flange brackets are preferred over the taper flangeThe high flange brackets are preferred over the taper flange
  76. 76. BAND MATERIALBAND MATERIAL • These bands made of stainless steel strips of differentThese bands made of stainless steel strips of different size and thickness are recommended for different teeth.size and thickness are recommended for different teeth. These available on 8 feet rolls or cut of 2 inches to 2.5These available on 8 feet rolls or cut of 2 inches to 2.5 inches.inches. 1. For incisors - 0.125 x 0.003 inch1. For incisors - 0.125 x 0.003 inch 2. For canines, premolars – 0.150 x 0.004 inch2. For canines, premolars – 0.150 x 0.004 inch 3. For molars - 0.150 x 0.005 or 0.180 x 0.006 inch3. For molars - 0.150 x 0.005 or 0.180 x 0.006 inch
  77. 77. LOCK PINSLOCK PINS • Second stage safety lock pinSecond stage safety lock pin: Shoulder: Shoulder on head ensures free mesiodistal tipping.on head ensures free mesiodistal tipping. Labiolingual width of tail dimension isLabiolingual width of tail dimension is reduced to fit properly into bracket inreduced to fit properly into bracket in conjunction with inch arch wire.conjunction with inch arch wire. • One point safety lock pinOne point safety lock pin : Used in stage: Used in stage I and II.The pin has a shoulder that keepsI and II.The pin has a shoulder that keeps the head of the pin outside the bracketthe head of the pin outside the bracket slot and prevents the impingement of pinslot and prevents the impingement of pin on arch wire.The beveled undersurfaceon arch wire.The beveled undersurface of head permits free mesiodistal tipping.of head permits free mesiodistal tipping.
  78. 78. • Hook lock pinsHook lock pins : Used during III stage.: Used during III stage. Since there is no safety shoulder, theySince there is no safety shoulder, they hold the arch wire firmly against thehold the arch wire firmly against the base of the arch wire slot.Thickness –base of the arch wire slot.Thickness – 0.014” to 0.018” , length – 0.220 to0.014” to 0.018” , length – 0.220 to 0.2930.293 • High hat safety lock pinsHigh hat safety lock pins:: They have a gingival extension onThey have a gingival extension on head which provides a positive pointhead which provides a positive point for engagement of vertical or crossfor engagement of vertical or cross elasticselastics..
  79. 79. BUCCAL TUBESBUCCAL TUBES • Round molar tubes with 0.036Round molar tubes with 0.036 internal diameter and 0.250internal diameter and 0.250 length are routinely used.length are routinely used. • Flat oval molar tubes andFlat oval molar tubes and doubled back wires are useddoubled back wires are used when second permanentwhen second permanent molars are the anchor teethmolars are the anchor teeth and also used in mandibularand also used in mandibular dental arch when seconddental arch when second premolar is absent.premolar is absent.
  80. 80. AUXILLARY ATTACHMENTSAUXILLARY ATTACHMENTS • In addition to the foregoing parts, the lightIn addition to the foregoing parts, the light round arch wire technique requires theround arch wire technique requires the following adjustmentsfollowing adjustments ..
  81. 81. LINGUAL BUTTONS AND CLEATLINGUAL BUTTONS AND CLEAT
  82. 82. EYELETS:EYELETS: Are made from thin stainless steel stiff wires.Are made from thin stainless steel stiff wires. They are very useful in tying the ligature wire onThey are very useful in tying the ligature wire on anterior teeth for purpose of rotation.anterior teeth for purpose of rotation.
  83. 83. BALL END HOOKS:BALL END HOOKS: They are attached toThey are attached to buccal or lingual of molarbuccal or lingual of molar bands. Positioned as farbands. Positioned as far gingivally and near thegingivally and near the mesiodistal centre of themesiodistal centre of the tooth. Make the placing oftooth. Make the placing of elastic simple for patient.elastic simple for patient.
  84. 84. BYPASS CLAMPBYPASS CLAMP • Pinning of the arch wirePinning of the arch wire in the premolar bracketsin the premolar brackets can cause hinderence tocan cause hinderence to free tipping.free tipping. So in stage I and stageSo in stage I and stage II Bypass clamps are usedII Bypass clamps are used on the premolar brackets.on the premolar brackets.
  85. 85. LIGATURE WIRESLIGATURE WIRES These are very thin (0.007 to 0.009) stainless steel soft wires.These are very thin (0.007 to 0.009) stainless steel soft wires. - They are very useful in tying of the span of looped arch wire,- They are very useful in tying of the span of looped arch wire, which are far away from its ideal position, thus progressivewhich are far away from its ideal position, thus progressive increase In force and also avoiding plastic deformation of theincrease In force and also avoiding plastic deformation of the arch wire.arch wire. - Also used as extra holding devices - secure about arch wire- Also used as extra holding devices - secure about arch wire not getting disengaged from the bracket slot by slipping outnot getting disengaged from the bracket slot by slipping out
  86. 86. ELASTICSELASTICS • Elastics are made of synthetic latex and of uniform sizesElastics are made of synthetic latex and of uniform sizes and applying uniform forces when stretched to requiredand applying uniform forces when stretched to required length.length. • Thinner walled elastics are called “Thinner walled elastics are called “light elasticslight elastics” and” and thick walled elastics are called “thick walled elastics are called “Heavy elasticsHeavy elastics”” • These elastics will exert a force equal to between 60 andThese elastics will exert a force equal to between 60 and 70 gms when they are new and first placed.70 gms when they are new and first placed.
  87. 87. USES OF ELASTICSUSES OF ELASTICS • To open the biteTo open the bite • To correct the mesiodistal relationship ofTo correct the mesiodistal relationship of buccal segmentsbuccal segments • To close the anterior spacingTo close the anterior spacing • Corection of rotationCorection of rotation • Posterior crossbite corectionPosterior crossbite corection
  88. 88. CLASS I ELASTICSCLASS I ELASTICS CLASS II ELASTICS CLASS III ELASTICS
  89. 89. ELASTIC THREADELASTIC THREAD TIED IN FIGURE OF ‘8’TIED IN FIGURE OF ‘8’ PATTERNPATTERN
  90. 90. SEPARATING SPRINGSEPARATING SPRING
  91. 91. 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.
  92. 92. PLACEMENT IN ROTATED TOOTHPLACEMENT IN ROTATED TOOTH
  93. 93. 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.
  94. 94. THREE STAGES OFTHREE STAGES OF TREATMENTTREATMENT Begg’s technique is divided into 3 separate and distinct stages that must not be allowed to overlap. It is chiefly with the objective of preventing anchorage failure that the technique is divided into 3 distinct stages of tooth movement: 1.STAGE I 2.STAGE II 3.STAGE III
  95. 95. STAGE ISTAGE I STAGE I – OBJECTIVESSTAGE I – OBJECTIVES •Correction of Deep Anterior Over BiteCorrection of Deep Anterior Over Bite •Correction of Anterio-posterior Occlusal Relationship of theCorrection of Anterio-posterior Occlusal Relationship of the Buccal SegmentsBuccal Segments •Correction of anterior spacingCorrection of anterior spacing •Correction Of CrowdingCorrection Of Crowding •Correction Of Rotations.Correction Of Rotations. •Correction of posterior cross biteCorrection of posterior cross bite
  96. 96. ARCHWIREARCHWIRE MaterialMaterial • 0.016 special AJW – principal wire of Stage I.0.016 special AJW – principal wire of Stage I. • Combination of resiliency and flexibility.Combination of resiliency and flexibility. • Adequate stiffness for bite openingAdequate stiffness for bite opening
  97. 97. THE FIRST STAGE ARCHWIRETHE FIRST STAGE ARCHWIRE INCORPORATESINCORPORATES:: • Intermaxillary hooksIntermaxillary hooks • Molar anchorage bendsMolar anchorage bends • Toe-in or toe-out bendsToe-in or toe-out bends • Vertical loopsVertical loops • Bayonet bendsBayonet bends
  98. 98. Intermaxillary Hooks – ( IMH )Intermaxillary Hooks – ( IMH ) •Small loops for engaging elastics and cuspid tiesSmall loops for engaging elastics and cuspid ties • 2 types –2 types – • Z shapedZ shaped • Circle/ ovalCircle/ oval • Adv of Circle hook.Adv of Circle hook. • 2 – 2.5 outside diameter.2 – 2.5 outside diameter. • Mesial & Distal rolling possibleMesial & Distal rolling possible • Less space requirement.Less space requirement. • Less distortionLess distortion • Greater stiffness in horizontal and vertical plane.Greater stiffness in horizontal and vertical plane.
  99. 99. LocationLocation • Well aligned ant. – 1-2 mm mesial to the cuspidWell aligned ant. – 1-2 mm mesial to the cuspid bracket.bracket. • Spaced ant. – Further mesially.Spaced ant. – Further mesially. • Mildly crowded ant. – impinging on the bracket.Mildly crowded ant. – impinging on the bracket. • Z shaped: are angulated buccaly away from theZ shaped: are angulated buccaly away from the vertical, in order to avoid any possibility if wedging ofvertical, in order to avoid any possibility if wedging of distal arm of loop.distal arm of loop.
  100. 100. Anterior Segement:Anterior Segement: • Portion of the wire b/w intermaxillary hooks liesPortion of the wire b/w intermaxillary hooks lies gingival to buccal segment for effective intrusiongingival to buccal segment for effective intrusion
  101. 101. • Cuspid Offset bendCuspid Offset bend • Horizontal offset bend mesial to the IMH.Horizontal offset bend mesial to the IMH. • Proper positioning of the cuspid and the lateral incisor.Proper positioning of the cuspid and the lateral incisor. • Cuspid Curve:Cuspid Curve: • Labial curvature in cuspid area – incorporated to avoidLabial curvature in cuspid area – incorporated to avoid lingual tipping of canines.lingual tipping of canines. • In narrow arches requiring expansion, cuspid offset given.In narrow arches requiring expansion, cuspid offset given.
  102. 102. Anchorage bends / Tip back bendsAnchorage bends / Tip back bends.. •Placed immediately posterior to the 2Placed immediately posterior to the 2ndnd premolarpremolar bracketbracket • Bent so that when inserted into the buccal tubes theBent so that when inserted into the buccal tubes the anterioranterior section of the archwire lies in thesection of the archwire lies in the buccalbuccal sulcisulci
  103. 103. CHECKINGCHECKING
  104. 104. • Amount of bend varies from case to caseAmount of bend varies from case to case • The leverage force incorporated on the incisorsThe leverage force incorporated on the incisors should be around 65mgshould be around 65mg
  105. 105. • The purpose of anchor bend in upper arch is to preventThe purpose of anchor bend in upper arch is to prevent mesial migration of the molars;mesial migration of the molars; • In lower is to supply bodily control of the lower molars asIn lower is to supply bodily control of the lower molars as these are moved forward by action of Class II elasticsthese are moved forward by action of Class II elastics • Angulation depends onAngulation depends on • Stage of treatment - decreases as stage progresses.Stage of treatment - decreases as stage progresses. • Depth of overbite - decreases with bite opening.Depth of overbite - decreases with bite opening. • Rate of progress of case.Rate of progress of case.
  106. 106. Vertical Loops Used to supply local increased arch flexibility or used for space opening or closing, stops, rotation. The most vertical loops to align six anterior teeth are five, one in each interproximal area.
  107. 107. Lingually locked out teeth and verticallyLingually locked out teeth and vertically displaced teethdisplaced teeth • It may be difficult to engage the wire in the brackets atIt may be difficult to engage the wire in the brackets at times if thetimes if the space between proximating teeth is less thanspace between proximating teeth is less than the length of the bracket areathe length of the bracket area for a blocked out toothfor a blocked out tooth • Ligate the arch wire to the bracket of blocked out toothLigate the arch wire to the bracket of blocked out tooth
  108. 108. FORMING ARCH WIRE CONTAINING VERTICALFORMING ARCH WIRE CONTAINING VERTICAL LOOPSLOOPS
  109. 109. Contraction Loop in midline with incisor stops to tip crowns of upper centrals Vertical loops bent in case of high frenum attachment
  110. 110. Toe in and toe out bendsToe in and toe out bends • Horizontal offset bends combined with anchor bendsHorizontal offset bends combined with anchor bends - anti-rotational control- anti-rotational control • Anchorage bend bent lingually – toe in.Anchorage bend bent lingually – toe in. • Anchorage bend bent buccally – toe out.Anchorage bend bent buccally – toe out.
  111. 111. PINNING AND LIGATION OF ARCH WIRES In the Stage I 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.
  112. 112. • Free ends of the lock pins are turned mesially aroundFree ends of the lock pins are turned mesially around the bracketsthe brackets • The wire should extend 2-3mm past the buccal tubesThe wire should extend 2-3mm past the buccal tubes to prevent binding of the archwire in them.to prevent binding of the archwire in them.
  113. 113. TYING INTERMAXILLARY HOOKTYING INTERMAXILLARY HOOK TO CUSPID BRACKETTO CUSPID BRACKET No ties between intermaxillary hooks and cuspid bracketsNo ties between intermaxillary hooks and cuspid brackets cuspid tip distally the arch wirecuspid tip distally the arch wire SpacingSpacing
  114. 114. • Ligation done in figure of eight and always pass ligatureLigation done in figure of eight and always pass ligature through circlethrough circle
  115. 115. HOW TO ACHIEVE THE OBJECTIVES?HOW TO ACHIEVE THE OBJECTIVES? 1.Open the anterior over bite1.Open the anterior over bite - Proper amount of anchor bends at proper- Proper amount of anchor bends at proper locations.locations. -Continual wearing of class II or Class III elastics.-Continual wearing of class II or Class III elastics.
  116. 116. 2.2. Correction of the mesiodistal relationship of theCorrection of the mesiodistal relationship of the buccal segmentsbuccal segments.. - Continual wearing of class II or class III elastics- Continual wearing of class II or class III elastics as required.as required. - Proper anchorage bends in both- Proper anchorage bends in both upper and lower arch wires.upper and lower arch wires.
  117. 117. 3.3. Close any anterior spaceClose any anterior space:: LoopsLoops Plain arch wire with elastic from cuspid pin tail toPlain arch wire with elastic from cuspid pin tail to cuspid pin tail.cuspid pin tail.
  118. 118. 4.Eliminate any anterior crowding4.Eliminate any anterior crowding:: - Vertical loops between crowded anterior teeth, with- Vertical loops between crowded anterior teeth, with bracket areas modified for desired overcorrections.bracket areas modified for desired overcorrections. - Arch length designed so that intermaxillary circles- Arch length designed so that intermaxillary circles rest against mesial surfaces of cuspid brackets.rest against mesial surfaces of cuspid brackets.
  119. 119. 5.5.Overrotate all teeth that require rotatingOverrotate all teeth that require rotating -using elastic ligature or thread-using elastic ligature or thread -using spring auxiliary-using spring auxiliary
  120. 120. ROTATIONS OF CUSPID ANDROTATIONS OF CUSPID AND BICUSPIDBICUSPID Correction may be achieved by using either :-Correction may be achieved by using either :- 1.1. elastic threadselastic threads 2.2. rotating springsrotating springs
  121. 121. Elastic threadsElastic threads
  122. 122. Rotation springsRotation springs • Most efficient & versatile meanMost efficient & versatile mean • 0.014” & 0.016”0.014” & 0.016” • Vertical leg inserted in bracket slot from gingivalVertical leg inserted in bracket slot from gingival side, holding activating arm perpendicular to labialside, holding activating arm perpendicular to labial surface.surface.
  123. 123. ROTATION OF MOLARSROTATION OF MOLARS • Incorporation of toe-in or toe-out bendsIncorporation of toe-in or toe-out bends • Elastic ligature tiesElastic ligature ties • Recurved arch wire for molar tiltRecurved arch wire for molar tilt
  124. 124. 6. Correct posterior crossbites6. Correct posterior crossbites:: - Modify arch width of one or both arch wires- Modify arch width of one or both arch wires -wearing cross elastics-wearing cross elastics - Rapid maxillary overexpansion, followed by a- Rapid maxillary overexpansion, followed by a period of stabilization prior to the placement ofperiod of stabilization prior to the placement of complete appliances and the beginning of stage I.complete appliances and the beginning of stage I.
  125. 125. PRIORITIES IN THE STAGE IPRIORITIES IN THE STAGE I 11. It is generally agree that reduction of overbite must precede reduction of overjet. 2. While treating cases with anterior crowding, alignment of teeth becomes an important consideration. 3. when the upper incisors are very much proclined they should be subjected to a light intrusive force and a normal retractive class II elastic force till their proclination reduces.
  126. 126. PROBLEMS ARISING IN STAGE IPROBLEMS ARISING IN STAGE I • Failure to correct the deep-biteFailure to correct the deep-bite • Insufficient retraction of the anteriorsInsufficient retraction of the anteriors • Mandibular molars tipping linguallyMandibular molars tipping lingually • Rotation of the lower molarsRotation of the lower molars • Anterior spaces openingAnterior spaces opening • Rotation/tipping of upper molarRotation/tipping of upper molar • Extremely mobile molarsExtremely mobile molars
  127. 127. PROBLEMS ARISING IN STAGE IPROBLEMS ARISING IN STAGE I 1. BITE NOT OPENING:1. BITE NOT OPENING: A. Patient not wearing elastics:A. Patient not wearing elastics: - educate the patient- educate the patient -do not give enough elastics-do not give enough elastics - make it impossible to hook elastics and see if- make it impossible to hook elastics and see if problem is reportedproblem is reported B. Patient biting out bite opening bends.B. Patient biting out bite opening bends. - Remove the arch wire : restore bite- Remove the arch wire : restore bite opening bendsopening bends
  128. 128. - Check the level of mandibular molar tubes, lower them, if necessary. - Check position of anchor bends, if too far mesially, move them closer to molar tube. - Loose molar band - Improper angulations of buccal tube or entire molar bend..
  129. 129. 22. MOLAR WIDTH NARROWING. MOLAR WIDTH NARROWING AA.Vertical component of class II elastic force.Vertical component of class II elastic force - Form mandibular arch wire wider in posterior segment- Form mandibular arch wire wider in posterior segment B. Prolonged wearing of posterior cross elastics to widen opposingB. Prolonged wearing of posterior cross elastics to widen opposing molarsmolars - discontinue cross elastics and correct cross bite by others- discontinue cross elastics and correct cross bite by others means.means. C. Disto – lingually rotated cuspidsC. Disto – lingually rotated cuspids 1. Do not engage the arch wire in the cuspid brackets until these1. Do not engage the arch wire in the cuspid brackets until these teeth have been rotated by elastic thread or other means.teeth have been rotated by elastic thread or other means.
  130. 130. 3. ADVERSE TIPPING OF ANCHOR MOLARS3. ADVERSE TIPPING OF ANCHOR MOLARS - If tipped mesially : there is no anchor bends. If- If tipped mesially : there is no anchor bends. If tipped distaly too much anchor bends.tipped distaly too much anchor bends. - Improper placement of molar band or tube- Improper placement of molar band or tube - Excessive elastic force- Excessive elastic force - Oversize arch wire – molar tipped distally- Oversize arch wire – molar tipped distally
  131. 131. 4. NO APPRECIABLE CHANGE4. NO APPRECIABLE CHANGE - Patient not wearing elastics- Patient not wearing elastics - Arch wire bend out of shape- Arch wire bend out of shape - patient seen too soon- patient seen too soon 5.VERTICAL LOOPS BURIED IN THE GINGIVA5.VERTICAL LOOPS BURIED IN THE GINGIVA - Original, looped arch wire left in the mouth too- Original, looped arch wire left in the mouth too longlong - Misjudgment in the proper direction of vertical- Misjudgment in the proper direction of vertical loops when the arch wire was placedloops when the arch wire was placed
  132. 132. 6. ELASTICS WHICH BREAK OR DO NOT STAY ON:6. ELASTICS WHICH BREAK OR DO NOT STAY ON: a. may just be an excuse for not wearing elasticsa. may just be an excuse for not wearing elastics b. elastic will not stay on the intermaxillary circle.b. elastic will not stay on the intermaxillary circle. 7.LOCK PINS LOST;7.LOCK PINS LOST; a. occluso incisal forcea. occluso incisal force -use steel pin-use steel pin - Check anchor bends to facilitate opening the- Check anchor bends to facilitate opening the bitebite
  133. 133. 8. EXTREMELY MOBILE MOLARS:8. EXTREMELY MOBILE MOLARS: a. clenching of the teetha. clenching of the teeth b. intermittent wearing of elasticsb. intermittent wearing of elastics c. pathologyc. pathology d. excessive force applied to molard. excessive force applied to molar - Reduce arch wire size to 0.016 inch- Reduce arch wire size to 0.016 inch - Reduce elastic force to 2 ½ ounces- Reduce elastic force to 2 ½ ounces - Reduce degree of anchor bends- Reduce degree of anchor bends
  134. 134. 9.9. LOWER ANTERIOR TEETH TIPPING LABIALLY:LOWER ANTERIOR TEETH TIPPING LABIALLY: - May be an optical illusion with roots actually- May be an optical illusion with roots actually moving lingually.moving lingually. - Binding of the arch wire in bicuspid brackets- Binding of the arch wire in bicuspid brackets - Binding of ends of the arch wire inside distal ends- Binding of ends of the arch wire inside distal ends of buccal tubeof buccal tube
  135. 135. 10. ANTERIOR OPEN BITE NOT CLOSING:10. ANTERIOR OPEN BITE NOT CLOSING: - patient not wearing anterior vertical elastics- patient not wearing anterior vertical elastics - Persistent tongue thrust or other adverse habits- Persistent tongue thrust or other adverse habits - Too much anchor bend.- Too much anchor bend.
  136. 136. THANK YOUTHANK YOU
  137. 137. STAGE 2 AND STAGE 3 - BEGGSSTAGE 2 AND STAGE 3 - BEGGS TECHNIQUETECHNIQUE
  138. 138. STAGE IISTAGE II OBJECTIVES:OBJECTIVES: 1. Maintain all corrections achieved during1. Maintain all corrections achieved during first stage.first stage. 2. Close any remaining posterior space.2. Close any remaining posterior space.
  139. 139. ARCH WIRE ( 0.018 OR 0.022 SS) - To maintain the corrections already achieved. - To stabilize the teeth against any adverse reciprocal forces may occur as a result of the application of elastics or auxiliaries. LOCK PIN: - “Stage 2” safety lock pins.
  140. 140. HOW TO ACHIEVE THEHOW TO ACHIEVE THE OBJECTIVES?OBJECTIVES?
  141. 141. CLOSING OF ANY REMAININGCLOSING OF ANY REMAINING POSTERIOR SPACEPOSTERIOR SPACE • Proper application of elasticsProper application of elastics
  142. 142. CONTROL OF BICUSPID HEIGHTCONTROL OF BICUSPID HEIGHT
  143. 143. • Sometimes in stage 2 mesialisation of the anchor tooth isSometimes in stage 2 mesialisation of the anchor tooth is desirable..desirable.. • Achived by:Achived by: 1.1. Strength of horizontal elastics is increased from 2Strength of horizontal elastics is increased from 21/21/2 ounces to 6 or 8 ouncesounces to 6 or 8 ounces 2.2. Certain auxiliariesCertain auxiliaries
  144. 144. AUXILIARIES USED IN STAGE IIAUXILIARIES USED IN STAGE II • To establish anchorage in the anterior segment..To establish anchorage in the anterior segment.. 1.1. Passive uprighting springs on mandibularPassive uprighting springs on mandibular canine.canine. 2.2. The lower anterior braking archesThe lower anterior braking arches
  145. 145. FUNCTION OF THESEFUNCTION OF THESE AUXILIARIES:AUXILIARIES: Establish two point contact between the teeth andEstablish two point contact between the teeth and archwirearchwire prevent free tipping prevent free tipping  Starts to function as anchor teethStarts to function as anchor teeth
  146. 146. CORRECTION OF MIDLINECORRECTION OF MIDLINE • Class II intermaxillary elastics on one side andClass II intermaxillary elastics on one side and class III on other side.class III on other side.
  147. 147. SHORTENING LENGTH OFSHORTENING LENGTH OF DOUBLED-BACK ARCH WIRESDOUBLED-BACK ARCH WIRES
  148. 148. PROBLEM ENCOUNTERED DURINGPROBLEM ENCOUNTERED DURING SECOND STAGESECOND STAGE • Anterior bite closing:Anterior bite closing: a. Not enough anchor benda. Not enough anchor bend b. Bite – opening bends bitten outb. Bite – opening bends bitten out - Educate patient , correct the archwire- Educate patient , correct the archwire c. Patient not wearing the classII elasticsc. Patient not wearing the classII elastics d. Anchor molars out of occlusiond. Anchor molars out of occlusion - Discontinue class II or class III elastics. Use- Discontinue class II or class III elastics. Use horizontal elastics to get molars in occlusion.horizontal elastics to get molars in occlusion.
  149. 149. • Anterior teeth assuming class III relationAnterior teeth assuming class III relation a. Excessive wearing of class II elasticsa. Excessive wearing of class II elastics • Spaces Developing Between The AnteriorSpaces Developing Between The Anterior teethteeth:: a. Failure to give cuspid tiea. Failure to give cuspid tie b. Intermaxillary circles formed too far apart.b. Intermaxillary circles formed too far apart.
  150. 150. • Anchor molars rotating distobuccallyAnchor molars rotating distobuccally a.Toe – out on arch wirea.Toe – out on arch wire b.Too much force from horizontal elasticsb.Too much force from horizontal elastics • Posterior spaces not closing:Posterior spaces not closing: a. Patient not wearing elastics.a. Patient not wearing elastics. b.Arch wire not free to slide distally through buccal tube.b.Arch wire not free to slide distally through buccal tube. c. Arch wire pinned or caught in bicuspid bracket slot.c. Arch wire pinned or caught in bicuspid bracket slot.
  151. 151. • Second bicuspids tipping mesially in firstSecond bicuspids tipping mesially in first bicuspid extraction case:bicuspid extraction case: - Slight, expected mesial movement of anchorSlight, expected mesial movement of anchor molarmolar - Abnormal loss of anchorage, if secondAbnormal loss of anchorage, if second bicuspids are tipping excessively.bicuspids are tipping excessively.
  152. 152. STAGE IIISTAGE III
  153. 153. STAGE 3 UPPER AND LOWER ARCHSTAGE 3 UPPER AND LOWER ARCH WIREWIRE • Made from 0.020 SSMade from 0.020 SS
  154. 154. STAGE IIISTAGE III • OBJECTIVES:OBJECTIVES: 1. Maintain all corrections achieved during first and1. Maintain all corrections achieved during first and second stages.second stages. 2. Achieve desired axial inclinations of all teeth.2. Achieve desired axial inclinations of all teeth.
  155. 155. HOW TO ACHIEVE THEHOW TO ACHIEVE THE OBJECTIVES?OBJECTIVES?
  156. 156. DESIRED AXIAL INCLINATIONSDESIRED AXIAL INCLINATIONS OF ALL TEETHOF ALL TEETH • Changes in the mesiodistal inclinations of teeth areChanges in the mesiodistal inclinations of teeth are accomplished by the use of individualaccomplished by the use of individual root springroot spring oror mesiodistal uprighting springmesiodistal uprighting spring.. • Lingual or labial root torque is applied to anteriorLingual or labial root torque is applied to anterior teeth through the application ofteeth through the application of torqueing auxiliariestorqueing auxiliaries..
  157. 157. •   Original Spring: Smaller & fewer coils.Original Spring: Smaller & fewer coils. A longer lever arm.A longer lever arm. Refinement of original spring: Larger more resilient coilsRefinement of original spring: Larger more resilient coils Short lever arm. Short lever arm. 
  158. 158. HELIX RETENTIVE ARM ACTIVE ARM WITH HOOK AT THE END
  159. 159. UPRIGHTING SPRINGUPRIGHTING SPRING • Made from 0.014 for canine andMade from 0.014 for canine and premolars, 0.012 for incisors.premolars, 0.012 for incisors. • The helix and the active arm facesThe helix and the active arm faces the tooth surface and lie on thethe tooth surface and lie on the gingival aspect of the arch wiregingival aspect of the arch wire • The base arch wire is ligated andThe base arch wire is ligated and the ligature tie beneath thethe ligature tie beneath the archwirearchwire..
  160. 160. • Spring selected should be in the direction of rootSpring selected should be in the direction of root movement required.movement required. • The arm carrying the hook should be at an angle ofThe arm carrying the hook should be at an angle of 45 to the main arch wire before latching,45 to the main arch wire before latching, And parallel when latchedAnd parallel when latched
  161. 161. • A problem inherent in all uprighting springs is that:A problem inherent in all uprighting springs is that: when engaged and under tension, the coilwhen engaged and under tension, the coil pressespresses against the gingival edge of the bracketagainst the gingival edge of the bracket If arch wire is not ligated the coils can causeIf arch wire is not ligated the coils can cause the bracket to move away from the arch wirethe bracket to move away from the arch wire subsequent elongation of the toothsubsequent elongation of the tooth
  162. 162. SPRING PINSPRING PIN • A Combination of aA Combination of a Lock PinLock Pin andand an Uprightingan Uprighting SpringSpring
  163. 163. LINGUAL LOCK PINLINGUAL LOCK PIN
  164. 164. TEETH REQUIRINGTEETH REQUIRING UPRIGHTING:UPRIGHTING:
  165. 165. TORQUING AUXILLARYTORQUING AUXILLARY
  166. 166. • To torque roots of the maxillary anterior root palatallyTo torque roots of the maxillary anterior root palatally Originally spurs, were bent into the main maxillary arch wireOriginally spurs, were bent into the main maxillary arch wire (0.016 inch )(0.016 inch ) The torque transmitted in a spiral manner along the main arch wire toThe torque transmitted in a spiral manner along the main arch wire to thethe anchor molarsanchor molars.. Moved the molars buccally and rotate them distobuccaly..Moved the molars buccally and rotate them distobuccaly..
  167. 167. FOUR SPUR TORQUEING AUXILLARYFOUR SPUR TORQUEING AUXILLARY • Used for torqueing the upper anterior roots palatallyUsed for torqueing the upper anterior roots palatally • Bend with 0.014 or 0.016” wireBend with 0.014 or 0.016” wire
  168. 168. BENDING THE FOUR SPUR AUXILIARYBENDING THE FOUR SPUR AUXILIARY
  169. 169. ACTIVATING THE AUXILIARYACTIVATING THE AUXILIARY
  170. 170. APPLICATION OF THE THIRD STAGEAPPLICATION OF THE THIRD STAGE ARCH WIRES AND THE AUXILIARIES TOARCH WIRES AND THE AUXILIARIES TO THE TEETHTHE TEETH
  171. 171. OTHER TORQUING AUXILIARIESOTHER TORQUING AUXILIARIES USED:USED:
  172. 172. TWO SPUR TORQUEING AUXILLARYTWO SPUR TORQUEING AUXILLARY • Used when lateralUsed when lateral incisors do not requireincisors do not require palatal rootpalatal root
  173. 173. RECIPROCAL TORQUEING AUXILIARYRECIPROCAL TORQUEING AUXILIARY - Upper lateral incisors wereUpper lateral incisors were blocked out palatally beforeblocked out palatally before treatment.treatment. - Their root apices must beTheir root apices must be torqued labially to reduce thetorqued labially to reduce the tendency for the crowns totendency for the crowns to relapse lingually.relapse lingually.
  174. 174. INDIVIDUAL TORQUEING AUXILIARYINDIVIDUAL TORQUEING AUXILIARY • Auxiliary should extend at leastAuxiliary should extend at least one tooth pass tooth beingone tooth pass tooth being torqued, and around curve oftorqued, and around curve of arch, for maximum activation.arch, for maximum activation. • If placed gingivally, torque theIf placed gingivally, torque the root of the lateral lingually.root of the lateral lingually.
  175. 175. ONE TO ONE TORQUEING AUXILIARYONE TO ONE TORQUEING AUXILIARY • Indicated when two adjacent teeth require rootIndicated when two adjacent teeth require root torque in opposite directions.torque in opposite directions.
  176. 176. RAT - TRAP TORQUEING AUXILIARYRAT - TRAP TORQUEING AUXILIARY • Main arch wire is formedMain arch wire is formed from 0.020 inch roundfrom 0.020 inch round wire.wire. • The auxiliary is woundThe auxiliary is wound from either 0.014 or 0.016from either 0.014 or 0.016 inch highly resilientinch highly resilient round wire.round wire. • The torqueing “bars” doThe torqueing “bars” do not extend to the gingiva.not extend to the gingiva.
  177. 177. VERTICAL SPUR IN THE MAIN ARCHVERTICAL SPUR IN THE MAIN ARCH WIREWIRE
  178. 178. TORQUEING AUXILLARY FORTORQUEING AUXILLARY FOR LOWER INCISORSLOWER INCISORS
  179. 179. REVERSE TORQUEING AUXILIARYREVERSE TORQUEING AUXILIARY • Indicated if lower anterior teeth are becoming tooIndicated if lower anterior teeth are becoming too proclined.proclined. • For labial root torqueFor labial root torque
  180. 180. • For lingual root torqueFor lingual root torque
  181. 181. PROBLEMS ENCOUNTERED DURINGPROBLEMS ENCOUNTERED DURING STAGE IIISTAGE III • Maxillary MolarsWidening:Maxillary MolarsWidening: a. Anchor bends present in maxillary arch wire.a. Anchor bends present in maxillary arch wire. b.Too much bite – opening bend between cuspidb.Too much bite – opening bend between cuspid and bicuspidand bicuspid c. maxillary arch wire too small in diameter.c. maxillary arch wire too small in diameter. d. Maxillary arch wire too wide.d. Maxillary arch wire too wide. e.Torqueing auxillary not constricted adequately.e.Torqueing auxillary not constricted adequately.
  182. 182. • Mandibular molars narrowingMandibular molars narrowing a. Lower arch wire not wide enougha. Lower arch wire not wide enough b. class II elastics exerting too much forceb. class II elastics exerting too much force c presence of steel ligature tie from the lingual ofc presence of steel ligature tie from the lingual of the mandibular cuspid to the lingual of thethe mandibular cuspid to the lingual of the mandibular molarmandibular molar • Anterior bite deepening:Anterior bite deepening: a.a. Too much power in the torqueing auxillaryToo much power in the torqueing auxillary b. Maxillary arch wire too thin.b. Maxillary arch wire too thin. c. Patient not wearing class II elasticc. Patient not wearing class II elastic
  183. 183. • Teeth not uprighting mesiodistally:Teeth not uprighting mesiodistally: A. springs not activeA. springs not active B. Arch wire caught on the edge of the bracketB. Arch wire caught on the edge of the bracket - Tighten spring – pin to draw arch wire in- Tighten spring – pin to draw arch wire in bracketbracket - Draw arch wire into bracket with a steel- Draw arch wire into bracket with a steel ligature tieligature tie C. Occlusal interference caused by an elevatedC. Occlusal interference caused by an elevated tooth.tooth. D. Springs placed in backwardsD. Springs placed in backwards
  184. 184. Maxillary anterior teeth not torqueing palatallyMaxillary anterior teeth not torqueing palatally 1.1. Not enough force from maxillary torqueingNot enough force from maxillary torqueing auxiliaryauxiliary 2.2. Maxillary incisal edges caught lingual to lowerMaxillary incisal edges caught lingual to lower anterior teethanterior teeth Lower anterior teeth labially inclinedLower anterior teeth labially inclined 1.1. Normal mesial migration of teeth during thirdNormal mesial migration of teeth during third stagestage
  185. 185. THANK YOUTHANK YOU

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