Modified beggs /certified fixed orthodontic courses by Indian dental academy

SEMINAR ON

MODIFIED
INDIAN DENTAL ACADEMY
BEGGS
Leader in continuing dental education
www.indiandentalacademy.com


1

Introduction
The present Begg practice differs considerably from the
traditional. Begg practice as under gone many changes over
the time which have enhanced its efficiency and made it
capable of meeting the contemporary treatment objectives.
It must be noted that the basic tenants of Begg
mechanotheropy have largely remained unaltered because
they are relevant for ever.
They can be summarized as follows;
1. Use of light orthodontic forces
2. Crown tipping movement followed by root movement for
efficient ultimate bodily translation with the least taxation of
anchorage.


2

3. Use of brackets permitting free tipping movements in the
initial stages due to minimum friction between wire and the
bracket.
4. Use of differential force for movements of different group of
teeth.
5. A definite sequence of treatment stages, eg. Bite correction
proceeding other movements. Treatment is divided into three
clear cut stages.
6. Use of light intraoral elastics.


3

7. En mass movement of anterior and posterior teeth for
objectives like overjet reduction and correction of posterior
occlusion.
8. Overcorrection of all displacements.
9. Use of round high tensile wires.
The changes introduced by various workers are on
account of the following reasons;
1. Changes in the treatment philosophy : Not all Begg
practitioners accept the alterational occlusion concept today as
the basis for treatment planning. Attempts are being made to
reconcile the Begg treatment with the Andrew’s six keys to
normal occlusion.


4

2. changes in the treatment approach: Advantages of mixed
dentition treatment are realized. Profile consideration has
assured greater importance reducing the number of extraction
cases and seeking extraction choices other than the first
bicuspids in many cases.
3. In order to overcome the deficiencies in the traditional Begg
treatment such as its inability in achieving final finishing or in
intruding the upper anteriors, the Begg mechanics is modified.
4. Several refinements have been introduced to take advantage
of the newly developed materials, especially the wires.
5. Attempts have been made to combine the best in Beggs with
the good aspects of other techniques.

5

What is conventional Begg, Modified Begg and refined Begg?

Conventional Begg is the Begg treatment as outlined in the
textbook authored by Begg & Kesling.
The term modified Begg is applied to the treatment which
follows the Begg principles to a large extent, but which uses
brackets other than the ribbon arch bracket. Examples of some
such brackets are the combination brackets (Chun-Hoon,
Kessler, Fogel and Magill, four stage or C.A.T.), the edge wise
brackets in Beddtiot approach and the tip edge brackets.


6

The refined Begg is the current Begg practice using the same
Begg brackets, which is significantly deviated from the
conventional Begg. It is still within the framework of basic Begg
tenets.


7

THE MODULAR SELF LOCKING APPLIANCE SYSTEM
1 1976
Sep
653 – 660 The Modular Self-Locking Appliance
System A Variation in the Combination Technique - MAXWELL S.
FOGEL, DDS

2 1976

JACK M. MAGILL, DDS JCO

Oct

728 - 741 The Modular Self-Locking Appliance

System Part 2: A Variation in the Combination Technique –
3 1976

Dec


System Part 4: A Variation in the Combination Technique 4 1976

Nov


System Part 3: A Variation in the Combination Technique 5 1977

Jan

51 - 59 The Modular Self-Locking Appliance System

Part 5: A Variation in the Combination Technique

8

THE MODULAR SELF LOCKING APPLIANCE
SYSTEM
This method, which is a light wire system using a single pivotal
bracket or twin self-locking low frictional attachments, has
clinically demonstrated simplified and securely controlled
mechanics for individual and collective tooth movements to
attain optimum end results.
The insert bracket, become the cornerstone of a completely
practical round wire technique by combining it with a twin selflocking modular attachment.


9

Both single and double insert brackets, with selflocking components, offer simple and practical
time-saving feature by completely eliminating
ligature tying and repeated pin placement.

An added factor is the versatility of this unique
method of directing tooth movement in all planes, in
most instances without the use of time-consuming
application of multiple spring auxiliaries


10

Insert Bracket
The principal module is the Insert Bracket, which is made of a
special soft stainless steel. The stainless steel insert bracket
does not undergo electrolytic changes, although it possesses
the desired quality of softness. Steel is stronger, generally
lasting throughout treatment, and can be opened and closed as
many times as necessary.
The elements of the insert bracket are:

Archwire chamber (.025"). For maximum performance in light
wire therapy, the round archwires float freely in the .025
chamber. The chamber is strategically placed in relation to
bracket wings, permitting adequate tipping of the archwire,
setting in motion less restricted tooth movements.

11

Slot apex (.012").
Constricted portion of
funnel, permits snapping in
and retention of wire prior
to closure of beaks

Seat. Base of insert bracket which rests in the grooved wing of
the receptacle for stability.
Stem. Extension of insert bracket fits into the vertical slot and
holds insert bracket in position when bent at right angle.
General thickness (.018").
Bracket head (.070" X .070").
Overall length (.235" ).

12

Placement of Insert Bracket
The stainless steel insert bracket is easily fitted into the vertical
slot of the receptacle. The stem is cinched and bent laterally
with a light wire plier or a dull ligature cutter, pressed snugly
under the wing and against the side wall of the receptacle.
Removal of the insert bracket is also
a quick and easy procedure. The
stem is straightened and cut; the
head is grasped with the flat end of a
dull ligature cutting plier; the insert
bracket is removed, using the
receptacle wing as a fulcrum.

13

There is adequate tipping movements and free flowing
movement of the attachment along the archwire.

In this technique, the constricting influences of the edgewise
archwire is eliminated, and also the menial chore of wire
ligation and the binding effects of ligation.

14

Receptacle
The receptacle is made in three sizes — Small (.150"),
Medium (.180"), Wide (.200")
And is contoured for specific teeth in the anterior and posterior
segments

The three vertical slots accommodate insert brackets and
auxiliaries. A single slot is used in the early stages and both
mesial and distal slots are used in the finishing stages

15

It is suggested that the receptacle be placed toward the incisal
edge of the band in order to provide sufficient metal backing for
the insert bracket

The receptacles are routinely spot welded to the bands in two
strategic locations, namely the tabs and the body of the
attachment


16

Receptacles are also available in either clear or tooth-colored
plastic. It is our belief that bonding of either plastic or metal
brackets is a unique innovation.


17

Molar Tube Attachment
The oval or slightly flat molar tube with mesial hook is an
important component of the Modified Combination Technique


18

The action of the tip-back bend in the light round wire as it
behaves in the buccal tube and its effect on the positioning of
the molars is directly related to the shape of the buccal tube.
Garcia and Brandt have shown that there is less lingualization
(rolling in) and unfavorable rotation of molars with the oval or
flat tube than with round tubes


19

A tip-back bend, also known as a resistance or anchorage
bend, when placed in a round wire becomes a modified toe-in,
whereas the oval tube resists this action.
Molar control and anchorage are definitely more favorable with
the oval buccal tube.
The oval tube has a vertical slot to assist in molar uprighting or
increased molar resistance, when necessary.


20

Insertion of Light Wire Into Insert Bracket
The .014, .016 or .018 round archwire is snapped into the
insert bracket with mild finger pressure.
In special situations involving major malpositions of certain
teeth, a wire director may be used to guide the archwire into
the insert slot, where it is quickly and easily snap-locked into
the circular insert chamber.


21

Finally, closure of the insert bracket beaks is accomplished by
gently using How pliers.
Usually, the cuspid insert brackets are closed first, followed by
the four incisor teeth, a remarkably simple and rapid procedure.


22

Removal of Archwire From Insert Bracket
Removal is accomplished by opening the insert bracket with an
insert spreader.
The insert spreader, an .012 flat-bladed instrument, is carefully
fitted into the insert slot and simply pushed forward, opening the
slot to its original dimension and preparing the release of the
wire.
The archwire is snapped out of the slot, using a scaler which
acts as a miniature crowbar, effectively and gently disengaging
the archwire without distorting it.


23

STAGE 1 (TIPPING)
Insert bracket can be placed in any of three positions in the first
stage of light wire treatment, positions of choice are the mesial
slot of the receptacle on the upper and lower four incisors and in
the distal slot on the upper and lower cuspids.
Centering the insert bracket in the first stage requires removing
it to place the inserts in the mesial and distal slots for the next
stage.
Exceptions may be made for specific tooth malpositions and the
initial insert brackets can be placed wherever they will be most
effective.
Where tooth malpositions are not too severe, it is strongly
recommended that double insert brackets be considered from
the start of the first stage

24

Special Consideration
When the malocclusion is characterized by a deep overbite, the
first stage usually includes the incisal coverage bite plate
1. accomplishes a preliminary bite
opening,
2. eliminates occlusal interference and
helps avoid anchorage loss,
3. prevents bracket shearing, band
destruction, or bonding failure on lower
incisors and cuspids, and
4. provides an opportunity for repositioning
the mandible, when the tendency for this
phenomenon exists.

25

Placing Bands and Archwires
When preliminary bite opening has been established
sufficiently, banding and placement of archwires constitutes the
first stage of treatment.
Uncrowding through action of vertical loops flows easily and
quickly. The multiple-loop archwire is changed for a plain twolooped archwire as soon as possible, while continuing Class II
mechanics until a Class 1 molar and cuspid relation is achieved.


26

The two-looped archwires can be preformed and easily adjusted
for cuspid-to-cuspid contact, to avoid recrowding.
The loops can also continue to move the cuspids distally, if
necessary.

Class III Mechanics
The rationale for Class III mechanics includes:
1. Improved movement of lower incisors over basal bone.
2. Avoiding stress on lower molars and preventing excessive
forward movement into extraction space.

27

3. Less lingualization of lower incisors than with the use of lower
horizontal elastics.
4. Compensation for tipping of occlusal plane caused by Class II
mechanics. The tipped occlusal plane returning to its original
position after Class 111 mechanics.
5. It is often desirable to overcorrect lingual positions of lower
incisors, to compensate for the forward movement of the lower
dentition as a result of leveling and uprighting.


28

Transpalatal Bar
The transpalatal bar is a maxillary resistance unit which is made
of a single .036 semi-soft round wire, which fits into lingual .036
horizontal tubes on the maxillary molars.
The appliance is bent back behind the tubes, cinching slightly,
creating a fixed/removable resistance appliance. This appliance
can be made in the mouth quickly and easily.


29

With this additional anchorage reinforcement providing bracing
support to resist forward movement in the upper arch during
Class III mechanics,
One can use intramaxillary elastics in the upper arch in addition
to the intermaxillary elastics.
In this manner, maxillary incisors move lingually and distally at
the same time as the mandibular teeth are being retracted.
This strategy proves most rewarding in the attainment of
optimum incisor position and subsequent improved facial
esthetics.


30

End of First Stage
The first stage of treatment generally brings about a compelling
biologic response in which reduction of protrusion, bite opening,
uncrowding, and correction of jaw relationships take place
simultaneously and without excessive tipping.


31

STAGE II (LEVELING)
The objectives of the second stage are:
1. Leveling (alignment).
2. Preliminary uprighting of cuspids and bicuspids.
3. Correction of rotations and labiolingual malpositions.
4. Continued bite opening.
5. Improved arch relations.
6. Improved arch form.
7. Closure of all remaining extraction spaces .


32

The second stage of treatment sets forth the modular aspect of
the Modified Combination Technique in the conversion to a
double bracket insert.
The second bracket insert is placed in the unoccupied mesial
or distal vertical slot of the receptacle, opposite to the insert
bracket used in the first stage, creating a double bracket
These bracket inserts are widely
spaced for more effective tooth
movement during the leveling and
finishing stages.


33

By placing another insert bracket at the other extremity of the
receptacle, the twin inserts offer a synergistic action with one
effort complementing another.
This arrangement is precisely what we have in mind with the
Modified Combination Technique, where two or more low
frictional components are used to blend for the production of
physiologic tooth movement.
The upper and lower second bicuspids are banded at this time,
using mesial and distal bracket inserts.
With severely irregular tooth positions, an .012 or .014 highly
tempered round steel archwire can be used to start the task of
tooth alignment and changed to an .016 archwire after a few
visits
34

Leveling and Space-Closing Appliance
This appliance is made of .014 or .016 wire, having a spaceclosing helical loop.
This imparts flexibility to engage tipped teeth, and begins
uprighting teeth adjacent to the extraction spaces.
All conventional adjustments can be incorporated into this
appliance.
Once snapped and locked into position, it will translate most
gentle forces to the teeth, arranging the dentition according to
plan.


35

Auxiliary springs for uprighting
and rotating may be applied
while main archwire is fully
engaged in the insert brackets .

A cardinal requirement of this technique is to permit the
archwires to function for long periods without interference or
unnecessary adjustments. It is definitely a mistake to change
archwires too frequently. A good high grade, fully tempered
steel wire is recommended.
36

When Stage II is completed, the accomplishments should
include a generalized alignment of all teeth, with rotations and
overbite corrected, and all anterior and extraction spaces
closed.
The teeth adjacent to the extraction sites should demonstrate
improved axial positions, with final movements taking place
during the next stage.


37

STAGE III (FINISHING)
This final step in treatment deals with correction of axial
inclinations of anterior and posterior teeth, with special
emphasis on lingual root torque and labial crown torque of
maxillary incisors.
Closure of small spaces, maintenance of overbite correction,
and ideal arch form are vital functions of this stage.
Final movements occur by means of an .016 or .018 dual helical
spring archwire,


38

This has proven to be exceedingly effective for uprighting and
aligning teeth.
These archwires, plus a superimposed torquing appliance,
impart a gentle though positive action to complete correction
of axial inclinations of cuspids and bicuspids in the extraction
area, as well as satisfactory axial inclinations of upper incisor
teeth

Torquing appliance
for central incisors.

39

Toward the end of the
third stage of treatment.

Final appliance embodies the ideal modifications which have
always been routine requirements such as: upper lateral incisor
and molar offsets, ideal arch form, gable bends and molar
tipback adjustments.
It is imperative that cuspids and bicuspids be tied together to
prevent reopening of extraction spaces. Very fine ligature wire
(.006) can be snapped into the cuspid and bicuspid insert
brackets and tied.

40

Further progress

Optional use of receptacle as a regular
edgewise bracket.

The Low Profile Receptacle has recently been created to offer
less bulk in height and width


41

SUMMARY OF THE MODIFIED COMBINATION
TECHNIQUE FEATURES
• No special skills required to insert archwires.
• No special ties.
• Reduced number of chairside assistants needed.
• Lessened chair time.
• Minimal unwanted tooth movements.
• Easy, rapid, uncomplicated torque for incisor teeth.
• No unpredictable reactions to
torque.


42

• Low frictional relation between wire and bracket chamber
makes elastic cord more applicable for rotations, uprighting, and
space closing. This procedure is simplified because no wire
disengagement is necessary and teeth flow along wire into
correct positions.
• Fewer archwire changes.
• Treatment time moderately reduced.
• A lesser number of auxiliary springs in the third stage of
treatment.
• Smaller gauge wires and larger archwire chamber permit
greater flexibility and increased biologic response, via natural
forces of occlusion.

43

• Archwires designed and tempered for long range of action,
making frequent visits unnecessary.
• No heavy base wires required for special tooth movements.
• The modularity of the system enables the operator to "plug
into treatment".
• The self-locking system is a natural for bonding, because of
less pressure and tension on bonded attachment. Plastic
brackets are more compatible with self-locking inserts, since
ligature stresses are eliminated.


44


45

Beddtiot
(Begg-edgewise diagnosis-determined totally individualized orthodontic technique
– Hocevar AJO-DO, Volume 1985 Jul (31 - 46): )

The appliance system known as the Begg-edgewise

diagnosis-determined totally individualized orthodontic
technique (BEDDTIOT) offers the capacity to employ selected
principles and features of Begg and edgewise mechanisms in
specific situations in which they are most advantageous.
The intent was to incorporate the important advantages,
features, and capabilities of many fixed appliances and
minimize deficiencies, making the most of current
understanding of orthodontic biomechanics and technology.

46

The control and precision of edgewise appliances (having full
torque and angulation built in) is combined with the capabilities
for anchorage conservation and rapid tooth movement (of the
''light-wire differential force" approach to biomechanics) by
means of attachments that are versatile, simple, economical,
and small.
Treatment is individualized.
Begg principles are employed in some cases; various edgewise
techniques in others. A wide variety of combinations may be
employed easily.


47

FOUNDATIONS

Light wire
•Gentle, long-range force systems may be employed for fast,
efficacious alignment and major movements of crowns and/or
roots.
• Minimal bracket size yields maximum interbracket arch wire
spans.
•Light, undersized wires have ample free play in the brackets.
•These factors, together with extensive use of elastomeric
ligatures and elastics, combine to produce an appliance that
can provide low force levels over great elastic ranges
•Alignment may be achieved instead with extremely light
auxiliary wires.

48

Brackets
The brackets are narrow, single-width (0.050 inch or 1.3 mm)
edgewise brackets with 0.022 inch (height) ´ 0.028 inch
(faciolingual depth) horizontal arch wire slots.
On the lingual side of the bracket (that is, against the band or
bonding pad) is a 0.020 X 0.020 inch vertical slot.


49

The arch wire slots are ''torqued"
(cut at such angles to the brackets
that they will be oriented parallel to
the plane of the arch when the teeth
are positioned properly)

Except for torque, the brackets are all identical. Therefore, they are
interchangeable; any bracket may be used on any tooth. Placed with its torqueindicator groove gingival, a bracket provides lingual root torque; with the groove
occlusal, it provides lingual crown torque. The standard torques make up a set
with a smooth progression— 0°, 5°, 10°, 15°, and 20 °

50

Brackets can be prewelded on bonding pads and indirect
bonding provides superbly accurate positioning.
Each of the five brackets prewelded on both flat and curved
universal bonding pads provides maximum versatility.
The pads are of minimal size, and their shape facilitates the
placement of the brackets with either end toward the gingiva.
So that each may be used for either lingual crown or root
torque.
The brackets are small in all dimensions to ensure optimal
appearance and minimal lip and cheek irritation.


51

This also lessens
Occlusal interference
Enamel surface involved in bonding
And problems with gingival proximity and oral hygiene.
Narrow brackets have long, resilient spans of arch wire
between them


52

The dimensions of the arch wire slot allow considerable (but
limited) mesiodistal tipping on undersized wires (10° distal
crown tip on 0.016 inch, the usual working wire), as well as
limited uprighting (5° mesial crown tip on 0.018-inch arch wire)

Thus, if the arch wire slots are
oriented perpendicular to the long
axes of the canines, they allow
optimal limited tipping on the lighter
wire during retraction and optimal
limited uprighting by auxiliaries on the
heavier wire.


53

Uprighting springs are not needed for ''braking" (to prevent
overtipping) and need not be removed before treatment is truly
completed (they cannot go too far). In cases that do not warrant
sequential tipping and uprighting, brackets may be angulated on
the teeth as necessary to achieve and maintain desired
inclinations.


54

Uprighting springs may be inserted in
the 0.020 ´X 0.020 inch vertical slot.
The original springs are only slightly
different from those used in the Begg
technique; as the helix is farther from
the arch wire, the hook arm is slightly
longer and the helix winds out away
from the tooth from the pin leg, the
hook arm does not require the extra
offset bend usually used in Begg
springs


55

A new spring design offers
rotation control and less bulk. It
is more hygienic, less likely to
impinge upon or irritate the
gingiva, and less conspicuous in
appearance


56

The vertical slot has many potential uses. It can
accommodate ligatures, elastic hooks, rotation devices, and
various other auxiliaries.
Turned 90° (so it is horizontal), it can serve as a miniature
buccal tube. An example of its function as a buccal tube
would be to gain control of partially erupted or impacted
second molars that require uprighting or crossbite correction


57

The basic buccal tubes are conventional 4.5 mm long,
0.022 ´X 0.028 inch "edgewise" tubes with 25° lingual crown
torque for lower and 10° for upper first molars.
The distal end of the maxillary tube is angulated outward 10°
from the welding flanges to maintain the proper rotation ("toein").
In cases that require headgear to maxillary molars, a tube
assembly like that just described, with the addition of a 0.051inch round tube, is used. The headgear tube is located
occlusal and slightly buccal to the main tube and is not
angulated.


58

In cases with deep overbites or moderate-to-severe
anchorage requirements, an additional rectangular tube is
carried diagonally across the buccal surface of the basic tube,
its mesial end pointing gingivally. Headgear tubes may or may
not be used

The additional tube is (like the basic tube) 4.5 mm long and
the inside dimensions are 0.022 ´x 0.028 inch

59

The additional tube will be referred to as the outer tube and the
basic tube as the inner tube.
The outer tube crosses the inner tube at an angle of
approximately 15° and is somewhat gingival to the inner tube.
It carries the main (working) arch wires during the bite-opening
and retraction phases of treatment, while rectangular sectional
wires in the inner tubes and second premolar brackets lock
molar and premolar teeth together so neither can tip
independently; as a unit they provide tremendous anchorage
for bite opening and retraction


60

The gingivally positioned and angulated outer tubes direct
the arch wires away from the danger of distortion from
mastication.
They provide effective built-in "anchor bend" while the actual
bends can be slight (usually about 25°) and still provide
sufficient force to intrude the anterior teeth and hold the
posterior teeth upright.
Considerable force for incisor intrusion can be derived from
the arch wires because the molars
cannot tip distally without extruding
the premolars.


61

The center of resistance (CR) of a molar is at or near the
furcation. The CR of the unit made by locking a molar and
premolar together with a sectional wire is a few millimeters
further mesial. The distal tipping moment created upon the
posterior anchorage by an arch wire activated to intrude
incisors equals the product of the magnitude of the force
upon the incisors and the distance from the incisors to CR
(M = F x d).


62

The mesial tipping moment of a Class II elastic on the posterior
anchor unit is the product of the elastic's force magnitude and
the distance of its line of action from the CR. Thus, if the CR of
the anchor unit is further mesial, the distal tipping moment upon
it is smaller and the mesial tipping moment greater. Therefore,
more intrusive force (approximately 40% more in this
illustration) can be applied to the incisors without a tendency to
tip the anchor unit distally.


63

Rotations
It is preferable on a round tooth (premolar or canine) to offset
the bracket slightly toward the side of the tooth that is displaced
lingually.
Simple engagement of the bracket on the arch wire with a small
elastomeric ligature will correct the rotation.
If the bracket is so far from the arch wire that this would be too
forceful, a larger, more gentle ligature may be used or the
bracket may be tied to the arch wire with elastomeric thread


64

Torque control with brackets and arch wires
One of the reasons the smaller (0.018 X 0.025 inch) edgewise
bracket slot gained some favor was the fact that the edgewise
wires required for precise control in the larger (0.022 X 0.028
inch) brackets were too rigid. In fact, there is no need for the
heavy edgewise wires ever to be used in the large brackets.
Similarly precise control can be attained with lighter forces by
using more resilient rectangular wires bent as ribbon arches—
0.020X0.016 inch, 0.021 X 0.016 inch, 0.022X 0.016 inch, or
square 0.019 X 0.019 inch, 0.020 X 0.020 inch, 0.021 X 0.021
inch or 0.022 X 0.022 inch wires.


65

These wires are easier for the operator to work with than the
heavier edgewise wires. A 0.022 X 0.016 inch ribbon arch has
just over half the cross-sectional area of an 0.022 X 0.028 inch
edgewise arch and is only one third as stiff; yet it fits the bracket
just as precisely

A 0.022 X 0.016 inch ribbon arch is only one third as forceful as a 0.022
X 0.028 inch edgewise wire; yet it can provide the same precise control
in the same "edgewise" bracket.

66

In most instances the lighter ribbon wires are preferable to
square ones.
Heavy rectangular arch wires should not be used to deliver
active torquing forces because force levels would be too high
and the range too limited.
If and when arch wires of new nonsteel alloys become available
in appropriate sizes for precise bracket engagement, these
extremely resilient gentle wires could effect all torquing and
uprighting; the need for any auxiliaries would then be virtually
eliminated.


67

How it is different
In the Begg technique, the anterior teeth are tipped continuously
until all of the spaces are closed and the overjet eliminated.
There is then an abrupt transition to the mechanics required for
root positioning.
A virtually total reversal of the biologic processes involved in
tooth movement must occur throughout the supporting
structures of the anterior teeth. Apices that either were not
moving or were moving anteriorly while crowns were being
tipped posteriorly are suddenly forced to move posteriorly. This
requires change to resorptive tissue response along the
posterior surfaces of the roots near their apices where, until that
moment, there has been either no activity or deposition.

68

In BEDDTIOT, on the other hand, tipping appears to be ended
abruptly by mechanical means when the play between bracket
and wire is exhausted.
However, because the wire is flexible, there must be a transition
period while the wire is deformed enough to create a moment
equal and opposite to that created by the retracting elastic.
The tooth is still being retracted while the total moment affecting
it is being reduced to zero and, as the moment decreases, the
proportion of translation relative to tipping increases.


69

One of the most important advantages of the BEDDTIOT
appliance is its facility for both three dimensional control and
limited tipping with light forces using a simple bracket.


70

The four stage light wire appliance


71

The four stage light wire appliance
This appliance enables the orthodontist to combine both the
tipping and bodily movement principles of mechanics. The
system permits the use of pure Begg mechanics in that part of
the treatment and in those cases in which it is most effective. It
also permits the use of a straight wire appliances in the same
cases or in any cases in which a rigid, preangular-pretorqued
finishing procedure is required.


72

Brackets and tubes
This appliance system has a combination bracket design in
which the lower third of the bracket is a type 256 Begg bracket
and the upper two thirds of the bracket is a 0.018 by 0.025 inch
straight wire slot with in-and-out positioning, preangulated and
pretourqued.


73

The begg slot will accept all auxiliaries and arch wires used in
Begg treatment and it performs a typical Begg bracket in
relation to tipping, bite opening, incisor and molar positioning,
and torque.
The appliance is set up in the standard manner with the 0.036
inch Begg tube placed gingivally on the first molars. All Begg
slot heights, other than the molars, are dictated by the
edgewise slot and, as such, are 1 to 1.5 mm. more gingival
than in a routine Begg banding.
It is essential to set up the straight wire slot so that on the
straight wire series the wire is level from the molar tube to all
other brackets.

74

In clinical preparation, it is desirable to band the molars first.
Slight variations in the dimension from molar tube to cusp tip will
exist because of anatomic differences, but a cusp-tip-to-tube
distance of 3.5 mm. is a desirable starting point. If 3.5 mm. is
acceptable, then all other edgewise slots must also be at 3.5
mm. except those on the canines and lateral incisors.

Upper and lower canine brackets are placed gingivally 0.5 to 1
mm. more, depending on tooth size and shape. Such a position
promotes canine-protected occlusion.

75

The upper lateral incisors are placed 0.5 mm. more incisally to
free them from interferences on the working occlusal
movements. Each tooth must receive the specific brackets
designed for it so that angulation, torque, and the in/out
compensation are correct.
The 1 to 1.5 mm. increased gingival positioning of the Begg slot
does not seem to affect the bite-opening or tipping
characteristics of Begg treatment.
Free tipping is made very effective by means of a specially
tapered bracket slot.


76

Special bypass pins and safety lock pins are used to reduce
binding.

The pins used are of a special length, since the width of some
of the combination brackets is larger than a routine 256 bracket.

The pin length is slightly greater in order to clear the tie wings of
the edgewise part of the bracket, especially on the maxillary
incisors.


77

Begg molar tubes are kept gingivally and can be obtained with
convertible straight wire tubes on the lower molar.
The convertible tubes provide for desired Class II elastic hooks
during Stages I, II, and III. They can be adapted to function as
a routine straight wire type of bracket when the straight wire
system is continued with first and second molars.
It is not recommended that second molars be incorporated into
the Begg system initially.
All Begg treatment should be built around the first molar as the
anchor unit, since experience shows that this is the most
effective differential anchorage position and the most desirable
for bite-opening mechanics of the Begg philosophy.

78

After the bite is opened and retraction of incisors has been
completed, the second molars can be banded without altering
the anchorage or bite-opening potential of the system.
When the appliance is properly and accurately constructed, the
system is set up so that all edgewise slots are positioned for
accepting a straight arch wire.
The angulation, tip, and torque are comparable to current
straight wire systems.


79

Ligation of the wire can be done routinely with ligature wire or
elastic modules.
The lower molar combination tube permits ease of passing
from first to second molars.
Headgear tubes are available if desired.
Use of the edgewise portion of the bracket is not begun in
most instances until late in Stage III.


80

Clinical experience with the combination bracket indicates that
the Begg portion of the bracket is highly successful and fulfills all
the essentials of a true 256 type slot.
The treatment procedures necessitate the use of pure Begg type
principles when the Begg slot is being used.
All arch wire forms, anchor bands, bypass bends, and elastic
forces are similar to a routine Begg treatment approach.
Because of the difference in the physical characteristics of the
bracket parts, any attempt to alter the Begg treatment principles
by switching slots or forces is prone to problems and anchorage
difficulty.

81

All Stage I, II, and III objectives should be followed, and this
can be done effectively only if free tipping is exercised within
the Begg slot.
It is recommended that treatment be initiated with routine
0.016 inch round Australian wire (orange special plus) using
40- to 45-degree anchor bends and 2½ to 3 ounce Class II
elastics.
Vertical loop arches are suggested as the initial wire if gross
irregularity exists and bite opening is desired immediately. A
free-tipping appliance is essential, and all recorded problems
which can affect tipping and bite opening must be controlled.


82

For the best physiologic response to the appliance, the Begg
procedures should be carried completely through Stage I and
Stage II and at least partly through Stage III.
Routine 0.016, 0.018, and 0.020 inch round wires, toe in or
out, anchor bends, and intra- and interarch elastics are used
as recommended in Begg therapy.
At the end of Stage II, the occlusion should show the typical
Stage II characteristics: spaces closed, bite opened to an
edge-to-edge relationship, molars Class I or better, incisors
retracted and tipped lingually, all rotations and ectopically
repositioned teeth overcorrected.

83

Stage III is essential, the combination bracket is not intended as
a substitute for this phase of treatment. When the occlusal
relationship and treatment objectives are ready for Stage III, the
severe tipping of the buccal segments and incisors, which is
typical and characteristic of Begg therapy, produces a very
irregular pattern to the angulated rectangular slots.
Short interbracket distance between the edgewise slots
increases force values and leveling forces.
Stage III should be carried out with 0.020 inch base wires,
constricted in the maxillary arch, and having reduced anchor
bends in a typical Begg program.


84

All Begg uprighting springs and torquing auxiliaries can be
placed in the Begg slot with no difficulty. The Stage III
mechanics should be continued until the occlusion approaches
a fairly level plane and the edgewise slots are almost parallel.
When the alignment has reached this degree of leveling and
uprighting, the Begg portion of treatment has ceased.
The Begg wires and springs are removed and the remaining
treatment is done in the rectangular slot with a straight arch
wire. The new wires may be braided round, braided rectangular,
nitinol, routine round, or edgewise wires up to 0.018 by 0.025
inch.


85

Banding of second molar
Banding of second molars is, however, often essential for
proper marginal ridge control, to improve the buccolingual
position of the second molars, and to act in functional balance.
These movements are best accomplished in late Stage III and
with the rectangular straight wire mechanics.

The second molars can be banded or bonded during Stage IV,
and sectional 0.014, 0.016, or 0.018 inch wires can be used to
begin leveling without interfering with Stage III.


86

The second molars can be bonded or banded with routine
straight wire tubes placed at the same occlusogingival positions
as the first molar rectangular tube.
Since the Stage III arches are in the round tube, the sectional
auxiliary wires to level the second molars can be placed in the
rectangular tubes.
When the Stage III is removed and straight wire treatment
initiated, the second molars are
level and ready for incorporation
into the finishing mechanics.


87


88


89

TIP EDGE
It was Dr Peter Kesling who modified
a single straight wire bracket, to create
the tip edge.
The technique was first introduced at
the Kesling-Rocke orthodontic center,
Westville, Indiana, USA, in 1986.
Although the modification is
essentially simile and confined largely
to removing two diagonally opposed
corners from the rectangular slot.

Dr Peter Kesling

90

Dynamics of tip edge
The proto type tip edge bracket is derived from a single .
022inch slot straight wire bracket merely by cutting away two
diametrically opposed corners from the arch wire slot, thereby
allowing differential movement.


91

Each bracket is thus enabled to tip in the predetermined
direction, whereas with the full thickness archwire in place, it will
resist tipping in the reverse direction.
The desired direction of tipping, in the routine orthodontic cases,
is easy to predict; in general, distal crown tipping is he way the
bracketed teeth will naturally want to incline, the exception
being the second premolar in the 1st premolar extraction case,
which will require to tip mesially.


92

The Tip-Edge bracket also contains many features already
familiar to the edgewise or straight wire operator including
conventional tie wings, which accept standard elastomeric
ligatures.

Bracket identification is by small circular markers at the disto
gingival tie wings of the maxillary anterior brackets, and
similarly placed triangular markings for the mandibular
anteriors.


93

In common with some straight wire brackets, a vertical slot is
incorporated lingual to the main archwire slot, which
accommodates a range of possible auxiliaries. The dimension
of the vertical slot is .020 inch square. With a round funnel
shaped entry to facilitate insertion.


94

The strangely shaped inner surface to the main archwire slot, due to
the lateral extension is some times referred to as ‘propeller slot’. This
preserves rotational control throughout the range of tip permitted by
the bracket, without determinant to aesthetics, since it is concealed by
the archwire itself.
The ‘cut out surfaces’ of the archwire slot form the ‘tip limiting
surfaces’, which restricts the degree of tipping.
The intact surfaces are therefore ‘finishing surfaces’, containing the
individualized finishing prescription for each tooth.
The point at which the tip limiting and finishing surfaces meet
constitutes the central ridge , the opposing central ridge provide
vertical control until final finishing and also the points at which torque
is imported, under the influence of auxiliary springs, during the final
rectangular wire phase.


95

The basic sequence of the Tip-Edge treatment
Maxillary right canine at the start of
treatment
Following retraction the crown will tip
distally, at the end of stage II
A rectangular wire in stage three with
the side winder will commence root
uprighting
Because the archwire is rectangular,
torque will be achieved automatically
with tip correction, until the bracket
prescription is expressed

96

The pre adjusted finishing prescription contained within the Rx-1
bracket system is identical in principle to today’s straight wire
systems, with the tip in the face, torqe in the base.
The values are particular to Tip-Edge, but alongside various
prescription in common use today, they compare most closely to
Roth specification


97

TP orthodontics also manufactures the twin version of the Tip-Edge
bracket in both .018 and .022 inch formats, sometimes known as the
freedom brackets.
A dynamic slot
The unique feature of the Tip-Edge, is that the arch wire slot
increases its vertical dimension as the tooth tips. Tipping of the tooth
crown, during initial translation, alters the axial inclination between the
vertical space available for the archwire from .022 to a maximum .028
inches. The explanation lies in the geometry of the bracket


98

This feature has considerable clinical significance. Levelling
and aligning is greatly assisted, so much so that it is possible
to setup from a .016 to a .022 inches stainless steel archwire in
a single move.
The inter bracket distance is far greater than with any other
conventional twin type bracket as, with Tip-Edge, the inter
bracket span is effectively the distance between the central
ridges.
The dynamic slot makes possible an entirely new means of
torque delivery, when the vertical slot dimension is closed by
an auxiliary spring, against a rectangular archwire, to produce
a tree-dimensional precision finish.

99

Vertical reactions during retraction


100

Bite opening
Early bite opening is one of the key reasons why differential tooth
movement so frequently demonstrates a decrease in treatment
time, particularly in deep bite cases.
Edgewise bracket used with full archwires are unable to intrude the
incisor segments until the canine root angulations are corrected,
which in turn delays overjet reduction.
A straight wire bracket exacerbates this problem by prescribing a
greater distal root inclination, which requires to be achieved
clinically before the curve of spee can be leveled. A segmental arch
approach can overcome this problem, but at the expense of added
complexity.
Segmental arches are never required with Tip-Edge, overbite
reduction can take place from the outset irrespective of canine
angulation.


101


102

Molar tubes
In the interest of combining the advantages of both straight wire and
Begg mode of treatment, Tip-Edge employs double buccal tubes.
These comprises a normally sited preadjusted straight wire
rectangular tube of .022X.028 inches, which is convertible and a
gingivally placed round tube of .036inch internal diameter.

The rectangular tubes are the easy out
design, with the posterior inner lumen slightly
flared towards the occlusal. This facilitates
archwire removal when cinch back has been
used.


103

Use of round tube is confined to bite opening in the initial stages of
treatment in deep bite cases.
All space closure and root uprighting is carried out in the rectangular
tubes.
The round tube offers significant advantages when deriving molar
anchorage and bite opening from anchor bends during which their
more gingiva position gives better protection
from occlusal trauma.
In addition the increased length of the molar
tubes makes more efficient use of the anchor
bend in terms of bite opening. As well as the
friction arising from it.

104

Auxiliaries
Many of these are begg derived and designed for orthodontists
unfamiliar with rectangulart wire.
The Side Winder
It is the everyday workhorse among the Tip-Edge auxiliaries. It
generates mesiodistal root movement and used when conjunction
with rectangular archwires, produce torque correction as well. It is
made in .014 inch high tensile stainless steel.
So called because it carries its coils alongside the archwire, over the
bracket face, withy a significant improvement over the former Begg
type uprighting spring, which carried its coils gingivally


105

It has undergone considerable variation.
Original versions were retained in the vertical slots by bending the
protruding gingival tails 90degrees, which made them fiddlesome
to remove. It was subsequently realized that the spring pressure of
the activated arm reciprocally keeps the tail of the spring securely
seated up the vertical slot, so that loner tails wee deleted.

106

For the most significant improvement has come with the ‘invisible side
winder’. This is not strictly invisible, although aesthetics are improved
by the fact that the wire of the spring overlays the bracket and
archwire.
It has several functional advantages. It s retained in position by the
elastomeric modules, in addition to its own spring pressure. This also
enables the modules to be changed if necessary.


107

Because of the bulky hook as been eliminated, the spring arm has
the wider range of activation than as the previously possible. While
the extra power of the spring is an advantage, particularly on the
incisors, when delivering the final torque prescription.
Some reduction of activation on canines and premolars may
frequently be indicated, therefore in order not to strain anchorage
during uprighting phase.


108

Side-winders come in clockwise and anti clockwise formats, the one
a mirror image of the other.
Selection of correct spring for each tooth is according to the
direction of second order correction required as seen from the labial.
Hence an upper right canine requiring distal root correction will need
a counterclockwise rotation and so froth


109

Side winder springs should always be inserted from the occlusal and
never gingivally.
If the spring is inserted upside down, form the gingival, the occlusal
forces will impact beneath the coils and distort them labially, away
from the bracket. This spoils the action of the spring as well as
causing discomfort


110

Power pins
This is a traction hook that can be fitted in the vertical slot.
Made of soft stainless steel, it will normally inserted from the gingival,
and is retained in the slot by bending the occlusally projecting tail
90degrees. Strictly this bend should be made in the opposite
direction to the elastic pull, since this avoids the possibility of a
slackly turned pin doing a U turn and being pulled out of the slot by
the elastic.


111


112

Rotating spring
The rotation spring is seldom required for correcting initial rotations. It
is because the rotations of the anterior teeth are dealt with by full
bracket engagement with light nickel titanium wires.
Premolar rotations are sometimes corrected with traction
elastomerics, if bonded later in the treatment. However rotation spring
prove very useful for recapturing a rotation that has recurred in
treatment, particularly if the patient is in a heavy archwire.


113

Like the side winder rotation spring comes in clockwise and counter
clockwise version and is made in .014inch high tensile stainless
steel. Selection is simply a matter of viewing the tooth from the
occlusal and determining in which direction derotation is required.
To avoid occlusal interferences rotation springs should always be
inserted gingivally, passed up the vertical slot with a light wire plier.
Holding the spring arm directly to the labial, at 90 degrees to the
tooth surface, the long leg can be bent along the labial face of the
tooth, to the same side as the hook will be engaged, the surplus end
then tucking gingivally under the archwire. This contact of the leg
against the crown ensures that when the spring arm is hooked over
the archwire, the coils will be wound up to activate the spring. Finally
the hook should be squeezed.

114


115

Bonding and setting up
Since the Tip Edge appliance is preadjusted. With a torque
and tip prescription incorporated in each attachment, it should be set
up like any other straight wire appliance.
Bracket placement
A mid crown position is recommended for routine bonding.
Each bracket should be aligned with its vertical axis parallel with the
long axis of the tooth, and at the midpoint of the crown mesio distally.
The height of the bracket should be at the vertical midpoint of the fully
erupted clinical crown


116

Tip Edge brackets are considerably smaller than a Siamese twin type
bracket, which is an aesthetic advantage, but also makes the
accurate placement of Tip Edge bracket rather more difficult,
particularly on large clinical crowns. For this reason, Tip-Edge
brackets are supplied with the option of colored plastic jigs, they
provide the ready sight line for the correct angulation of each bracket,
but they also make the brackets much easier to handle in
conventional bonding tweezers


117

The mid crown height can be gauged by eye. On a normally shaped
incisor, correct angulation up the long axis will result in the incisal
wing being parallel to the incisal edge of the crown.
The rationale behind a mid crown bonding position is that the middle
point of the crown is generally the point of the labial surface. It
therefore follows that placing a pre torqued bracket further gingivally
will decrease the torque prescription, while placing it too incisally will
increase the torque.


118

Bonding position incisally is contraindicated because
1. The prescribed torque value in the bracket base is effectively
altered
2. For any given overjet reduction, the amount of retroclination
produced during the initial tipping stage will be increased . in turn
this will require an increase in the amount of root uprighting
during stage III
3. When the side winder spring uprights the root, in both tip and
torque planes, during the third stage, it is placed at greater
mechanical disadvantage if the distance between the point of
rotation and the root apex is increased. This results in loss of
efficiency

119

Premolar brackets
Where as the anterior Tip-Edge brackets are designed to allow distal
crown tipping during translation during the first stage of treatment,
premolar may require to tip either mesially or distally, according to the
extraction pattern.
The Tip-Edge brackets have identical torque and tip value in the
upper 1st and 2nd premolars, similarly in the lower also.
Upper premolar brackets are identified by circular markings in the
gingival tie wing, lowers by triangular markings, in the usual way.
The occlusal tie wing carries an arrow, which will indicate the
direction of rotation.


120

Premolar jigs are modified by the addition of a 90 degree angle at the
tip of the jig, which indicates the direction of rotation. (Queen’s
university, Belfast –‘Irish jig’).


121

Correct selection of premolar brackets for different extraction
configuration
1st premolar extractions

2nd premolar extractions

1st molar extraction or non
extraction


122

Molar tubes
Bonded first molar tubes are contraindicated in Tip-Edge.
The rectangular buccal tubes should be aligned to the brackets, at
mid crown height, just as with a straight wire appliance.
The round wire will therefore sit towards the gingival margin.
In the mandibular arch, the tubes should be parallel to the occlusal
cusps, in the maxillary arch, seating the band fractionally higher
toward the distal may be helpful in obtaining final seating of the disto
buccal cusp.
It should be noted that round tubes can be omitted altogether in
class III malocclusion and reduced overbites.


123

Second molars are unnecessary to reinforce bite opening, contrary to
straight wire practice and their inclusion in early stages, particularly
in extraction cases, merely add friction.
However, final alignment of the second molars during the finishing
phase I frequently necessary. Second molar tubes are also available,
although not specifically for Tip Edge, with minus 14 degrees of
torque and 10 degrees of distal offset (maxillary) and minus 10
degrees of torque and zero offset (mandibular).


124

Stage I
Objectives
1. Alignment of upper and lower anterior segments
2. Closure of anterior spaces
3. Correction of increased overjet or reverse overjet
4. Correction of increased overbite or anterior open bite
5. Work toward buccal segment crossbite correction


125

Anchorage mode
Since the Tip Edge appliance has the capability of combining
the treatment advantages of both Begg and straight wire concepts, it
has the flexibility to proceed in the either mode, while exploiting the
advantages of differential tooth movement. Anchorage may therefore
be derived from a number of possible sources.
Setting up stage I

The base archwire
.016 inch round high tensile wire is ideal for stage I. This has the
necessary resilience to withstand forces of occlusion, combined with
the flexibility required to align mild tooth to tooth irregularities. It is
particularly suitable for bite opening, offering a good range of action
without excessive forces.


126

The horseshoe shaped archform, as used in the early straight wire
techniques, is not appropriate for the early stages of Tip Edge,
since use of an anchorage bend requires a straight posterior leg.
Combining a buccal archwire curvature with a vertical anchor bend
will cause the wire to wiggle and rotate with in the buccal tube,
which will invite a molar rotation.
The Intermaxillary circles should not be more than 2mm in front of
the canine bracket after alignment.
If bending an archwire up by hand, each circle should be formed so
that the posterior section loops to the labial of the anterior segment
and not vice versa.


127

Repositioning cuspid circles
To roll circle distally, will require a counter clockwise rotation.
First unravel the anterior segment the desired amount using the light
wire plier, then winding up the posterior segment to restore the
horizontal segment.

128

Preformed archwires are also available which are made of .016
inch Bow-Flex wire. These are size graded according to the
distance in millimeters between the cuspid circles, which can be
ascertained in the mouth by a flexible plastic ruler, between the
mesial surfaces of both canine brackets.

Co-ordination of the archform

129

Anchorage bends
The correct position of the anchor bends should be 2mm infront of the
molar tube. Placing the anchor bend further forward than this will
cause them to protrude occlusally and slightly lessen the amount of
overbite reduction imparted in the anterior segment.
The maximum vertical deflection permitted in the anterior segment can
be till to the depth of labial sulcus. The intrusive force distributed
between the six anterior teeth amounts only 2 ounces in the upper and
rather less in the lower.
The auxiliary arch
.014 NiTi under arch can be used for aligning the anterior segment,
and can usually discarded at the 1st or 2nd adjustment visits.

130

Anterior spacing.
Elastomeric chains can be used, but its force values are less easily
controlled than the E-links, which comes in the variety of lengths.
Generally a size E-9 is appropriate for closing anterior spacing.
Intermaxillary elastics
These require to wear full time from the upper cuspid circles to the
distal ends of the lower archwire.


131

It is absolutely essential to keep the elastic forces light at all times.
50gms or 2 ounces each side may be as little as 1/6th of that
recommended for straight wire, and is one major reason why TipEdge escapes the unwanted side effects of intermaxillary elastics.
Using forces in excess of 50grams with Tip-Edge increases the risk
of elongating the upper incisors, by overcoming the intrusive effects
of the upper anchor bends, as well as provoking problems in the
lower molar control.


132

The routine adjustment visits throughout the stage I is 6 weeks.
At each adjustment visit, the following checks will be necessary
1. Measuring the overjet.
2. Observing the overbite
3. Molar widths.
4. Checking the intermaxillary circles.
5. Siting of anchor bends.
6. Distal arch ends.
7. Distortion of the archwire.
8. Reassessing the elastic tension.


133

Stage II
Objectives
Closure of residual spaces
Correction of centerlines
Derotation of 1st molars
Levelling of 1st molars
Continuing crossbite correction
Maintaining the stage I corrections


134

If premolars are not bonded in the stage I. it will required to be
picked up and aligned at a pre stage II visit.
The procedure for a deep bite cases at the pre stage II visit is
• Remove the 0.016 archire
• Bond the premolars
• Using the same archwires, remove the anchorage bends and
replace them with the vertical bite sweeps, to retain the overbite
reduction previously gained. In the upper arch, this will be an
increased curve of Spee, and in the lower arch an inverted curve of
Spee. Much as in the straight wire techniques.
• Reinsert the archwires, but in the rectangular molar tubes.


135

Stage II archwires
An intermediary wire between the flexible 0.016 inch stainless steel
stage I and the rigid but passive .0215X.028 inch stainless steel stage
III is the preferable.
The choice is .020 inch high tensile stainless archwires.
Space closure
Cuspid circles serve as the traction hooks
Buccal segment spacing can be closed very easily by applying
elastomeric E-links from the cuspid circles yo the molarhooks
Free sliding mechanics are greatly facilitated throughout the stage II
by the design of Tip-Edge brackets, as the friction with conventional
bracket is eliminated due to the opening of the vertical slot dimension
during tooth translation.


136

Appling the breaks
A gently active Side-winder can be placed on a canine to induce a
distal root movement, anterior to the space to be closed, in each
quadrant to be braked. This will significantly increases the anterior
anchorage, hence resistance to retraction, and so favor the protraction
of posterior teeth.
1 st molars corrections
A limited amount of molar rotation can be expected as a result of space
closure with free sliding mechanics.
If the molars are mesially rotated after the space closure, a simple
adjustment to the archwire at the end of the stage II, keeping a 1 mm
buccal offset and 10 degree of lingual toe in opposite the interspace
between the 1st molar and premolar will derotate the molar.

137

The vertical adjustment in the archwire can be combined with the
molar derotation adjustment, opposite the molar to premolar
contact points. It consist of an ‘anti tip’ bend of more than 10
degrees, aimed at the sating the molar cusps into occlusion.

Stage II checks
1. Observing the space closure
2. The distal arch ends
3. Molar widths
4. Labial segment position and inclination
5. Attention to centerlines
6. Derotation of 1st molars

138

7. ‘un-tip’ the molars
8. Avoid over compression of the gingival cinchback of the archwire
9. Interarch relationship

Stage III
Objectives
1. Correction of torque and tip angles for each tooth individually
2. Attainment of optimum facial profile compatible with stability
3. Maintenance of class I occlusion
4. Final detailing

139


140

Choice of archwire
Only one size of rectangular wire is ever used in stage III. This is .
0215X.028 inch ‘Shiny Bright’ stainless, the lateral dimension is .
027 inch to facilitates the insertion into molar tube.
Comes in 2 formats- plane or pretorqued
Archform
•Approximately 5 degrees of lingual toe-in should be placed
opposite the mesial molar contacts. This ensures that the archwire
enters the preangulated molar tubes at an equivalent angle to
straight wire archform.
•2mm expansion in the molar region


141

Traction hooks
Crimped on the midway between lateral incisor and canine
Always point gingivally
Accept elastics or elastomerics from either direction
Preparation of archwire ends

Correlated stage III archwires

142

Testing Molar Torque


143

Cinch back


144

Stage III checks
1. Progress of tip and torque

2. Available space in the arch
3. Unwanted space
4. Condition of sidewinder
5. Activation of sidewinder

145

6. Interarch relationship
7. The vertical relationship
8. Molar width
9. Second molars
10. Profile consideration


146

Precision finishing
Picking up second molars
Occlusal seating
Braided rectangular arches
Titanium–niobium archwire
Sectioning the main archwire
Positioners


147


148

The separate arch system (SAS)
The new concept in the begg technique- The separate arch
system
Yoshinari Ashikari

The separate arch system is a system of conducting orthodontic
treatment by partitioning the dental arch into an anterior segment
and a posterior segment. The movement period is normally divided
into three stages sometimes after stage III is also required.


149

Stage I
1. Improvement of the overbite of the anterior teeth.
2. Elimination of crowding in the anterior teeth
Stage II
1. Elimination of displacement of the posterior teeth
2. Establishment of occlusal relationship of the posterior teeth
Stage III
1. Harmonizing of maxillary and mandibular dental arches
2. Uprighting of all teeth


150

Brackets
The brackets are reversed, that is attached upside down with the
bracket slot opening incisally.
Their positions are calculated from the incisal edges of the
relevant teeth, normally upper central incisors 4.0 mm; upper
lateral incisors, 3.5 mm; canines, 4.5 mm; premolars 4 mm.
Mesiodistally they are positioned centred, except for the lower
canines, which can be positioned 0.5mm mesially. High profile
brackets are used for the upper laterals, and normal brackets for
the rest.


151

Brackets are set upside down for the following reasons
1. Even under biting pressure, the wire will be held firmly in place
by the brackets
2. The brackets and wires can be tightly ligated and locked
3. The operations of setting and removing wires, mounting
auxiliaries are made easier.
Buccal tubes
For the 1st molars 5mm long flat oval tubes with hooks are ued
For the 2nd molars round or rectangular tubes are used
They are positioned 4mm from the cusp tips.


152

Wires
Anteriors wires -0.012, 0.014, & 0.016 inch Australian wire of atleast
special plus hardness
Posterior wires -0.016 inch Australian wire of atleast extra special
plus
Anterior k-type wires (shape) –0.016 inch Australian wire of atleast
extra special plus hardness
Plain archwires -0.012, 0.014, & 0.016 inch NiTi wires and 0.014
inch Australian wire of atleast extra special plus hardness
From 1-4 wires are used in each segment in each stage. Basic wire
combinations are identified as I, II, and III, each with a ‘plus x’ factor
to allow for additional wires.

153

I is one wire, II is two wires, III is three wires: ‘plus x’ is +1


154

Coil springs
Used to connect anterior and posterior wires, open or closed coil
springs are chosen, depending on the diameters that results when
anterior and posterior wires placed one on top of the other.
Pliers used for wire bending
Ohno-type arch forming pliers, arch contouring pliers, tweed arch
bending pliers, light pliers
Wire bending
1.Anterior wires
The distance between the distal ends of the canine brackets is
measured, and that is added to 24mm, this is taken as the retentive
length of the wire. When crowding is present, length is determined by
estimating what the length will be after the crowding has been
155
eliminated.

The arch form is bent to mach the ideal arch form desired at the
completion of orthodontic treatment.
2. Posterior wires
Light wire pliers are applied about 3cm from the distal end of a straight
11.5cm wire, the wire is bent back, then another bend is made 6mm
from the first so that the wire crosses over itself.here it is wound one
turn round, to produce a hook, and cut. At the mesial end wire is cut
7cm from the double back end.
One wire is wound clockwise, the other counterclockwise. They are
adjust to the buccal tube in such a way that, as much as possible, play
is eliminated. The double back wire end section is given horizontal
curve with ohno arch forming plier to give it toe in


156

3. Anterior k type wires with AK hooks.
Use is made of 0.016 inch extra special plus wire that has been bent
in conformity to an arch symmetry chart. After the distal end of the
canine and mesial end of the buccal tube of the 1st molars are
measured, a wire size chart is made, and the wire bent in
accordance with this chart, a wire bender can be used at this time.

157

Arch symmetry chart

Wire size chart


158

Formation of anterior k- type wire with hooks


159

The advantage of using AK hooks are

They can be matched up accurately with the distal end of the
brackets at the time they are being made.
It is easy to hang elastics onto them and to mount and remove the
archwires from the brackets.
Elastics do not slip off, hence can be left even on eating


160

Wire retention
a. Lock pins
b. High hat o rings- high hat
safety pins are inserted
into the brackets in
reverse direction, and the
wire is held in place with
O ring
c. Super high hat ligature
cross- retention is
offered by the 0.011
inch ligature in place of
O rings

161

d. T pin uprighting- involves use of
a T pin in conjunction with an
uprighting spring, a hook pin is
also used instead of a T pin

e. Twist- torque- used for torque on
individual teeth

f. High hat rotation T pins- involves
use of T pin in conjunction with a
high hat pin. Easy to attach
intermaxillary elastics and
vertical elastics

162

g. Bypass ligature- used to
retaining type II wire

h. T pin ligature- used for
retaining type II wire


163

i. Retention of posterior wires- a double back end is inserted
into an oval tube with a hook and held in place by an O ring


164

Elastics
A variety of elastics can be used including class II, class III, check
elastics, and vertical elastics


165

Stage I
Commence by using a type III wire or III + I wire.
Brackets are attached to incisors and canines.
For anterior wires 0.014inch Australian wire
special plus or higher grade is used. Sometimes
0.012inch NiTi wire is added.
For the posterior wires 0.016 inch Australian
wire extra special plus or higher is used.
The double back ends of the posterior wires are inserted into the
buccal tubes on the first molars, and adjusted so that the hooks end
up in the buccal side, with the round loops of the hooks close to the
cervices, and tips of the hooks pointing crownwards.

166

The posterior and anterior wire are joined with 0.030 inch diameter
closed coil springs. Two closed coil springs of 1 mm length are use for
each connection (8 there fore for the whole mouth).
The distal end of the anterior wire and the mesial end of the posterior
wires are bent into round loops, using light wire plier. The finished type
three wire is placed into the mouth, lining the posterior wires up with
the canines and 1st molars, and the anterior wire with the incisor and
canines, and then fastened.
The distal end of the anterior wires are rolled into circles and cut (roll
up cut). A length of 3 – 5 mm of posterior wire is left at the mesial ends
of the canines, and bent inwards.
When crowding is severe, the wires are doubled by adding 0.012 inch
NiTi wire to the anterior wires

167

In non extraction cases, the mesial end of the posterior wires are cut
longer, after estimating how much length will be needed once
crowding is relived.
In the beginning ordinary lock pins are used, but it is good to gradually
replace the incisor lock pins with high hat O rings, and canine lock
pins with high hat ligature or rotation T pin. The rollup cuts and M cuts
are adjusted at every visit of the patient.
Intermaxillary elastics are attached to the circle hooks at the distal
ends of the anterior wires and to buccal tube hooks on the first molars.
This is followed until there is improvement in the overbite and overjet.


168

Stage II
Stage II is alignment of posterior teeth begins after the alignment of
anterior teeth is completed.
Type II wire is used
Normally a 0.016 inch anterior k type wire
of extra special plus grade or higher is
used, together with a plain arch wire of
NiTi wire, normally 0.016 inch which can
be activated with a tip back bend and a
molar offset as required.
Special plus or higher grade 0.014 inch
Australian wire can also be used
When displacement in the posterior teeth is severe, treatment can
begin with 0.012 wire for both anterior k-type wire and plane arch
169
wire.

Both wires are checked against the wire size chart, the lengths are
measured, and then they are mounted and fastened with lockpins.
The lock pins used are;
Canines - rotation T pins or high hat ligature
Incisors - rotation T pins or high hat O rings
Premolar section – T pin at 900
In nonextraction cases, differential orthodontic force is used to
advantage. When it is desired to move the posterior teeth forward,
the canines are connected to the 2nd premolars by means of
elastomeric modules and the teeth are moved one at a time.
When it is desired to move the anterior teeth distally, the second
premolar and the first molar are made to provide the anchorage.

170

Slightly stronger elastics than those used in stage I are used in this
stage.

Method of closing extraction spaces. Pulling is achieved through
elastomeric modules.

Method of using intermaxillary elastics in stage II

171

Stage II ends when the extraction spaces close up, displacement in
the posterior teeth is eliminated, and the occlusal relationship is
firmly established.
One activates the anterior k-type wire by the addition of an
anchorage arc, which is made at the distal end if the AK hook


172

Stage III
This stage begins with the use of type II wire. By the end of stage
II, overjet, overbite, and the occlusal relationship have been
corrected.
When a greater torque to the NiTi wire is desired, a twist torque
technique is used.

Molar offset are incorporated. Lockpins can be changed from 900 T
pins to 100 T pins in order to achieve over uprighting, and individual
teeth can be adjusted.


173

After stage III
Type I wire either round or rectangular is used and the conventional
Begg method is followed. The anchorage bend is increased by 150.
Annealed wire can, if desired, be cut and passed through the first
molar oval tube and fastened, so as to reduce the size of the lumen to
that of a single tube.


174


175

Lingual Beggs
In 1982, Paige introduced a lingual lightwire technique with a
horizontally slotted unipoint combination bracket and both round and
ribbon wires.
It was the Fujita, Kurz, Kelly, Paige in the late 1970’s worked on
lingual orthodontics.
Fujita confirmed that orthodontic treatment with brackets placed on
the lingual is possible, and that there was an obvious improvement in
esthetics and increased patient acceptance for this form of treatment.


176

Bracket Design Criteria
The first important factor to be considered in designing lingual
attachments is that interbracket distance is reduced on the lingual

Therefore, the bracket must be designed to be as narrow as
possible mesiodistally. Keeping the buccolingual distance minimal
would also have advantages, since a small buccolingual dimension
will increase interbracket distance. In crowded situations, more
brackets could be placed at the initial appointment if the bracket
profile is small

177

Secondly, as a consequence of decreased bracket width, mesiodistal
root control becomes more difficult. Cuspid and bicuspid uprighting
after closure of extraction spaces requires efficient mechanisms for
uprighting.
A possible solution to this problem is the use of vertical slots for arch
auxiliaries.
The third factor to consider is the topography of the lingual surfaces
of the maxillary and mandibular anterior teeth.
The lingual contours of the anterior teeth seem to vary a great deal
Because of the concave and convex surfaces, the amount of torque
supplied to the tooth by the bracket will be very sensitive to its
occlusal-gingival placement.


178

A very small change in the occlusal-gingival placement can
produce a large change in root torque.
It has been argued that this problem could be solved by indirect
bonding procedures.


179

A fourth factor for consideration would be ease of insertion, ligation,
and removal of the archwires.
A very satisfactory solution in the technique is the incisal/occlusal
placement of the archwire. The use of vertical slots could permit the
use of pins to increase ease of ligation.
Archwire Design
Because of the reduced interbracket distance, consideration of
archwire selection is very important.
The general shape of the archwires resembles the mushroom shape
as proposed by Fujita
When use of elastics to the archwire is required a horizontal loop
distal to the cuspids have added

180

Mushroom arches with horizontal loops for elastics.
Formation of this loop in Nitinol or other very resilient archwire may be
difficult and, therefore, placed only when needed or when ready for
elastic wear in the stainless steel archwires

181

The amount of constriction or expansion, or toe-in or toe-out of the
archwire will be dictated by the proposed treatment mechanics. The
distal ends of the archwire should always be annealed. This allows
easy removal of the wire from the molar tube and allows easy
shaping distal to the tube for the necessary patient comfort. Cutting
the distal ends of the archwire flush with the tube has proven to be
unsatisfactory because it invariably produces patient discomfort.
Molar Tube Design
Conventional oval tube with a mesiogingival hook


182

Initially, the reasoning behind the oval tube was to allow for doubleback bends to prevent irritation to the tongue. However, the
discovery that the distal end could be bent in a buccal direction
negated the need for a double-back bend. The squashed oval tube
has some advantages in that it increases patient comfort, allows
molar control, and will accept a ribbon arch.
Securing of Archwires
Various methods of securing the archwire are available and will be
dictated by the position of the bracket relative to the archwire. A
common one, proposed by Fujita,4 is with doubled-over O-ring
elastics . Pins and steel ligatures are also used when the situation
warrants it.
Regardless of the method of securing archwires, the operator will
183
discover that it will be more time-consuming from the lingual initially.

Double-back O-loops for ligation.

Steel ligatures and pins for ligation.


184

Use of Auxiliaries
There is an advantage to the use of auxiliaries for precise root
control, because the arch-wire does not need to be removed to
place the auxiliaries.
Uprighting springs are necessary for proper mesiodistal control
during uprighting and esthetic positioning of anterior teeth.
The safety-hold uprighting spring works adequately in most
circumstances. A special consideration is needed for uprighting of
cuspids and bicuspids at the extraction spaces, because of the inset distal to the cuspids.
Uprighting springs with longer arms are recommend.


185

The uprighting spring is still placed from the gingival direction.
Because the arch-wire is placed from the incisal-gingival direction
the archwire should be secured by a ligature or elastic module.
The use of a power arm of .016"×.022 " Elgiloy (Rocky
Mountain/Orthodontics) is also effective in cuspid retraction and
uprighting


186

Rotations can be controlled by the use of thick .030" elastic thread
wedged between the archwire and the bracket base and then tied
on the opposite side of the bracket. This has an advantage of not
requiring archwire removal to effect the necessary rotation.
Torquing of maxillary and mandibular anterior teeth requires
special consideration. Begg mechanotherapy traditionally requires
torquing of maxillary and mandibular anterior teeth during Stage III
of treatment. the application of force on the tooth is at the incisal
edge


187

Use of Elastics
The size and strength of the elastics are the same as for
conventional light-wire orthodontic therapy.
Class II elastics from the lingual of the first molars to the archwire
loop lingual to the maxillary cuspids, appears to restricted the
movement of the tongue during speech. In order to provide more
tongue space these elastics may be placed on the buccal of the
mandibular first molars. Anterior attachment of the elastic may be
buccal or lingual to the cuspid, as it does not seem to affect speech
or tongue function.
No difficulty was experienced with Class I intra-arch elastic
placement on the palatal or lingual areas.

188

All maxillary and mandibular teeth may be bracketed with little
interference from occlusion. Although the maxillary and mandibular
molars were banded on our patients, direct bonding is definitely
feasible.
Headgear tubes should be welded to the buccal of the molar bands, if
necessary, for extraoral treatment procedures.
Although our patients received direct bonding procedures, indirect
bonding techniques may be practical and may improve placement of
the brackets.
For isolation, a Hygroformic saliva ejector or the Unitek lingual saliva
ejector is used to keep the tongue retracted and to control moisture.


189

Placement of the bracket is based on the work of Fujita. He has
recommended that the molar tube be placed approximately 3mm from
the lingual cusp tip and the slot of the brackets on the anterior teeth
approximately 4mm from the incisal edge.
Deep bite situations present the most challenging mechanics for
bracketing. In extraction cases, the goal is to move the maxillary
cuspids to a position where the lingual surface is not in occlusion so
that these teeth may be bracketed. This may require the maxillary or
mandibular cuspid to be tipped distally separately as necessary, which
may be accomplished with the lingual cleat placed on the buccal of the
cuspid in a distogingival position.


190

Once the cuspids are bracketed, Class II elastics can be initiated to
the lingual archwire to begin opening the bite. When the bite is
open, placement of additional brackets can continue as normal.
Rotation of the cuspid is an undesirable side effect of the elastic
action on the cleat, but can be corrected later by continuing
retraction from the lingual side.


191

TP 256-500 mini-mesh lower incisor labial brackets, which have
narrow bonding bases, are used for both upper and lower incisors.
The brackets are adapted to the study models to conform to the
lingual surfaces of each tooth. The mini-mesh may be ground to
make it narrower.
Upper lateral incisor labial brackets are adapted to the cuspids, and
the curved upper cuspid labial brackets to the bicuspids. Usually
little reshaping is required.
The slot of the 256-500 bracket allows up to 60° of tipping action
with its wide mesiodistal bracket channel


192

A bracket height of 3.5mm from bracket slot to incisal edge is
recommended for the upper central incisors, lower incisors, and
cuspids. For bicuspids and upper lateral incisors, 3.0mm from slot
to lingual cusp is sufficient.
To provide proper interbracket distance in Stage I , the vertical slots
of the brackets should be directed incisally for incisors and cuspids
and occlusally for bicuspids.

Stage I bracket placement with vertical
slots directed incisally/occlusally to
receive archwire with vertical loops.
Note horizontal circles distal to cuspid
brackets.


193

For Stage II and Stage III , a new set of brackets must be bonded
with the vertical slots directed gingivally.

Space closure with Stage II
mechanics. High-hat pins act as
hooks on cuspid brackets, and
both buccal and lingual elastics are
in use.

Stage III bracket placement with
vertical slots directed gingivally,
torquing auxiliaries for incisors,
and uprighting springs for
bicuspids.

194

A bracket seater made of .019" × .025" wire, will fit into the TP
bracket slots to hold the brackets at the correct heights during direct
bonding. All brackets can be bonded in about 30 minutes

Bracket seaters made of .
019"´.025" wire: A for anterior
brackets and B for bicuspids.


195

The mushroom-shaped archwire should have horizontal loops for
elastics distal to the cuspids. Offset bends are usually necessary at
the bicuspids and molars.

A toe-out bend is generally used in the lower arch and a toe-in bend
in the upper, depending on the amount of constriction or expansion
needed.

The distal ends of the archwire can be annealed to permit easy
bending into the embrasures and prevent tongue irritation


196

Final adjustment of cuspid position in Stage III is best accomplished
by using a labial arch with open vertical loops. This wire is supported
by buccal tubes and by brackets bonded to the distolabial surfaces
of the bicuspids.

The ends of the wire are annealed and cinched to facilitate the effect
of the loops on the cuspids. Cuspid prominence can usually be
reduced within five weeks.


197

K B Horizontal brackets
KB technique is called revised Begg technique. It become
completed by rearranging the treatment goals of stage I, stage II,
stage III of original Begg technique from a biological standpoint to
meet the social needs of the patient at that time.
I
II
III
Original Begg

III
II
I

KB technique

Therefore the operations and patients become feel to ease in reducing
the no of things to be done as stage goes by just like a reverse
triangle
198

The new type of buccal tube and torquing brackets
In order to solve the problems of round buccal tubes, here uses the
ribbon arch type which is easy to direct force and which brings littie
loss of distribution of force.
The dimensions of the buccal tube
Inside margin of the buccal tube is rounded to reduce friction. In
addition to a vertical slot, a 6degree distal offset is incorporated to
prevent molars from distobuccally rotating in the mesial movement of
the molars.


199

The brackets are modified by carrying out torque and reverse
torque by combining a ribbon archwire with angulated bases of the
bracket.

KB Horizontal brackets
The original tip edge brackets have a 26 degree tipping cut. If
the canine tips by 26 degree it takes 10 months to upright since
the speed of uprighting by using the uprighting springs is 2.5
degree per month. Here the tipping cut was made to 6 degrees
to applying the idea of KB technique top the tip edge brackets
and these brackets are called KB Horizontal brackets.

200


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202

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