BEGG’S PHILOSOPHY BEGG’S PHILOSOPHY AND TECHNIQUEAND TECHNIQUE

Presented byPresented by

Susna Susna PaulPaul

CONTENTSCONTENTS

• EVOLUTION OF BEGGS TECHNIQUEEVOLUTION OF BEGGS TECHNIQUE

• BEGGS PHILOSOPHYBEGGS PHILOSOPHY

• BEGGS TECHNIQUEBEGGS TECHNIQUE

• COMPONENTS COMPONENTS

• STAGE ISTAGE I

• STAGE IISTAGE II

• STAGE IIISTAGE III

DEVELOPMENT OF DEVELOPMENT OF LIGHT WIRE LIGHT WIRE TECHNIQUETECHNIQUE

• Dr. Percival Raymond Begg Dr. Percival Raymond Begg was born in 1898 was born in 1898

in a small, gold mining town Coolgardie, west in a small, gold mining town Coolgardie, west

AustraliaAustralia..

• Grew up in south Australia. Grew up in south Australia.

• In his early twenties he worked in a sheep and cattle In his early twenties he worked in a sheep and cattle

station in New south Australia, looking after both cattle station in New south Australia, looking after both cattle

and sheepand sheep..

• As a boy he saw the sketch of Australia aborginal and As a boy he saw the sketch of Australia aborginal and

noticed their teeth were worn flat, no one thought to tell noticed their teeth were worn flat, no one thought to tell

him why or how it him why or how it

happened.happened.

• He noticed many people with crooked teeth and saw many He noticed many people with crooked teeth and saw many

feeble attempts at correction of these problems with many feeble attempts at correction of these problems with many

treatment failures and few successestreatment failures and few successes..

• As he wanted to help such people he enrolled in As he wanted to help such people he enrolled in

the dental course at the University of Melbourne the dental course at the University of Melbourne

instead of taking the medical course, as he instead of taking the medical course, as he

originally intended.originally intended.

• At the commencement of third year of training, Dr At the commencement of third year of training, Dr

Begg decided to practice orthodontics after Begg decided to practice orthodontics after

graduating in dentistry. graduating in dentistry.

• 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 His introduction to Dr. Angle’s work led him to

travel to Pasadena, California in 1924 to study travel to Pasadena, California in 1924 to study

with Dr. Angle..with Dr. Angle..

- Coincidentally with Begg’s arrival in California Dr. Coincidentally with Begg’s arrival in California Dr.

Angle was developing he Edgewise arch Angle was developing he Edgewise arch

mechanisms, which he felt was a vast mechanisms, which he felt was a vast

improvement over the Ribbon arch Applianceimprovement over the Ribbon arch Appliance

- Angle instructed Dr. Begg and Fred Ishii of Japan in Angle instructed Dr. Begg and Fred Ishii of Japan in

the use of the Edgewise mechanism, before it was the use of the Edgewise mechanism, before it was

revealed to the profession. Since Dr. Angle was ill, revealed to the profession. Since Dr. Angle was ill,

it was they who first treated patients with Edge it was they who first treated patients with Edge

wise Appliancewise Appliance

• During Dr. Begg’s stay Dr.Angle wrote, and read During Dr. Begg’s stay Dr.Angle wrote, and read

for the first time, his paper entitled. “ The latest for the first time, his paper entitled. “ The latest

and Best in orthodontic Mechanism” ( published in and Best in orthodontic Mechanism” ( published in

Dent. Cosmos 1928 and 1929 ). It disclosed the Dent. Cosmos 1928 and 1929 ). It disclosed the

use of edge wise Mechanism.use of edge wise Mechanism.

• In November, 1925 Dr. Begg sailed back to In November, 1925 Dr. Begg sailed back to

Australia. In December of the same year he began Australia. In December of the same year he began

practicing Orthodonics in Adelaide, south practicing Orthodonics in Adelaide, south

Australia.Australia.

• Begg was the only orthodontist in Adelaide in 1926 Begg was the only orthodontist in Adelaide in 1926

practiced Edgewise non extraction, technique.practiced Edgewise non extraction, technique.

• He was appointed Lecturer in Orthodontics at the He was appointed Lecturer in Orthodontics at the

university of Adelaide, a position he held until the university of Adelaide, a position he held until the

university’s retirement age. ( Retirement in 1964).university’s retirement age. ( Retirement in 1964).

• For two years, Dr. Begg faithfully followed Dr. Angle’s For 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.

•However in many of his patients he wasn’t satisfied However in many of his patients he wasn’t satisfied

with post treatment profiles and there was the with post treatment profiles and there was the

serious problem of relapses.serious problem of relapses.

•In February of 1928 he began to routinely remove In February of 1928 he began to routinely remove

teeth or reduce tooth widths by mesio - distal teeth or reduce tooth widths by mesio - distal

stripping in patients with excess tooth substance.stripping in patients with excess tooth substance.

• He learnt from experience and his ever – growing He learnt from experience and his ever – growing

appreciation of the role of appreciation of the role of attritional occlusion attritional occlusion in in

the development of man’s dentition..the 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 He retreated many patients who had relapse due

to retention of excessive tooth material.to retention of excessive tooth material.

CHANGING THE MECHANICSCHANGING THE MECHANICS

- Dr. Begg began to realize the Edgewise mechanism Dr. Begg began to realize the Edgewise mechanism

was not designed to rapidly close extraction space was not designed to rapidly close extraction space

or quickly reduce deep overbites.or quickly reduce deep overbites.

- To facilitate such changes he began using 0.20’’ To facilitate such changes he began using 0.20’’

round platinized gold, rather than rectangular, arch round platinized gold, rather than rectangular, arch

wire in 1929. In 1931 he started using .018’’ round wire in 1929. In 1931 he started using .018’’ round

stainless steel wire, bending the now popular stainless steel wire, bending the now popular

vertical loops and intermaxillary hooks right into the vertical loops and intermaxillary hooks right into the

arch wires.arch wires.

- He soon realized that if round arch wire were engaged in He soon realized that if round arch wire were engaged in

edgewise brackets..edgewise brackets..

- In 1933, about 3 years after switching from rectangular In 1933, about 3 years after switching from rectangular

to round arch wire material, he began treating some to round arch wire material, he began treating some

cases using S.S. White ribbon arch brackets, to which he cases 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 with He realized that these relatively narrow brackets with

vertically facing slots allowed the teeth to move under vertically facing slots allowed the teeth to move under

much lighter forces. much lighter forces.

• To improve rotation tooth control with the use of To improve rotation tooth control with the use of

smaller round wires in the Ribbon Arch Brackets, smaller round wires in the Ribbon Arch Brackets,

Dr. Begg filed their bases before soldering them to Dr. Begg filed their bases before soldering them to

the bands. This reduced the widths of the arch the bands. This reduced the widths of the arch

wire slots.wire slots.

A NEW WIRE!A NEW WIRE!

• In the early 1940’s Dr. Begg met Arthur J.Wilcock, director of In 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 After many years of research Wilcock produced a cold drawn heat treated wire that combined the balance between heat treated wire that combined the balance between hardness and resilience with the unique property of zero hardness and resilience with the unique property of zero stress relaxation that Dr.Begg was seeking.stress relaxation that Dr.Begg was seeking.

• This unusual wire permitted to open anterior over bites, while This unusual wire permitted to open anterior over bites, while controlling arch form and providing molar stability.controlling arch form and providing molar stability.

• He also produced the modified Ribbon arch brackets, He also produced the modified Ribbon arch brackets,

lock pins and special buccal tubes to meet Dr.Begg’s lock pins and special buccal tubes to meet Dr.Begg’s

ever-changing requirements in these experimental ever-changing requirements in these experimental

yearsyears

• In 1952 Dr Begg began to use 0.016’’ round stainless In 1952 Dr Begg began to use 0.016’’ round stainless

steel wires instead of 0.018’’ permitting to open steel wires instead of 0.018’’ permitting to open

anterior overbites quickly.anterior overbites quickly.

• In 1954 Dr.Begg published paper entitled, “Stone In 1954 Dr.Begg published paper entitled, “Stone

Age Man’s dentition” Age Man’s dentition”

• At the end of his article he disclosed a new At 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 technique”, advocating at that time the use of

0.018” diameter stainless steel arch wires in 0.018” diameter stainless steel arch wires in

modified Ribbon Arch brackets.modified Ribbon Arch brackets.

• The technique describe in this 1954 article was The technique describe in this 1954 article was

much different from what it is today.. much different from what it is today..

• Even so, it drew relatively large response including Even so, it drew relatively large response including

correspondance from three prominent orthodontist correspondance from three prominent orthodontist

who expressed an interest in the treatment who expressed an interest in the treatment

method disclosed – his found from the Angle method disclosed – his found from the Angle

school, Dr. Spencer Atkinson; Dr. Robert strang school, Dr. Spencer Atkinson; Dr. Robert strang

and Dr. CharlesTweed.and Dr. CharlesTweed.

• In 1956 Dr. Begg had another article published In 1956 Dr. Begg had another article published

entitledentitled, , Differential Force in orthodontic Treatment.Differential Force in orthodontic Treatment.

• While he did not specifically define differential force While he did not specifically define differential force

in so many words, its operation was explained.in so many words, its operation was explained.

• As a result of reading this article several As a result of reading this article several

orthodontists visited Dr.Begg in Adelaide, South orthodontists visited Dr.Begg in Adelaide, South

Australia.Australia.

• In 1957 Dr.H.D. Kesling and Dr. George Dissham In 1957 Dr.H.D. Kesling and Dr. George Dissham

came from the United states..came from the United states..

INTRODUCTION OF BEGG TECHNIQUE IN THE UNITED INTRODUCTION OF BEGG TECHNIQUE IN THE UNITED STATESSTATES

• Upon Kesling’s return from Adelaide,he had plans to Upon Kesling’s return from Adelaide,he had plans to

implement his new technique in his practice along with implement his new technique in his practice along with

Dr.R. A. Rocke not just to selected patients, but every Dr.R. A. Rocke not just to selected patients, but every

patient. patient.

• In 1959 the Kesling and Rocke Orthodontic group invited In 1959 the Kesling and Rocke Orthodontic group invited

over 150 orthodontist from across the united states, to over 150 orthodontist from across the united states, to

assess the results of their results of their 100 assess the results of their results of their 100

consecutively – treated cases by Begg technique.consecutively – treated cases by Begg technique.

• Dr .H.D. Kesling, first Dr .H.D. Kesling, first

orthodontist in the orthodontist in the

United States to United States to

practice the Begg practice the Begg

Technique, and the one Technique, and the one

most responsible for most responsible for

popularizing its use popularizing its use

through showings and through showings and

courses courses

• While the results were not of the quality of the results While the results were not of the quality of the results

achieved today, they demonstrated the ability of the achieved today, they demonstrated the ability of the

Begg technique to Begg technique to quickly open deep anterior quickly open deep anterior

bitesbites. Treatment time was relatively . Treatment time was relatively shortshort, and the , and the

number of number of adjustments were fewadjustments were few. As a result there . As a result there

arose a demand for training in this new technique.arose a demand for training in this new technique.

• First course in Begg Technique had 31 students, was First course in Begg Technique had 31 students, was

held in the new orthodontic center in Westville, Indiana held in the new orthodontic center in Westville, Indiana

in June 1959 (1week course). The brackets used were in June 1959 (1week course). The brackets used were

the new Double - Tab type. the new Double - Tab type.

• However, the use of the double tab bracket However, the use of the double tab bracket

proved difficult, as arch wires were proved difficult, as arch wires were unnecessarily unnecessarily

complicatedcomplicated to permit desired tooth movement. to permit desired tooth movement.

• Also, it Also, it lackedlacked the ability to the ability to overcorrect overcorrect the the

teeth which is so necessary to reduce the teeth which is so necessary to reduce the

tendency for relapse.tendency for relapse.

• Dr Begg realized that, he had to finish his cases Dr Begg realized that, he had to finish his cases

with more precision. with more precision.

• Dr. Begg was mainly concerned with Dr. Begg was mainly concerned with

repositioning the teeth in stable positions over repositioning the teeth in stable positions over

basal bone. The final settling of teeth he left to basal bone. The final settling of teeth he left to

the forces of occlusion, guided when necessary the forces of occlusion, guided when necessary

by an upper retainer with circumferential wire.by an upper retainer with circumferential wire.

• Also he realized the growing demand for training Also he realized the growing demand for training

in his new technique required that the treatment in his new technique required that the treatment

be organised in some manner to facilitate both be organised in some manner to facilitate both

teaching and learningteaching and learning..

• The result was that in April of 1960, as Dr. Begg The result was that in April of 1960, as Dr. Begg

began unpacking his models (which he had began unpacking his models (which he had

brought as part of his presentation before the brought as part of his presentation before the

American Association of Orthodontist), members American Association of Orthodontist), members

of the Kesling and Rocke group were stunned by of the Kesling and Rocke group were stunned by

his quality of treatment . Hours after seeing the his quality of treatment . Hours after seeing the

quality of results achieved by Dr.Begg with quality of results achieved by Dr.Begg with

modified Ribbon Arch brackets, Dr.Kesling made modified Ribbon Arch brackets, Dr.Kesling made

the decision to scrap his double- tab brackets.the decision to scrap his double- tab brackets.

In the years between Dr.Kesling’s first visit in 1957 and his trip to In 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:the United states in the spring of 1960, Dr.Begg did the following:

1.Finished his cases with such 1.Finished his cases with such detail and precision detail and precision that they that they

could not be discerned from similar cases treated with Edgewise could not be discerned from similar cases treated with Edgewise

mechanism.mechanism.

2. Separated the technique into 2. Separated the technique into three distinct stages three distinct stages and and

established objectives for each stage.established objectives for each stage.

3.Developed 3.Developed root torqueing auxiliaries root torqueing auxiliaries separate from the main separate from the main

arch wire.arch wire.

4.Introduced mesiodistal 4.Introduced mesiodistal uprighting springuprighting spring..

5. Emphasized the importance of 5. Emphasized the importance of free tipping free tipping of tooth crowns in of tooth crowns in

the early stages of treatment.the early stages of treatment.

6. Suggested taking 6. Suggested taking stage models stage models to discipline the orthodontist.to discipline the orthodontist.

BEGG’S PHILOSOPHYBEGG’S PHILOSOPHY

They were:They were:

1.Theory of attritional occlusion1.Theory of attritional occlusion

2.Theory of differential forces2.Theory of differential forces

ATTRITIONAL OCCLUSIONATTRITIONAL OCCLUSION

• In 1939 Dr.Begg wrote his doctoral thesis “ The In 1939 Dr.Begg wrote his doctoral thesis “ The

Evolutionary Reduction and degenaration of Evolutionary Reduction and degenaration of

Man’s Jaws and teeth’’. Man’s Jaws and teeth’’.

• In 1954 Dr.Begg published paper entitled, In 1954 Dr.Begg published paper entitled,

“Stone Age Man’s dentition” “Stone Age Man’s dentition”

• Concept of normal occlusion------- ANATOMICALLY Concept of normal occlusion------- ANATOMICALLY CORRECT OCCLUSIONCORRECT OCCLUSION

• Stone age man’s dentition Stone age man’s dentition

• This occlusion was far more efficient and healthy This occlusion was far more efficient and healthy than “textbook normal occlusion”. than “textbook normal occlusion”.

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 not only had extensive occlusal and interproximal

wearwear

2.2.total lack of :total lack of :

I.I. CariesCaries

II.II. periodontal diseaseperiodontal disease

III.III. tooth crowding. tooth crowding.

• Hard, coarse and gritty Hard, coarse and gritty food quickly causes food quickly causes incisal and occlusal incisal and occlusal wear. wear.

• Initially the incisal wear Initially the incisal wear is oblique. is oblique.

• The lower incisors tip The lower incisors tip labially, while the upper labially, while the upper incisors become more incisors become more upright until they upright until they assume an edge to assume an edge to edge relationship.edge relationship.

• This restraint the natural tendency for the lower This restraint the natural tendency for the lower

incisor to become more procumbent, also incisor to become more procumbent, also

encourages further crowding of these teeth. encourages further crowding of these teeth.

• Persistence of anterior overbite also locks the Persistence of anterior overbite also locks the

maxillary incisors in an anatomically and maxillary incisors in an anatomically and

functionally abnormal labial location.functionally abnormal labial location.

Attrition causes continual changes in the shapes Attrition causes continual changes in the shapes

and sizes of the teeth.and sizes of the teeth.

Mesial migration and vertical eruption in Mesial migration and vertical eruption in

the presence of attrition result in their moving the presence of attrition result in their moving

occlusomesially in the jawsocclusomesially in the jaws

GINGIVAL RECESSION AND VERTICAL GINGIVAL RECESSION AND VERTICAL ERUPTIONERUPTION

• The physiologic process of continual The physiologic process of continual tooth eruption tooth eruption

has evolved to compensate for occlusal attrition. It has evolved to compensate for occlusal attrition. It

persists in modern man, even in the absence of persists in modern man, even in the absence of

attrition. attrition.

• As a result of this, there is often continual increase in As a result of this, there is often continual increase in

the vertical dimension between maxilla and mandible. the vertical dimension between maxilla and mandible.

Consequently civilized man’s face grows ‘longer’ with Consequently civilized man’s face grows ‘longer’ with

age.age.

• This eruption is often clinically misinterpreted as This eruption is often clinically misinterpreted as

gingival recession, when in fact it is the teeth that gingival recession, when in fact it is the teeth that

are erupting, and the gingival margin that is are erupting, and the gingival margin that is

remaining relatively stationary. remaining relatively stationary.

• In primitive man the In primitive man the

excessive occlusal forces excessive occlusal forces

of mastication retard this of mastication retard this

eruption to a rate eruption to a rate

harmonious with the harmonious with the

progression of attritional progression of attritional

wear..wear..

LACK OF CARIESLACK OF CARIES

• Pits and fissures are quickly reduced by occlusal Pits and fissures are quickly reduced by occlusal

wear, thereby eliminating the focus of most wear, thereby eliminating the focus of most

caries.caries.

• The diet itself is of low in carbohydrates and its The diet itself is of low in carbohydrates and its

coarseness plus high volume prevents the coarseness plus high volume prevents the

accumulation of dental plaque, without which accumulation of dental plaque, without which

there can be no dental decay.there can be no dental decay.

PROXIMAL WEARPROXIMAL WEAR

• Gingival embrassure areas (black triangles) in Gingival embrassure areas (black triangles) in

civilized man become larger with age, due to lack civilized man become larger with age, due to lack

of proximal wear.of proximal wear.

NO proximal

wear

SurfaceSpongy and

nonkeratinized

Bacterial Stagnation and

invasion

Gingival trough deepens

PERIODONTALdisease

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

ERUPTION OF FIRST PERMANENT MOLARSERUPTION OF FIRST PERMANENT MOLARS

The edge to edge anterior tooth relationship The edge to edge anterior tooth relationship

lower teeth being further forward in relation to the upper teeth lower teeth being further forward in relation to the upper teeth

the mandibular second deciduous molars are mesial to the the mandibular second deciduous molars are mesial to the

maxillary decidous second molars. maxillary decidous second molars.

The lower first permanent molar is then able to erupt in a more The lower first permanent molar is then able to erupt in a more

mesial position and proper initial relationship with the maxillary mesial position and proper initial relationship with the maxillary

first permanent molar is achieved. first permanent molar is achieved.

ERUPTION OF SUCCEDANEOUS ERUPTION OF SUCCEDANEOUS TEETHTEETH..

• Attrition brings about enough reduction in Attrition brings about enough reduction in

mesiodistal dimensions of teeth to allow mesiodistal dimensions of teeth to allow

adequate space for the erupting permanent adequate space for the erupting permanent

canines.canines.

• In the absence of attrition there is often not In the absence of attrition there is often not

enough space for the canineenough space for the canine

ERUPTION OF THIRD MOLARSERUPTION OF THIRD MOLARS

• In civilized man as no proximal wear occurs In civilized man as no proximal wear occurs

causes inadequate room distal to the second causes inadequate room distal to the second

molars for normal eruption of third molars molars for normal eruption of third molars

which leads to delayed eruption and complete which leads to delayed eruption and complete

impaction.impaction.

• Since attrition especially interproximallly Since attrition especially interproximallly

causes a continoual reduction in mesiodistal causes a continoual reduction in mesiodistal

tooth widths, the incidence of tooth crowding is tooth widths, the incidence of tooth crowding is

relatively low in primitive man.relatively low in primitive man.

PHENOMENON TO SUPPORT PHENOMENON TO SUPPORT ATTRITIONAL OCCLUSIONATTRITIONAL OCCLUSION

• Third molars- only teeth that have their root Third molars- only teeth that have their root

formation completed before eruption in civilized formation 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 At the age of 12 to 13 years the third molar

begin to erupt in attritional occlusion.begin to erupt in attritional occlusion.

CHANGE IN CURVE OF WILSONCHANGE IN CURVE OF WILSON

• As the permanent molars As the permanent molars erupt the bucco– lingual erupt the bucco– lingual plane is oblique. As wear plane is oblique. As wear progress, the plane becomes progress, the plane becomes horizontal, then begins to horizontal, then begins to slant downwards and cusp of slant downwards and cusp of carabelli serves to carabelli serves to increase increase overall occlusal surface overall occlusal surface areaarea..

• In civilized man the In civilized man the buccolingual plane is oblique buccolingual plane is oblique throughout life.throughout life.

SECONDARY DENTINE AND PULPAL SECONDARY DENTINE AND PULPAL PAINPAIN

• Value of pulpal pain is not to warn of caries, but Value of pulpal pain is not to warn of caries, but

to warn of atttrition approaching the pulp faster to warn of atttrition approaching the pulp faster

than secondary dentin can be laid down. than secondary dentin can be laid down.

• Teeth continually erupt vertically, migrate Teeth continually erupt vertically, migrate

mesially, and usually are collectively too large to mesially, and usually are collectively too large to

be accommodated in the jaws without a reduction be accommodated in the jaws without a reduction

of tooth mass. of tooth mass.

• This reduction, which occurs naturally in primitive This reduction, which occurs naturally in primitive

man from attrition, can be replaced in civilized man from attrition, can be replaced in civilized

man by planned mesiodistal stripping and / or man by planned mesiodistal stripping and / or

tooth extractions.tooth extractions.

DIFFERENTIAL FORCEDIFFERENTIAL FORCE

• In 1956 Dr Begg introduced the concept of In 1956 Dr Begg introduced the concept of

Differential force Differential force

• His observations was based on the work of His observations was based on the work of

Storey and Smith and their experiments on Storey and Smith and their experiments on

tooth movement response to different tooth movement response to different

pressure applications.pressure applications.

• IT IS DEFINED AS A FORCE THAT RESULTS IN A IT IS DEFINED AS A FORCE THAT RESULTS IN A

DIFFERENT RATE OR TOOTH MOVEMENT AT ONE DIFFERENT RATE OR TOOTH MOVEMENT AT ONE

END THAN THE OTHER.END THAN THE OTHER.

• A range of light pressures which would cause teeth A range of light pressures which would cause teeth

to move at an optimum rate and with minimal to move at an optimum rate and with minimal

disturbance of the supportive tissues - disturbance of the supportive tissues - optimum optimum

orthodontic forceorthodontic force..

• Pressures below slow rate of responsePressures below slow rate of response

above undermining resorption above undermining resorption

retarding tooth retarding tooth

movement. movement.

WHEN WHEN LIGHTLIGHT FORCES ARE USED FORCES ARE USED

ANCHOR UNIT ANCHOR UNIT STABLESTABLE

ANTERIORS ANTERIORS TIPTIP

WHEN HEAVY FORCES ARE USED

ANCHOR UNIT ANCHOR UNIT MOVEMOVE

ANTERIORS ANTERIORS STABLESTABLE

• The significance of this concept is enhanced by the The significance of this concept is enhanced by the

ability to choose mechanics ability to choose mechanics that promote free tipping that promote free tipping

where the greatest movement is desired and prevent where the greatest movement is desired and prevent

free tipping where stability or anchorage is indicated.free tipping where stability or anchorage is indicated.

• A goal of Begg’s treatment is over correction of the A goal of Begg’s treatment is over correction of the

teeth to allow for the natural tendency for relapse that teeth to allow for the natural tendency for relapse that

occurs when orthodontic appliance removed.occurs when orthodontic appliance removed.

• The differential force technique is designed to permit The differential force technique is designed to permit

teeth to move towards their anatomically correct teeth to move towards their anatomically correct

positions in the jaw under the influence of very light positions in the jaw under the influence of very light

forces – as would occur naturally in the presence of forces – as would occur naturally in the presence of

attrition.attrition.

..

• The light intra oral forces of Begg Technique do The light intra oral forces of Begg Technique do

not place undue strain on the anchor molars.not place undue strain on the anchor molars.

• The appliance is designed to permit the teeth to The appliance is designed to permit the teeth to

move move independently of one another independently of one another – whether – whether

tipping freely in the early stages or during detailed tipping freely in the early stages or during detailed

root positioning in the final stage.root positioning in the final stage.

• The movement of all teeth is due to the The movement of all teeth is due to the

synergistic effect of the forces and appliances synergistic effect of the forces and appliances

working together in the presence of proper working together in the presence of proper

diagnosis.diagnosis.

• The begg synergistic arch graphically The begg synergistic arch graphically

demonstrates and emphasizes the importance of demonstrates and emphasizes the importance of

the combination of various components the combination of various components

comprising the Begg theory and technique.comprising the Begg theory and technique.

SEVEN SYNERGISTIC COMPONENTSSEVEN SYNERGISTIC COMPONENTS

1. A 1. A diagnosis and treatment plan diagnosis and treatment plan that recognizes the persistence of that recognizes the persistence of

hereditary forces of mesial migration and vertical eruption of teeth and has hereditary 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. The 2. The simultaneous movement simultaneous movement of all teeth. From the beginning of of 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 of 3. The total separation of root moving forces root moving forces from arch wire forces during from 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 the 4. The application of proper elastic forces to create the desired differential desired differential

movement of the teeth. movement of the teeth.

5. The use of 5. The use of light round continuous arch wires light round continuous arch wires bent from bent from

the hardest wire possible – Not only must the wire be of the hardest wire possible – Not only must the wire be of

highest quality, but the arch wire have proper form, including highest quality, but the arch wire have proper form, including

bite opening bends, to control the vertical dimension.bite opening bends, to control the vertical dimension.

6. The use of 6. The use of molar attachments molar attachments that prevent free that prevent free

mesiodistal tipping and yet permit the arch wire to slide freely mesiodistal tipping and yet permit the arch wire to slide freely

mesio distally. This permits the rapid retraction of the anterior mesio distally. This permits the rapid retraction of the anterior

teeth.teeth.

7. The use of 7. The use of attachments on all teethattachments on all teeth, except anchor , except anchor

molars, that control rotations yet permit free tipping in the molars, that control rotations yet permit free tipping in the

desired direction and free sliding along arch wires.desired direction and free sliding along arch wires.

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.

77The 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 ARCH SYNERGISTIC ARCH ””

BEGG’S TECHNIQUEBEGG’S TECHNIQUE

• An orthodontic technique may be defined as a An orthodontic technique may be defined as a

systematic sequence of definite procedures to systematic sequence of definite procedures to

achieve the correction of malocclusion with a achieve the correction of malocclusion with a

specific type of appliance or with a combination of specific type of appliance or with a combination of

appliances.appliances.

• The method consist essentially of The method consist essentially of tipping tipping

movements of the teethmovements of the teeth. Two successive . Two successive

tipping movements are required to achieve bodily tipping movements are required to achieve bodily

movement. The first to position the tooth crowns movement. The first to position the tooth crowns

and second to position the tooth roots. As a result and second to position the tooth roots. As a result

of these tipping movements, complemented by of these tipping movements, complemented by

intrusion, extrusion and rotation of teeth whenever intrusion, extrusion and rotation of teeth whenever

required, optimal occlusion, axial positioning and required, optimal occlusion, axial positioning and

alignment of the teeth are secured. alignment of the teeth are secured.

COMPONENTS OF BEGG COMPONENTS OF BEGG APPLIANCEAPPLIANCE

• 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, in down to its proper diameter, in

order to give it the required order to give it the required

properties of resiliency, properties of resiliency,

toughness and tensile strength. toughness and tensile strength.

––produce force for a longer produce force for a longer

duration without frequent duration without frequent

reactivation, over long distance.reactivation, over long distance.

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.

4. SPECIAL PLUS GRADE:4. SPECIAL PLUS GRADE:

- - Hardness and resiliency of 0.016” wire, is excellent Hardness and resiliency of 0.016” wire, is excellent for supporting anchorage, and reducing deep overbites.for 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 plus Also 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.

6. SUPREME GRADE:6. SUPREME GRADE:

- - It is ultra light tensile fine round stainless It is ultra light tensile fine round stainless

steel wire.steel 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 - Although supreme exceeds the yield

strength of E.S.P, it is intended for use in either strength of E.S.P, it is intended for use in either

short section or full arches where sharp bends are short section or full arches where sharp bends are

not required.not required.

PRECAUTION TAKEN WHILE BENDING THE PRECAUTION TAKEN WHILE BENDING THE WIREWIRE

• When the wire is bent around the round beak of the When the wire is bent around the round beak of the

pliers, the stress on the crystalline structure is confined pliers, the stress on the crystalline structure is confined

to a small area, which may cause the wire to breakto a small area, which may cause the wire to break

When bending the wire around the square beak When bending the wire around the square beak

the points of stress are offset, providing more area for the points of stress are offset, providing more area for

crystalline adjustment and there fore less chance crystalline adjustment and there fore less chance

fracture.fracture.

MODIFIED RIBBON ARCH BRACKET ( TP -MODIFIED RIBBON ARCH BRACKET ( TP -256- 500)256- 500)

By changing the lock pins, the size of the arch By changing the lock pins, the size of the arch

wire slot can be changed to accept properly wire slot can be changed to accept properly

either a 0.016 inch or a 0.020 inch arch wireeither a 0.016 inch or a 0.020 inch arch wire

REQUIREMENTS FOR A LIGHT WIRE REQUIREMENTS 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 A means to guide both the tail and head of lock pin during lockingpin during 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.

TYPESTYPES

1. Full flange 1. Full flange

2.Half flange 2.Half flange

1. Bondable 1. Bondable

2. Weldable 2. Weldable

Full flange brackets will have more friction with arch wire Full flange brackets will have more friction with arch wire and hence hindrance to smooth tipping movement of and hence hindrance to smooth tipping movement of anteriors.anteriors.

In half flange brackets, contact of the flange In half flange brackets, contact of the flange with arch wire is minimal , thus friction is also minimal.with arch wire is minimal , thus friction is also minimal.

The high flange brackets are preferred over the taper flange The high flange brackets are preferred over the taper flange

BAND MATERIALBAND MATERIAL

• These bands made of stainless steel strips of These bands made of stainless steel strips of different size and thickness are recommended for different size and thickness are recommended for different teeth. These available on 8 feet rolls or cut different teeth. These available on 8 feet rolls or cut of 2 inches to 2.5 inches.of 2 inches to 2.5 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 3. For molars - 0.150 x 0.005 or 0.180 x 0.006 inchinch

LOCK PINSLOCK PINS

• Second stage safety lock pinSecond stage safety lock pin: :

Shoulder on head ensures free Shoulder on head ensures free

mesiodistal tipping. Labiolingual width of mesiodistal tipping. Labiolingual width of

tail dimension is reduced to fit properly tail dimension is reduced to fit properly

into bracket in conjunction with inch arch into bracket in conjunction with inch arch

wire.wire.

• One point safety lock pin One point safety lock pin : Used in : Used in

stage I and II. The pin has a shoulder that stage I and II. The pin has a shoulder that

keeps the head of the pin outside the keeps the head of the pin outside the

bracket slot and prevents the bracket slot and prevents the

impingement of pin on arch wire. The impingement of pin on arch wire. The

beveled undersurface of head permits beveled undersurface of head permits

free mesiodistal tipping. free mesiodistal tipping.

• Hook lock pins Hook lock pins : Used during III : Used during III

stage. Since there is no safety stage. Since there is no safety

shoulder, they hold the arch wire shoulder, they hold the arch wire

firmly against the base of the arch firmly against the base of the arch

wire slot. Thickness – 0.014” to wire slot. Thickness – 0.014” to

0.018” , length – 0.220 to 0.2930.018” , length – 0.220 to 0.293

• High hat safety lock pinsHigh hat safety lock pins::

They have a gingival extension on They have a gingival extension on

head which provides a positive head which provides a positive

point for engagement of vertical or point for engagement of vertical or

cross elasticscross elastics..

BUCCAL TUBESBUCCAL TUBES

• Round molar tubes with Round molar tubes with 0.036 internal diameter and 0.036 internal diameter and 0.250 length are routinely 0.250 length are routinely used.used.

• Flat oval molar tubes and Flat oval molar tubes and doubled back wires are doubled back wires are used when second used when second permanent molars are the permanent molars are the anchor teeth and also used anchor teeth and also used in mandibular dental arch in mandibular dental arch when second premolar is when second premolar is absent. absent.

AUXILLARY ATTACHMENTSAUXILLARY ATTACHMENTS

• In addition to the foregoing parts, the In addition to the foregoing parts, the

light round arch wire technique requires light round arch wire technique requires

the following adjustmentsthe following adjustments . .

LINGUAL BUTTONS AND CLEATLINGUAL BUTTONS AND CLEAT

EYELETS:EYELETS:

Are made from thin stainless steel stiff Are made from thin stainless steel stiff

wires. They are very useful in tying the ligature wires. They are very useful in tying the ligature

wire on anterior teeth for purpose of rotation.wire on anterior teeth for purpose of rotation.

BALL END HOOKS:BALL END HOOKS:

They are attached to They are attached to

buccal or lingual of buccal or lingual of

molar bands. Positioned molar bands. Positioned

as far gingivally and as far gingivally and

near the mesiodistal near the mesiodistal

centre of the tooth. Make centre of the tooth. Make

the placing of elastic the placing of elastic

simple for patient.simple for patient.

BYPASS CLAMPBYPASS CLAMP

• Pinning of the arch wire Pinning of the arch wire

in the premolar in the premolar

brackets can cause brackets can cause

hinderence to free hinderence to free

tipping.tipping.

So in stage I and So in stage I and

stage II Bypass clamps stage II Bypass clamps

are used on the are used on the

premolar brackets.premolar brackets.

LIGATURE WIRESLIGATURE WIRES

These are very thin (0.007 to 0.009) stainless steel soft These are very thin (0.007 to 0.009) stainless steel soft

wires.wires.

- They are very useful in tying of the span of looped arch - They are very useful in tying of the span of looped arch

wire, which are far away from its ideal position, thus wire, which are far away from its ideal position, thus

progressive increase In force and also avoiding plastic progressive increase In force and also avoiding plastic

deformation of the arch wire.deformation of the arch wire.

- Also used as extra holding devices - secure about arch - Also used as extra holding devices - secure about arch

wire not getting disengaged from the bracket slot by wire not getting disengaged from the bracket slot by

slipping out slipping out

ELASTICSELASTICS

• Elastics are made of synthetic latex and of uniform Elastics are made of synthetic latex and of uniform sizes and applying uniform forces when stretched to sizes and applying uniform forces when stretched to required length.required length.

• Thinner walled elastics are called “Thinner walled elastics are called “light elasticslight elastics” ” and thick walled elastics are called “and thick walled elastics are called “Heavy elasticsHeavy elastics””

• These elastics will exert a force equal to between 60 These elastics will exert a force equal to between 60 and 70 gms when they are new and first placed.and 70 gms when they are new and first placed.

USES OF ELASTICSUSES OF ELASTICS

• To open the biteTo open the bite

• To correct the mesiodistal relationship To correct the mesiodistal relationship

of buccal segmentsof buccal segments

• To close the anterior spacingTo close the anterior spacing

• Corection of rotationCorection of rotation

• Posterior crossbite corectionPosterior crossbite corection

CLASS I ELASTICSCLASS I ELASTICS

CLASS II ELASTICS

CLASS III ELASTICS

ELASTIC THREAD ELASTIC THREAD TIED IN FIGURE OF TIED IN FIGURE OF

‘8’ PATTERN‘8’ PATTERN

SEPARATING SPRINGSEPARATING SPRING

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.

PLACEMENT IN ROTATED TOOTHPLACEMENT IN ROTATED TOOTH

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.

THREE STAGES OF THREE 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

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 Correction of Anterio-posterior Occlusal Relationship

of the Buccal Segmentsof the Buccal Segments

•Correction of anterior spacingCorrection of anterior spacing

•Correction Of Crowding Correction Of Crowding

•Correction Of Rotations.Correction Of Rotations.

•Correction of posterior cross bite Correction of posterior cross bite

ARCHWIREARCHWIRE

Material Material

• 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

THE FIRST STAGE ARCHWIRE THE 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

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/ oval Circle/ 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.

LocationLocation

• Well aligned ant. – 1-2 mm mesial to the cuspid Well 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 the Z shaped: are angulated buccaly away from the vertical, in order to avoid any possibility if vertical, in order to avoid any possibility if wedging of distal arm of loop.wedging of distal arm of loop.

Anterior Segement:Anterior Segement:

• Portion of the wire b/w intermaxillary hooks Portion of the wire b/w intermaxillary hooks

lies gingival to buccal segment for effective lies gingival to buccal segment for effective

intrusionintrusion

• 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 avoid Labial curvature in cuspid area – incorporated to avoid

lingual tipping of canines.lingual tipping of canines.

• In narrow arches requiring expansion, cuspid offset In narrow arches requiring expansion, cuspid offset

given.given.

Anchorage bends / Tip back bendsAnchorage bends / Tip back bends..

•Placed immediately posterior to the 2Placed immediately posterior to the 2ndnd

premolar bracketpremolar bracket

• Bent so that when inserted into the buccal Bent so that when inserted into the buccal

tubes the tubes the anterioranterior section of the archwire lies in section of the archwire lies in

the the buccal sulcibuccal sulci

CHECKINGCHECKING

• Amount of bend varies from case to caseAmount of bend varies from case to case

• The leverage force incorporated on the The leverage force incorporated on the

incisors should be around 65mgincisors should be around 65mg

• The purpose of anchor bend in upper arch is to The purpose of anchor bend in upper arch is to prevent mesial migration of the molars;prevent mesial migration of the molars;

• In lower is to supply bodily control of the lower In lower is to supply bodily control of the lower molars as these are moved forward by action of Class molars as these are moved forward by action of Class II elasticsII elastics

• Angulation depends on Angulation depends on

• Stage of treatment - decreases as stage Stage of treatment - decreases as stage

progresses.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.

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.

Lingually locked out teeth and vertically Lingually locked out teeth and vertically

displaced teethdisplaced teeth

• It may be difficult to engage the wire in the brackets at It may be difficult to engage the wire in the brackets at

times if the times if the space between proximating teeth is space between proximating teeth is

less than the length of the bracket area less than the length of the bracket area for a for a

blocked out toothblocked out tooth

• Ligate the arch wire to the bracket of blocked out toothLigate the arch wire to the bracket of blocked out tooth

FORMING ARCH WIRE CONTAINING FORMING ARCH WIRE CONTAINING VERTICAL LOOPSVERTICAL LOOPS

Contraction Loop in midline with incisor stops to tip crowns of upper centrals

Vertical loops bent in case of high frenum attachment

Toe in and toe out bendsToe in and toe out bends

• Horizontal offset bends combined with anchor Horizontal offset bends combined with anchor

bends 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.

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.

• Free ends of the lock pins are turned mesially Free ends of the lock pins are turned mesially

around the bracketsaround the brackets

• The wire should extend 2-3mm past the buccal The wire should extend 2-3mm past the buccal

tubes to prevent binding of the archwire in tubes to prevent binding of the archwire in

them.them.

TYING INTERMAXILLARY HOOK TYING INTERMAXILLARY HOOK TO CUSPID BRACKETTO CUSPID BRACKET

No ties between intermaxillary hooks and cuspid No ties between intermaxillary hooks and cuspid

brackets brackets

cuspid tip distally the arch wire cuspid tip distally the arch wire

SpacingSpacing

• Ligation done in figure of eight and always pass ligature Ligation done in figure of eight and always pass ligature

through circlethrough circle

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 -Continual wearing of class II or Class III

elastics.elastics.

2. 2. Correction of the mesiodistal relationship of Correction of the mesiodistal relationship of the buccal segmentsthe buccal segments..

- Continual wearing of class II or class III - Continual wearing of class II or class III elastics 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.

3.3. Close any anterior spaceClose any anterior space::

LoopsLoops

Plain arch wire with elastic from cuspid pin Plain arch wire with elastic from cuspid pin

tail to cuspid pin tail.tail to cuspid pin tail.

4.Eliminate any anterior crowding4.Eliminate any anterior crowding::

- Vertical loops between crowded anterior teeth, - Vertical loops between crowded anterior teeth,

with with

bracket areas modified for desired bracket areas modified for desired

overcorrections.overcorrections.

- Arch length designed so that intermaxillary - Arch length designed so that intermaxillary

circles rest against mesial surfaces of cuspid brackets.circles rest against mesial surfaces of cuspid brackets.

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

ROTATIONS OF CUSPID AND ROTATIONS 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

Elastic threadsElastic threads

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 gingival Vertical leg inserted in bracket slot from gingival

side, holding activating arm perpendicular to side, holding activating arm perpendicular to

labial surface.labial surface.

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

6. Correct posterior crossbites6. Correct posterior crossbites::

- Modify arch width of one or both arch - Modify arch width of one or both arch

wireswires

-wearing cross elastics-wearing cross elastics

- Rapid maxillary overexpansion, followed by - Rapid maxillary overexpansion, followed by

a period of stabilization prior to the placement of a period of stabilization prior to the placement of

complete appliances and the beginning of stage I.complete appliances and the beginning of stage I.

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.

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

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 - make it impossible to hook elastics and see if problem is reportedsee if problem 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

- 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..

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 opposing B. 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 1. Do not engage the arch wire in the cuspid brackets until

these teeth have been rotated by elastic thread or other means.these teeth have been rotated by elastic thread or other means.

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

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

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 b. elastic will not stay on the intermaxillary

circle.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

bite bite

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

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 - Binding of ends of the arch wire inside distal

ends of buccal tubeends of buccal tube

10. ANTERIOR OPEN BITE NOT CLOSING:10. ANTERIOR OPEN BITE NOT CLOSING:

- patient not wearing anterior vertical - patient not wearing anterior vertical

elasticselastics

- Persistent tongue thrust or other adverse - Persistent tongue thrust or other adverse

habitshabits

- Too much anchor bend. - Too much anchor bend.

THANK YOUTHANK YOU

STAGE 2 AND STAGE 3 - BEGGS STAGE 2 AND STAGE 3 - BEGGS TECHNIQUETECHNIQUE

STAGE IISTAGE II

OBJECTIVES:OBJECTIVES:

1. Maintain all corrections achieved 1. Maintain all corrections achieved

during during

first stage.first stage.

2. Close any remaining posterior space.2. Close any remaining posterior space.

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.

HOW TO ACHIEVE THE HOW TO ACHIEVE THE OBJECTIVES?OBJECTIVES?

CLOSING OF ANY REMAINING CLOSING OF ANY REMAINING POSTERIOR SPACEPOSTERIOR SPACE

• Proper application of elasticsProper application of elastics

CONTROL OF BICUSPID HEIGHTCONTROL OF BICUSPID HEIGHT

• Sometimes in stage 2 mesialisation of the anchor Sometimes in stage 2 mesialisation of the anchor tooth is desirable..tooth is desirable..

• Achived by:Achived by:

1.1. Strength of horizontal elastics is increased from Strength of horizontal elastics is increased from 221/21/2 ounces to 6 or 8 ounces ounces to 6 or 8 ounces

2.2. Certain auxiliariesCertain auxiliaries

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 mandibular Passive uprighting springs on mandibular

canine.canine.

2.2. The lower anterior braking archesThe lower anterior braking arches

FUNCTION OF THESE FUNCTION OF THESE AUXILIARIES:AUXILIARIES:

Establish two point contact between the teeth Establish two point contact between the teeth and archwire and archwire

prevent free tipping prevent free tipping 

Starts to function as anchor teethStarts to function as anchor teeth

CORRECTION OF MIDLINECORRECTION OF MIDLINE

• Class II intermaxillary elastics on one side and Class II intermaxillary elastics on one side and

class III on other side.class III on other side.

SHORTENING LENGTH OF SHORTENING LENGTH OF DOUBLED-BACK ARCH WIRESDOUBLED-BACK ARCH WIRES

PROBLEM ENCOUNTERED DURING PROBLEM 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. - Discontinue class II or class III elastics. Use horizontal elastics to get molars in occlusion. Use horizontal elastics to get molars in occlusion.

• 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 b. Intermaxillary circles formed too far

apart.apart.

• Anchor molars rotating distobuccally Anchor molars rotating distobuccally

a. Toe – out on arch wire a. 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 b.Arch wire not free to slide distally through buccal

tube.tube.

c. Arch wire pinned or caught in bicuspid bracket c. Arch wire pinned or caught in bicuspid bracket

slot.slot.

• Second bicuspids tipping mesially in first Second bicuspids tipping mesially in first bicuspid extraction case: bicuspid extraction case:

- Slight, expected mesial movement of Slight, expected mesial movement of anchor molaranchor molar

- Abnormal loss of anchorage, if second Abnormal loss of anchorage, if second bicuspids are tipping excessively.bicuspids are tipping excessively.

STAGE IIISTAGE III

STAGE 3 UPPER AND LOWER ARCH WIRESTAGE 3 UPPER AND LOWER ARCH WIRE

• Made from 0.020 SSMade from 0.020 SS

STAGE IIISTAGE III

• OBJECTIVES:OBJECTIVES:

1. Maintain all corrections achieved during first 1. Maintain all corrections achieved during first and second stages.and second stages.

2. Achieve desired axial inclinations of all teeth.2. Achieve desired axial inclinations of all teeth.

HOW TO ACHIEVE THE HOW TO ACHIEVE THE OBJECTIVES?OBJECTIVES?

DESIRED AXIAL DESIRED AXIAL INCLINATIONS OF ALL TEETHINCLINATIONS OF ALL TEETH

• Changes in the mesiodistal inclinations of teeth Changes in the mesiodistal inclinations of teeth

are accomplished by the use of individual are accomplished by the use of individual root root

spring spring or or mesiodistal uprighting springmesiodistal uprighting spring..

• Lingual or labial root torque is applied to Lingual or labial root torque is applied to

anterior teeth through the application of anterior teeth through the application of

torqueing auxiliariestorqueing auxiliaries..

•   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 Refinement of original spring: Larger more resilient

coilscoils

Short lever Short lever

arm. arm. 

HELIX

RETENTIVE ARM

ACTIVE ARM WITH HOOK AT THE END

UPRIGHTING SPRINGUPRIGHTING SPRING

• Made from 0.014 for canine and Made from 0.014 for canine and

premolars, 0.012 for incisors.premolars, 0.012 for incisors.

• The helix and the active arm The helix and the active arm

faces the tooth surface and lie on faces the tooth surface and lie on

the gingival aspect of the arch the gingival aspect of the arch

wirewire

• The base arch wire is ligated and The base arch wire is ligated and

the ligature tie beneath the the ligature tie beneath the

archwirearchwire..

• Spring selected should be in the direction of root Spring selected should be in the direction of root

movement required.movement required.

• The arm carrying the hook should be at an angle The arm carrying the hook should be at an angle

of 45 to the main arch wire before latching,of 45 to the main arch wire before latching,

And parallel when latchedAnd parallel when latched

• A problem inherent in all uprighting springs is that:A problem inherent in all uprighting springs is that:

when engaged and under tension, the coil when engaged and under tension, the coil presses against presses against

the gingival edge of the bracketthe gingival edge of the bracket

If arch wire is not ligated the coils can cause the If arch wire is not ligated the coils can cause the

bracket to move away from the arch wire bracket to move away from the arch wire

subsequent elongation of the toothsubsequent elongation of the tooth

SPRING PINSPRING PIN

• A Combination of a A Combination of a Lock PinLock Pin and and an an

Uprighting SpringUprighting Spring

LINGUAL LOCK PINLINGUAL LOCK PIN

TEETH REQUIRING TEETH REQUIRING UPRIGHTING:UPRIGHTING:

TORQUING AUXILLARYTORQUING AUXILLARY

• 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 wire Originally 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 The torque transmitted in a spiral manner along the main arch

wire to the wire to the anchor molarsanchor molars..

Moved the molars buccally and rotate them distobuccaly.. Moved the molars buccally and rotate them distobuccaly..

FOUR SPUR TORQUEING AUXILLARYFOUR SPUR TORQUEING AUXILLARY

• Used for torqueing the upper anterior roots Used for torqueing the upper anterior roots

palatallypalatally

• Bend with 0.014 or 0.016” wireBend with 0.014 or 0.016” wire

BENDING THE FOUR SPUR AUXILIARYBENDING THE FOUR SPUR AUXILIARY

ACTIVATING THE AUXILIARYACTIVATING THE AUXILIARY

APPLICATION OF THE THIRD STAGE ARCH APPLICATION OF THE THIRD STAGE ARCH WIRES AND THE AUXILIARIES TO THE WIRES AND THE AUXILIARIES TO THE

TEETHTEETH

OTHER TORQUING AUXILIARIES OTHER TORQUING AUXILIARIES USED:USED:

TWO SPUR TORQUEING AUXILLARYTWO SPUR TORQUEING AUXILLARY

• Used when lateral Used when lateral

incisors do not require incisors do not require

palatal rootpalatal root

RECIPROCAL TORQUEING AUXILIARYRECIPROCAL TORQUEING AUXILIARY

- Upper lateral incisors were Upper lateral incisors were

blocked out palatally blocked out palatally

before treatment. before treatment.

- Their root apices must be Their root apices must be

torqued labially to reduce torqued labially to reduce

the tendency for the the tendency for the

crowns to relapse lingually.crowns to relapse lingually.

INDIVIDUAL TORQUEING AUXILIARYINDIVIDUAL TORQUEING AUXILIARY

• Auxiliary should extend at Auxiliary should extend at

least one tooth pass tooth least one tooth pass tooth

being torqued, and around being torqued, and around

curve of arch, for maximum curve of arch, for maximum

activation.activation.

• If placed gingivally, torque If placed gingivally, torque

the root of the lateral the root of the lateral

lingually.lingually.

ONE TO ONE TORQUEING AUXILIARYONE TO ONE TORQUEING AUXILIARY

• Indicated when two adjacent teeth require Indicated when two adjacent teeth require

root torque in opposite directions.root torque in opposite directions.

RAT - TRAP TORQUEING AUXILIARYRAT - TRAP TORQUEING AUXILIARY

• Main arch wire is Main arch wire is

formed from 0.020 inch formed from 0.020 inch

round wire.round wire.

• The auxiliary is wound The auxiliary is wound

from either 0.014 or from either 0.014 or

0.016 inch highly 0.016 inch highly

resilient round wire.resilient round wire.

• The torqueing “bars” do The torqueing “bars” do

not extend to the not extend to the

gingiva.gingiva.

VERTICAL SPUR IN THE MAIN ARCH VERTICAL SPUR IN THE MAIN ARCH WIREWIRE

TORQUEING AUXILLARY FOR TORQUEING AUXILLARY FOR LOWER INCISORSLOWER INCISORS

REVERSE TORQUEING AUXILIARYREVERSE TORQUEING AUXILIARY

• Indicated if lower anterior teeth are becoming Indicated if lower anterior teeth are becoming

too proclined.too proclined.

• For labial root torqueFor labial root torque

• For lingual root torqueFor lingual root torque

PROBLEMS ENCOUNTERED DURING PROBLEMS ENCOUNTERED DURING STAGE IIISTAGE III

• Maxillary Molars Widening:Maxillary Molars Widening:

a. Anchor bends present in maxillary arch wire.a. Anchor bends present in maxillary arch wire.

b.Too much bite – opening bend between cuspid b.Too much bite – opening bend between cuspid

and bicuspid and 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.

• 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 c presence of steel ligature tie from the lingual of the mandibular cuspid to the lingual lingual of the mandibular cuspid to the lingual of the mandibular molarof the mandibular 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 elastic c. Patient not wearing class II elastic

• 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 elevated C. Occlusal interference caused by an elevated

tooth.tooth.

D. Springs placed in backwards D. Springs placed in backwards

Maxillary anterior teeth not torqueing palatallyMaxillary anterior teeth not torqueing palatally

1.1. Not enough force from maxillary torqueing Not enough force from maxillary torqueing

auxiliaryauxiliary

2.2. Maxillary incisal edges caught lingual to lower Maxillary 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 Normal mesial migration of teeth during

third third

stagestage

THANK YOUTHANK YOU