Begg seminar /certified fixed orthodontic courses by Indian dental academy

SYMPOSIUM ON

THE BEGG TECHNIQUE
CONVENTIONAL
AND
CONTEMPORARY

PART II

STAGE I AND STAGE II MECHANICS
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


 ATTACHMENTS
 STAGE I
 STAGE II
 REFINEMENTS
 PROBLEMS THAT ARISE DURING
TREATMENT AND REMEDIES

THE BEGG TECHNIQUE
Designed to permit teeth to move
towards their anatomically correct
position in jaws under the influence of
very light forces.


Attachments used in Begg’s technique
Brackets & lock pins
Bands
Molar tubes
Ball end hooks
Lingual Attachments

Design of Bracket & Tubes
The design of the attachments on all teeth except molar
must permit free crown tipping by arch wire & elastic
during first 2 stages & also permit root tipping by
auxiliaries used with arch wire & elastic during 3 rd
stage.
Molar tube must provide the molars that can be placed
& maintained in upright position without tipping or
rotation.

Brackets
• Main attachment
• Modified ribbon arch brackets - slots facing
gingivally (narrow brackets – permit free tipping in
all the direction)
• It has a slot to carry the arch wire and a vertical slot
to carry the lock pin to hold the wire

Requirements for a light wire bracket
• Ease of arch wire engagement.
• Mean to guide both tail and head of lock pin.
• Positive retention of arch wire in all 3 stages.
• Free tipping and sliding of arch wire. Ability to effect and hold rotations.
• Ability to prevent accidental tipping in stage 3.
• Facility to use pins or springs.
• Should not deform under occlusal load.
• Maximum comfort.

Dimensions
Depth of slot - 0.020”

.020”

Height of

.020”


.045”

.015”
.125”

slot - 0.045”
Base dim. -0.122” x
0.125”
Pin slot dim. – 0.020”
SS sheath thickness
- 0.015”

.122”

Classification of brackets
According to constitution Metallic (stainless steel)
bondable
weldable
Non Metallic (Aesthetic)
plastic
ceramic
According to placement
Labial
Lingual
According to anatomical bases
Flat
Curved
•

Bondable brackets may have jigs for positioning ranging height from 3.5
to 4.5 mm.

Metallic brackets
 Must be made of good quality SS sheets of
minimum thickness 0.015” for adequate strength
 Slot depth must not exceed 0.022”
(for rotational control)
 Weldable bracket can be welded on band
(flat base or curved base)

Bondable brackets
Strong union of bonding mesh with the
proper base by way of brazing is essential.
It is done without obliterating mesh holes.


Mesh
Mini mesh (TP 256 -050)smallest base available.
same size of bracket.
more esthetic.
Super mini mesh (TP 256-150)
-larger than mini mesh.
extends slightly beyond the
bracket base.
more bonding surface.

Esthetic brackets
Plastic brackets
•
•
•
•

Made of polycarbonates
Available in tooth color or crystal clear plastic
Flat for centrals
Curved for cuspids & bicuspids


Ceramic brackets
 Esthetic bracket
 Ceramaflex II 256 begg(TP labs) having all
unique feature of metal brackets
 Polycrystalline alumina manuf. by injection
molding. Base is polycarbonate for easy
debonding.

Anatomical bases

• Flat base for incisors

• Bracket flange and base curved for cuspid &
bicuspid – lack rotational control


Other types of brackets
•

LTD limited tipping design brackets

•

With built in torque – Kameda brackets

•

Combination brackets

•

Tip edge brackets


LOCK PINS


Essential to hold the wire in bracket & allows the force to be

transmitted from arch wire & elastics to teeth.


Made from soft SS or brass (nylon for ceramic)



Must be soft to permit easy bending close to bracket vertical

wall

Types of lock pins
One point safety lock pin
 Used during first stage with 0.016” wire
 Shoulder on labial surface of head
 Beveled under surface tipping(35%
more)
 Lab-lin width of pin in slot area is 0.024”
 Rotational control with 0.016” wire
 Available plain or with brake- off notch

Second stage Safety lock pins
• Shoulder on labial surface of head ensure
free mesiodistal tipping.
• Lab-lin width of pin(0.020”) reduced 0.004”
as compare to stage 1 pins to permit use
with 0.018”or 0.020” inch wire.
• Available with brake- off notch.


Hook pins
• Used on all teeth that do not require mesiodistal tipping
• Absence of shoulder and hook shape permits
positive locking of arch wire and auxiliaries
in 3rd stage.
• Hold to use wire against bracket in ant. tooth
with rotating spring.


High hat pins
Pin with an extension on head to readily
accept vertical or cross elastics.
Can be used in any stage.

Super high hat
Indicated for fixation the segments with
elastics following surgery.

T pins
• Lock pin with broad head that controls the
mesiodistal inclination of tooth.
• Normally used in 3rd stage to replace
deactivated m-d springs as a mean of m-d
stability.
• Can be used to limit free tipping in any stage.

Ceramaflex pins
Modified pins.
Used with ceramic brackets.
Bulkier than its metallic version SS / brass and
nylon pins.
For nylon pins bending  special heating
device “nylon lock pin iron” button.

Lingual pin
To lock the wire in bracket during stage 3 when
plain uprighting springs are used.

Spring pin
A combination of safety lock pin and uprighting
spring.
Eliminates the need for ligating the arch wire
to the bracket.


Bands
Although bonding has replaced the banding
there are number of indications--- Teeth that will receive heavy intermittent forces
against attach. e.g.. Molar.
 Teeth req. both labial & lingual attach.
 Teeth with short clinical crown.
 Tooth surface incompatible to bonding.

Dimensions of bands commonly used---• Molars
0.005” x 0.18” or 0.006” x 0.20”
• Bicuspids
0.004” x 0.15” or 0.005” x 0.15”
• Anteriors
0.004” x 0.125” or 0.003” x 0.125”
Bands can be custom made or preformed
(with or without attachments.)

Molar tubes
Designed to permit free m-d sliding of arch wire
free distolingual tipping of anterior teeth
Tubes –weldable, solderable or bondable.
with hook or without hook.
with vertical slot (uprighting springs).
2 to 6 degree distolingual offset tubes are also
available.


Types of molar tubes
Round
Dimension - 0.036” inside diameter x 0.25” long


Flat oval tube
• Dimension - 0.027” x 0.050” internal diameter,
0.20” long,
• When 1st permanent molar is missing / extracted,
used on 2nd molar.
• Also used in mandibular arch on 1st permanent molar
when mandibular 2nd premolar is missing / extracted.


Interchangeable tube
Permits switching from a double back arch
wire to a straight back arch wire with out
loosing mechanical advantage and change of
tube.


Combination tube
• Consist of gingival round tube 0.036”diametre x
6.2mm long & rectangular (ribbon) occlusal tube
0.025”x 0.018” dia x 5.5 mm long.
• Used when finishing is done by rectangular
wire.


Additional round tube
Placed on molars for engaging lip bumpers,
head gears etc.
Placed gingival to main tube.


Ball end hook
• For the hook less tube, ball end hook is placed
at the mesial end of molar tube with free end
directed gingivally and distally.
• Prevents rotation of molars as
compared to elastic attached to distal end.
• Especially useful in short clinical crown.
• Increased patient cooperation.


Lingual attachments
Lingual button or cleat
Placed on lingual surface of teeth for
attachment of elastics, elastic thread, wire
ligature.
Placed on m-d center unless severe crowding
is present or tooth is rotated.
Can be bondable or weldable.
Lingual cleats are used instead of button
because they provide greater versatility for
attachment of elastics.

Advantages :
•

Cleats are not rigid, so adjustable.

•

Continue to retain elastic as teeth changes its position.

•

Low profile can be flattened if impinge on tongue.

•

In case of tongue thrusting one leg can be projected.

•

Welding flange is thin and flexible no distort lingual surface
of band.

Disadvantage :
•

Occasionally irritates tongue, may distort by chewing force.


Cleat Lug
•
•
•
•

Made from heavier metal.
Placed lingually in gingival 1/3 of molar band.
Can bear good pressure.
Facilitate proper pushing of bands at their
proper places.


Seating lug hook
Has flat or curved bases.
Can be used on lingual surfaces on all teeth.
Used for placement of elastics and for easy
insertion and removal of band.


Hooks for elastics
For applying elastics or elastic thread for
rotational movement.


Lingual sheath
• This is used to put auxiliaries like
expanders or TPA.
• Internal diameter 0.036”.


By pass clamps
Provide a simple means of loosely connecting an
arch wire to buccal surface of bracket.
Generally used on bicuspids.
Permit vertical & rotational control during
posterior space closure.
Two levels of attachment are possible.


C clamp

(Lyman Wagers , 1967 , JCO)

Provide a simple means of loosely connecting
an arch wire to buccal surface of bracket.
Ordinarily used on bicuspids
Made from .018 wire.
Can be placed on bands prior to their
cementation in the mouth.


ELASTICS
• Internal diameter – 3/8” (9.5 mm), 5/16” (7.9 mm), ¼” (6.4
mm), 3/16” (4.8 mm) and 1/8” (3.2 mm)
• Intended force values – 2 Oz (57 gm), 31/2 Oz. (99 gm),
41/2 Oz.( 128 gm), 6 Oz. (170gm), and 8 Oz (227 gm)
varieties.
• The funda was that when stretched 3 times their diameter,
the elastics would give the force that they were marketed to
be giving.

Placement of Attachment
Brackets placement
Height: 4mm from incisal edge except LI 3.5 mm
M-D centre of tooth (on rotated tooth slight off
centre – 1 mm closure to the proximal surface
that is rotated towards lingual)


• If distance is less  ↑chances of occlusal
interference and / or bracket displacement.
• If distance is more, difficult to maintain
dental arch length and rotations because
arch wire will be below the contact area
between the teeth.

Lingual buttons & cleats
Positioned directly opposite to area of arch
wire engagement. (Bracket).
To permit free m-d tipping & uprighting.


Buccal tubes
Mesial end of tube is in line with centre of
mesiobuccal cusp.
Mandibular tube should be placed as gingivally
as possible to keep arch wire away from
occlusal plane.


Elastic hook
Positioned, so that the elastic will pull from a
point as near to the center of crown as
possible.


Power arms
Used for selective maxillary incisor intrusion to minimize gummy smile in
cases of VME.
Deep bite cases where molar extrusion in bite opening is undesirable.
To avoid canting of plane during treatment.
Reduce torque required on incisors.
0.017”x 0.025” or large size wire, 5-7 mm in length,
Follow contour of alveolus.
Soldered to band just above the molar tube.

Stage I in Begg
Technique


Begg technique is divided into three
stages---- Stages I and II – Crown tipping phase.
 Stage III – Root tipping phase.
 Overlapping of the stages must be avoided.
 Objectives of each stage met before proceeding.

Objectives of Stage I
 Correction of crowding and irregularity.
 Closure of anterior spaces.
 Correction of rotations.
 Elimination of deep bites edge to edge bite / openbite
except in class III.
 Openbites  Overbite relations.
 Correction of Mesiodistal relations of buccal segments
Class I and Class II  Mild class III.
Class III  Class I or Class II.

Objectives of Stage I
 Co-ordination of upper and lower arches.
 Correction of anterior and posterior cross bites.
 Axial relation of anchor molars corrected – upright position.
Extraction spaces become smaller.
All tooth movements carried out simultaneously & in
both arches.


Orthodontic apparatus in Stage I
Attachments – Bands, brackets, tubes &
lingual cleats.
Archwires.
Ligatures.
Elastics.
Auxiliaries - Rotation springs.
Act simultaneously to reciprocal advantage with each
other.

Archwires
The technique could not have been developed if
Wilcock had not produced suitable wire.
– Round austenitic SS – heat treated and cold
drawn.
– Combination of resiliency and flexibility.
– Adequate stiffness for bite opening.
– 0.016” special AJW – principal wire of Stage I.
– 0.018” special – Molar extraction cases
– 0.014” special – rotating springs.

Parts of the archwire
Intermaxillary Hooks – ( IMH )
Small loops for engaging elastics and cuspid ties.
– 2 types –
• Boot
• Circle/ Helical

– Adv of Circle hook.
•
•
•
•
•

2 – 2.5mm outside diameter.
Mesial & Distal rolling possible.
Less space requirement.
Less distortion.
Greater stiffness in horizontal and vertical plane.

Location of IMH
– Well aligned anterior teeth – 1-2 mm
mesial to the cuspid bracket.
– Spaced anteriors – Further mesially.
– Mildly crowded anteriors – impinging on
the bracket.
– Severely crowded – multi loop wires.


Anterior space closure methods


Offset bends in the labial segment
– Horizontal offset bend mesial to the IMH.
– Bayonet bends act to hold the teeth in positions of
overcorrection during treatment.

Cuspid Curve
– Labial curvature in cuspid area – incorporated to
avoid lingual tipping of canines.
– In narrow arches requiring expansion, cuspid offset
given.

Anchorage bends / Tip back bends.
– In buccal segment of the archwire, mesial to
the tube with vertex facing occlusally.
Angulation depends on –

– Stage of trt. - as stage progresses.
– Depth of overbite - with bite opening.
– Rate of progress of case.


Location of anchor bend
• 3mm in front of mesial end of molar tube
(approx at the junction of 2nd PM and molar)
• Degree 300 – 50 0 for 0.016”
Anchor curve – non extraction cases.
-does not need frequent
adjustments.


Co-ordination of stage I
archwires


Correction of rotations in cuspids
and bicuspids


Tying intermaxillary hook to the
cuspid bracket


Placement of elastics


• Dontrix guage
• 2-2.5 ounces of force
• 1ounce = 28.33gms of force


Position of teeth at the end of stage I

Occlusion at the end of stage I


Importance of stage models

Check arch contour and width.
Inclination of upper and lower anterior teeth.
 Self discipline to complete each stage before proceeding.
Overcorrections in trt. – rotations, overbite corrections and mesiodistal relatrions.

Better insight how anchorage maintained in treatment.
Better conception of how the technique progresses.
Visual aid for the patient and parents

Stage II in Begg
Technique

Objectives of Second Stage
Maintain all corrections achieved during stage I.
 M-D molar relationship maintained – Cl II or Cl III elastics.
 Original spaces b/w ant. teeth prevented from recurring –
tying IM circles to cuspid brackets.
Over rotations


of cuspids maintained – engaging brackets – offset on the teeth.


Objectives of Second Stage


of bicuspids held – replacing elastic threads with steel ligature ties.



of Central and lateral incisors – maintained –
continued use of bayonet bends in the archwires.

Bite opening maintained – continued use of bite opening bends & Cl II
or Cl III elastics.
Correction of posterior crossbite maintained – modifying archwire or
cross elastics.

Close any remaining posterior spaces.


Wearing of horizontal elastics.

Commencement of stage II –
Lateral ceph & stage models.
Intraoral photographs.

Lateral Ceph. compared with that of original
M.O





antero posterior tooth movements in ref
to each other & to face & cranium.
anchorage maintained properly.
inclination of the anterior teeth.

Malocclusion of 2nd stage – not same as at
the beginning of treatment.
Most malocclusions – similar appearance –
conclusion of first stage mechanics.
Edge to edge or mild open bite relation.
Spaces b/w cuspids & 2nd bicuspids.
Class II  Class I or Class III.
Class III  mild Class II

Archwires
0.020” arch wires used.
Only function – to maintain the corrections –
achieved. ( bite opening, arch form & tooth
alignment.).
Stabilize the teeth against –Reciprocal forces –
application of elastics or auxiliaries.


Anchorage bend


in comparison with that given in the stage I.

Variation in location--Far enough forward – spaces close before anchorage
bends reaches molar tube.

Rate of progress & amount of space remaining.
If rapid – bends placed further forward.
Little space – tooth contact before anchor bend
reaches molar tube.

Inserting and activating archwires
Insert and check
Degree of anchorage bend –
- adequate to resist forward pull of elastics.
- rest passively – halfway b/w brackets & mucolabial fold.
Distal ends of the archwires –
1 – 2 mm beyond the distal end of the tubes.
Anchorage bends sufficiently forward
- too far or too less.


Class II elastics –
- relieved of correcting overjet.
- used to maintain overcorrected
positions of ant. & post. teeth.

Horizontal or intramaxillary elastics for space closure.

Six elastics worn simultaneously.

Problems encountered with elastic wear


Tooth movements carried out during the 2nd
stage of treatment
Spaces in the buccal segment to be closed.
Extn. space of four first premolars.
Congenital absence of 2nd P.M.
Lost buccal teeth due to caries.
Spaces b/w teeth in Non-Extn cases.

Exception.
Extreme tooth spacing – small tooth size.

Auxillaries sometimes used in
stage II


Teeth positions at the end of Stage II
Extraction spaces closed.
Crowns of upper and lower ant. teeth –
tipped back or ‘dished in’.


Conclusion
 Through the use of the optimum orthodontic
force ie, one that moves the teeth most rapidly,
with least discomfort to the patient and with least
damage to the teeth and their investing tissues,
effective space closure is achieved with
minimum taxation of anchorage.
 Teeth are left in the proper position to be
uprighted and put into good axial relation in the
third stage.

Disadvantages of Conventional Begg
Round wire – Ribbon bracket combination – no precise control
for fine finishing.
True intrusion of upper incisors – nil or minimal.
Overuse of Class II elastics
Lack of upper incisor intrusion.
Undesirable proclination of lower incisors.
Tipping of mandibular & occlusal planes.
Uncontrolled tipping –
root resorption.
long third stage.
Overemphasis on tooth material reduction – ruined profiles.

Refinement in the
conventional Begg
technique

The differences are----• Changes in the concepts.
• Improvement in the hard wear.
• Modifications in the mechanics.


Changes in concepts
‘Theory of Attritional Occlusion’ &
Differential force concept.
Treatment objectives.
Diagnosis.
Treatment Planning.
Biomechanics.
Archform.


Changes in the hardware
 Attachments.
 Archwires.
 Elastics.
 Other components.
Bypass hooks.
Power pins.
TPA & Jasper Jumper – when indicated..


Stage wise modifications
Stage I.
Multilooped archwires avoided.
MAA.
Incisor intrusion –imp. in bite opening.
Bypass wires & distalizing archwires.
Base wire  0.018” as soon as possible.
Open bite cases – 0.014” wire initially.

Stage II.
MAA.
Base wire – 0.020”.
Brakes to avoid excessive incisor tipping.

Stage III.
Base wire – 0.020” premium.
Uprighting springs & torquing aux. – finer higher
grades.
Second molar banding.
Head gear when necessary.

Finishing stage.
Rectangular wires.
Later – difft. elastic config. with lighter round wires
tight buccal occlusion.
Pre – finishing ceph.

Retention
Conventional Begg – no emphasis – lower
retention.
Now – retention – till relapse tendency due to –
growth or third molars ruled out.

Essentials of Begg – Unaltered
 Light orthodontic forces.
 Crown tipping + Root tipping

bodily movement with least

taxation on anchorage.
 Brackets – free tipping in initial stages.
 Differential forces.
 Sequence of trt. stages.

Essentials of Begg – Unaltered
 Light intra-oral elastic force.
 Enmasse movements of ant. and post. teeth – overjet &
correction of post. Occlusion.
 Separation of root moving forces from archwire forces.
 Over corrections of all displacements.
 Use of round high tensile wires.

Placement of attachments


Archwires
Still used – Round high tensile SS wires of AJW.
Earlier used grades-

Special plus.
Extra special plus – resistant to bite opening.

Recently – new series of wire grades & sizes.
Premium, premium+, supreme – in the order of
increasing yield strength.
Superior properties  pulse straightening, as
against spinner straightening of older grades.

Properties of newer grade wires
•
•
•
•
•

Yield strength
Working range
Resiliency
Zero stress relaxation
Formability


Refinements in mechanics
Stage I
Objectives – remained same – some added &
elaborated.

Priorities in Stage I:
Overbite before overjet.
Alignment of teeth.
Proclination to be reduced before applying higher
intrusive force.


Objectives – described under two sub stages.
Substage I – A.
 Create space for correcting crowded teeth / close
spacing if already present.
 Alignment – correction of labolingual displ / rotations.
 Upper incisor inclination - + 10° of normal.
 Rotations / BL positions of upper molars corrected.
 PM rotations.
 Upper arch broadened in canine – PM area – to permit
mandibular advancement.


Substage I – B.
 Bite opening.
 incisor intrusion, molar extrusion.
 Retraction of upper ant. to eliminate the overjet with control over the root
position.
 Mech. of controlled tipping of upper incisors.
 Preventing uncontrolled tipping of lower incisor – during bite opening.
 Root control – extreme lingual or labial position of some ant. teeth.
 Mandibular plane angle – controlled.
 Correction of midline.
 Interarch reln. corrected to Cl I.
 Displ. & rotn. of P.M’s corrected – if bonded.

Alignment of crowded anterior teeth


Closing anterior spacing
Retracting proclined upper ant. teeth.
- 0.016 SS.
- elastics – class II – upper.
- class I lower.
Spacing to be closed without retracting.
– Fig.of 8 elastomeric tie.
Active space closure – not attempted till intrusion is
accomplished.


Improving incisor inclination
Proclined  class II elastics.
Retroclined  bite opening bends without elastics.

Molar position correction
Approp. toe in or toe out bends – in SS 0.016
archwire.
Mild B.L disp. – expansion /contraction in archwire.


Substage I B
Bite opening
Preference – incisor intrusion & avoiding molar
extrusion.
Conventional Begg –
bite opening – molar extrusion + lower incisor
protrusion.


Intrusive force – bite opening bends - acts labially
Labial crown/lingual root tipping.
Resisted by elastics.
Magnitude & direction of net resultant force
intrusive.
Anchor bends upper 0.016” wire
= 45 g force/side.
Extrusive comp. of class II elastic
= 30 g / side.
Resultant
= 15 g / side.
on 3 teeth
= 5 g/ tooth.
Same combination used irrespective of upper incisor
inclination.

CR


Gradual increase in intrusive force –
anchor bend 30°- 50° - 0.016 archwire
elastic force –using for longer periods –
switching from yellow ( 5/16”) to
Road runner ( 3/8” ) elastics.
Directional changechanging from class II  Class I 
from TPA.
Alternative – ‘power arms’


Arch wire design modifications
Conventional bite opening
bends.
3mm mesial to the molar tube.
Intrusion of upper canines & of
LI and CI.
Gable bends – distal to canines.
extrusion of canines, intrusion of
LI & CI.
Hocevar’s modification. –
a bend on either
side of canines. CI – intrusion.
Canine & LI – extrusion.

Bite opening curve ( anchor & gable
bends).
Canines – extrusion, LI and CI –
intrusion.
Modification – Dr. Jayade.
 Mild gingival curve – midpoint 3mm
over the brackets.
 Vertical step up bend – 4 – 5 mm
ht., 2 – 3 mm mesial to the molar
tube.
 Anchor bend – upper end of the
step.

Preventing uncontrolled tipping of the
lower incisors.
o Brackets bonded – gingivally.
o MAA – labial root torque – lower incisors.
o Ends of lower archwire bend distal – molar
tubes.

Root control – extreme lingual or labial
positions of the ant.
o Labial movement of instanding incisors or
canines- MAA.
o Lingual root movement – canines – marked
root prominence – for placing into cancellous
bone.

Correcting midline discrepancy
Upper midline - after alignment, uneven Cl II
elastics.
If both midlines shifted in opp. directions –
midline diagonal elastic.
Lower midline alone – unilateral lower Cl I
elastic.

Correcting inter - arch relationships to
Class I
• Growing child – class II – class I –
encouraging the mandibular growth.
• Adults – mesial movement of the lower post.
dental segment - class II elastics.
• Selected cases – distalizing upper molars.

Check list at the end of Stage I
 Incisors – edge to edge relation.
 Midlines matching.
 Molar & canines – class I.
 Upper and lower arch forms – matching.
 Molar rotations & BL displ. Corrected.
 Good control – root positions & mandibular
plane angle.

Stage II
Objectives----Common –
– Maintain all corrections – in stage I.
– Close all extraction spaces.

Additional.
– Controlled tipping – space closure – ant.
retraction.
– Prevent excess tipping – efficient brakes – space
closure by protracting post.
– 1st pm extn. cases – rotations & crossbites of 2 nd
pm corrected. www.indiandentalacademy.com

Archwires in Stage II of Refined Begg
In extn. & non extn. cases –
0.018” P or P+, or 0.020” P wires.
If stage corrections involved – extreme deep bite, badly
distorted arch forms or severe rotations – 0.020 archwires
effective.
Anchor bends
PM bypassed – except when in distobuccal rotation.

Controlled tipping of the incisors
MAA – lingual root torque – controlled lingual tipping –
incisors during retraction.
( bite opening force - intrusive force supplemented
with moment – MAA).
Lower incisors – sig. retraction – lingual root torque.
Canines – excess tipping – 0.010 uprighting springs.

Braking mechanics

Braking springs: passive uprighting
springs – 0.018 wire.

Second PM extn.
Cases – excess
space closed by post.
protraction.
Good profile at start of
treatment.
‘Brakes’ – reverse
anchorage site.

Angulated T pins: prevent further tipping


Check list
• Spaces closed completely.
• Anterior edge to edge bite or +ve overjet in open bite
cases.
• Canine & molar relations – Cl I or super Cl I


Problem
Shooting
in
Begg
&
its Management

• However Begg appliance is not without any
problems.
• A thorough knowledge of
 Basic mechanics involved
 Manifestations of various problems
 Causes
 Remedies

highly essential for succ.
completion of www.indiandentalacademy.com case.
each and every

Problems Encountered During Begg Trt.
Problems can occur in any stage or can either
be
 Poor tissue response
 Lack of patient cooperation
 Poor mechanics
Identification of problem is imp. for
producing successful results.

Extra diagnostic aids – valuable in analyzing
trt. results
A large mirror can reflect occ. surface of
either arch.
 A tongue blade or base plate sheet for
checking defi. in level of ind. teeth
 Study models
 Caliper or various gauges

Problems encountered during first stage and
their remedies
1.Bite not opening.
 Poor elastic cooperation.
 Educate patient and the parents.
 Lack of co-operation can be discovered
 Purposely not providing enough elastics
 Making it impossible for patient to hook
elastics
 Discovering the patient without elastics on
school or other places


Orthodontist has responsibility in seeking pt.
cooperation with elastics
 Should be worn conti. except brushing
Instruct patient carefully where to attach elastics,
after inst., have him place E himself
 Make sure patient can place elastic easily &
remain in place without slipping off & undue
breakage

 Patient biting out bite opening bends.
 Remove aw, restore bite opening bends.
 Check eating habits.
 Lower the level of mandibular molar tubes.
 Move the anchor bends closer to the molar
tubes

 Over retention of looped archwire
 Replace looped AW with plain AW as soon
as possible

Anchor molars out of occlusion.
 Vertical elastics from U-m to L-m.
 Horizontal elastics from most pos. place molar
 molar mesially  occ.

 Poor quality AW or that has become weaker
 Use stiffer 0.018” pr +p.s wire with adeq. AB

 Loose molar band.
 Readapt and recement (same band if fit
proper) band.

 Improper angulation of buccal tube or
entire molar band.
 Remove molar band, correct angulation
(tube II to occ.& buccal surface of molar)


 A W binding due to bicuspid ligature or
clamp which is too tight
 Make sure PM are not ligated tightly

 Binding & friction among anterior teeth
due to pinning or ligating too tightly
 make sure pins or ligatures are loose
enough


 Use of elastics that are too loose
 Exert insufficient retraction force to keep lin.
surface of U-I in contact with incisal edge
of L-I stepping up process is weak
 Assure class II force is adequate

 Use of elastics that are too tight
 Mesial tipping of lower molars (if AB force
inadequate)
 Assure class II force is adequate

 Binding of archwire in tube
 If wire does not extend through distal of tube,
may catch on inside wall & gouge sufficiently
 ant. teeth forward & excessive distal
tipping of molars. The end of wire can move
forward not backward when forces are released
”Ratchet & Pawl” or ‘Trammel” effects
 Replace with longer arch wire
 Bend distal end of wire

 Grinding & clenching
 Palpate teeth for undue mobility
 Depress molar with blunt instrument, for sign
of loosening or extrusion pumping of molar or
trumpet valve effect for their tendency to rise
again after depressed.
Reciprocal movement reflects influ. of
excessive class II force & clenching.
 Prescribe sugar less gum
 Patient education ”keep lips together &
teeth apart”

 Excessive force due to habitual biting of
lip & tongue
 Prevents retraction U-ant. teeth stepping
up process
 Patient education

 Patients habit of holding jaw forward in class
I
 To ↓ discomfort & self cons. about facial esth.
 Caution the patient not to allow lower jaw to
come forward in response to pulling forces
exerted by class II elastics

2. Molar width narrowing (usually L – M)
 Vertical component of Class II elastic
 Considerable AW expansion in molar region.

 Prolonged wearing of cross elastics
 Discontinue cross elastics
 Correct cross bite by other means- doubled
back wire, vertical elastics or finger springs.

 Distolingually rotated cuspids.
 Engage wire in cuspid bracket after derotation.

 PM rotational elastic tie on the lingual from

bicuspid to the molar.
 Extend archwire to the 2nd molar.
 Toe out bends on the distal end of the arch wire.

 Retie elastic thread from the PM to the arch wire.

 Rolling of the distal ends of the AW.
 Place toe in or toe out bends.

3. Adverse tipping of anchor molars .
 No AB ( if tipped mesially )
 Too much AB ( if tipped distally )
 Proper AB in place for too long. (tipped distally )
 Place bracket on first molar and band second molar

 Improper placement of M tube or band.
 Loose molar band.
 Excessive elastic force.
 Use sensitive tension gauge, if force delivered
proper, see whether pt. is wearing more elas.

 Improper placement of elastics on tooth.
 instruct patient proper placement, provide
hooks in desired areas

 Oversize archwire
 Replace with 0.016 hard aus. wire.


4. No appreciable changes.
 Not wearing elastics.
 Archwire bent out of shape.
 Oral habits that counteract forces of
appliances.
 Identify & eliminate the habit ,if possible

 Patient seen too soon.
 Dismiss pt. for at least 6 weeks

5. Vertical loops buried in the gingiva .
 Looped archwire left too long.
 Replace it with plain archwire with
bayonet bends.

 Misjudgment in proper direction of
loops.
 If ant. are still crowded or irregular
modify direction of loops.


6. Elastics which break or do not stay on.
 Excuse for not wearing elastics.
 Educate patient

 Elastic not staying on Intermax. circle .
 Instruct pt. to pull elastic distally into circle.
 Open I.M circle vertically.


 Distal end of archwire too short or
imbedded in the gingiva.
 Make new archwire or bend the wire.
 Elastic hook on the molar band.

7. Lock pins lost.
 Occlusal – incisal forces.
 Use steel pins, if brass pins previously
 Check AB to facilitate opening the bite.

 Patient picking out them.
 Patient education.
 Bend tails of pins tightly.
 Use ligature wires.

8. Extremely mobile molars.
 Clenching of teeth.
 Prescribe sugar less gum

 Intermittent wearing of elastics.
 Patient education

 Pathology.
 Take IOPA x-ray, check med.-dental
history, refer to periodontist, general dentist
or physician.

 Excessive force applied to the molar.
 Reduce archwire to 0.016 inch.
 Reduce elastic force to 21/2 oz.
 Reduce anchor bends.

 No apparent cause.
 Remove AW and elastics for 8-10 weeks,
molar should tighten. Resume trt.

9. Lower anterior teeth tipping labially.
 Optical illusion with roots moving ling.
 Education of both pt. & orthodontist

 Binding of archwire in bicuspid brackets.
 Use bypass clamps.
 Remove bicuspid band temporarily.

 Binding of ends of AW inside buccal
tubes.
 Replace with wires of sufficient length.

 Poor diagnosis
 Reconsider the need for extn of teeth.

10.Anterior open bite not closing.
 Patient not wearing ant. vertical elastics .

 Persistent tongue thrust or other adverse
habits.
 Placement of lingually directed spurs on lower
anterior teeth.
 Refer to speech and swallowing therapy spec .

 Too much anchor bend.
 Reduction of anchor bends.

11. Tooth not rotating.
 Not enough space.
 Check diagnosis or archwire design.

 Not enough activation in the bracket
area of the archwire.
 Remove AW and activate bracket area
between vertical loops

 Elastic threads slipping over the top of
the tooth.
 Use bypass clamp to lower the level of AW
 Lower the lingual button.

12. Midline discrepancy.
 Asymmetrical tipping of anterior teeth.
 Do nothing, study situation carefully to
confirm that space closure & ultimate
uprighting of teeth in 3rd stage will correct
midline.

Stage II (Objectives)

 Maintain all corrections achieved during 1st
stage

 Closure of remaining posterior space
Problems encountered during second stage
and their remedies
1.Ant. bite closing
 Lack of bite opening bends
 Remove AW, place proper bite-opening bends

 Bitten out bite opening bends, arch wire
distorted
 Pt. edu. for proper diet
 Remove, correct & replace archwire

 Anchor molar out of occlusion
 Discontinue Class II or Class III elastics
 Horizontal elastics from most pos. place
molar  molar mesially  occ.
 Vertical elastics from U-m to L-m

 Patient not wearing I.M elastics properly
 Educate patient

2. Ant. teeth assuming class III relationship
Excessive wearing of class II elastics
 Discontinue Class II elastics till teeth are in edge
to edge relation
 place class III elastics, discontinue class III
elastics when ant. teeth are edge to edge


3. Spaces dev. between ant. teeth.
 Failure to give cuspid tie
 Intermax. circles formed too far apart
 Roll one or both circles mesially, tie with steel lig.
 if space is too large, close space with hor. elastic
from 3-3

4. Anchor molars rotating distobuccally
 Toe-out on arch wire
 Remove arch wire & place toe in bend

 Too much force from horizontal elastics
 Use lighter hor. Elastics
 Tie elastic thread from 3 lingual button to
lingual hook on molar.

 Elastics pulling on distal of molar tube
 Place the hook properly
 Edu. pt. to place elastic on hook rather than
around tube.

5. Canine roots bulging on labial plate of
alv. bone
 Normal distal tipping of canine crown slig.
mesial movement of apices, ( canine is
corner tooth) bulging of labial plate of alv.
bone. will disappear during stage III
 Do nothing

 Poor arch form
 Poor bracket placement
 if bracket is to far gingival tooth will supra
erupt. Inclined plane relationship with opposing
teeth  rotate mand. cuspid crowns lingually
 roots labially


6. Posterior space not closing
 Poor elastic cooperation.
 Educate the patient
 Make sure that pt. can hook the elastics

 AW not free to slide distally through tube
 Remove source of resistance
 End of wire striking 2nd molar
 AB in molar tube
 Arch wire short & caught on burr inside tube

 A W pinned or caught in PM bracket slot
 Unpin archwire, remove from slot
 Place bypass clamp

 Pt. placing tongue or pencil in space
 Educate patient

 Occlusal interference
 ↑ AB to open bite
 Check bracket level

 Ant. teeth not free to tip distally
 Use proper brackets
 Make sure AW is not pinned too tightly
 Make sure AW is seated in bracket slot, not
caught on flange of bracket
 If tongue habit, place spurs on lingual
surface of teeth, refer to speech and
swallowing therapy spec.

7. Mesial tipping of 2nd PM
 Slight, expected mesial movement of
anchor molar
 proceed with stage II, conti. to guard anchorage

 Abnormal loss of anchorage
 Remove AW, ↑ AB
 ↓ elastic force
 Check for loose molar band or tubes

8. Mand. ant. teeth achieving desired
lingual inclination before space closure
 Careful preservation of anchorage
 Apply braking mechanics
 Apply 6- 10 oz. horizontal elastics with braking
mechanics

 Excess space present at beginning of trt.
(Cong. small or missing teeth or space from
trauma or caries)
 Clinical experience & education of patient

9. Relapse of crowding
 Intermax. circles not abutting to canines
 Pins dislodged from brackets
10. Too much retraction of U –incisors resulting
in gummy smile
 Uncontrolled tipping of incisors
 Use MAA

 Not attaining proper intrusion of U - incisors
 Use of Power arms or TPA for wearing class I
elastics

Anchorage loss during stage I & stage
II
 Vertical loop touching the labial surface
of the teeth

 Proper arch wire fabrication
 Proper location of loops & limitation of the
number of loops
 Slightly labial inclination of loops in severe
crowding cases

 Vertical loop impinging on the gingival
tissue
(If impinge on gingiva become imbedded by next
visit, Prolong stage I & II)

 Careful modification of loops
 Slightly labial inclination of loops when arch first
applied
 Do not modify the loop without removing from
mouth

 Intermaxillary hooks not cranked out
(Vertical portion of I.M.H resting snugly against
the canine  +ve braking mechanism)

 I.M.H should be cranked out before arch wire is
applied

 Use horizontal circle

 Distal leg of I.M.H sliding against the lock
pin & becoming engaged in canine bracket
(Prevents free and simple tipping of canine crown
Usually happen when loop arch wire are used to
unravel ant. crowding)

 I.M.H should be cranked far enough labially,
engage against the mesial surface of bracket


 Elastic over the I.M.H engaging the labial
surface of canine
(Due to using thick elastics or two elastics)
 Modify I.M.H so that elastic not
produce undesirable pressure


 Lock pin binding the arch wire in bracket
(prevent free tipping of teeth)

 Use special safety lock pins
 If possible, pin tails should be bend before
head strike the arch wire

 Cuspid forced out into buccal plate
(Improper arch wire form, Causes drag teeth
can not tip freely)

 Place the distal ends of arch wire in molar
tubes, see if wire lies so far labially in canine
region

 Too strong elastic force
 Use proper intermaxillary elastic force
 2-2½ ounce

 Wearing more than one elastic
 Pt. must be properly educated in
Function of elastics
Danger of wearing more elastics

 Elastics not worn continuously
(Intermittent wearing causes anchor tooth to
become loose, Ant. teeth hardly move, Prolong
Rx  anchorage loss)

 Proper patient education


 Arch wire accidentally engaged in the
slot of second premolar
(Increases friction)

 Use of bypass clamp
 Remove the premolar band for first 6 weeks


 Arch wire binding in buccal tube
(If arch wire too short to protrude through the
distal end of molar tube,
When cut to proper length, cause internal burring
(not removed by ordinary polishing)

 Make always slightly longer than necessary
 Do not cut the end of wire until all modifications
and bends

 End of arch wires striking the second
molar
(Retards and sometimes stops the distal sliding
of arch wire (usually in upper molar)

 Extend the arch wire farther distally
buccal to 2nd molar

 If impossible, cut it short enough to
allow it to slide freely until next visit

 End of arch wire penetrating gingival tissue
(Usually distal end of lower arch
Gingival tissue (bone) prevent free sliding)

 instruct pt. to visit orthodontist if they feel
discomfort or can not engage elastics

 Anchorage bends engaging buccal tube
(Once entered in molar tube free sliding is prevented
due to three point contact)
 Check the situation every visit
 If necessary remove the arch wire, st. it and, make
new AB mesially


 Ligating premolar too tightly to arch wire
Arch wire can not slide distally
 Ligate the arch wire lightly so that arch is free to
slide


 Distorted anchorage bend
(Seen in negligent pt. mesial to lower molar tube,
esp. when lower 2nd premolars are not present)

 Examine the arch wire closely
 If distorted ,remove from mouth, eliminate the
distortion


 Too much anchorage bend
 May cause distortion of arch wire
 May cause arch wire to rotate in molar tubes
rotate the molars  failing to depress molars

 Improper toe in
 Results in loss of control of anchor teeth &
failure to reduce ant. deep bite.

 Proper amount of toe in or toe out  by
placing the AW in molar tubes & in ant.
brackets

 The wire should pass st. forward & occlusally
as it leaves the tube by action of AB.


 Arch wire too soft
 AW material must have higher resiliency
 Other wise Rx time will increase  more
anchorage loss

 Starting stage II too soon
 If ant. teeth are not in genuine end to end
contact, not free to tip under the forces of
horizontal elastics

 Wrong type of bracket
 Do not use edge wise bracket
 May allow ample tipping labiolingually but
it restricts mesiodistal tipping and causes loss
of anchorage


 Bend – over free end of lock pin
impinging on arch wire
 Use short lock pin
 Cut the lock pin tail off flush with the side of
bracket
 Bend all pins tail to mesial


 Arch wire rolling in buccal tube
 Avoid too much anchorage bend
 and/or too much toe in bend


 Improper arch wire form
 Arch wire should keep all teeth in the cancellous
through of alveolar bone

 Arch wire must be bilaterally similar in form or
should be so shaped as to eliminate any
asymmetry of arch

 Upper and lower arch wire forms not
coordinated
 Teeth will assume faulty relationship
 Ant. or pos. cross bite  cuspal interference 
prolonged Rx time


 Internal diameter of buccal tube too
small or large
 Best internal diameter 0.036” for 0.016” wire
 If less free sliding will reduced
 If more  molar control lessen, depression
force on ant. lessen


 Length 0.20” – 0.25”
 Shorter tube  lessens molar control & force of
anchor bend,

 Longer tube  more control, reduces the
distance of arch wire between mesial end of
molar tube and premolar bracket operational
difficulties during stage 3.

 Binding of doubled-back arch wire in flat
oval tube
 Binding will occur by having the legs too far
apart

 May be due to too large a radius where the
arch wire returned on itself, or too long a
vertical section extending from the hook that is
wound around the arch.
 Legs of double back are not
parallel.


 Improper ligature tie at canine
 do not pass ligature ties on canines over the
incisal of brackets  prevents free tipping

 It should pass directly distally across the labial
surface of canine


 Anchorage bend too far mesially
 Ideal location at the mesial of anchor molar
 It may become restricted by ligature tie on
bicuspid, preventing free distal sliding

 Arch wire will be projected towards the occlusal
plane and be deformed by occlusal forces.


 Anchorage curves instead of bends
 Gently curved anchor bend can be initially
placed so far mesially in the arch wire that it is
unnecessary to remove the arch wire from
mouth in order to make a new bend farther .


 Using 0.014” instead of 0.016” wire
 insufficient force from its AB to prevent the
anchor molars from being tipped mesially .
 Ant. Deep bite will also not open

 Thumb or finger sucking, lip sucking,
tongue thrusting and abnormal sleeping
habits
 Habit breaking measures

 Loosening of anchor molar bend
 Pull the affected molar forward
 Anterior teeth are not depressed


Conclusion
A thorough knowledge of basic principles
involved in Begg mechanotherapy is
essential to avoid any form of problems
during treatment.
An awareness of all possible problems help
us in every stage of treatment, leading to
excellent treatment results.


Thank you
For more details please visit


Begg seminar /certified fixed orthodontic courses by Indian dental academy

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