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Stage i in refined begg /certified fixed orthodontic courses by Indian dental academy

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

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


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  • 1. GOOD MORNING INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. REFINEMENTS IN BEGG TECHINQUE www.indiandentalacademy.com
  • 3. CONTENTS -INTRODUCTION -OVER VIEW OF REFINED BEGG -APPLIANCE COMPONENTS -STAGE I Stage 1 A Sub stage 1B -STAGE II and PRE STAGE III -STAGE III -TORQUING AUXILLARIES -FINISHING AND DETAILING -KAMEDANIZED BEGG -CONCLUSION -REFERENCES www.indiandentalacademy.com
  • 4. INTRODUCTION No treatment modality is ever perfect. With passage of time its drawbacks become apparent . Unless the treatment evolves to overcome those drawbacks, it is likely to become stagnant and then die slowly. Refinements also become necessary to incorporate new concepts and technological progress, the present day of Begg practice has gradually refined from to overcome shortcomings of the conventional Begg and to assimilate contemporary thinking and material advances. www.indiandentalacademy.com
  • 5. BEGG PRACTICE CAN BE GROUPED UNDER THREE BROAD CATEGORIES CONVENTIONAL (TRADITIONAL ) BEGG – Treatment philosophy as Advocated by R P BEGG and P KESLING Others – CADMAN, BARRER, RALEIGH WILLIAMS, FLETCHER, SAIN, BRANDT. MODIFIED BEGG – Follows Principles of Begg , but brackets other THAN Ribbon arch brackets are used Eg Combination Brackets- CHUN-HOON, KESSLER, FOGELL AND MAGILL, C.A.T REFINED BEGG- current Begg practice using Begg (Ribbon Arch) brackets, BUT SIGNIFICANTLY deviates FROM CONVENTIONAL BEGG and these can be elaborated under THREE headings - CHANGE IN CONCEPTS - IMPROVEMENTS IN HARDWARE - MODIFICATION IN MECHANICS IN ALL THREE STAGES OF TREATMENT www.indiandentalacademy.com
  • 6. ADVANTAGES OF BEGG TREATMENT -Light forces are used , physiologically more acceptable -Anchorage control very efficient -Quick correction of deep overbites -Early resolution of malocclusion - Roots are efficiently uprighted and torqued -Demands on patient cooperation is minimized - DIS-ADVANTAGES OF BEGG TREATMENT -Round wire and bracket combination unable to give precise control for fine finishing -Posterior root torque was difficult to achieve -Rotational control was poor -True intrusion of upper incisors was minimal -Ill efects of class ii elastics www.indiandentalacademy.com
  • 7. Uncontrolled tipping of incisors Long third stage of treatment No failsafe mechanism to check tipping of tooth www.indiandentalacademy.com
  • 8. 1) CONCEPTUAL CHANGE ; -Theory of attritional occlusion and differential force concept -Treatment objectives -Treatment planning -Biomechanics -Archform 2) CHANGES IN THE HARDWARE; -A) ATTACHMENTS – -Brackets -Molar tubes -B) ARCHWIRES-Premium, Premium plus, Supreme. - Alpha titanium wires , combination wires www.indiandentalacademy.com
  • 9. ELASTICS Ultra light (road runner ) ormco Light (yellow) tp labs OTHERS TPA , JASPER JUMPER www.indiandentalacademy.com
  • 10. 3) STAGE WISE MODIFICATIONS STAGE I -Ultra Fine Aust Archwires, CO-AX ,NITI MAA INCISOR INTRUSION BYPASS ARCHWIRES, DISTALISING ARCHWIRES 0.018 WIRES STAGE II MAA 0.020 WIRE APPLY EFFICIENT BRAKES STAGE III 0.020 BASE ARCH WIRE www.indiandentalacademy.com
  • 11. UPRIGHTING SPRINGS , TORQUING AUXILLARIES BAND SECOND MOLARS USE OF HEAD GEARS FINSHING STAGE ; RECTANGULAR WIRES DIFFERENT ELASTIC CONFIGURATIONS www.indiandentalacademy.com
  • 12. www.indiandentalacademy.com
  • 13. STAGE I in REFINED BEGG The entire treatment is organized into Three Distinct Stages which facilitated an orderly sequence of various corrections, in the efficient conduct of treatment. OBJECTIVES OF STAGE I -ALIGNMENT -CORRECTION OF ABNORMAL OVERBITE -CORRECTION OF OVERJET -ELIMINATION OF CROSSBITE -CORRECTION OF ARCH FORM -MATCHING OF MIDLINES -ATTAINING CLASS I MOLAR AND CANINE RELATION SUB STAGE IA STAGE I SUB STAGE IB www.indiandentalacademy.com
  • 14. SUB STAGE I-A  OBJECTIVES:  To create space for CORRECTING CROWDING or to close       EXCESS SPACING if already present Alignment of anterior teeth by CORRECTING LABIOLINGUAL DISPLACEMENTS and or ROTATIONS or CROSSBITES To IMPROVE UPPER INCISOR INCLINATION to within +/ - 10 degrees of normal ROTATIONS AND BUCCOLINGUAL POSITIONS OF UPPER MOLARS are CORRECTED so that TPA can be fitted UPPER ARCH FORM IS BROADENED if narrow to permit MANDIBULAR ADVANCEMENT for correcting class II relationship Duration 1- 6 months AIM – TO SHIFT TO 0.018 P/ P+ ARCH WIRE as soon as possible www.indiandentalacademy.com
  • 15. SUB STAGE I-B OBJECTIVES: -BITE OPENING -RETRACTON OF ANTERIORS TO ELIMINATE CROWDING -CONTROL OF MANDIBULAR PLANE ANGLE -MATCHING UPPER AND LOWER MIDLINES -CORRECTING INTER ARCH RELATIONSHIP TO CLASS I -DURATION 4 -6 MONTHS ENTIRE FIRST STAGE – 6- 10 MONTHS www.indiandentalacademy.com
  • 16. ARCHWIRES IN STAGE I CORRECTION OF MALALIGNMENT PRODUCE LIGHT CONSTANT FORCE OVER LONG DEFLECTIONS AND LONG TIME NI TI , MULTISTRANDED WIRES GENERALLY USED AS SECTIONALS CONSIDERATION OF ANTERIOR OVERBITE VERTICAL COMPONENT OF CLASS II HAS UNDESIRED EFFECT ( EXTRUSION) ON INCISORS AND MAND MOLARS . PREFERRED ARCHWIRE .018 P+ /P. OPEN BITE CASES .014 P/P+ IN MAXILLARY ARCH PREFFERED ARCHWIRE IN SUB STAGE I-B IS .018 www.indiandentalacademy.com
  • 17. SUB STAGE 1 A 1) ALIGNMENT of the CROWDED TEETH The archwire chosen should have – Stiffness – to resist undesired effect of class II elastics Flexbility - to facilitate application of continuous forces -DECLINE IN THE USE OF MULTILOOPED ARCHWIRES ILL EFECTS OF MULTILOOPED ARCH WIRES (SIMS) Inadequate or uneven bite opening Labial flaring of incisor teeth and canines Loss of control on molars Failure to maintain anchorage Difficult and time consuming Loop orientation may change during unravelling of crowding Difficult to maintain arch form Difficult to maintain oral hygiene www.indiandentalacademy.com
  • 18. ALIGNMENT OF TEETH WITHOUT THE USE OF MULTILOOPED ARCHWIRES BASE WIRES MUST BE STIFF PREFERABLY 0.016SS WITH ANCHOR BENDS BUT NOT WITH CUSPID CIRCLES NITI ARCHWIRE IS INSERTED INTO ALL THE BRACKETS AND TIED TO SS BASE ARCH WIRES AT 3 PLACES ie AT MIDLINE, BETWEEN LATERALS AND CANINES ELASTICS ARE HOOKED TO THE HIGH HAT PINS IN THE CANINE BRACKETS FOR DISALIZATION TWO SITUATIONS WHERE FULL LENGTH NITI WIRES ARE USED -MAXILLARY CANINES HIGHLY PLACED -CLASS III CASE WITH POOR INCISOR VISIBILITY www.indiandentalacademy.com
  • 19. AMOUNT OF CANINE DISTALIZATION NEEDED TO RELIEVE CROWDING MINIMAL CROWDING CUSPID CIRCLES FORMED .5MM DISTAL TO CANINES MORE AMOUNT OF CROWDING DISTALIZE CANINE ALONG SS BASE ARCH WIRE , CUSPID CIRCLES ARE OMITTED . USE CLASS I ELASTICS IN MANDIBULAR ARCH PRECAUTIONS IF EXCESS TIPPING – USE UPRIGHTING SPRINGS TO GET CONTROLLED TIPPING MOLAR STOPS IN MANDIBULAR ARCH DISTAL ENDS ARE LIGHTLY BENT www.indiandentalacademy.com
  • 20. Class I elastics are not used in the upper arch as it can tax anchorage When sufficient space is created 0.016 S S wire with cuspid circle is used . AMOUNT OF ARCH WIRE DEFLECTION NEEDED A) If minimal crowding of 1-2mm use 0.016 or 0.014 S S with offset bends or v bends to correct malalignment .there after shift to 0.018 ss for bite opening B) if crowding is more than 2mm 0.0165 coax or 0.009 supreme ,0.016 niti wires are used AMOUNT OF ROTATIONAL CORRECTION REQUIRED - Archwire should fill the bracket slot as much as possible for rotational correction Supreme wires------ labiolingual correction Niti or coax------ correction of rotations www.indiandentalacademy.com
  • 21. Niti, coax, supreme wires for correcting incisor irregularity are usually used as sectionals from canine to canine. In combination of stiff SS wires Two imp points to be noted while using sectional wires are -Started after canines have been distalized sufficiently for aligning the malposed incisors -Base wire will require offsets so that they do not impede action of flexible wires ANTERIOR OPEN BITE 0.014 SS WIRE is used when extrusion of anteriors are required OVER CORRECTIONS OF ROTATIONS Rotated teeth should be over corrected at each visit on the lesser dimension wire using rotation modules. www.indiandentalacademy.com
  • 22. OTHER CORRECTION OF SUBSTAGE 1 A CLOSING ANTERIOR SPACING Decide the position of incisors first- determine whether they need to be retracted or they are in proper inclination. a) retract the proclined incisors on 0.016 S S wire with cuspid circles 2mm mesial to the canine brackets and elastic cuspid ties. Class 1 or II elastics are used to retract the teeth b) When spacing is to closed without retracting the anteriors spaces are closed by tying anterior teeth with a figure of 8 elastomeric tie. Since intrusion of teeth requires some amount of space active apace closure should not be done till intrusion is accomplished if existing space is less than 2mm. www.indiandentalacademy.com
  • 23. IMPROVING THE INCLINATION OF INCISORS Excessively proclined incisors are retracted by using class II elastics Retroclined incisors are corrected by placing loops mesial to molar tubes MOLAR POSITION CORECTION Toe in or out bends are used to correct molar rotations Mild bucco lingual corrections are carried out using expanded arch forms Severe discrepancies are corrected using TPA ,Quad helix, Nitipalatal expander. ARCH FORM CORRECTIONS Arch form in most of the cases can be broadened in canine to canine region by shaping 0.016 ss arch wires PINS USED IN SUB STAGE 1 A 1) well positioned incisors receive stage 1 pins 2) Cuspid retractions - high hat pins – facilitate engagement of elastics 3) Brackets that engage both the base wire a well as the sectional wires www.indiandentalacademy.com --hook pins or ligature wires are used
  • 24. SUBSTAGE 1 B Major part of stage 1 treatment Archwires used are standard 0.018 P, P+ . Elastics employed are class II light or ultra light elastics BITE OPENING Unless other wise indicated preference during bite opening is for incisor intrusion and for avoiding molar extrusion , -incisor intrusion reduces gummy smile -Intruded incisors are placed in thicker zone of palatal bone and symphyseal bone -This facilitates root movements --molar extrusion in adult patients are not stable and increases the class II profile -Whether to intrude uppers or lowers are determined by esthetic requirements Refinements in Begg has over come many shortcomings of conventional Begg in bite opening Round wires used Begg technique have no capability of their own to counter the labial flaring of upper incisors www.indiandentalacademy.com
  • 25. Labial flaring of incisors are resisted by class II elastics VARIED STRATEGY FOR CONTROLLING THE MAGNITUDE AND DIRECTION OF THE NET INTRUSIVE FORCE ACTING ON UPPER INCISORS 1)Initially (in substage 1a) intrusive force applied is 45 gm while class II force is 60 gm. This mainly reduces the proclination of teeth but causes very little intrusion 2) As the inclination improves the intrusive force is gradually increased to about 60 gm while classII force is reduced to 30 gm on each side , bringing about further correction of inclination of teeth 3) As the incisors become more upright the elastic direction is changed to an oblique direction ( anteriorly pointing downwards) it not only reduces inclination but also brings about active intrusion of incisors A gradual increase in the intrusive force is brought about by increasing the anchor bend from about 30 to 50 degrees and elastic usage is for longer duration (35days) instead of changing them frequently www.indiandentalacademy.com
  • 26. The directional change is effected by changing class II orientation to class I orientation 1) Applying elastics from TPA to attachment on lingual side 2) Use power arms on upper molars made from 0.018X0.025 WIRE WHICH IS BENT IN FORM OF HOOK and soldered to buccal aspect of upper molars ( Dr Jyothindra K) LOCATION OF BITE OPENING BENDS Many authors have proposed different sites for bite opening bends Any bite opening bend in archwire divides it into segments that no longer remain parallel to the occlusal plane They exert reciprocal intrusive and extrusive force on different teeth to a variable effect 1) The conventional bite opening bend placed 3mm mesial to the molar tube tend to cause more intrusion of the upper canines and progressively less intrusion of the lateral and central incisors due to bowing effect www.indiandentalacademy.com
  • 27. 2) Gable bends placed distal to canines tend to cause a relative extrusion of canines while there is progressively more intrusion of the lateral and central incisors. 3) With Hocever modification the centrals are subjected to intrusion while the canine and lateral incisor are both extruded 4) Bite opening curve (or Kameda design the canines (and premolars if engaged) are extruded while the laterals and centrals experiences progressively more intrusive effect. Modifications for uniform intrusion of incisors A mild gingival curve is incorporated in the anterior segment from mesial of one cuspid circle to corresponding point on the other side (swain) If further augmentation of intrusive effect is needed gingival curve is augmented with a vertical step up bend 4-5 mm in height and placed 2-3 mm mesial to molar tube. Uniform intrusion of 6 anterior teeth www.indiandentalacademy.com
  • 28. www.indiandentalacademy.com
  • 29. Vertical step up bends are effective in anterior intrusion, but tend to tip the anchor molar distally to a greater extent Excess molar tipping is avoided by the use of distal vertical elastics If second molars are present ,wire is passed through the molar tubes on both the molars Use of elastics from TPA TPA carries hooks that are bent in the TPA or are soldered which lie in line with the lateral incisors. an additional oval shaped wire is soldered in the center kept slightly away from the palate ,this helps in generating constant intrusive effect from the tongue Brackets are bonded lingually with slots facing incisally www.indiandentalacademy.com
  • 30. ELIMINATION OF OVERJET With the combination higher intrusive force and lighter elastic force that is used now for incisor intrusion the chances for obtaining a proper M/F ratio for controlled tipping are much better Further augmentation with MAA auxiliary is also needed PREVENTING UNCONTROLLED TIPPING OF LOWER INCISORS 1) Lower incisor brackets are bonded as gingivally as possible, anchor bends are reduced 2) MAA with labial root torque is used on the lower incisors 3) the ends of lower incisors are cinched back 4) Lingual root movement of canines having marked prominence is corrected using Jenners auxillary 5) If adjacent incisors need reciprocal torque a spec auxillary is used CONTROLLING MANDIBULAR PLANE ANGLE More likely to happen with high angle cases with weak masseteric sling www.indiandentalacademy.com Adjuncts like TPA , high pull head gear, bite blocks can be used
  • 31. CORRECTION OF MIDLINE DISCREPANCY UPPER MIDLINE CORRECTION IS DONE USING SLIGHLTY UNEVEN CLASS II elastics If both midlines are shifted a diagonal elastics is utilized along with class II elastics In lower arch if deviation is severe classI elastics with an uprighting springs added on the opposite side for correction CORRECTION OF INTER ARCH RELATIONSHIP A) IN GROWING CHILD CORRECTION of molar relation from class II to class I is MOSTLY ACHIEVED by encouraging mandibular growth. Functional appliances like EVAA appliance is used b) Mesialisation of lower molars is brought about by the use of class II elastics in adult patients c) In selected cases class II molar relation is corrected using distalizing appliances www.indiandentalacademy.com
  • 32. Lock pins used in stage I -B Stage III lock pins for engaging the archwire into the slots as soon as Aligament is completed Use of high hat pins on palatal brackets are recommended for ease in attachment of elastics CHECK LIST AT THE END OF STAGE I -incisors are in edge to edge relation -midlines are matching – Upper and lower archforms are matching -molar rotations and buccolingual displacements are corrected -good control of root positions and mandibular plane angle are maintained Molar relation is usually improved to class I , the rest of molar correction can also be carried out in stage II www.indiandentalacademy.com
  • 33. ANCHORAGE CONSIDERATIONS IN STAGE I The causes for anchor loss during stage I is summarized as follows -Insufficient resistance from the anchor bends either because bends are inadequate -Excessively heavy elastic pull -Increased resistance from anterior teeth due to -Incisor and canine roots touching labial cortical plates -Abnormal tongue or lip posture -Overjet reduction before overbite correction -High mandibular plane angle reflecting weak musculature www.indiandentalacademy.com
  • 34. INCORPORATION OF CONTEMPORARY TREATMENT CONCEPTS IN REFINED BEGG Four refinements; 1) UPPER MOLAR DISTALIZATION in Begg treatment Wilsons Bimetric Arch Principle Movement causd by Modified begg archwire mostly causes distal tipping of upper molars Upper molars are distalised in growing child to gain a permanent increase in the archlength of about 2mm Case selection Normal Mandibular plane angle Late mixed or early permanent dentition Upper molars should be normally placed Profile considerations Absence of third molar is helpful www.indiandentalacademy.com
  • 35. Upper arch wire made of 0.016 premium wires One teardrop shaped loop to be made mesial to molar Loops have legs that are 6-7 mm in height 4mm wide , about 45 degree bite opening bend is placed Activation is by opening the loops by 2mm class II elastics are used ELASSTIC LOAD REDUCTION PRINCIPLE Sequential use of class ii elastics Tp green elastics for first week Tp pink elastics for second week Tp yellow elastics for following 2-3 weeks www.indiandentalacademy.com
  • 36. MOLLENHAUER ALIGNING AUXILLARY (MAA) MAA attempts root control from the very beginning without significantly affecting the anchorage and overbite correction . This has become possible by using a combination of a stiff base archwire made from 0.009 supreme grade wires. Development of MAA MOLLENHAUER first experimented with rectangles made of 0.010 wires for reciprocal torque on adjacent incisors (SPECS) 0.009 wire was manufactured at Mollenhauers request He made Boxed Auxllary “ an Aligning Auxillary for Ribbon arch Brackets “ Requirements of MAA -It must generate very light forces -When reciprocal torque is needed the adjacent rectangles shoud not diverge more than 45 degree -Auxillary must resist deformation -Base wire should be able to resist vertical and transverse forces from MAA hence 0.018 wire is used - MAA is first engaged and then main archwire engaged piggyback www.indiandentalacademy.com
  • 37. Advantages of MAA -EFFICACY IN INTRUSION AND SIMULTANEOUS RETRACTION OF ANTERIOR TEETH -Efficiency in rapidly bodily alignment of anterior teeth -Stable results -Reciprocability of torquing forces on the instanding incisors -Periodontal advantages in such cases because prolonged root torquing forces are not required during stage III -Possibility of remodelling point A and B APPLICATIONS OF MAA AUXILLARY -Bodily alignment of anterior teeth -Can be used as braking mechanism -Labial root torque in brachyfacial individuals to prevent ligualising of the roots -Labial root torque in class III cases -Can be used for controlling mesiodistal root tip www.indiandentalacademy.com
  • 38. MODIFICATION IN APPLICATION OF MAA -Holding down the boxes for lingual root torque with the tail end of the lock pins was difficult with the available pins --hence applying the torquing action of the MAA directly on the gingival surface of the teeth there by eliminating the need for pins to hold down the boxes. -CONSTRUCTION OF MAA - Tweed plies -Rectangles with uniform height of 4mm -The width of the rectangles could be varied depending on the widthof the teeth -The wire ends are wound around the mesial of the terminal boxes -Blank is then activated by shaping it into open ended circle www.indiandentalacademy.com
  • 39. INDICATIONS -In Achieving Controlled Lingual Tipping Of The Upper And Lower Incisors -When root apices are very close to labial or lingual cortical plates at the start -instanding laterals or lingually placed canines -preventing uncontrolled labial tipping of the lower incisors in stage I -As a braking mechanism RECENT INTRODUCTION OF RECTANGULAR WIRES Rectangular wire bent in the form of an arc in edgewise mode but engaged in Begg brackets in ribbon mode acts like a torquing auxillary -0.0175 x0.025 braided rectangular Niti wire TURBO (Ormco) ( By Dr Tejashri) www.indiandentalacademy.com
  • 40. OTHER BOXED AUXILLARY -Mini versions of MAA -Made from 0.009 – 0.012 -A) Two boxed auxillary on central incisors for classII div2 -B) Two boxed for instanding incisors -C)Jenner auxillary- two boxes on upper or lower canines with very prominent roots --made of 0.012 wire --Lingual root torque exerted from these boxes reduces the prominence to facilitate anterior retraction -D) SPEC Auxillary -Used for reciprocal torquing of the adjacent teeth a cross over bend is placed between the two boxes if it is fitted piggy back www.indiandentalacademy.com
  • 41. Functional appliances in conjuction with Refined Begg When a JASPER jumper or Churro jumper is to be used upper molar band are provided with double round tubes The lower molar tubes combination tubes EVAA Appliance -Van der Schuerrin and De Smit ( JCO 1994) --Simple Design, inexpensive , -Well tolerated by patients -Additional attachment required is round buccal tubes occlusal to conventional Begg in upper molars --the appliance is made after both arches are well aligned --Instanding incisor in maxilla is positioned properly so that mandible is easily anteriorly positioned -Widening of upper arch in canine premolar region required --construction bite is taken with 5-6www.indiandentalacademy.com mm of sagittal advancement and 3-4mm of vertical clearance
  • 42. The appliance consists of right and left occlusal blocks joined by lower plate. It is anchored to occlusal tubes of the upper molars with the help of U loop wire elements The flanges touch the lower alveolar mucosa but can be kept free from of contact with lower incisors Bite blocks negate the extrusive effect of class II elastics In low angle cases lower surface of the occlusal block can be trimmed for erupting the lower molars Appliance worn full time except while brushing Duration of wear is 5-6 months full time extended by 3-4 months during night www.indiandentalacademy.com
  • 43. MIXED DENTITION TREATMENT Mulligans 2X4 appliance can be adapted to Beg set up Distal tipping or uprighting of the molar can be done Correction of mild crowding in lower incisor region Begg appliance in combination with other appliance like RME www.indiandentalacademy.com
  • 44. STAGE II AND PRE STAGE III OBJECTIVES -to maintain all corrections achieved during stage I -To close all extraction spaces- by retraction of incisors or protraction of molars AIMS -CONTRLEED TIPPING OF INCISORS -PREVENTING EXCESS TIPPING OF INCISORS BY USING BRAKES -CORRECTION OF MOLAR RELATIONSHIP -CORRECTION OF CROSSBITE AND SECOND PREMOLAR ROTATIONS www.indiandentalacademy.com
  • 45. ARCH WIRES IN Stage II Arch wires made of 0.018 P,P+ OR 0.020 P ANCHOR BENDS ARE REDUCED TO MAINTAIN achieved correction The premolars are bypassed till the spaces close except when premolars are disto buccaly rotated A MAA auxillary for lingual root torque is is a must during second stage If canines appear to tip distally excessively 0.010 uprighting springs are added The adequacy of anterior retraction is judged clinically BRAKING MECHANICS FOR PROTRACTING POSTERIORS The brakes reverse the anchorage site from the posterior to anterior segment by permitting only bodily movement of anterior teeth COMMONLY USED BRAKES IS AS FOLLOWS 1) Braking springs uprighting springs made of 0.018 wire angulation between the stem is reduced 2) angulated T pins prevent for the tipping 3) Combination wires: SS OR Alpha titanium – ant segment 0.022 x0.018 ribbon www.indiandentalacademy.com mode and post segment 0.018
  • 46. www.indiandentalacademy.com
  • 47. Torque in anterior segment can be built by using torquing turret 4) Torquing auxillary ; Two or Four spur auxillary which is activated to the desired or MAA in 0.010 , 0.011 Can be used along with a strong base arch wire ELASTICS Upper and lower class I elastics If molar relation correction is needed class II elastics are added till the molar relation gets corrected Class II should be used as sparingly as possible Because of bite deepening effect part time wear for 8- 10 hours is recommended Only class I elastic is given in lower arch if Cross Bite seems to develop Light (yellow) elastics are preferred Stronger (green) elastics are used for posterior protraction PINS Hook pins are commonly used. www.indiandentalacademy.com If only base archwire is used then Stage III pins are used
  • 48. CHECK LIST at the End of SECOND STAGE -All spaces are closed Teeth well aligned Anteriors are in edge to edge bite Incisors are upright or mildly retroclined Canines or premolars are in mild or moderate mesio distal angulation Molars are in class I OR super class I PRE STAGE III In the premolar brackets at the end of stage I 0.016 wire is used for one visit to pick up the pre molars Offsets can be used to engage pre molars the upper arch wire is given a gable bend distal to canine to maintain overbite Lower wire is give a mild anchor bend and a gable bend Distal ends are cinched to prevent opening of the extraction spaces www.indiandentalacademy.com 0.018 wire is switched over to 0.020 wire
  • 49. STAGE III A PROPERLY MANAGED stage III is what differentiates a well treated Begg case from a poorly treated one Correction of Labio lingual and Mesiodistal root positions of all the teeth that is achieved during the third stage is mandatory for achieving optimum esthetics OBJECTIVES -TO MAINTAIN CORRECTION ACHIEVED DURING STAGE I AND II - TO ACHIEVE DESIRED ROOT POSITIONS ,INCLINATION OF ALL THE TEETH - –AUGMENT ANCHORAGE -TO MONITOR CORRECT INCLINATION OF POSTERIOR TEETH -TO CORRECT POSITONS OF SECOND MOLARS -TO MONITOR UNDESIRED SEQUELS LIKE ROOT RESORPTION AND PARAFUCTIONAL HABITS www.indiandentalacademy.com
  • 50. MECHANICS OF STAGE III Auxillaries used generate reciprocal reactions in all the planes of space which when not properly controlled result in complications a) Lingual root torquing auxillary – labial crown movement, extrusion of anteriors, intrusion of posteriors, buccal crown movement of posteriors b) Labial root Torque auxillary- effects in opposite direction c) Uprighting springs for distal root movement- similar effects as that of lingual root torquing auxillary d) Uprighting springs for mesial root movement- opposite effect In first pre molar extraction cases the reciprocal effects from the springs on the 5s for mesial root movement neutralize those from the springs for distal root movement on the 3s . But reciprocal forces from the springs on the incisors as also lingual root torquing auxillary tend to cause mesial crown movement of the anterior segment , extrusion of anteriors, intrusion of posteriors www.indiandentalacademy.com , flaring of the molars
  • 51. In second premolar extraction or first molar extraction cases or in the non extraction cases where all the springs face distally , the above said effects become accentuated Mesial crown moving forces are commonly resisted by cinching the distal ends of the arch wires and use of class II elastics PROBLEMS ENCOUNTERED IN STAGE III UNDESIRED SAGITAL MOVEMENTS -REVERSION OF CLASS II INTERARCH RELATION DUE TO MESIALISATION OF UPPER ARCH --MESIAL MOVEMENT OF BOTH THE ARCHES CAUSES REVERSION OF BIMAXILLARY PROTRUSION --INDIVIDUAL CROWN MOVEMENTS CAUSING CROWDING --MESIAL AND DISTAL CROWN MOVING TENDENCIES IN THE TEETH ADJACENT TO EXTRACTION SPACES CAUSES OPENING OF THE www.indiandentalacademy.com EXTRACTION SPACES
  • 52. UNDESIRED VERTICAL MOVEMENTS -Causes deep bite to redevelop - in second premolar and first molar extraction cases open bite may develop in molar region -UNDESIRED TRANSVERSE MOVEMENT -Causes molar to roll out buccally and rotate -ROOTRESORPTION POSSIBILITIES -GENESIS OF THIRD STAGE COMPLICATIONS -- More amount of lingual root torque more is the reciprocal effect -Forces generated by uprighting springs -Use of weak base arch wire www.indiandentalacademy.com
  • 53. OVERCOMING THIRD STAGE PROBLEMS 1) MINIMIZE THE NEDD FOR ROOT MOVEMENT - Plan from the beginning - Diagnose the case correctly , the amount of reduction in proclamation - Use efficient braking mechanism to protract molars - Tip the incisor in controlled manner , use of MMA , LIGHT UPRIGHTING springs - 2) USE OF HEAVY BASE WIRES 0.020 premium grade wires These resist the vertical and transverse reactions 3) LIGHTER AUXILLARIES AND UPRIGHTING SPRINGS Spurs made of 0.012 wire is the choice Mini uprighting springs 0.012 and 0.010 wires www.indiandentalacademy.com
  • 54. 4) LIGHT CLASS II ELASTICS Yellow elastics (TP ORTHO) 5) REINFORCEMENT OF ANCHORAGE In severe proclination Head gear or TPA is added in the upper arch Lip bumper in the lower arch Bite blocks for vertical augmentation Molar uprighting in reinforcing the anchorage www.indiandentalacademy.com
  • 55. Start and finish of third stage At the start Teeth must be well aligned and leveled Spaces closed, Correct distal tipping of upper molar Some percentage of correction achieved is always lost during third stage Overdo corrections by 15% at the end of second stage COMPLETION Of THIRD STAGE Visual inspection Palpate the roots Radiographs- lateral ceph ,OPG. Teeth should be mildly overtorqued and over uprighted www.indiandentalacademy.com
  • 56. ELASTICS LIGHT CLASSII ELASTICS FOR MAINTAINING INTER ARCH RELATIONSHIP BLUE OR RED ELASTICS IN DISTAL VERTICAL OR BOX CONFIGURATION IF SPACES REOPEN GREEN OR BLUE ELASTICS MAY BE USED BANDING SECOND MOLARS WHEN MALALIGNED, BANDED MIDWAY DURING THIRD STAGE SECTIONAL WIRE 0.012 OR 0.014 IS USED AFTER ALIGNMENT CONTINUOUS WIRE 0.016 IS USED www.indiandentalacademy.com
  • 57. TORQUING AUXILLARIES AND UPRIGHTING SPRINGS Torquing auxillaries with spurs The lingual torquing effect is on account of two factors- -the vertical plane in which the torquing auxillary orients when fitted on the two central incisors, is changed to the horizontal plane of the arch wire when fully tied to it -when torquing auxillary is opened to the larger arc of the anterior region it rolls inwards Both these effects force the tips of the spurs to press in a lingual direction against the gingival portion of the crown Auxillary is made from 0.012 P + PULSE STRAIGHTENED On an average length of the spur should be 5mm can be varied according to the length of the crown www.indiandentalacademy.com
  • 58. Inclination of the spur should be kept 0 0 ,hence activation is 100% Slightly overregulate the spur and keep the legs of the spur divergent Distal leg of the spur is kept 0.5mm short Inter spur span is curved as recommended by KESLING Recommended size of the circle is an old 50 paise coin Forces increase with the decrease in the diameter of the circle www.indiandentalacademy.com
  • 59. Single root torquing auxillary (KESLING) Used on any tooth other than molars Upper premolars for buccal root torque Long arm should extend three to four adjacent teeth when engaged in the brackets Convexity facing upwards exerts buccal root torque Made 0.012 wire RECIPROCAL TORQUING AUXILLARY (SPEC) EMPLOYED WHEN TWO ADJACENT TEETH REQUIRE ROOT TORQUE IN OPPOSITE DIRECTIONS Made of 0.010 wire www.indiandentalacademy.com
  • 60. REVERSE TORQUING AUXILLARY FOR CONTROLLING THE ROOTS OF CANINES OR PREMOLARS -FRANCICUS TAN -For labial root movement of the palatally impacted canines MADE of 0.012 P+ Wire, inserted into the molar from the distal end Activation is by rotating the auxillary 90 o BUCCAL ROOT TORQUE ON THE MOLARS Boot designed occlusal extensions on the molars Made of 0.014 wire www.indiandentalacademy.com
  • 61. Lingual root torque only on the lateral incisors Made of 0.012 wire Convexity of the auxillary facing gingivally www.indiandentalacademy.com
  • 62. UPRIGHTING SPRINGS Made from 0.009 supreme grade wire (MOLLEHAUER) Minisprings differ from the older springs in two ways -coil of the spring is only twice the size of the wire -Stem of the spiring runs tangential to the coil Activation 100% Angulation 180, previously 135 MAXI – Coil diameter 4 TIMES THAT of wire Mini- Coil diameter 2 times that of wire Midi – In between, made of 0.010 or 0.012 www.indiandentalacademy.com
  • 63. FINISHING AND DETAILING OBJECTIVES 1) INTRA ARCH OBJECTIVES Good inter dental contacts, proper inclinations, rotations over corrected, complete space closure, flat curve of spee, maintainence of lower inter canine arch width, proper archforms 2) INTER ARCH OBJECTIVES Normal overjet ,overbite, class I molar, canine, interdigitation of posterior cusps 3) FUNCTINAL REQUIREMENTS MATCHING CO-CR , NORMAL CUSPID ,INCISOR GUIDANCE, HEALTHY TMJ ARTICULATION 4) CONTROL OF THE ETIOLOGIC FACTORS 5) SOFT TISSUE FACTOR – FRENECTOMY, CSF www.indiandentalacademy.com
  • 64. ROUND FINISHING ARCHWIRES – 0.020 WIRE IS USED CONTINUE USE OF TORQUING AND UPRIGHTINNG AUXILLARY FIRST ORDER ADJUSTMENTS -PROPER LABIOLINGUAL POSITIONNING OF UPPER LATERAL INCISOR -UPPER CANINE PROMINENCE -OFFSET BETWEEN MOLARS AND PREMOLARS -TOE IN FOR UPPER MOLARS -SECOND ORDER ADJUSTMENTS -VERTICAL ARCHWIRE STEPS -A SLIGHT MESIAL ANGULATION OF MOLARS -A DISTAL TIP OF LOWER MOLARS www.indiandentalacademy.com
  • 65. TIP AND TORQUE CORRECTIONS OVER TORQUE AND OVER TIP ALL THE TEETH BY 10 -15 % RECTANGULAR FINISHING WIRES RECTANGULAR MOLAR TUBES ARE REQUIRED 0.022 X0.018 ALPHA TITANIUM ARCHWIRE IS USED TORQUING TURRET IS USED T PINS ARE USED IN CONJUNCTION www.indiandentalacademy.com
  • 66. KAMEDANIZED BEGG STAGE I -CONTROL UNNECESARY TIPPING OF TOOTH USE SECTIONAL NiTi OVER BASE ARCH WIRES AND T PINS BITE OPENING BENDS DISTAL TO CANINES AND MESIAL TO MOLARS USE OF ELASTICS ; www.indiandentalacademy.com
  • 67. www.indiandentalacademy.com
  • 68. STAGE II RIBBON ARCH TYPE BUCCAL TUBE 6 0 OFFSET IN MAXILLA TORQUING BRACKETS 200 FOR MAXILLA 100 REVERSE TORQUE IN MANDIBLE COMBINATION WIRE BYPASS LOOP FOR PREMOLARS E- LINKS AND POWER CHAINS USED BUCCALLY AND LINGUALLY www.indiandentalacademy.com
  • 69. www.indiandentalacademy.com
  • 70. STAGE III ONLY UPRIGHTING IS CARRIED OUT www.indiandentalacademy.com
  • 71. CONCLUSION: KNOWLEDGE ABOUT VARIOUS APPLIANCE PHILOSOPHIES , TECHNIQUES IS A REQUIREMENT FOR THE ORTHODONTIST. USING THE ACQUIRED KNOWLEDGE, SUITABLE TREATMENT STRATEGY SHOULD BE PERFORMED ON THE PATIENTS. THE MARKETING DICTUM “ ONE SIZE FITS ALL “ SHOULD NOT BE FOLLOWED. INDIVIDUALISATION OF THE TREATMENT PLAN AND CHOICE OF APPLIANCE SHOULD BE GIVEN PRIME IMPORTANCE. PROS AND CONS ARE A PART AND PARCEL OF EACH APPLIANCE SYSTEM, HENCE ORTHODONTIST SHOULD CONCENTRATE MORE ON OVERCOMING THE SHORTCOMINGS AND IMPROVISE THE APPLIANCE SYSTEM FURTHER. www.indiandentalacademy.com
  • 72. REFERENCES Mollenhauer B. New approaches to the Begg technique . Aust orthod j :10;4 , 1987. Mollenhauer B. An aligning auxillary for ribbon arch brackets . Aust orthod j :11; 1990. Kameda A. Begg technique and practice. J ind orthod soc.23:51;1992. Vijay P Jayade. Refined Begg for modern times. I ed :2001. Sims MR . Looped system: A contemporary approach . Am j orthod :61; 278 , 1972. Swain B F. Current orthodontic concepts and technique. Vol 11, 2 ed , Saunders, 1975. Barrer : Current concepts in Begg philosophy. Jol Clin Orthod ,16: 2 , 1982. Mamutil. Begg rotation module. J Clin Orthod.21, 1987. Divakar HS , Jayade VP. JIOS interviews . JIOS 1997. Wagers L . Pre orthodontic guidance and corrective mixed dentition treatment www.indiandentalacademy.com concept . Am J Orthod 69:1976.
  • 73. THANK YOU www.indiandentalacademy.com