Refined Begg –
Modifications And
Their Rationale
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing de...
Introduction.
Change – keyword of every trt. modality
Drawbacks become apparent with passage of time.
Refinements become n...
Changes introduced on account of following
reasons:
Change in trt. Philosophy:
AO concept - acceptance.
reconcile Begg trt...
To improve finishing and intrusion of upper ant.
To take adv. of newly introduced materials.
Combine best in Begg + good a...
Essentials of Begg – Unaltered.
Light orthodontic forces.
Crown tipping + Root tipping bodily
movement with least taxati...
Light intra-oral elastic force.
Enmasse movements of ant. and post. teeth –
overjet & correction of post. Occlusion.
Se...
Disadvantages of Conventional Begg.
Round wire – Ribbon bracket combination – no
precise control for fine finishing.
Pos...
Overuse of Class II elastics
Lack of upper incisor intrusion.
Undesirable proclination of lower incisors.
Tipping of mand...
Begg practice grouped into:
Conventional Begg.
Modified Begg. – brackets other than Ribbon
arch brackets – (combination ...
‘Conventional’ vs ‘Refined’ Begg.
Changes in concepts.
Improvements in hardware.
Modification in mechanics ( all stages...
Changes in concepts.
„Theory of Attritional Occlusion‟ & Differential
force concept.
challenged overemphasis of extns.
an...
Functional occlusion – Roth.
 Synchronization of CO & CR.
 Elimination of hanging palatal cusps – upper post.
Teeth.
 C...
 Diagnosis
Conventional Begg – few criteria.
ī to A – Pog line
ANB & FMA.
Present broad based diagnosis.
Skeletal, dental...
Treatment Planning.
Cookbook approach – discarded.
Overempahsised need to extract – previously
 Mixed dentition consider...
Biomechanics.
controlled tipping – 1st two stages.
Mollenhauer – root control from 1st stage -
MAA.
Advantages:
uncontrol...
Archform.
formerly – no due importance.
present –
maintenance – lower archform.
maintaining or improving upper archform.
...
Changes in the hardware.
Attachments.
built in adjustments – torque ( Kameda ) &
anti –rotation ( Mollenhauer )
distal of...
Elastics.
Ultra light ( “Roadrunner” of Ormco)
Light elastics ( „yellow‟ ).
Other components.
Bypass hooks.
power pins.
...
Stagewise modifications.
Stage I.
Multilooped archwires avoided.
MAA.
Incisor intrusion –imp. in bite opening.
Bypass wir...
Stage II.
MAA.
Base wire – 0.020.
Brakes
Stage III.
Base wire – 0.020 premium.
Uprighting springs & torqung aux. – finer...
Finishing stage.
Rectangular wires.
Later – difft. elastic config. with lighter round wires tight
buccal occlusion.
Pre –...
Refinements.
Refinements in
Diagnosis.
Treatment approach.
Hardware.
Mechanics.
Finishing.
Retention.
www.indiandentalacad...
Refinements in Hardware.
Attachments on teeth.
Brackets. -
retained original dimensions.
Built in adjustments.
Incisor b...
Built in torque.
Raising gingival or incisal edge of bracket base away from
tooth surface. (Kameda ).
Placement of attach...
Mesiodistal location.
Usually kept in the M-D center of crowns.
If rotated 1mm closer to the proximal surface rotated
towa...
• Properties.
– High resistance to torsional forces.
– friction.
– debonding characteristics.
– No special adhesives / spe...
Molar tube.
Round tube – 0.036” x 6mm.
Oval tubes – 0.072” x 0.024” lumen, 5mm length.
Combination tube
Round ( gingival ...
♪ Other attachments.
♪ Hooks:
Buccal hook ( centre of MB cusp. )
Palatal cusp ( Centre of distolingual cusp )
♪ Lingual bu...
Archwires.
Still used – Round high tensile SS wires of AJW.
Earlier used grades-
Special plus.
Extra special plus – resist...
Newer grades Size.
Premium - 0.020.
Premium + - 0.010, 0.011, 0.014, 0.016,
0.018.
Supreme - 0.008, 0.010, 0.011.
www.indi...
Spinner straightening vs Pulse straightening.
Disadv. Of spinner straightening.
Resultant deformation.
Y.S value ( working...
Working range  increased.
Frictional resistance  increased.
Composition  Same.
Stress relaxation  No sig. diff.
Uses....
Other materials.
Unravelling crowded teeth – early trt. Goals.
Several wires –
1st gen.- Nitinol.
TMA,
Chinese NiTi, Supe...
Polymeric materials.
to match esthetics of ceramic brackets.
Alpha Ti – finishing stage.
alpha phase – HCP stabilized
size...
Refinements in mechanics.
- Stage I.
Objectives – remained same – some added &
elaborated.
Priorities in Stage I:
Overbite...
Objectives – described under two substages.
Substage I – A.
Create space for correcting crowded teeth / close
spacing if...
Substage I – B.
Bite opening.
incisor intrusion, molar extrusion.
Retraction of upper ant. to eliminate the overjet
with...
Mandibular plane angle – controlled.
Correction of midline.
Interarch reln. corrected to Cl I.
Displ. & rotn. of P.M‟s...
Archwires in Stage I.
Preferred archwire – 0.018 P or P+.
Initially – 0.016 or 0.014 often in combination
with other flexi...
On post. teeth.
Loss of control over molar position.
Loss of anchorage.
Difficulty in construction & adjustment.
Difficult...
Alignment without multiloop.
Space created by sliding the teeth along the arch.
class II elastics – upper arch.
class I el...
• Space created – distal tipping of canine.
– Minor crowding – 0.016 SS with cuspid circle lightly
pressing canine br.
– c...
– Excess tipping of canines – controlled by light uprighting
springs.
– Molar stops – prevent mesial movemt of lower molar...
• Closing ant. spacing.
Retracting proclined upper ant. teeth.
- 0.016 SS.
- elastics – class II – upper.
- class I lower....
• Improving incisor inclination.
• Proclined  class II elastics.
• Retroclined  bite opening bends without elastics.
• M...
Substage I B
Bite opening.
Preference – incisor intrusion & avoiding molar
extrusion.
Conventional Begg –
bite opening – ...
• Intrusive force – bite opening bends - acts labially
- labially placed brackets.
Labial crown/lingual root tipping.
Res...
• Excess proclination or retroclination corrected in
1st substage.
• Then intrusive and class II elastic force varied.
- o...
CR
www.indiandentalacademy.com
Gradual increase in intr. force –
anchor bend 30°- 50° - 0.016 archwire
elastic force –using for longer periods –
switchin...
Power arms.
Long been used in preadusted edgewise appliance.
Trivandrum Intrusion Technique –
Dev. By Dr. K. Jyothindra Ku...
Present technique:
Problem eliminated – elastics -
Molar power arm I/M circle anteriorly.
Vectors – same direction
- elas...
www.indiandentalacademy.com
Clinical use.
made of 17x25 or larger size wire.
optimal length – 5-7 mm, follows contour of the
alveolus.
Soldered to ban...
Location of bite opening bends.
( Arch wire design modifications ).
Conventional bite opening bends.
3mm mesial to the mol...
Bite opening curve ( anchor & gable bends).
Canines – extrusion, LI and CI – intrusion.
Modification – Dr. Jayade.
Mild g...
Elimination of Overjet – control over root
positions.
Edge to edge relation – controlled tipping.
Uncontrolled tipping – ...
higher intrusive forces & light or ultra light elastic
forces – incisor intrusion & controlled tipping.
Bite opens - intr...
• Development of MAA
Mollenhauer –rectangles made in 0.010 “ wire for
reciprocal torque on adjacent incisors (SPECS) too
...
• Requirements of MAA
– Must generate very light root moving forces
– when reciprocal torque is required with the adjacent...
For lingual root torque
Mollenhauer engaged MAA
first & base arch wire piggy
back
but rectangles lift away from
the tooth ...
ADVANTAGES OF MAA
– simultaneous intrusion and retraction of incisors
– of rapid bodily alignment of anterior teeth with g...
– Short stage three
– Possibility of growing cortical bone at point A & point B.
Various applications of MAA
– bodily alig...
– By bending more +ve Torque as a braking
mechanism
– For controlling mesio-distal tipping (MAA
tip)
www.indiandentalacade...
Modification of MAA
– With available pins holding down the boxes for
lingual root torque was difficult. So, torquing actio...
– When reciprocal root torque is required on
adjacent teeth the concerned box rides over
the main arch wire with a cross o...
Preventing uncontrolled tipping of the lower
incisors.
o Brackets bonded – gingivally.
o MAA – labial root torque – lower ...
Controlling mandibular plane angle.
open during trt. – molar extrusion – worsening of
Cl II profile.
Correcting midline di...
Correcting inter - arch relationships to
Class I.
• Growing child – class II – class I – encouraging
the mandibular growth...
Check list at the end of Stage I.
Incisors – edge to edge relation.
Midlines matching.
Molar & canines – class I.
Uppe...
Objectives.
Common –
– Maintain all corrections – in stage I.
– Close all extraction spaces.
Additional.
– Controlled tipp...
Archwires in Stage II of Refined Begg
In extn. & non extn. cases –
0.018” P or P+, or 0.020 P wires.
If stage corrections ...
Controlled tipping of the incisors.
MAA – lingual root torque – controlled lingual
tipping – incisors during retraction.
(...
Braking mechanics.
Second PM extn. Cases – excess space closed by
post. protraction.
Good profile at start of trt.
„Brakes...
Combination wires: either of SS or Alpha Ti alloy.
Ant segment. – 0.022 x 0.018 (ribbon mode).
Post. segment – 0.018 round...
Strength of elastics –
– Light ( yellow ) Class I or II elastics – ant. retraction.
– Ultra light Class II elastics.
– Str...
Pre Stage III.
Need  PM‟s not engaged – extn spaces are closed.
PM‟s – different vertical level.
Horizontal offset reqd. ...
Objectives.
 Maintain corrections.
 To achieve desired root positions.
Addnl. Objectives.( Refined Begg ).
 Monitor sag...
Problems encountered in Stage III.
Undesired sagittal movements.
Mesial movement of upper arch – Corrected Cl I  Cl
II.
...
Complications – related to :
1. Amount of lingual root torque needed for
incisors & distal root movement.
2. Amount of for...
Remedies:
Minimize need for root movements.
– Correct diagnosis & carefully planning extn.
– Using efficient brakes.
– Inc...
Lighter aux. & Uprighting springs.
– Because of reduced need to torque – 2 spur used.
– 0.012 wire used.
– Uprighting spri...
Reinforcement of the anchorage.
Extreme MO,
Sagittal direction
– reverse torquing in lower incisors.
– Head gear or TPA – ...
Archwires.
Cuspid circles tightly touching – cuspid brackets.
Post. segment gingivally in reln. to the ant. seg.
Contra...
• Elastics:
very light class II elastics.
• Second molars banded midway in third stage.
Completion of third stage:
Degree ...
Torquing auxiliaries.
Torquing auxiliary with Spurs.
Refinements –
0.012 P+ wire (PS).
0.014 or 0.016 special + - used pr...
Other torquing Aux.
Single root torquing Aux.( Kesling ).
Buccal root torque – upper PM.
Direction of curvature – lingual...
Reciprocal torquing Aux.( „SPEC‟ ) .
Two adjacent teeth – torque in opp. Direction.
0.009 or 0.011 wires – Stage I.
0.012...
Reverse torquing Aux – controlling roots of
canines or PM‟s.
Franciskus Tan – Nov ‟87 JCO.
– Labial root movement – palata...
Buccal root torque on molars.
Lift palatally hanging cusps.
Boot design occlusal extensions
Inserted from mesial..
Boot p...
Labial root torque – only on LI.
0.012 wire.
Convexity of aux. facing gingivally.
Indication – lower LI – (central & cani...
Uprighting springs.
Earlier springs – 0.016 & 0.014
Mini springs – Mollenhauer – ( 0.009” dia )
Supreme grae wire.
Differe...
Securing pins.
• Mollenhauer – jamming – with lock pin labial to
base arch wire.
• Ligature – passing lig. Wire – through ...
Stage IV
Finishing with Begg appliance – difficult , not impossible.
Objectives of finishing & detailing.
• Intra arch obj...
• Interarch objectives.
– Normal overjet and overbite.
– Cl I canine & Molar reln.
– Tight interdigitation of all thecusps...
• Round & Rectangular Finishing wires used.
• Round wires.
– 0.020 stage II wires used.
– Archwires given – ideal shape & ...
• Second order adjustments.
– U 2 , shorter in reln to U1 and U3.
– Mesial angulation of U6.
– U3‟s slightly more mesially...
• Check list on finish.
– Establish all Andrews six keys.
– Check the midline.
– Check the occlusion – Centric position.
–...
Conclusion.
Many shortcomings of the Begg appliance have
been highlighted at different points in time ever
since its intro...
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com
Upcoming SlideShare
Loading in...5
×

Refined begg – modifications and their rationale /certified fixed orthodontic courses by Indian dental academy

371

Published on


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

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
371
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Refined begg – modifications and their rationale /certified fixed orthodontic courses by Indian dental academy

  1. 1. Refined Begg – Modifications And Their Rationale www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
  2. 2. Introduction. Change – keyword of every trt. modality Drawbacks become apparent with passage of time. Refinements become necessary to incorporate new concepts and technological progress. www.indiandentalacademy.com
  3. 3. Changes introduced on account of following reasons: Change in trt. Philosophy: AO concept - acceptance. reconcile Begg trt. with Andrews six keys to normal occlusion. Change in trt. Approach: Adv. of mixed dentition trt. realized. profile considerations imp. www.indiandentalacademy.com
  4. 4. To improve finishing and intrusion of upper ant. To take adv. of newly introduced materials. Combine best in Begg + good aspect of other techniques. www.indiandentalacademy.com
  5. 5. Essentials of Begg – Unaltered. Light orthodontic forces. Crown tipping + Root tipping bodily movement with least taxation on anchorage. Brackets – free tipping in initial stages. Differential forces. Sequence of trt. stages. www.indiandentalacademy.com
  6. 6. Light intra-oral elastic force. Enmasse movements of ant. and post. teeth – overjet & correction of post. Occlusion. Separation of root moving forces from archwire forces. Over corrections of all displacements. Use of round high tensile wires. www.indiandentalacademy.com
  7. 7. Disadvantages of Conventional Begg. Round wire – Ribbon bracket combination – no precise control for fine finishing. Post – root torque Rotational control poor. True intrusion of upper incisors – nil or minimal. www.indiandentalacademy.com
  8. 8. Overuse of Class II elastics Lack of upper incisor intrusion. Undesirable proclination of lower incisors. Tipping of mandibular & occlusal planes. Uncontrolled tipping – root resorption. long third stage. Overemphasis on tooth material reduction – ruined profiles. No fail safe mech. To check tipping or uprighting / torquing movements. www.indiandentalacademy.com
  9. 9. Begg practice grouped into: Conventional Begg. Modified Begg. – brackets other than Ribbon arch brackets – (combination br., edgewise br, tip edge br.) Refined Begg. www.indiandentalacademy.com
  10. 10. ‘Conventional’ vs ‘Refined’ Begg. Changes in concepts. Improvements in hardware. Modification in mechanics ( all stages ) www.indiandentalacademy.com
  11. 11. Changes in concepts. „Theory of Attritional Occlusion‟ & Differential force concept. challenged overemphasis of extns. ant. teeth remain stationary under heavy forces – only till hyalinised areas – eliminated. Treatment objectives. static occlusion – Andrew‟s six keys - goal of Refined Begg. www.indiandentalacademy.com
  12. 12. Functional occlusion – Roth.  Synchronization of CO & CR.  Elimination of hanging palatal cusps – upper post. Teeth.  Cuspid protected occlusion.  Incisor guidance. www.indiandentalacademy.com
  13. 13.  Diagnosis Conventional Begg – few criteria. ī to A – Pog line ANB & FMA. Present broad based diagnosis. Skeletal, dental & soft tissue analysis. Growth estimation. VTO. www.indiandentalacademy.com
  14. 14. Treatment Planning. Cookbook approach – discarded. Overempahsised need to extract – previously  Mixed dentition considered  Growth modulation – before or during fixed appl. phase.  Molar distalization – selected cases.  Avoid extractions when possible.  Extn. options – as dictated by diagnosis – all 4‟s/5‟s/upper 4‟s,lower 5‟s/ single arch extns./single LI. www.indiandentalacademy.com
  15. 15. Biomechanics. controlled tipping – 1st two stages. Mollenhauer – root control from 1st stage - MAA. Advantages: uncontrolled tipping prevented. third stage shorter. lingual root torque – canine roots abutting against labial cortical plate. www.indiandentalacademy.com
  16. 16. Archform. formerly – no due importance. present – maintenance – lower archform. maintaining or improving upper archform. www.indiandentalacademy.com
  17. 17. Changes in the hardware. Attachments. built in adjustments – torque ( Kameda ) & anti –rotation ( Mollenhauer ) distal offset in molar tubes. Archwires. Higher grade Australian wires – Premium,Premium +, supreme. Multistranded ( co-ax ) NiTi. Alpha Ti. Tandem wires. www.indiandentalacademy.com
  18. 18. Elastics. Ultra light ( “Roadrunner” of Ormco) Light elastics ( „yellow‟ ). Other components. Bypass hooks. power pins. TPA & Jasper Jumper – when indicated. www.indiandentalacademy.com
  19. 19. Stagewise modifications. Stage I. Multilooped archwires avoided. MAA. Incisor intrusion –imp. in bite opening. Bypass wires & distalizing archwires. Base wire  0.018 as soon as possible. Open bite cases – 0.014 wire initially. www.indiandentalacademy.com
  20. 20. Stage II. MAA. Base wire – 0.020. Brakes Stage III. Base wire – 0.020 premium. Uprighting springs & torqung aux. – finer higher grades. Second molar banding. Head gear when necessary. www.indiandentalacademy.com
  21. 21. Finishing stage. Rectangular wires. Later – difft. elastic config. with lighter round wires tight buccal occlusion. Pre – finishing ceph. Retention Conventional Begg – no emphasis – lower retention. Now – retention – till relapse tendency due to – growth or third molars ruled out. www.indiandentalacademy.com
  22. 22. Refinements. Refinements in Diagnosis. Treatment approach. Hardware. Mechanics. Finishing. Retention. www.indiandentalacademy.com
  23. 23. Refinements in Hardware. Attachments on teeth. Brackets. - retained original dimensions. Built in adjustments. Incisor brackets : Antirotational adjustments. Mesial or distal edge raised – ML/DL correction www.indiandentalacademy.com
  24. 24. Built in torque. Raising gingival or incisal edge of bracket base away from tooth surface. (Kameda ). Placement of attachments. Upper and lower canine brackets – more incisally placed. Lower incisor bracket – more gingivally. U/L PM bracket – more occlusally. Molar tubes – Upper  occlusally. Lower  more occl. than conventional gingival position. www.indiandentalacademy.com
  25. 25. Mesiodistal location. Usually kept in the M-D center of crowns. If rotated 1mm closer to the proximal surface rotated towards the lingual. New Material.- Ceramic Begg bracket. “Ceramflex II 256 Begg” – ( TP Ortho ). Polycrystalline alumina  Injection molding. Bonding surface – polycarbonate base. Enable easy debonding To avoid enamel fracture.www.indiandentalacademy.com
  26. 26. • Properties. – High resistance to torsional forces. – friction. – debonding characteristics. – No special adhesives / special instruments for debonding. • Pins used – SS/ brass and nylon pins. www.indiandentalacademy.com
  27. 27. Molar tube. Round tube – 0.036” x 6mm. Oval tubes – 0.072” x 0.024” lumen, 5mm length. Combination tube Round ( gingival ) & Rectangular ( ribbon ) 0.025 x 0.018, 5mm. Adjustment. Upper molar tubes – 10° distolingual rotational offset. when fixed per. To mesial aspect of molar. Lower molar tube - 5° distolingual rotational offset. www.indiandentalacademy.com
  28. 28. ♪ Other attachments. ♪ Hooks: Buccal hook ( centre of MB cusp. ) Palatal cusp ( Centre of distolingual cusp ) ♪ Lingual buttons, cleats or eyelets. Placed slightly off center – over correcting rotations. ♪ Additional round tubes. For engaging lip bumpers, head gears, distal ends of U loops of EVAA appl. www.indiandentalacademy.com
  29. 29. Archwires. Still used – Round high tensile SS wires of AJW. Earlier used grades- Special plus. Extra special plus – resistant to bite opening. Recently – new series of wire grades & sizes. Superior properties  pulse straightening, as against spinner straightening of older grades. www.indiandentalacademy.com
  30. 30. Newer grades Size. Premium - 0.020. Premium + - 0.010, 0.011, 0.014, 0.016, 0.018. Supreme - 0.008, 0.010, 0.011. www.indiandentalacademy.com
  31. 31. Spinner straightening vs Pulse straightening. Disadv. Of spinner straightening. Resultant deformation. Y.S value ( working range, resililency.) Study by Dr. Abraham Skaria, Dr. Jyothindra Kumar – following parameters of new grade wires. UTS  PS wires – 8 – 10 % higher value. LDR  10% higher for 0.016 wire. 235% higher for 0.020 wires. www.indiandentalacademy.com
  32. 32. Working range  increased. Frictional resistance  increased. Composition  Same. Stress relaxation  No sig. diff. Uses. Supreme grade wire – 0.008 – 0.011 Unravelling crowdede ant. teeth. Boxed reciprocal torquing aux. Mini uprighting spring. www.indiandentalacademy.com
  33. 33. Other materials. Unravelling crowded teeth – early trt. Goals. Several wires – 1st gen.- Nitinol. TMA, Chinese NiTi, Superelastic Japanese Niti. Recent – Cu Niti. Max. superelastic range. Low hysteresis. Low modulus. Rough surface ( ion implantation) www.indiandentalacademy.com
  34. 34. Polymeric materials. to match esthetics of ceramic brackets. Alpha Ti – finishing stage. alpha phase – HCP stabilized sizes – 16x22, 18x22. Niobium Ti www.indiandentalacademy.com
  35. 35. Refinements in mechanics. - Stage I. Objectives – remained same – some added & elaborated. Priorities in Stage I: Overbite before overjet. Alignment of teeth proclination to be reduced before applying higher intrusive force. www.indiandentalacademy.com
  36. 36. Objectives – described under two substages. Substage I – A. Create space for correcting crowded teeth / close spacing if already present. Alignment – correction of labolingual displ/rotations. Upper incisor inclination - + 10° of normal. Rotations / BL positions of upper molars corrected. PM rotations. Upper arch brodened in canine – PM area – to permit mand. advancement. www.indiandentalacademy.com
  37. 37. Substage I – B. Bite opening. incisor intrusion, molar extrusion. Retraction of upper ant. to eliminate the overjet with control over the root position. Mech. of controlled tipping of upper incisors. Preventing uncontrolled tipping of lower incisor – during bite opening. Root control – extreme lingual or labial position of some ant. teeth. www.indiandentalacademy.com
  38. 38. Mandibular plane angle – controlled. Correction of midline. Interarch reln. corrected to Cl I. Displ. & rotn. of P.M‟s corrected – if bonded. www.indiandentalacademy.com
  39. 39. Archwires in Stage I. Preferred archwire – 0.018 P or P+. Initially – 0.016 or 0.014 often in combination with other flexible wires. Dis adv. of multilooped wires. Ill effects of ant. teeth. or uneven bite opening. Labial flaring. www.indiandentalacademy.com
  40. 40. On post. teeth. Loss of control over molar position. Loss of anchorage. Difficulty in construction & adjustment. Difficulty in maintaining archform. Difficulty in maintaining oral hygiene. www.indiandentalacademy.com
  41. 41. Alignment without multiloop. Space created by sliding the teeth along the arch. class II elastics – upper arch. class I elastics - lower arch. Base wires – reasonably stiff - Not worsen existing overbite. - Affect lower arch form. Base wires 0.016 or 0.014 SS with flexible wires like NiTi. www.indiandentalacademy.com
  42. 42. • Space created – distal tipping of canine. – Minor crowding – 0.016 SS with cuspid circle lightly pressing canine br. – crowding ( 1mm ) – 0.014 SS – cuspid circle – 0.5 distal to canine br. – more severe – sliding canines distally – 0.104 /0.016 SS. Class II elastics – upper Class I elastics – lower. www.indiandentalacademy.com
  43. 43. – Excess tipping of canines – controlled by light uprighting springs. – Molar stops – prevent mesial movemt of lower molars. o Ant. openbite cases- upper archwire – 0.014 SS. anchor bends upright mesially angulated upper molar teeth. www.indiandentalacademy.com
  44. 44. • Closing ant. spacing. Retracting proclined upper ant. teeth. - 0.016 SS. - elastics – class II – upper. - class I lower. Spacing to be closed without retracting. – Fig. of 8 elastomeric tie. Active space closure – not attempted till intrusion is accomplished. www.indiandentalacademy.com
  45. 45. • Improving incisor inclination. • Proclined  class II elastics. • Retroclined  bite opening bends without elastics. • Molar position correction. – Approp. toe in or toe out bends – in SS 0.016 archwire. – Mild B.L disp. – expansion /contraction in archwire. www.indiandentalacademy.com
  46. 46. Substage I B Bite opening. Preference – incisor intrusion & avoiding molar extrusion. Conventional Begg – bite opening – molar extrusion + lower incisor protrusion. efficacy in intruding upper incisor – questionable. stereotype approach – all cases. www.indiandentalacademy.com
  47. 47. • Intrusive force – bite opening bends - acts labially - labially placed brackets. Labial crown/lingual root tipping. Resisted by elastics. Magnitude & direction of net resultant force intrusive & elastic. Anchor bends upper 0.016 wire = 45 g force/side. Extrusive comp. of class II elastic = 30 g / side. Resultant = 15 g / side. on 3 teeth = 5 g/ tooth. Same combination used irrespective of upper incisor inclination. www.indiandentalacademy.com
  48. 48. • Excess proclination or retroclination corrected in 1st substage. • Then intrusive and class II elastic force varied. - orientation of resultant kept close to C. Res. Steps. – Intrusive force applied 45g, CL II force 60g. – Inclination improves. Intr force - 60g, Cl II - 30g. – Incisors upright – elastic applcn.- oblique ( ant. pointing downward direction ). www.indiandentalacademy.com
  49. 49. CR www.indiandentalacademy.com
  50. 50. Gradual increase in intr. force – anchor bend 30°- 50° - 0.016 archwire elastic force –using for longer periods – switching from yellow ( 5/16”) to Road runner ( 3/8” ) elastics. Directional change- changing from class II  Class I  from TPA. Alternative – „power arms‟ www.indiandentalacademy.com
  51. 51. Power arms. Long been used in preadusted edgewise appliance. Trivandrum Intrusion Technique – Dev. By Dr. K. Jyothindra Kumar. For selective max. intrusion in the Begg technique. Analysis of force vectors of pure Begg technique – – Intrusive vector of the max. arch wire & – Extrusive vector of the Class II elastics. Equal & opp. Class II vector – lower molar extrusion & lingual rolling. Intrusion, extrusion or no change – incisors. www.indiandentalacademy.com
  52. 52. Present technique: Problem eliminated – elastics - Molar power arm I/M circle anteriorly. Vectors – same direction - elastic pull & archwire force unidirectional. Little mesial molar movement – elastic force close to the C.R of the molar. Anteriorly – force vector  close to C.R of ant. pure intrusion. www.indiandentalacademy.com
  53. 53. www.indiandentalacademy.com
  54. 54. Clinical use. made of 17x25 or larger size wire. optimal length – 5-7 mm, follows contour of the alveolus. Soldered to bands – above molar tubes. 2.0 oz elastic, 0.016 archwire - 40° anchor bend,  82 g force ( agrees with recommendations of optimal value for incisor intrusion ) www.indiandentalacademy.com
  55. 55. Location of bite opening bends. ( Arch wire design modifications ). Conventional bite opening bends. 3mm mesial to the molar tube. Intrusion of upper canines & of LI and CI. Gable bends – distal to canines. extrusion of canines, intrusion of LI & CI. Hocevar‟s modification. – a bend on either side of canines. CI – intrusion. Canine & LI – extrusion. www.indiandentalacademy.com
  56. 56. Bite opening curve ( anchor & gable bends). Canines – extrusion, LI and CI – intrusion. Modification – Dr. Jayade. Mild gingival curve – midpoint 3mm over the brackets. Vertical step up bend – 4 – 5 mm ht., 2 – 3 mm mesial to the molar tube. Anchor bend – upper end of the step. www.indiandentalacademy.com
  57. 57. Elimination of Overjet – control over root positions. Edge to edge relation – controlled tipping. Uncontrolled tipping – hasten root resorption( Reitan). Controlled tipping – upper incisors during retraction. elastic force alone- uncontrolled tipping. for controlled tipping – counter moment. Ratio – b/w 5:1 and 8:1. intrusive force – counter moment. Conventional Begg.- low intrusive force, heavy elastic force. www.indiandentalacademy.com
  58. 58. higher intrusive forces & light or ultra light elastic forces – incisor intrusion & controlled tipping. Bite opens - intrusive force. Moment augmented – MAA. www.indiandentalacademy.com
  59. 59. • Development of MAA Mollenhauer –rectangles made in 0.010 “ wire for reciprocal torque on adjacent incisors (SPECS) too heavy force In 1984, on request of Mollenhauer , A. J. Wilcock made 0.009” supreme wire Initially he used it similar to niti or co-axial wire. Later boxed aux. named “ An Aligning auxiliary for ribbon arch bracket”. www.indiandentalacademy.com
  60. 60. • Requirements of MAA – Must generate very light root moving forces – when reciprocal torque is required with the adjacent rectangle must not diverge by more than 450 – Auxiliary should resist deformation (resilient supreme grade pulse straighten wire) – Base wire should be able to resist vertical and transverse reactive forces from MAA www.indiandentalacademy.com
  61. 61. For lingual root torque Mollenhauer engaged MAA first & base arch wire piggy back but rectangles lift away from the tooth surface. So, Thickest possible pins (ceramaflex) used. www.indiandentalacademy.com
  62. 62. ADVANTAGES OF MAA – simultaneous intrusion and retraction of incisors – of rapid bodily alignment of anterior teeth with gentle forces – Stable results – Reciprocablility of torquing forces on instanding laterals or palatally placed canines. – Periodontal advantages – gingival dehiscences associated with prolonged labial root torquing is eliminated www.indiandentalacademy.com
  63. 63. – Short stage three – Possibility of growing cortical bone at point A & point B. Various applications of MAA – bodily alignment of crowded teeth – To apply labial root torque on lower incisors in growing brachyfacial cases. – Can also be used for labial root torque on upper incisors in class III cases. www.indiandentalacademy.com
  64. 64. – By bending more +ve Torque as a braking mechanism – For controlling mesio-distal tipping (MAA tip) www.indiandentalacademy.com
  65. 65. Modification of MAA – With available pins holding down the boxes for lingual root torque was difficult. So, torquing action of MAA is directly applied on gingival surface of teeth. For this base wire is engaged first and MAA is engaged piggy back. www.indiandentalacademy.com
  66. 66. – When reciprocal root torque is required on adjacent teeth the concerned box rides over the main arch wire with a cross over bend and pressed against the incisor surface of the crown www.indiandentalacademy.com
  67. 67. Preventing uncontrolled tipping of the lower incisors. o Brackets bonded – gingivally. o MAA – labial root torque – lower incisors. o Ends of lower archwire bend distal – molar tubes. Root control – extreme lingual or labial psitions of the ant. o Labial movement of instanding incisors or canines- MAA. o Lingual root movement – canines – marked root prominence – for placing into cancellous bone. www.indiandentalacademy.com
  68. 68. Controlling mandibular plane angle. open during trt. – molar extrusion – worsening of Cl II profile. Correcting midline discrepancy. upper midline - after alignment, uneven Cl II elastics. if both midlines shifted in opp. directions – midline diagonal elastic. lower midline alone – unilateral lower Cl I elastic. www.indiandentalacademy.com
  69. 69. Correcting inter - arch relationships to Class I. • Growing child – class II – class I – encouraging the mandibular growth. • Adults – mesial movement of the lower post. dental segment.- class II elastics. • Selected cases – distalizing upper molars www.indiandentalacademy.com
  70. 70. Check list at the end of Stage I. Incisors – edge to edge relation. Midlines matching. Molar & canines – class I. Upper and lower arch forms – matching. Molar rotations & BL displ. Corrected. Good control – root positions & mandibular plane angle. www.indiandentalacademy.com
  71. 71. Objectives. Common – – Maintain all corrections – in stage I. – Close all extraction spaces. Additional. – Controlled tipping – space closure – ant. retraction. – Prevent excess tipping – efficient brakes – space closure by protracting post. – 1st pm extn. Cases – rotations & crossbites of 2nd pm corrected. Stage II www.indiandentalacademy.com
  72. 72. Archwires in Stage II of Refined Begg In extn. & non extn. cases – 0.018” P or P+, or 0.020 P wires. If stage corrections involved – extreme deep bite, badly distorted arch forms or severe rotations – 0.020 archwires effective. Anchor bends PM bypassed – except when in distobuccal rotation. www.indiandentalacademy.com
  73. 73. Controlled tipping of the incisors. MAA – lingual root torque – controlled lingual tipping – incisors during retraction. ( bite opening force - intrusive force supplemented with moment – MAA). Lower incisors – sig. retraction – lingual root torque. Canines – excess tipping – 0.010 uprighting springs. www.indiandentalacademy.com
  74. 74. Braking mechanics. Second PM extn. Cases – excess space closed by post. protraction. Good profile at start of trt. „Brakes‟ – reverse anchorage site – posterior  ant. Commonly used: Braking springs: passive uprighting springs – 0.018 wire. Angulated T pins: prevent further tipping www.indiandentalacademy.com
  75. 75. Combination wires: either of SS or Alpha Ti alloy. Ant segment. – 0.022 x 0.018 (ribbon mode). Post. segment – 0.018 round . Alpha Ti – easier to engage in ant. br. slots. chance of distortion. Use SS combination wire - torque than alpha Ti. Disadv. – expensive. SS 0.022 x 0.018 sectionals – torqued in ribbon mode – piggy back over 0.018 base wire. www.indiandentalacademy.com
  76. 76. Strength of elastics – – Light ( yellow ) Class I or II elastics – ant. retraction. – Ultra light Class II elastics. – Stronger ( green ) – class I – posterior protraction. Check list. • Spaces closed completely. • Ant. edge to edge bite or +ve overjet in open bite cases. • Canine & molar relations – Cl I or super Cl I www.indiandentalacademy.com
  77. 77. Pre Stage III. Need  PM‟s not engaged – extn spaces are closed. PM‟s – different vertical level. Horizontal offset reqd. – engagement in PM bracket & molar tube. Archwire: 0.016 wire – one visit – arch wire engagement in PM Offset b/w PM & Molar. Upper wire – gable bend. Lower wire – mild anchor & gable bend. www.indiandentalacademy.com
  78. 78. Objectives.  Maintain corrections.  To achieve desired root positions. Addnl. Objectives.( Refined Begg ).  Monitor sagittal & vertical anchorage.  Monitor & correct inclinations of post. Teeth  Correct – 2nd molars – when reqd.  Monitor trt. for undesirable sequels – root resorption, parafunctional habits Stage III. www.indiandentalacademy.com
  79. 79. Problems encountered in Stage III. Undesired sagittal movements. Mesial movement of upper arch – Corrected Cl I  Cl II. Mesial movement of both arches – BMP. Individual crown movements – crowding. Mesial & distal crown movement – extn. Site – open spaces. Undesired vertical movements. Undesired transverse movements – upper molars roll buccally. Root resorption. www.indiandentalacademy.com
  80. 80. Complications – related to : 1. Amount of lingual root torque needed for incisors & distal root movement. 2. Amount of force generated – auxiliaries & springs. 3. Use of weak base wires www.indiandentalacademy.com
  81. 81. Remedies: Minimize need for root movements. – Correct diagnosis & carefully planning extn. – Using efficient brakes. – Incisors tipped in a controlled manner. Use of heavy base wires. – 0.020 P wire , stiffness 3x – Special + wires. www.indiandentalacademy.com
  82. 82. Lighter aux. & Uprighting springs. – Because of reduced need to torque – 2 spur used. – 0.012 wire used. – Uprighting springs- mini springs – 0.009 slightly bigger coils – 0.012 wire – canines & PM‟s. Light Class II elastics. – Because of lighter reciprocal actions. www.indiandentalacademy.com
  83. 83. Reinforcement of the anchorage. Extreme MO, Sagittal direction – reverse torquing in lower incisors. – Head gear or TPA – upper molars. – Lip Bumper – lower molars. Vertical Augmentation. – High pull head gear, post bite blocks. Transverse – 0.020 premium grade wires – enough contraction & toe in. www.indiandentalacademy.com
  84. 84. Archwires. Cuspid circles tightly touching – cuspid brackets. Post. segment gingivally in reln. to the ant. seg. Contraction & toe in – upper wire And expansion in lower – less. decided – looking at original study models. Arch wires properly co-ordinated. Wire ends – annealed & tightly cinched. www.indiandentalacademy.com
  85. 85. • Elastics: very light class II elastics. • Second molars banded midway in third stage. Completion of third stage: Degree of uprighting & torquing assessed – Visual inspection – Palpating – roots. – Radiographs – Lateral Cephalogram. Panoramic radiograph. Occlusal film.- labiolingul alignment – LI roots www.indiandentalacademy.com
  86. 86. Torquing auxiliaries. Torquing auxiliary with Spurs. Refinements – 0.012 P+ wire (PS). 0.014 or 0.016 special + - used previously. Inter spur span is curved – not angulated or kept straight. Modifications: Reverse labial torque – one or both laterals. Torquing boxes – canines for lingual root torque. www.indiandentalacademy.com
  87. 87. Other torquing Aux. Single root torquing Aux.( Kesling ). Buccal root torque – upper PM. Direction of curvature – lingual or buccal root moving effect. 0.012” P + wire – used. www.indiandentalacademy.com
  88. 88. Reciprocal torquing Aux.( „SPEC‟ ) . Two adjacent teeth – torque in opp. Direction. 0.009 or 0.011 wires – Stage I. 0.012” – Stage III. www.indiandentalacademy.com
  89. 89. Reverse torquing Aux – controlling roots of canines or PM‟s. Franciskus Tan – Nov ‟87 JCO. – Labial root movement – palatally impacted max.canine. – Wire used  0.012” P+ with 0.018” or 0.020 base wire. – Inserted in molar tube from distal. – Activated – rotating it 90° . www.indiandentalacademy.com
  90. 90. Buccal root torque on molars. Lift palatally hanging cusps. Boot design occlusal extensions Inserted from mesial.. Boot portion – twisted lingually & toe in given. www.indiandentalacademy.com
  91. 91. Labial root torque – only on LI. 0.012 wire. Convexity of aux. facing gingivally. Indication – lower LI – (central & canine – no torque reqd.) www.indiandentalacademy.com
  92. 92. Uprighting springs. Earlier springs – 0.016 & 0.014 Mini springs – Mollenhauer – ( 0.009” dia ) Supreme grae wire. Differences. Older Mini Coil 4 times – wire dia 2 times. Stem Radial to coil Tangential to coil. www.indiandentalacademy.com
  93. 93. Securing pins. • Mollenhauer – jamming – with lock pin labial to base arch wire. • Ligature – passing lig. Wire – through bracket in front of archwire – passed behind archwire outside bracket. • Sims – insert pin lingual – main wire – after pinning with Stage III pins. www.indiandentalacademy.com
  94. 94. Stage IV Finishing with Begg appliance – difficult , not impossible. Objectives of finishing & detailing. • Intra arch objectives. – good interdental contacts, proper faciolingual positioning of teeth. – All rotations over corrected. – Complete space closure. – Vertical levelling. – Flat curve of spee. – Proper tip & torque. – Maintenance of lower I/Canine dimensions. www.indiandentalacademy.com
  95. 95. • Interarch objectives. – Normal overjet and overbite. – Cl I canine & Molar reln. – Tight interdigitation of all thecusps of post. Teeth. • Functional requirements. – Matching CO – CR. – No cuspal interference during function. – Cuspid & incisor guidance. • Control of etiologic factors. • Soft tissue factors – Frenectomy , CSF etc. www.indiandentalacademy.com
  96. 96. • Round & Rectangular Finishing wires used. • Round wires. – 0.020 stage II wires used. – Archwires given – ideal shape & co-ordinated. – First order & Second order adjustments made. First order. – Labio lingual position of upper laterals. – Upper canine prominence. - Molar offset . - Toe in for U6 – proper Cl I . - Lower canine „tucked in‟. www.indiandentalacademy.com
  97. 97. • Second order adjustments. – U 2 , shorter in reln to U1 and U3. – Mesial angulation of U6. – U3‟s slightly more mesially angulated. – L3 & L2 – levels to be adjusted. • Rectangular finishing wires. – Alpha Ti – 0.022 x 0.018 ribbon wires. – Precise torque – build in ant. segment. – Soft – easy to bend. Harder in mouth. – 0.022 vertical dimension – enough clearence – 0.040 vertical slot – vertical settling of the teeth. www.indiandentalacademy.com
  98. 98. • Check list on finish. – Establish all Andrews six keys. – Check the midline. – Check the occlusion – Centric position. – Occlsuion in functional movements. – Excellent interdigitation. – Over correction not required or use 10 ½ / 10 reln. www.indiandentalacademy.com
  99. 99. Conclusion. Many shortcomings of the Begg appliance have been highlighted at different points in time ever since its introduction. But the basic tenets of Begg mechanotherapy have stood the test of the time and largely remained unaltered. The trend in Refined Begg is in the scientific progression of Dr. Begg‟s concepts, especially in the use of ultra light forces. With the advances in technology & materials, a better realization of these concepts has been possible, ultimately leading to superior results in treatment. www.indiandentalacademy.com
  100. 100. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

×