KAMEDA TECHNIQUE

Introduction

This technique was developed by Akira Kameda

He has been carrying out orthodontic treatment with the Begg technique since 1966 and some cases ended in successful but many cases which had a series of trouble did not go well around that time.

This technique was developed over a period from 1966-1986

He took beggs weak points and modified it for stable and better finish

Drawbacks Of Pure Begg Technique

Empirical diagnosis

Unnecessary tipping of tooth in all directions (including anchor molars)

Collapse of arch form

Rotation and mesial tipping of second premolars during stage II

Complicated and unstable stage III

Gummy face with clockwise rotation of occlusal plane]

Most malocclusions are not composed of mesiodistally inclined teeth but made up of labiolingually inclined teeth, therefore it was not necessary to carry out orthodontic treatment by mesiodistally tipping teeth but necessary to conduct orthodontic treatment by labiolingually moving teeth.

In order to control unnecessary tipping of teeth, especially mesiodistally tipping, principle of horizontal bar’s tooth movement was used from Stage I.

Principle of horizontal bar tooth movement

► CO-AX wire is used in conjunction with main archwires, locking the two wires with Safety – T pins and a single wire with 90º T pin

► this will prevent teeth from tipping mesiodistally, but allow teeth to tip more or less labiolingually by taking advantage of round wire.

Philosophy of revised begg and pure begg in tipping tooth movement

Role of Bite opening and Anchor bends

► The bite opening bends are to be placed distal to canine in addition to the usual anchorage bends,

► The anchorage bends will play a role of anchoring molars and bite opening canines, and the bite opening bends will serve bite opening for incisors.

► very gentle light force is used rather than the past light force

► The apex of upper and lower incisor roots will be depressed toward wide sites of trough of cancellous alveolar bone

► if the upper and lower incisors are sufficiently depressed to decrease overbite and then, by lingual inclination of the upper and lower incisors including the alveolar process, gummy face will be prevented and the risk of developing root resorptions will be minimized.

CLASSII ELASTIC FORCE

► Depending on the degree of overjet and overbite,class II elastic force is divided into three steps as follows .

► no elastics, ► 40-50 gr Class II elastics► 60-70 gr, elastics ► very gentle light force is used rather than the

past light force

KB NEW TYPE BUCCAL TUBES

► Round buccal tubes employed in the Begg techniques are used with a round wire, frictions will be free and

► Free tooth movement is possible, but anchor molars tend to roll in.

► Correcting lingually inclined anchor molars is difficult.

► Directing the force of anchorage bends and of bite opening bends is difficult, and their bite opening efficiency will be decreased.

► In order to solve these side effects, buccal tubes do not have to be round, and ribbon arch type which is easy to direct force and which brings little loss of distribution of force is preferable.

► A new type of buccal tubes was designed after getting a hint from dr. White’s lecture on the occasion of the NABSO meeting in 1986.

► The inside margin of this new buccal tube is rounded to decrease friction.

In addition to vertical slot, a 6-degree distal offset is incorporated to prevent molars from distobuccally rotating in the mesial movement of molars .

KB NEW TYPE BUCCAL TUBE

Round tube vs KB

► With regard to the way of distalizing canines it is not tip canines distally during Stage I, but it is to move canines naturally in the distal direction while overbite is being decreased by bite opening bends.

► That is, the bite opening of incisors is conducted with the fulcrum of canines, and canines are not allowed to distally tip.

► Also as regards the treatment goals of Stage I, it is not only good enough to established an edge-to-edge occlusion but also to bring about L 1 to Md at an angle at 85º.

Advantages of KB buccal tube

1. This buccal tube can be used for the revised Begg technique as well as for Tip Edge system, 2. The buccolingual inclination of molars can be corrected or prevented, 3. Extraction spaces are not prevented from closing because of low friction between buccal tubes and archwires, and 4. It becomes possible to efficiently direct the force of anchorage bends and bite opening bends.

► It is important to conduct Stage I longer than usual by adding the correction of midline discrepancy and the establishment of Class I relation of canines to the treatment goals of Stage I.

► It is also important to consider correcting whatever possible to be corrected before a patient gets tired of orthodontic treatment and to do that, it is necessary to prolong the duration of Stage I, and go ahead with the enclosure of extraction spaces and so on at the same time.

Stage II

The major goals of Stage II, are

1. The torquing of upper and lower incisor roots and

2. The closure of extractions spaces.

The characteristics of Stage II on the revised Begg is to carry out necessary torquing or reverse torquing by using the torquing and or reverse torquing brackets in combination with ribbon arch wires , and totally simplify stage II in the long run.

STAGE II

There are a few things to be solved before ribbon archwires are used in place of main archwires from Stage II and the most important thing in closing extraction spaces is three dimensional control of second premolars.

That is to prevent second premolars from subsiding from rotating and also from mesially inclining on the occasion of closing extraction spaces.

Therefore, By-Pas Loos,was designed and used instead of conventional By Pass Clamp.

TorquingAt first, torque is given to upper

and lower incisors 20 degree torquing brackets for use of upper incisors 10 degree reverse torquing brackets for use of lower incisors in conjunction with control bars, or in combination with ribbon archwires as main archwires. 20 degree torquing brackets on the upper canines 10 degree reverse torquing brackets on the lower canines.

This By Pass Loop is the combination of By Pass Loop and T pin, and second pre molars are safely bypassed when By Pass Loops are locked into the second premolar brackets.

In this way, second premolars can be easily controlled in all directions when extraction spaces are closed.

Control of second premolars using KB By-Pass loops

E –Links & Power pins► E –Links were designed to

substitute for circle hooks to effectively carry out an masse tooth movement.

► By use of E links to be hooked on the brackets from canine to canine and by use of power pins to be slipped lingual to the ribbon archwire with T pins, elastics can be hooked without circle hooks.

Stage III

► What to be handled in Stage III is quite simple since torquing has been already completed during Stage II.

► Uprighting by means of uprighting springs is the only thing to be left and if uprighting is completed, then active treatment will be ended, with 10º T pins holding the over upright teeth.

► Accordingly, only angulation of 5º, 9º and 11º for upper teeth and angulation of 2º, 2º and 5º for lower teeth are incorporated into the brackets, and not torque is added to the brackets.

► Ribbon arch types of 0.028 x 0.022 buccal tubes designed for the revised Begg technique are to be used.

► The wire to be used during Stage II and III is 0.022 x 0.16 ribbon archwire.

► outline of our Tip Edge system with reference to Stage I, II and III

First of all, By-Pass Loop which is designed for the use of Tip Edge is to be tied with elastics or locked on the upper and lower second premolars brackets during Stage I

Then 0.16 ESP plain archwire with bite opening bends of 30º for upper and 20º for lower and with anchorage bends of 40º for lower and with anchoarage bends of 40º for upper and lower is used to conjunction with CO-AX wire.

► When the upper and lower incisors especially IMPA become ideal. 0.018 main archwire is switched to ribbon archwires as in the revised Begg technique, and torquing of incisor roots and space closing of extraction sites are conducted in Stage II.

► Teeth are uprighted with uprighting springs during Stage III and active treatment is finished. In any event, the force system in itself of the revised Begg technique can be applied to the Tip Edge brackets.

► That is, this idea of the revised Begg technique can be utilized by decreasing friction between archwires and brackets, regardless of vertically long or horizontally long brackets.

The treatment goals of maxillary protrusion in 1981 based on the average mean of 400 treated maxillary protrusion cases, and also the treatment goals of mandibular protrusion were computed from the average mean of 900 treated mandibular protrusion cases.

The removal of crowding and rotation, either E-Links or 0.014 sectional archwire can be used from canine to canine, power pin is inserted into vertical slots for easy placement of Class II elastics on canines, and then en masse tooth movement is to be conducted.

As the treatment goals of Stage I are attained after the completion of bite opening. 0.018 archwire is used and teeth up to the second molars are to be controlled

Diagnosis and treatment planning can be done and extraction site can be determined almost automatically. However, on the occasion of ALD 6mm, where either the first pre-molars or the second premolars are possible to be extracted.

In that event, judging criteria on the whole are :

The size of arch length discrepancy

Anchorage value

Growth tendency

Soft tissue analysis

Organized occlusions

► Reducing the number of teeth as a means of harmonizing the size of the jaw with the size of teeth is a kind of compromise approach by reducing tooth substance at one section of dental arches.

► Therefore, it is a matter of course that special attention should be paid to the occlusion organized by orthodontic treatment with the extraction of teeth.

► To be more specific, in the event of first premolar extraction cases, the height of the contact points between canines and second premolars becomes different, or the contact relations of the proximal surfaces between canines and second premolars proves inferior, whereas the contact and occlusal relation between second premolars and first molars are favourable.

► Also with regard to second premolars extraction cases, though the contact and occlusal relations between canines and first premolars are favourable, the height of the contact points between first premolars and first molars comes to be different, the contact relations of proximal surfaces between first premolars and first molars turn out to be inferior, and first premolars trigger off a distobuccal rotation after orthodontic treatment.

► The distal surfaces of canines and the mesial surfaces of second premolars will be reduced if first premolars are extracted, and also arrange that the distal surfaces of first premolars and the mesial surfaces of first premolar and the mesial surfaces of first molars will be stripped off if second premolars are extracted.

References.

1. Outline of the revised Begg technique and Tip Edge system ( KB Technique). Journal of Japanese Orthodontic Society, Jan., 1989.

2. The Begg technique in Japan. Amer. J. Orthodont., 81 (3), 209-228.1982.

3. Refined Begg – Jayade.