Refined begg 1 /certified fixed orthodontic courses by Indian dental academy

REFINED BEGG
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


CONTENTS
Evolution of Refined Begg’s
 Differences b/w Conventional and Refined
 Stage I – Substage Ia
- Substage Ib
 Checklist of Stage I



EVOLUTION OF REFINED
BEGG


Leyman Wagers: Treatment during mixed
dentition.



Milton sims: Undesired effects of multiloop



Swain: Advised using of headgear &
rectangular wires in certain situations.



Mulie, Ten hoeve & brandt: Need for
intrusion of upper incisors during bite
opening.



Hocevar: Difficulty in obtaining upper
incisor intrusion.



Kameda :Need to start root torque early.



Thompson: Need for posterior root torque.



Mollenhauer: Inadequacy of the theory of
attritional occlusion. Need for obtaining
functional occlusion.


DIFFERENCES





CONCEPTUAL CHANGES
Theory of attritional occlusion: Questioned by
Corrucini. Over emphasis on ext. in the
anticipation of crowding.
Concept of differential forces: It was thought
that light intra or inter arch forces would retract
the ant.,whereas heavier forces would make the
ant. teeth as anchor teeth & protract only the
post.It is now known that when heavy forces are
used for protracting the post. the ant. Teeth
would remain stationary until the hyalinised
tissue is eliminated. Then they would move
posteriorly.This resulted in dish in the profile.Now
prevented by using sufficient brakes.

TREATMENT OBJECTIVES
 For

static occlusion: Andrew’s 6
keys.
 Functional occlusion:
Synchronization of CO & CR.
 Elimination of hanging palatal cusps
of the upper posterior teeth, which
may cause functional disturbances.
 Cusped protected occlusion.
 Incisor guidance.

DIAGNOSIS
 Skeletal,

analysis.
 VTO

dental & soft tissue


TREATMENT PLANNING










COOK BOOK APPROACH DISCARDED.
Benefits of treatment during mixed dentition is
recognized.
Direct & modulate growth by using functional or
orthopedic appliances.
Conversion of borderline cases in non extraction.
”When in doubt, extract”discarded. Leeway space
is used to resolve mild crowding. Interproximal
reduction.
Upper molar distalization.
Asymmetric extractions.

BIOMECHANICS
Controlled tipping in 1st two stages
followed by root uprighting.
 Mollenhauer: Root control from the very 1st
stage. MAA- Aligns teeth, exerts ultra light
torquing & up righting forces on the
anterior teeth.Combines 1st & 3rd stage of
begg.3rd stage is shorter.
 Prevents undesirable uncontrolled tipping.
 Provides labial & lingual root torque.



ARCH FORM
Recognizes the benefits of maintaining the
lower arch form.
 Improving the upper arch form.
 Proper arch form & coordination of upper
& lower arch wires is checked at every
stage.



CHANGES IN THE HARDWARE
ATTACHMENTS
 Basic design of the begg bracket has not
changed.
 Depth of slot:0.020”,ht.0.045”,base 3mm
into 3mm.



BUILT IN ADJUSTMENTS


ANTI ROTATIONAL
ADJUSTMENT:MOLLENHAUER


BUILT IN TORQUE


KAMEDA:


DISTAL OFFSET IN THE MOLAR
TUBES


ARCH WIRES
Higher grade Australian arch wires like:
Premium, Premium plus, Supreme.
 Pulse straightened.
 Unraveling of crowding: Thin premium
plus or supreme wires, multi-stranded (coax) or NiTi wires are used.
 For finishing: alpha titanium wires.
Rectangular wires.
 Tandem wires :combination of rect.&
round cross sections in the ant. & post.
segment. Braking mechanism.



STAGE 1: Sub stage1-A & Sub
stage1-B


OBJECTIVES of sub stage 1A:Alignment(1-6mon)



To create space for correcting the crowded teeth,
or to close spacing if already present.



Alignment of anterior teeth by correcting
labiolingual displacements & / rotations.



Anterior crossbites present are corrected.



Improve upper incisor inclination. If they are
excessively flared, their proclination is reduced to
112degree to the S-N plane. Retroclined: they
are uprighted to 92degree to the S-N plane.

Rotations and bucco-lingual positions of the
upper molars are corrected so that a TPA
can be fitted. Molar crossbites are also
corrected.
 Certain types of rotations which can be
corrected by using palatal or lingual
attachments are corrected.
 If the upper arch form in the canine
premolar area is narrow, it is broadened to
permit mandibular advancement for
correcting the class 2 relationship. Distorted
archform correction is started as soon as the
0.016 archwire is employed. The lower
archform is maintained as a rule unless it is
excessively distorted.



ARCHWIRES IN STAGE - 1


Spacing present /space to be created
 The anteriors need to slide over the
archwire.0.016”
 Correction of malalignment: Wires
-light constant forces over long deflections
& long time are used. e.g.. NiTi,
multistranded wires & SS small dia. wires.
Used as sectionals with a S.S wire.
 Consideration of ant. overbite in the
context of effect of elastics.
 Class 2 elastics: stage 1:retracting the
upper ant.
 Vertical component: extrusion of the upper
anteriors & lower molars. Lingual rolling of
the lower molars.





Preferred wire:0.018”P+ or P because:



provides adequate intrusive force levels on the
incisors for true intrusion, after overcoming the
extrusive component of class 2 elastics.



Resists the lingual rolling of lower molars.



Open bite: Require extrusion of upper anteriors.
Upper archwire:0.014 P or P+ for bite closure.



Archform & rotational control:0.018”



Very efficient in correcting & maintaining the arch
form.



Better rotational control. When all teeth are well
aligned this wire can be used from the very start.

ALIGNMENT OF CROWDED
ANTERIOR TEETH


Initially-Multiloop wire: 0.016 S.S wire


Ill effects on anterior teeth: Inadequate
bite opening & labial flaring of incisor teeth
& buccal movement of the canine during
space creation
round tripping.
 Ill effects on post. teeth: Loss of control
over molar position & failure to maintain
anchorage.
 Difficult in construction & adjustment. As
teeth gradually align the loop orientation
may change & cause soft tissue irritation.
 Difficulty in maintaining arch form, width &
symmetry because of excessive flexibility
of the archwire.
 Difficulty in maintaining oral hygiene.



ALIGNMENT IN REFINED
BEGG
Relief of crowding
space opening
Sliding the canine crowns distally along
the 0.016 S.S wire.
 Flexibility: multistranded wires & NiTi
wires in sections along with S.S base
wires.



ARCHWIRE-NEGATE THE
EFFECTS OF ELASTICS
Stiff:0.016”S.S or 0.014” S.S
 Canines are malposed: diff. to engage
0.014”S.S-NiTi full length wire+0.014”S.S
with anchor bends without cuspid circles.





Both are engaged in the same molar tube.



In the ant. reg. the flexible wire is
engaged in the canine brackets & as many
brackets.



The S.S wire is not engaged in any of the
brackets but is ligated to the flexible wire
at 3 pts. :midline, b/w the laterals &
canines on either side.



The elastics are hooked to the high hat
pins in the canine brackets for their
distilization.


FULL LENGTH NiTi
ARCHWIRES
Max. canines are highly placed& also need
to be distalized to relieve crowding.
 Ultra light class2 elastics are hooked over
the canine bracket to move them distally.
 Anterior bite does not deepen, since the
high position canine absorbs the extrusive
component of the class2 elastics.





Open bite situation upper full length of
flexible archwire with class 2 elastics can
be used till the upper crowding gets
relieved, since bite deepening effect is
desirable.


AMT. OF CANINE DISTALIZATION
NEEDED TO CREATE SPACE


O.5mm space required to relieve
crowding:0.016” S.S. wire, cuspid circles tightly
pressing against the canine bracket, so that the
circles push the canine distally to open space.



1mm space, bilateral canine
distalization:0.014”S.S. wire, cuspid circles
formed 0.5mm distal to the canine bracket. As
many teeth as possible are pinned starting with
the canine bracket& the malaligned teeth are
ligated. This creates a pressure on the canine
bracket that distalizes them.



More amount of crowding: Space is
provided by sliding the canine distally
along the 0.016” or 0.014” S.S. wire, with
class2 elastics for the upper canine & class
1 elastic for the lower canine. The elastics
are directly hooked on the canine brackets
by the high hat pins. The cuspid circles are
omitted.




Excessive distal tipping of the canine: Light
uprighting springs made in 0.010”supreme wire
to reduce distal tipping.



Lower archwire: both cuspid circles are omitted
for bilateral canine movement, molar stops are
bent against the mesial end of the molar tube,
thus preventing mesial movement of the lower
molar reducing space available for upper incisor
correction. Stabilizes the archwire, so that it does
not move from one side to another causing
change in the location of the anchor bend.



Molar stops are not given in the upper archwire
since they hinder www.indiandentalacademy.com of the anteriors.
the retraction



Both cuspid circles are omitted in the upper
archwire, its distal ends are lightly bent abt. 1mm
away from the distal ends of the molar tube to
prevent it from sliding from one side to another.
This permits simultaneous uprighting of the
molars under the action of anchor bends which
are mesially angulated in class2 malocclusions.



When cuspid circle is omitted only on one side in
the upper archwire, the wire is stabilized using a
cuspid tie to the circle on the other side. Under
similar conditions the molar stop may still be
required in the lower archwire on the opposite
side to resist forward molar movement.

AMOUNT OF WIRE
DEFLECTION




Required to engage the archwire in the brackets
on crowded and malaligned teeth.
Min.1-2mm:0.014”/0.016”S.S.with offset or V
bends to align teeth partially. The force exerted is
not excessive on the periodontium, nor will it
dislodge the bracket. The bends are eliminated in
the next visit bringing abt. complete alignment.


Crowding more than 2mm:Flexible wire
0.016” or 0.014”NiTi,0.0165”coax or
0.009” Supreme
 Choice: Same dia. co-ax exerts less force
than NiTi when deflected over same
dist.0.009”S.S. supreme exerts more force
than 0.014”NiTi.
 NiTi: highest spring back, hardly get
permanently deformed when deflected
over large distances. S.S. have lesser
spring back. The co-ax wires are prone to
perm. deformation.
 Friction: Least with S.S. they resist sliding
of teeth least. NiTi have more& co-ax will
offer max. res.
 Cost: NiTi more than co-ax & supreme.



AMOUNT OF ROTATIONAL
CORRECTION REQUIRED








The wire should fill the slot as much as possible.
The springback of thin supreme is comparable to larger
dimension NiTi.
Supreme: Labio lingual displacements are to be corrected.
NiTi or co-ax wires should be considerer for rotational
correction.
0.014”NiTi round wires-permit full engagement in badly
malplaced teeth, with min. perm. deformation over large
distances

.


FLEXIBLE SECTIONALS






NiTi , co-ax or supreme wires in combination with S.S. base
wires, since weak to resist the adverse effects of the
elastics.
Should be started only after the canines have distalized
sufficiently to open adequate space to align incisors.
The base wire should not be very close to the brackets
since they hinder the action of the sectionals. Vertical
offsets are given to keep them away from brackets for 1-2
visits. Eliminated when the teeth are sufficiently aligned.


INDICATION FOR USING
SINGLE LOOP








When one incisor is crowded out of the arch, remaining
incisors & the other side of the canine are well aligned but
angulated towards the crowded incisor.
Loop-0.014” or 0.016” at the crowded incisor. The cuspid
circle touches the canines.
Loop is activated by opening it 2mm. Midlines are
corrected.
In the upper arch uneven class2 elastic force (Road runner
on the side of crowding & yellow elastic on the other side)


ANTERIOR OPEN BITE
0.014”S.S.-upper arch-extrusion, Class 2
elastics.
 Class 2 cases upper molars are mesially
angulated-mild to moderate anchor bends
are given.
 Lower arch wire is 0.016” S.S.



OTHER CORRECTIONS
CLOSING OF ANTERIOR SPACING
 Proclined: simultaneous retraction & space
closure.
 Well positioned without proclination: Teeth
moved mesially to close spaces. (midline
diastema)



RETRACTING PROCLINED OTHERWISE
WELL ALIGNED TEETH






S.S. 0.016”,cuspid circle 2mm mesial to the
canine bracket & cuspid ties are given. If placed
more than 2mm-elastic cuspid tie gets
overstretched-tipping of the canine mesially.
Class2 elastics-retracting upper anteriors
Class1 elastics-retracting lower incisors.
Space starts closing-cuspid circles touch the
canine brackets, they are rolled mesially every
visit till the spaces close.


SPACE CLOSED WITHOUT
RETRACTION






Macrognathia & microdontia: Cuspid circle are
kept mesially. Spaces are closed by tying the
anterior teeth with fig.8 elastomeric tie.
SPACED,PROCLINED,MALALIGNED:
malalignment is first.0.016” S.S. with mesially
placed cuspids.2 stage procedure: part of the
space is utilized by teeth undergoing alignment,
remaining space must be closed by incisor
retraction.
Since intrusion of the incisors takes some space
active space closure should not be started until
intrusion is accomplished, if the existing space is
less than 2-3mm on either side.

IMPROVING INCLINATION OF
UPPER INCISORS
Excessively proclined upper incisors:
retracted by class1 elastics with mild to
moderate anchor bends.
 Retroclined incisors: upright under the
effect of bite opening bends.
 This part of correction is due to
uncontrolled tipping. Beneficial at this
stage because it moves the root apices
away from the lingual & labial cortical
plate.



MOLAR POSITION
CORRECTION
Rotated molars: are corrected by toe in &
toe out bends in a S.S.0.016” wire.
 Mild buccolingual displacement: expansion
& contraction in the S.S. wire assisted by
cross elastics. More than 2mm of lateral
movement should not be attempted with
0.016” archwires. Such movements can be
accomplished by 0.7to 0.9mm S.S. wire.
T.P.A, Quad helix. Skeletal expansion: mid
palatal suture split.



ARCH FORM CORRECTION
Class2-broadened in the canine premolar
area by shaping the S.S. 0.016” archwire
suitably.
 If bite has to be opened by incisor
intrusion: premolars are bypassed by
having bayonet bends in the archwire b/w
the canines & the 1st premolars.
 Bite opening: premolar extrusion-anchor
curves are given.



PINS IN SUB STAGE 1A
Well positioned incisors: Stage 1 pins:
the full ht. of the slot is
available(0.045”)for free sliding of these
teeth for space opening or closure.
 Cuspids need to slide along the archwire
to align the crowded incisors, they are
engaged in the archwire using high hat
pins. They permit free sliding & elastic
engagement.
 Hook pins: To engage both the sectionals
& the base archwire in the brackets to
align malposed teeth.



Refined begg 1 /certified fixed orthodontic courses by Indian dental academy

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