Modern begg –

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Modern begg –

  1. 1. Modern Begg – Beddtiot & CAT Techniques. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Introduction Conventional Begg – empirical and cook book trt. Begg operators – limitations - need to diverge from orthodox trt. Contemporary trt. goals & strategies – incorporated into Begg practice. Modern Begg. Refined Begg. www.indiandentalacademy.com
  3. 3. Modern Begg. Follows Begg principles – large extent. Brackets – modified ( other than Ribbon arch type – used in conventional Begg) www.indiandentalacademy.com
  4. 4. BEDDTIOT. (Begg Edgewise Diagnosis Determined Totally Individualised Orthodontic Technique.) Offers capacity to employ selected principles and features of Begg and Edgewise mechanisms – specific situations – most advantageous. Primary Goal Facility to treat each patient’s needs – most efficient for that individual. www.indiandentalacademy.com
  5. 5. Strong points in Begg Technique: Proficiency in bite opening.( with  elastics ) Differential response to force. pitting limited tipping x translation. optimal ant. movement, anchorage conservation. Edgewise appl. Precise control. Facilitates anch. Expenditure. www.indiandentalacademy.com
  6. 6. Foundations: Light wire. Gentle, long range force systems Min. bracket size – max. interbracket span. Light undersized wires. www.indiandentalacademy.com
  7. 7. Differential response to force. Simple horizontal force  Tooth  tip. Crestal bone – exp. 3x times more force than apical bone. Crestal region – force sufficient – rapid tooth movement. Apical region – insufficient force. www.indiandentalacademy.com
  8. 8. Less bone around the neck of the tooth than apex. strain near the alveolar crest. Stress in apical region. Above factors – multiply each other. powerful adv. – very light “simple tipping forces”. www.indiandentalacademy.com
  9. 9. www.indiandentalacademy.com
  10. 10. Retraction – tipping + uprighting Adv. – anchorage conserved. Effective translatory retraction – greater force – greater anchorage loss. Repositioning roots after tipping – reaction strain – insufficient for anchor loss www.indiandentalacademy.com
  11. 11. Modern orthodontic system – concerned: Interdental relationships. Facial str. & appearance. Orientation of the dentition in the face. Oral function. Best approach – determined by diagnosis. Appliance – versatile. www.indiandentalacademy.com
  12. 12. Brackets. Dimensions: Narrow, single width – edgewise br. ( 0.050 inch or 1.3 mm). Horizontal slot – 0.022” ( height ) x 0.028” (faciolingual depth). Vertical slot – 0.020 x 0.020”. Archwire slots – torqued. . www.indiandentalacademy.com
  13. 13. Torque values - 0°, 5°, 10°, 15°, 20°. All brackets identical - except for torque. Torque indicator groove - gingival – lingual root torque. - occlusal – lingual crown torque www.indiandentalacademy.com
  14. 14. Brackets: bonding preferred. Prewelded – flat/curved – universal bonding pads. Advantages: Facially facing archwire slots – engagement of archwire easy. Small dimensions – . lip & cheek irritation.  occlusal interference.  bonding enamel surface.  problems with gingival proximity & oral hygiene. www.indiandentalacademy.com
  15. 15. Interbracket – long resilient span - archwire. Wire – less distortion. Less elastic range requd. force. Considerable ( limited ) tipping . 0.016 wires - 10° distal crown tipping. 0.018 wires - 5° mesial crown tipping (uprighting) “braking” – not required. Vertical slot Uprighting springs Turned 90° - miniature buccal tube. www.indiandentalacademy.com
  16. 16. Uprighting springs. Original Recent Original. Helix farther from archwire. Hook arm – no extra offset reqd. Recent More hygienic. irritation on gingiva. Appearance –less conspicuous www.indiandentalacademy.com
  17. 17. Buccal Tubes: Dimensions: 4.5 mm long, 0.022 x 0.028” – edgewise. lingual crown torque, 25° – lower. 10° - Upper. Distal end of max. tube - 10° outward angulation. ( toe- in). Headgear tube – 0.051” – occlusal & buccal. www.indiandentalacademy.com
  18. 18. In cases with deep bite/ moderate - severe anchorage req Addnl. Rect. Tube – diagonally across – buccal surface of basic tube – mesial end pointing gingivally. Dimensions. 4.5mm long, 0.022 x 0.028”. Outer tube ( Addnl. Tube ) - 15° angulation to inner tube. www.indiandentalacademy.com
  19. 19. Bite Opening: Outer tubes – main arch wire – bite opening & retraction phases. Gingival angulation – effective built in anchor bends.( actual bend - - 25° ). Inner tubes – Rect. sectional wires – lock PM & Molar. single large tooth – C.R mesial than - C.R of Molar www.indiandentalacademy.com
  20. 20. Bite opening – more potent – check elastics. Intrusive force - - less tendency to tip – anchor units distally. www.indiandentalacademy.com
  21. 21. Rotations: Early belief – rotation control difficult. Offset bracket – side of tooth disp. lingually. Overcorrection – thickwalled – elastomeric lig.- placed on wire – before insertion. Bayonet bends. www.indiandentalacademy.com
  22. 22. Torque control: Disadv. Of larger slot – 0.022 x 0.028 – large wires used – precise control – Rigid. Overcome – resilient rect. Wires – ribbon mode. Sizes used: Square wires. 0.019 0.020 0.021 0.022 0.020 x 0.016” 0.021 x 0.016” 0.022 x 0.016” www.indiandentalacademy.com
  23. 23. Newer non steel alloy archwires – Extremely resilient – gentle forces Approp. size – precise bracket engagement. Esthetic & Hygienic. ( eliminate – aux.) Torqued brackets  build trt. into the appl. Facial root torque – lower incisors – augment anchorage. 0.022 x 0.016” , 5° torque. Limit tipping of upper incisors - palatal torque. www.indiandentalacademy.com
  24. 24. Important adv. - BEDDTIOT – Facility for both 3 dimensional control & simple bracket Limited tipping – light forces Facilitate application of the best modality in every situation. www.indiandentalacademy.com
  25. 25. Combined Anchorage Technique Variable Anchorage systems. Design of the attachment – provides optimum light wire & straight wire trt. capabilities. Four stage light wire appliance  successful collaboration b/w Begg practitioners & Unitek Beneficial design features – adv. of Begg & St. wire. www.indiandentalacademy.com
  26. 26. Advantages & Disadv. of the two tech. Begg light wire appl. Advantages: Light optimum force –( 60 – 90 g ) Continuous force. Min. friction. Rapid alignment, leveling , rotation of ant. teeth. Rapid overbite correction. Simultaneous crown tipping. Continuous paralleling of roots at extn. sites. Continuous torquing. Extra oral force unnecessary. www.indiandentalacademy.com
  27. 27. Disadvantages. Diff. – co-ordinating max. & mand. arch Diff. – bilateral symmetry. Premolar & molar torque control – diff. Diff. in stabilizing teeth – final artistic positioning. www.indiandentalacademy.com
  28. 28. Straight wire appliance. Advantages: Precise control – PM & M torque. Bilateral symmetry – BL inclinations – readily attained. Bilateral symetry of arch form. bends in archwires. Finishing Self limitation of movmt. & stabilization of teeth- final detailing. www.indiandentalacademy.com
  29. 29. Disadvantages. force levels – wider bracket, interbracket span. Rapid ant. alignment diff. Overbite correction diff. Addnl. anchorage – necessary- friction. Extra oral force – reqd. Alignment – incisors & canines – in sequence. www.indiandentalacademy.com
  30. 30. Dynamic & Static anchorage. Dynamic anchorage It comprises – physical forces generated by the appl. – in a complex interrelationship – equally effective forces – biologic environment. Light wire force sys. Biologic force sys. Unipoint contacts Muscle action Anchor bend Tooth morph & mass. Archwire Cuspal interlock. Aux. wire Freeway & fnl. Paths. Tipping force Occl. Force & migr. Intr forces Bone density Extrusive forces Growth Rot. Forces Habits www.indiandentalacademy.com
  31. 31. Static Anchorage. Increasing the forces – within the appl. Less effect of the biologic force sys. CAT – dynamic & static anchorage resistance dev. - applied – certain stages – trt. program. Stage I & II  Dynamic. Stage III  Dynamic / Static. Stage IV  Static. www.indiandentalacademy.com
  32. 32. Four Stage Light wire Appliance:  Appl. – vehicle – transmitting force – teeth &indirectly – bone & soft tissue.  Design of appl. Elements, positioning, adjustments & manipulations – imp. – max. trt. efforts. Caution: Prudent to use conventional approach – each trt. stage – as long as progress is good. www.indiandentalacademy.com
  33. 33.  Brackets. Gingival or Ribbon arch slot – free tipping, no binding. Edgewise slot – precise final detailing. Three bracket types – optimal rotations, tipping & torque. Base beveled – friction or binding with archwire. Torque, tip, in –out – sp. vary for each tooth. www.indiandentalacademy.com
  34. 34. Molar tube: 0.036 round tube – gingivally.( Begg ) 0.018 x 0.025” or 0.022 x 0.028”. Tubes - 7° offset – addnl. molar control – Stage II. 0.018 x 0.025 slot – recommended. Conventional tubes – preferred to convertible tubes. www.indiandentalacademy.com
  35. 35. Placement of brackets & tubes: All teeth except 2nd molars – receive attachment – as soon as practical: increase force control. Mandibular 1st molar tubes – placed first. 0.036 tube – gingival margin. rect. Tube – middle third of crown. edgewise tube – 3.5 mm – tip of buccal cusp of 1st molar. 3.5 mm – std. for all brackets, EXCEPT, Canines & upper LI br. canine br. – 0.5 mm gingivally, LI br - 0.5 mm incisally. www.indiandentalacademy.com
  36. 36. Treatment technique: Trt. divided into 4 stages. Stage I - Organization. Overbite correction. Cl. II or Cl. III correction. Alignment, levelling, elimination of rotations- incisors. Correction of crossbite & archwidth problems. Overcorrection www.indiandentalacademy.com
  37. 37. Stage II. Consolidation. Closure of remaining spaces. Retraction of incisors. Maintenance of overbite, rotations, antero-post. corrections. Overcorrection. Stage III. Correction of crown & root inclination. Uprighting & paralleling of roots. Torquing of ant. teeth. Maintenance of corrections. www.indiandentalacademy.com
  38. 38. Stage IV. Final detailing. Attainment – ideal arch form & co-ordination of archwidth. Attainment – desired torque. Precise intercuspation & fnl. harmony. Optimal facial & dental esthetics. Commencement of retention. www.indiandentalacademy.com
  39. 39. Stage I. Archwires: Initiated – 0.016 round wires – Begg slot. Cl II elastic force – lingual rolling – lower molar. Mild exp. – ¼ ” – reqd. 45° anchor bend – 1-2 mm mesial – molar tube. In severe crowding – Multiloop – deep bite/ max. anchorage cases. Niti – shallow bites / min. anchorage req. www.indiandentalacademy.com
  40. 40. Anchor bends- Intrusive + labial movement. Extrudes & tips – molars – distally. Class II elastic force: Combination of intrusive + retractive forces – Center of rotn.- more apical – max. lingual crown tipping. Elastics: Very light elastic forces. 2 -3 oz. – 24 hrs a day. www.indiandentalacademy.com
  41. 41. Stage II. End of stage I – occl. organized appearance. St. II begins – consolidation of the dentition. Goals in Stage I – not reduced. Elastics: Intrarch elastics – max. ant. retrcn. & gen. space consolidation. 2-3 oz. Six elastics – used. Elastics eliminated – space closed. Arch wire bent distal to molar tube. www.indiandentalacademy.com
  42. 42. Archwire: 0.018” round wire. 25° anchorage bend, 5° toe in bend. Toe in bend – counter act rotational moment – inter arch elastics. www.indiandentalacademy.com
  43. 43. Stage III. Crown & root coordination/ torquing & paralleling stage. All spaces closed. Crown tipping may be considerable. All corrections – maintained. Molars & canine – Class I reln. post. occlsn. – inter locked – min. anchor loss- subsequent – torquing & uprighting. www.indiandentalacademy.com
  44. 44. Pre stage III reqd. – occasionally. Reevaluation of br. ht & posn. – recommended. Archwires: Maxillary: 0.020 dia. Constr. To Omega shape. Anchor bend 0 - 5°. Inset bend into molar tube. Vertical bend – premolar slot. V bend distal to canines. Cinched . Overcorrected. www.indiandentalacademy.com
  45. 45. Mandibular: 0.018 or 0.020 dia. Exp. ¼ ” bilaterally. Inset bend – molar tube. Vertical bend into premolar. V bend distal to canines. Anchor bend of 5° - 10°. Cinched. Overcorrected. www.indiandentalacademy.com
  46. 46. Auxiliaries: Uprighting springs. Two forms. Safety ligature – hold tooth – archwire. Safety lock spring – safety extension – holds wire in gingival slot. Wire size used – 0.014 or 0.016. Torquing Aux. 0.016 wire – four spur/ two spur. www.indiandentalacademy.com
  47. 47. Stage III – complicated. Constant monitoring –reqd. In CAT – absolute determination – final uprighting, B-L placement, torque – not reqd. Straight wire slot – final artistic finishing - teeth. www.indiandentalacademy.com
  48. 48.  Stage IV. Trt. done in edgewise slot. Preangulated,pretorqued, in – out features – precise crown & root pos’n. Stage IV – not a substitute – Stage III – Begg. Excellent bite opening. Enmasse retrcn. of incisors – Stage I & II. Rapid uprighting – canine & PM roots. Torque of incisors – Stage III. All these adv. to be used to greatest extent – Begg mech. www.indiandentalacademy.com
  49. 49. Stage IV: Primarily to increase – effectiveness & precision- final detailing. hygiene problems – auxiliary springs. Lingual crown torque of post. teeth. Establish bilateral symmetry – uprighting. Achieve – proper paralleling & torque. Coordinate arch form & width. Second molars: More optimal occlusal reln. To obtain best arch form. Coordinate crown & root torque of post. teeth. www.indiandentalacademy.com
  50. 50. To get levelling - two preliminary – round wires – 0.016 or 0.018 Nitinol wire. Edge wise slot mech. – alignment adequate. Wires used. 0.017 x 0.025 NiTi. 0.016 x 0.022 , 0,018 x 0.025 – SS. Max. torque benefit – 0.018 x 0.025 ss. Post. teeth good axial incl. – reduce force levels – 0.018 round . www.indiandentalacademy.com
  51. 51. Final Detailing. Adjustments / modifications – archwires - Discrepancies – size, symmetry, fn. of teeth. Repositioning br. / 1st order or 2nd order bends. Settling – 0.014 wire + vertical elastics. Finishing & Retention: Bonded canine to canine – lower. Hawleys Appliance – Upper. www.indiandentalacademy.com
  52. 52. Advantages of CAT. Enhances trt. potentials. Accumulates trt. advantages. Reduces response time. Enhances muscular effects. Simplifies co-operation. Variable anchorage effects. Reduced energy losses. Diversity of three slots. Controlled tipping & translation. Goal oriented trt. Establishes positive profile control www.indiandentalacademy.com
  53. 53. Conclusion. CAT system is a biomechanical approach to treatment which enables the clinician to vary the treatment technique, vary the type of movements and vary the resistance anchorage to simplify co-operation and to definitely expand the opportunity to overcome problems and enhance success of trt. www.indiandentalacademy.com
  54. 54. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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