consideration of stage 1 in begg technique/certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
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consideration of stage 1 in begg technique/certified fixed orthodontic courses by Indian dental academy

  1. 1. A general consideration of Stage I in Begg Technique. www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. Introduction • General objective of any ortho trt. – to obtain a result that simulates normal occlusion. • With Begg technique objective achieved by dividing trt. into 3 stages. Stages I and II – Crown tipping phase. Stage III – Root tipping phase. Stage IV – Finishing phase www.indiandentalacademy.com
  3. 3. • Overlapping of the stages must be avoided. • ie. Objectives of each stage met before proceeding • Therefore better results and fewer problems are encountered. • Division into stages – to prevent anchorage failure – Teaching and learning made easier. www.indiandentalacademy.com
  4. 4. Objectives of Stage I • Correction of crowding and irregularity • Closure of anterior spaces. • Correction of rotations. • Elimination of deep bites -edge to edge bite / open bite except in class III www.indiandentalacademy.com
  5. 5. • 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 • Co-ordination of upper and lower arches. www.indiandentalacademy.com
  6. 6. • 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. www.indiandentalacademy.com
  7. 7. Orthodontic apparatus in Stage I • Attachments – Bands, brackets, tubes & lingual cleats. • Archwires • Ligatures. • Elastics. • Auxiliaries.- Rotation springs. www.indiandentalacademy.com
  8. 8. • Apparatus applied simultaneously – to avoid breakage – Act simultaneously to reciprocal adv. with each other • Creeping into trt. avoided  Severe loss of anchorage. www.indiandentalacademy.com
  9. 9. Archwires Material – – 0.016 special AJW – principal wire of Stage I. – Combination of resiliency, flexibility & stiffness – Important for bite opening by incisor intrusion – Developed by rigid control in wire drawing and heat trt. – 0.018 special – Molar extraction cases – 0.014 special – rotating springs. www.indiandentalacademy.com
  10. 10. Parts • Intermaxillary Hooks – ( IMH ) Small loops for engaging elastics and cuspid ties – 2 types – • Boot • Circle/ Helical – Adv of Circle hook. • Mesial & Distal rolling possible • Less space requirement. • Less distortion • Greater stiffness in horizontal and vertical plane. • Neat & simple www.indiandentalacademy.com
  11. 11. Location – Well aligned ant. – 1-2 mm mesial to the cuspid bracket. – Spaced ant. – Farther mesially. – Mildly crowded ant. – impinging on the bracket. – Severely crowded – multi loop wires. www.indiandentalacademy.com
  12. 12. • Anterior Segment. – Portion of the wire b/w IMHs – lies gingival to buccal segment for effective intrusion – Reverse curve at midline – 2-3 mm elevated form occlusal plane for even intrusion. www.indiandentalacademy.com
  13. 13. • Cuspid Offset bend. – Horizontal offset bend mesial to the IMH. – Proper positioning of the cuspid and the lateral incisor. • Cuspid Curve: – Labial curvature in cuspid area – incorporated to avoid lingual tipping of canines. – In narrow arches requiring expansion, definite offset given. www.indiandentalacademy.com
  14. 14. • 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. www.indiandentalacademy.com
  15. 15. -Inclination of anchor molars. – Mild to moderate inclination – slight anchor bend. – Severe inclination – Initially no anchor bend. – Later gradually increases anchor bend to upright the molar. – No intrusion of anteriors beyond edge to edge or mild openbite. www.indiandentalacademy.com
  16. 16. • Location depends on – Time elapsed since commencement of trt. – as far mesially. Distal to bicuspid bracket. In mild open bite and overbite – anchor curve. -Depth of overbite. Greater reduction in overbite if closer to the molar tube. www.indiandentalacademy.com
  17. 17. • Rate of progress. • Amount of space remaining. • Location in looped archwire. • Non – extn. cases • 1st molar extn. cases. • 2nd Premolar extn. cases. Nearer the tube www.indiandentalacademy.com
  18. 18. • Toe in and toe out bends. – Horizontal offset bends combined with anchor bends. – Anchorage bend bent lingually – toe in. – Anchorage bend bent buccally – toe out. www.indiandentalacademy.com
  19. 19. • 4 functions. – Corrective – to correct existing molar rotations. – Preventive – to counteract rotations due to Cl I elastics. – Passive – to maintain normal alignment. – Combination of corrective and passive - to rotate molar but axis of rotation is at mesial or distal. www.indiandentalacademy.com
  20. 20. • Molar Stops. – Limit extent to which wire can slide through molar tube. – Indications. • For preserving space in Non extn. Trt. Mixed dentition trt. 3 types. – Removable locks – easily employed passively. – Bent into archwire – reduced bulk. – Coil spring. www.indiandentalacademy.com
  21. 21. Shape and form – Compromise b/w the shape of the M.O & normal occlusion. – Expansion for prevention. • ¼” in molar area for upper arches. • ½” in molar area for the lower arches. – Symmetry and co-ordination. • 2 types of stage I archwires Plain Looped www.indiandentalacademy.com
  22. 22. • Plain archwire. – Deep overbite. – Asymmetrical arches. – Mild or no crowding. • Looped archwies. – Moderate to severe crowding. – Consists of vertical loops 6-8mm high & 1 mm wide in the anterior segment. www.indiandentalacademy.com
  23. 23. www.indiandentalacademy.com
  24. 24. • Comparison. – Levelling and alignment. • Looped archwire due to greater flexibility is superior especially in the horizontal plane. – Bite opening. • Plain archwire due to lack of flexibility results in even intrusion of anteriors. – Maintaning archform. • Relative inflexibility of archwire enhances overall inflexibility. – Patient comfort. • Greater with plain archwire. www.indiandentalacademy.com
  25. 25. • Decline in the use of looped archwire due to :- – Ill effects on anterior teeth. • Inadequate or uneven bite opening. • Labial flaring of incisors and buccal movement of canines. www.indiandentalacademy.com
  26. 26. – Ill effects on posterior teeth. • Molar rotations • Anchorage loss. – Difficulty in construction and adjustment. – Difficulty maintaining arch form. – Difficulty in maintaining oral hygiene. www.indiandentalacademy.com
  27. 27. • Newer wires in Begg. – 0.014 SS, braided, twisted, Niti wires etc. – Not to be used alone. – In conjunction with base plain wire. www.indiandentalacademy.com
  28. 28. • Engagement of Archwire. – Insert into molar tubes and pin easily accessible incisor brackets. – Pin the cuspid brackets first in the looped wire. – Pinning done lightly and ligate loosely all severly displaced teeth. www.indiandentalacademy.com
  29. 29. • Rotated cuspids not engaged, loosely ligated & derotated with elastic threads or spring. • Archwire loosely attached to premolars by – Loose ligatures – Retaining ring www.indiandentalacademy.com
  30. 30. • Cuspid ties. – Ligature tie from intermaxilary hook to distal of cuspid bracket. – Prevents drifting of anterior teeth. – Loosely tied. – Precise & controlled tooth movements not possible if teeth are spaced interproximally. www.indiandentalacademy.com
  31. 31. www.indiandentalacademy.com
  32. 32. • Cut the ends of the archwire. • If cut flush with molar tube round of the edges. • Prevents ‘ratchet & pawl ‘ or ‘ trammel effect’. • If light forces are used – Reactivation in next appointment without removing the archwire. • If heavy forces are used – no movement or excessive movement. www.indiandentalacademy.com
  33. 33. • Elastics. – Hard to overstate the importance of elastics in Stage I of Begg technique. – Anterior retraction and antero-posterior correction of molar relation • Entirely due to elastic force. – Posterior crossbite • Mainly due to elastic force. – Bite opening. • Joint influence of archwire and elastic force. www.indiandentalacademy.com
  34. 34. • Types of elastics in Stage I. – Intermaxillary elastics – 2- 21/2 ounces / side. • Class II • Class III. – Anterior elastics • For space closure in the anterior region. • Used only after considerable retraction. • 1-2 ounces force exerted. • Criss – cross elastics. www.indiandentalacademy.com
  35. 35. Class II Class III www.indiandentalacademy.com
  36. 36. • Cross bite elastics. – Unilaterally or bilaterally. – Exerts 6-7 ounces vs ¼ - ½ ounce exerted by archwire. • Openbite elastics. – Used in box form. – Deferred till posterior occlusion is normal. – Chance of root resorption. • Elastomeric thread – For correcting rotation. www.indiandentalacademy.com
  37. 37. • Time interval b/w appointments. – Inversly proportional to the no. of new forces introduced. – Directly proportional to the length of time the forces should be maintained. www.indiandentalacademy.com
  38. 38. Problems encountered during first stage and their remedies. 1. Bite not opening. • Patient not wearing elastics. • Educate patient and the parents. • Patient biting out bite opening bends. • Restore bite opeing bends. • Check eating habits. • Lower the level of mandibular molar tubes. • Move the anchor bends closer to the molar tubes www.indiandentalacademy.com
  39. 39. • Inadequate anchor bends. • Anchor molars out of occlusion. • Vertical elastics. • Horizontal elastics. • Loose molar band. • Readapt and recement band. • Improper angulation of buccal tube or entire molar band. www.indiandentalacademy.com
  40. 40. 2. Molar width narrowing. • Vertical component of Class II elastic. • Considerable expansion in molar region. • Expansion auxiliary in 0.018 SS. • Prolonged wearing of cross elastics. • Correct crossbite by other means.- doubled back wire, vertical elastics or finger springs. • Distolingually rotated cuspids. • Engage wire in cuspid bracket after derotation. www.indiandentalacademy.com
  41. 41. • Rotational elastic tie on the lingual from the 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 bicuspid to the arch wire. • Rolling of the distal ends of the archwire. • Place toe in or toe out bends. www.indiandentalacademy.com
  42. 42. 3. Adverse tipping of anchor molars. • No anchor bends ( if tipped mesially ) • Too much anchor bends ( if tipped distally ) • Anchor bends in place for too long. • Place bracket on first molar and band second molar • Improper placement of molar tube or band. • Loose molar band. • Excessive elastic force. • Improper placement of elastics on tooth. • Oversize archwire • Replace with 0.016 wire. www.indiandentalacademy.com
  43. 43. 4. No appreciable changes. • Not weqring elastics. • Archwire bent out of shape. • Oral habits that counteract forces of appliances. • Patient seen too soon. 5. Vertical loops buried in the gingiva. • Looped archwire left too long. • Replace it with plain archwire with bayonet bends. • Misjudgment in direction of loops. • Modify direction of loops. www.indiandentalacademy.com
  44. 44. 6. Elastics which break or do not stay on. • Excuse for not wearing elastics. • Elastic not staying on intermaxillary circle. • Pull elastic distally into circle. • Open intermaxillary circle vertically. • Distal end of archwire too short or imbedded in the gingiva. • Bend away the wire or make new archwire. • Elastic hook on the molar band. www.indiandentalacademy.com
  45. 45. 7. Lock pins lost. • Occlusal – incisal forces. • Use steel pins • Open the bite. • Patient picking at them. • Patient education. • Bend tails of pins tightly. • Use ligature wires. 8. Extremely mobile molars. • Clenching of teeth. • Chew gum. www.indiandentalacademy.com
  46. 46. • Intermittent wearing of elastics. • Patient education. • Pathology. • Take periapical x-ray, refer to periodontist or physician. • Excessive force applied to the molar. • Reduce archwire to 0.016 inch. • Reduce elastic force. • Reduce anchor bends. • No apparent cause. www.indiandentalacademy.com
  47. 47. 9. Lower anterior teeth tipping labially. • Optical illusion. • Education. • Binding of archwire in bicuspid brackets. • Use bypass clamps. • Remove bicuspid band. • Binding of ends of archwires inside buccal tubes. • Replace with wires of sufficient length. • Poor diagnosis • Reconsider the necessity for extraction of teeth. www.indiandentalacademy.com
  48. 48. 10. Anterior openbite not closing. • Patient not wearing anterior vertical elastics. • Patient education. • Persistent tongue thrust or other adverse habits. • Patient education. • Placement of lingually directed spurs on lower anterior teeth. • Speech and swallowing therapy. • Too much anchor bend. • Reduction of anchor bends. www.indiandentalacademy.com
  49. 49. 11.Tooth not rotating. • Not enough space. • Check diagnosis or archwire design. • Not enough activation in the bracket area of the archwire. • Elastic threads slipping over the top of the tooth. • Lower the level of the archwire or lower the lingual button. 12.Midline discrepancy. • Asymmetrical tipping of anterior teeth. • Do nothing. www.indiandentalacademy.com
  50. 50. Summary. • Opening of the bite. – Use of 0.016 hard resilient wire. – Adequate bite opening bend. – Continual wearing of Class II o Class III elastics. • Elimination of anterior crowding. – Looped archwire. – Plain wire with coaxial alignment wire. www.indiandentalacademy.com
  51. 51. • Close anterior spaces. – Plain wire with latex elastic or e-chian. • Derotation of cuspids & bicuspids. – Derotation spring or elastic threads. www.indiandentalacademy.com
  52. 52. • Correction of posterior crossbite. – Modify archwidths of one or both archwires. – Use of cross elastics. – RME prior to stage • Mesiodistal relationship of buccal segment. – Wearing of class II or class III elastics. – Proper anchor bends. www.indiandentalacademy.com
  53. 53. CONCLUSION • Although Begg mechanotherapy has undergone considerable modifications and refinements,its division into three stages and the objectives of each stage have remained largely unchanged. • It is imperative that the objectives of Stage 1 be achieved before proceeding onto Stage 2 with the prime aim of preventing anchorage loss. As a result, one is able to do away with anchorage preparation and head gears. • Moreover, the over correction of most tooth positions by the end of Stage 1, which is quite early in the trt, helps in increasing the stability of the results. www.indiandentalacademy.com
  54. 54. www.indiandentalacademy.com Thank you For more details please visit www.indiandentalacademy.com

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