Begg seminar /certified fixed orthodontic courses by Indian dental academy


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Begg seminar /certified fixed orthodontic courses by Indian dental academy

  3. 3. THE BEGG TECHNIQUE Designed to permit teeth to move towards their anatomically correct position in jaws under the influence of very light forces.
  4. 4. Attachments used in Begg’s technique Brackets & lock pins Bands Molar tubes Ball end hooks Lingual Attachments
  5. 5. 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.
  6. 6. 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
  7. 7. 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.
  8. 8. 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”
  9. 9. 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.
  10. 10. 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)
  11. 11. Bondable brackets Strong union of bonding mesh with the proper base by way of brazing is essential. It is done without obliterating mesh holes.
  12. 12. 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.
  13. 13. Esthetic brackets Plastic brackets • • • • Made of polycarbonates Available in tooth color or crystal clear plastic Flat for centrals Curved for cuspids & bicuspids
  14. 14. 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.
  15. 15. Anatomical bases • Flat base for incisors • Bracket flange and base curved for cuspid & bicuspid – lack rotational control
  16. 16. Other types of brackets • LTD limited tipping design brackets • With built in torque – Kameda brackets • Combination brackets • Tip edge brackets
  17. 17. 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
  18. 18. 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
  19. 19. 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.
  20. 20. 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.
  21. 21. 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.
  22. 22. 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.
  23. 23. 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.
  24. 24. 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.
  25. 25. 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.
  26. 26. 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.)
  27. 27. 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.
  28. 28. Types of molar tubes Round Dimension - 0.036” inside diameter x 0.25” long
  29. 29. 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.
  30. 30. 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.
  31. 31. 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.
  32. 32. Additional round tube Placed on molars for engaging lip bumpers, head gears etc. Placed gingival to main tube.
  33. 33. 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.
  34. 34. 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.
  35. 35. 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.
  36. 36. 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.
  37. 37. 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.
  38. 38. Hooks for elastics For applying elastics or elastic thread for rotational movement.
  39. 39. Lingual sheath • This is used to put auxiliaries like expanders or TPA. • Internal diameter 0.036”.
  40. 40. 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.
  41. 41. 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.
  42. 42. 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.
  43. 43. 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)
  44. 44. • 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.
  45. 45. Lingual buttons & cleats Positioned directly opposite to area of arch wire engagement. (Bracket). To permit free m-d tipping & uprighting.
  46. 46. 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.
  47. 47. Elastic hook Positioned, so that the elastic will pull from a point as near to the center of crown as possible.
  48. 48. 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.
  49. 49. Stage I in Begg Technique
  50. 50. 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.
  51. 51. 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.
  52. 52. 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.
  53. 53. 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.
  54. 54. 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.
  55. 55. 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.
  56. 56. 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.
  57. 57. Anterior space closure methods
  58. 58. 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.
  59. 59. 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.
  60. 60. 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.
  61. 61. Co-ordination of stage I archwires
  62. 62. Correction of rotations in cuspids and bicuspids
  63. 63. Tying intermaxillary hook to the cuspid bracket
  64. 64. Placement of elastics
  65. 65. • Dontrix guage • 2-2.5 ounces of force • 1ounce = 28.33gms of force
  66. 66. Position of teeth at the end of stage I Occlusion at the end of stage I
  67. 67. 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
  68. 68. Stage II in Begg Technique
  69. 69. 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.
  70. 70. 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.
  71. 71. 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.
  72. 72. 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
  73. 73. 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.
  74. 74. 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.
  75. 75. 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.
  76. 76. 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.
  77. 77. Problems encountered with elastic wear
  78. 78. 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.
  79. 79. Auxillaries sometimes used in stage II
  80. 80. Teeth positions at the end of Stage II Extraction spaces closed. Crowns of upper and lower ant. teeth – tipped back or ‘dished in’.
  81. 81. 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.
  82. 82. 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.
  83. 83. Refinement in the conventional Begg technique
  84. 84. The differences are----• Changes in the concepts. • Improvement in the hard wear. • Modifications in the mechanics.
  85. 85. Changes in concepts ‘Theory of Attritional Occlusion’ & Differential force concept. Treatment objectives. Diagnosis. Treatment Planning. Biomechanics. Archform.
  86. 86. Changes in the hardware  Attachments.  Archwires.  Elastics.  Other components. Bypass hooks. Power pins. TPA & Jasper Jumper – when indicated..
  87. 87. 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.
  88. 88. 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.
  89. 89. 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.
  90. 90. 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.
  91. 91. 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.
  92. 92. Placement of attachments
  93. 93. 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.
  94. 94. Properties of newer grade wires • • • • • Yield strength Working range Resiliency Zero stress relaxation Formability
  95. 95. 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.
  96. 96. 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.
  97. 97. 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.
  98. 98. Alignment of crowded anterior teeth
  99. 99. 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.
  100. 100. 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.
  101. 101. Substage I B Bite opening Preference – incisor intrusion & avoiding molar extrusion. Conventional Begg – bite opening – molar extrusion + lower incisor protrusion.
  102. 102. 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.
  103. 103. CR
  104. 104. 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’
  105. 105. 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.
  106. 106. 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.
  107. 107. 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.
  108. 108. 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.
  109. 109. 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.
  110. 110. 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.
  111. 111. 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.
  112. 112. 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.
  113. 113. 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.
  114. 114. 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
  115. 115. 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
  116. 116. Problem Shooting in Begg & its Management
  117. 117. • 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 case. each and every
  118. 118. 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.
  119. 119. 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
  120. 120. Problems encountered during first stage and their remedies 1.Bite not opening.  Poor elastic co- operation.  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
  121. 121. 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
  122. 122.  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
  123. 123. 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
  124. 124.  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)
  125. 125.  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
  126. 126.  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
  127. 127.  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
  128. 128.  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”
  129. 129.  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
  130. 130. 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.
  131. 131.  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.
  132. 132.  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
  133. 133.  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.
  134. 134. 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
  135. 135. 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.
  136. 136. 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.
  137. 137.  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.
  138. 138.  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
  139. 139.  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.
  140. 140.  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.
  141. 141.  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 .  Patient education.
  142. 142.  Persistent tongue thrust or other adverse habits.  Patient education.  Placement of lingually directed spurs on lower anterior teeth.  Refer to speech and swallowing therapy spec .  Too much anchor bend.  Reduction of anchor bends.
  143. 143. 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
  144. 144.  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.
  145. 145. 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
  146. 146.  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
  147. 147.  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
  148. 148. 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
  149. 149.  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.
  150. 150. 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
  151. 151.  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
  152. 152. 6. Posterior space not closing  Poor elastic co- operation.  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
  153. 153.  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
  154. 154.  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.
  155. 155. 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
  156. 156. 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
  157. 157. 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
  158. 158. 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
  159. 159.  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
  160. 160.  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
  161. 161.  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  Use horizontal circle
  162. 162.  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  Use horizontal circle
  163. 163.  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
  164. 164.  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
  165. 165.  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
  166. 166.  Elastics not worn continuously (Intermittent wearing causes anchor tooth to become loose, Ant. teeth hardly move, Prolong Rx  anchorage loss)  Proper patient education
  167. 167.  Arch wire accidentally engaged in the slot of second premolar (Increases friction)  Use of bypass clamp  Remove the premolar band for first 6 weeks
  168. 168.  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
  169. 169.  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
  170. 170.  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
  171. 171.  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
  172. 172.  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
  173. 173.  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
  174. 174.  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.
  175. 175.  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.
  176. 176.  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
  177. 177.  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
  178. 178.  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
  179. 179.  Arch wire rolling in buccal tube  Avoid too much anchorage bend  and/or too much toe in bend
  180. 180.  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
  181. 181.  Upper and lower arch wire forms not coordinated  Teeth will assume faulty relationship  Ant. or pos. cross bite  cuspal interference  prolonged Rx time
  182. 182.  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
  183. 183.  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.
  184. 184.  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.
  185. 185.  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
  186. 186.  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.
  187. 187.  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 .
  188. 188.  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
  189. 189.  Loosening of anchor molar bend  Pull the affected molar forward  Anterior teeth are not depressed
  190. 190. 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.
  191. 191. Thank you For more details please visit