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Stage iii of begg’s technique changed /certified fixed orthodontic courses by Indian dental academy
 

Stage iii of begg’s technique changed /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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    Stage iii of begg’s technique changed /certified fixed orthodontic courses by Indian dental academy Stage iii of begg’s technique changed /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

    • Good Morning..Good Morning.. www.indiandentalacademy.com INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
    • Presented By: Dr. Pritam Dhoka. Department Of Orthodontics And Dentofacial Orthopaedics A.B.Shetty Memorial Institute Of Dental Sciences www.indiandentalacademy.com
    • END OF STAGE II www.indiandentalacademy.com
    • Stage II Records.  Points to be evaluated: 1) Bite opened. 2) Edge to edge incisor contact. 3) All rotations, anterior and posterior properly overcorrected. 4) Molar relationship overcorrected. 5) Good, well supported intercuspal posterior occlusion. 6) All space closed. 7) Buccolingual relationship of posterior teeth properly established. 8) Anterior teeth sufficiently retracted to allow for some relapse. www.indiandentalacademy.com
    • STAGE III OBJECTIVES: 1. Maintain all corrections achieved during first and second stages. 2. Achieve desired axial inclinations of all teeth. www.indiandentalacademy.com
    • Pre-stage III archwire.. The highly resilient 0.016 inch archwires should be used in gaining bicuspid bracket engagement preparatory to the placement of the heavier and less resilient 0.020-inch stage III archwire. This precaution avoids the imposition of excessive alignment forces on the bicuspid teeth. www.indiandentalacademy.com
    • Maxillary base arch wire 0.020-inch round stainless steel Australian heat- treated arch wire is used. Purpose -: 1}Maintening proper dental arch form. 2}Maintaing bite-opening that has been obtained. 3}Stabilizing(counteracting) against adverse reciprocal forces.www.indiandentalacademy.com
    • Intermaxillary hooks. -Located 1mm mesial to each canine bracket. -Formed with middle step of Tweed’s loop- forming pliers. (2mm diameter) -Ligation of hooks to canine brackets www.indiandentalacademy.com
    • Anchor bends. Reduced or removed? Archwire should just touch the mesial opening of the buccal tubes at 6 o’ clock position without exerting tipping action. www.indiandentalacademy.com
    • Molar horizontal offset. -Because of difference in the buccolingual dimensions of the molars and premolars. -To place the central developmental grooves of the teeth in alignment. Placed 1-2mm mesial to the molar tubes. www.indiandentalacademy.com
    • Occlusal blend (vertical step-up bend). -Mesial to the molar tube. - To obtain bicuspid bracket engagement -Maintain correct vertical molar-premolar relation. Change in the marginal ridge height thatChange in the marginal ridge height that will accompany uprighting of a mesiallywill accompany uprighting of a mesially tipped premolar should be taken intotipped premolar should be taken into consideration.consideration. www.indiandentalacademy.com
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    • ‘V’ bend ( Gingival bend, Accessory bite opening bend) Slight (about 15 degrees) ‘V’ bend distal to canines in the base archwire which will bow the incisal section of archwire gingivally. Extent should be sufficient to bring the anterior section of archwire to the level of gingival margin of the central incisors when the archwire is seated in the molar tubes and premolar brackets. www.indiandentalacademy.com
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    • Reciprocal actions of canine and premolar uprighting springs? Resultant openbite in the canine premolar area. www.indiandentalacademy.com
    • Reciprocal action of incisal torquing auxillary? Resultant deepening of overbite in central incisor area. www.indiandentalacademy.com
    • ‘V’ bend will produce an intrusive force on central incisors and and a slight extrusive force on canines and premolars, thus compensating distorting forces. Maintain the bite-opening achieved in earlier stages. www.indiandentalacademy.com
    • The posterior section of the base archwire is constricted. Molar portion of the base archwire should lie on the tips of lingual cusps of molars when the archwire is held over the occlusal aspect of dental arch to determine arch form. Care about expansion or constriction of canines? www.indiandentalacademy.com
    • To counteract the widening effect of incisor torquing auxillary i.e to counteract the untoward moments resulting from activation of incisor torquing auxillary which tips the molars buccally. www.indiandentalacademy.com
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    • If molar intrusion occurs it can be controlled by the use of vertical elastics between the maxillary and mandibular molars. www.indiandentalacademy.com
    • Bending archwires around tubes. Distal tips should be annealed to the level of distal of molar buccal tube. Wire is cut off 2mm distal to molar buccal tube and free end is bent so that it rests against the molar band occlusally to the molar tube. -Serves to maintain space closure. www.indiandentalacademy.com
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    • Care to be taken to prevent the beaks of pliers from resting against the distal surface of the tube. -Can set up a camming action that results in the archwire being drawn distally through the molar tube with such force during bending that the archwire can be permanently distorted in the inter-maxillary hook area. This can destroy the desired archform and permit the anchor molars to move buccally. www.indiandentalacademy.com
    • The bend should be barely snug against the distal end of tube. Cinching back the ends of archwire tightly cause molar expansion and disto-buccal molar rotation. www.indiandentalacademy.com
    • Lingual ligatures.Lingual ligatures. Described by Dr. Raleigh Williams. Made of 0.012-inch ligature wire. Tied to molar and pulled anteriorly through the cervical embrasure between lateral incisor and cuspids and is twisted around the archwire. www.indiandentalacademy.com
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    • Should be used to maintain space closure and hold corrected molar rotation. Should be snug but never tight. www.indiandentalacademy.com
    • Excessive tightening of this ligature tends to distort archform by flattening the archwire in the area of circle hook and may cause proximal binding which may interfere with uprighting. www.indiandentalacademy.com
    • Mandibular base archwire. 0.020-inch round stainless steel Australian heat-treated arch wire is used. www.indiandentalacademy.com
    • Intermaxillary hooks. Intermaxillary hooks are located 0.5mm mesial to each canine bracket. Formed with first step of Tweed’s loop-forming pliers. (1mm diameter) Small rings occupy less archwire space between the canine and lateral incisor brackets thereby providing more space for the horizontal arms of the lateral incisor uprighting springs. Ligation of hooks to canine brackets. www.indiandentalacademy.com
    • Slight (about 10 degrees) ‘V’ bend distal to canines in the base archwire which will bow the incisal section of archwire gingivally. As heavier base archwire is used, anchor bend reduced than in earlier stages to prevent distal tipping of molars. Molar horizontal offset and vertical step. www.indiandentalacademy.com
    • Expanded at its end to combat the continued tendency for the mandibular anchor molars to tip lingually from the wearing of class II elastics. www.indiandentalacademy.com
    • Mesio-distal Uprighting spring (Individual root-spring) Original uprighting spring with long lever arm and tail. www.indiandentalacademy.com
    • Refinement of the original spring. -Shorter lever arm. -Larger, more resilient coils. -As efficient as original spring. -The angulation of the active arm  and retentive arm is 135 degree. Advantages: self retaining and being short they do not interfere with springs on adjacent teeth. www.indiandentalacademy.com
    • Self retaining uprighting spring with 3 full coils to provide gentle, continuous force necessary to upright teeth without requiring reactivation. www.indiandentalacademy.com
    • Placed in the pin channels of the brackets. Helix should wind in the lingual direction i.e towards the tooth surface and lie on the gingival aspect of the archwire at the opening of the bracket slot. www.indiandentalacademy.com
    • Length of the hook is made slightly greater than the diameter of the helix to keep arm of spring parallel to the archwire in the vertical plane. To avoid the rotating force on the tooth, the arm of the spring is offset buccally to make it parallel to the archwire in the horizontal plane.www.indiandentalacademy.com
    • Direction of Hooks?Direction of Hooks? www.indiandentalacademy.com
    • Action of short arm uprighting spring. www.indiandentalacademy.com
    • Long-arm uprighting springs.Long-arm uprighting springs. -Used when mesiodistal diameters of canine and premolars are small where it is not possible to place the short-arm type of uprighting springs without the hooks contacting each other. www.indiandentalacademy.com
    • Inherent Problem? When the uprighting springs are engaged and under tension, the coils press against the gingival edge of the bracket. If the archwire is not safely tied into the slot in the bracket, this force from the coil can cause the bracket to move away from the archwire, with a subsequent elongation of the tooth. www.indiandentalacademy.com
    • Solution? Spring-pin.Spring-pin.  - combination of lock-pin and and an uprighting spring. The leg of the pin portion passes lingual to the archwire, and the tail of the spring fits labial to the archwire in the space in the space in the bracket slot, and the tooth is free to upright mesiodistally with no danger of it being elongated. Eliminates the need for ligating the arch wire to the bracket www.indiandentalacademy.com
    • Spring-pin is inserted in bracket with the pin portion passing lingual to the archwire. www.indiandentalacademy.com
    • Annealed end of spring is bent around the incisal end of bracket, securely locking the spring-pin and archwire in place. www.indiandentalacademy.com
    • Arm of spring is hooked over the archwire, activating the coils and creating the necessary force to upright the tooth mesiodistally. www.indiandentalacademy.com
    • The horizontal arms of the uprighting springs may need to be shortened as uprighting occurs to prevent space opening, tooth rotation, and impairment of the uprighting action which may result from contact of the hooks with the adjacent brackets or bands. www.indiandentalacademy.com
    •  The degree of activation of the uprighting spring depends on 1) Size of wire. 2) Diameter of the helix. 3) Number of turns in the helix. 4) Length of the arm of the spring, and 5) Size of the root of the tooth being uprighted. www.indiandentalacademy.com
    • In a first premolar extraction case: Order for need of teeth to be uprighted: Lower canines Upper canines Lower second premolars Upper second premolars Upper lateral incisors Lower lateral incisors www.indiandentalacademy.com
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    • Upper and lower canines-0.016-inch or 0.018inch, 2- coils Upper and lower second premolars- 0.016 inch , 2- coils Upper lateral incisors – 0.014 inch,2- coils Lower lateral incisors – 0,014 inch ,3- coils www.indiandentalacademy.com
    •  Most resilient available wire should be used (Australian heat-treated stainless steel) because: 1) Makes possible the engagement of the arm of the spring about the archwire, with little chance of deformation. 2) Insures full activation of the springs during a greater range of uprighting. 3) There is less need to reactivate the arms of springs to insure continuous uprighting of teeth. www.indiandentalacademy.com
    • Arch wire ligation prior to placement of uprighting spring www.indiandentalacademy.com
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    • MildMild discrepancy cases i.e in firstdiscrepancy cases i.e in first premolar extraction cases havingpremolar extraction cases having only aonly a mild excess of toothmild excess of tooth substance relative to jaw sizesubstance relative to jaw size?? www.indiandentalacademy.com
    • ModerateModerate discrepancy cases i.e indiscrepancy cases i.e in first premolar extraction casesfirst premolar extraction cases havinghaving considerable excess ofconsiderable excess of tooth substance relative to jawtooth substance relative to jaw sizesize?? www.indiandentalacademy.com
    • SevereSevere discrepancy cases i.e indiscrepancy cases i.e in which it is necessary to extractwhich it is necessary to extract eight teeth (4 first premolars and 4eight teeth (4 first premolars and 4 first permanent molars)?first permanent molars)? www.indiandentalacademy.com
    • Non-extractionNon-extraction cases, especiallycases, especially those cases that have anthose cases that have an excess ofexcess of jaw substance relative to toothjaw substance relative to tooth sizesize?? www.indiandentalacademy.com
    • Originally spurs to rest against the labial surfaces of upper central and lateral incisors were bent into the main maxillary archwire made from 0.016-inch archwire material. The effect was to move the molars buccally and also to rotate them disto- buccally. www.indiandentalacademy.com
    • By employing a heavier main base archwire in conjunction with a torquing auxiliary bent from lighter material (0.014 to 0.016-inch), it was possible to prevent undesired movement of the maxillary anchor molars. www.indiandentalacademy.com
    • Four-Spur torquing auxiliary.Four-Spur torquing auxiliary. Employed to torque upper and lower incisor roots palatally. Made with 0.016 or 0.014-inch archwire. www.indiandentalacademy.com
    • Factors which alter the forceFactors which alter the force values of an auxiliary:values of an auxiliary: 1) Type of wire 2) Diameter of the wire 3) Size of the circle 4) Angle the spur makes with the plane of the auxiliary 5) Axial inclination of the teeth 6) Length of the spur? www.indiandentalacademy.com
    • The amount of torque force is related to the extent that the spurs are tipped back, the torque force being derived from the amount of torque in main line of auxiliary archwire. The spurs play a passive role- they act only as means of delivery of torque force from the main line of archwire.www.indiandentalacademy.com
    • Procedure for bending four-spur torquing auxiliary: www.indiandentalacademy.com
    • Auxiliary is formed into an arc smaller than that of the anterior portion of the patients dental arch, with the spurs in a nearly horizontal position. www.indiandentalacademy.com
    • Torquing auxillary with spurTorquing auxillary with spurB E G G When spread along the wider curvature Lingual torquing Vertical plane in which the aux orients when fitted into the incisor is changed to the horizontal plane of the arch wire when tied to it The larger arc of the anterior portion of the wire roll inwards The tip of spur to press in aThe tip of spur to press in a lingual direction against thelingual direction against the gingival portion of thegingival portion of the crowncrown Inter spur span – lift in a labial direction Bracket slot Base arch wire Counter act www.indiandentalacademy.com
    • Pre-Wound Torquing Auxiliary.Pre-Wound Torquing Auxiliary. Not in common use. - Precise nature of wire-bending required. -Complex. Produced commercially- using special bending fixtures. Graduated sizes- Varying mesiodistal widths of teeth. www.indiandentalacademy.com
    • Simpler to apply. Capable of delivering greater amount of force through a greater range of movement than other types of incisor torquing auxiliaries. Wound either from 0.016 or 0.014-inch wire. www.indiandentalacademy.com
    • Activated by meeting the resistance of the stop on the midline of the archwire. Possible to remove torque bars from the lateral incisors as these teeth become adequately torqued. Can be modified to produce labial root movement. www.indiandentalacademy.com
    • Procedure for assembling a Stage III mechanism: 1} Place the upper and lower main base archwires in the mouth. 2} Lower archwire is pinned in place, using Stage III lock-pins on teeth that do not require mesiodistal uprighting. 3} Place proper spring pins in all remaining mandibular teeth and maxillary second premolar brackets. www.indiandentalacademy.com
    • 4} Pin the upper torquing auxiliary in one of the maxillary central incisor brackets. 5} Distal ends of auxiliary are then pinned into canine brackets gingival to main archwire with spring-pins. 6} Bend the distal ends of the archwire as described earlier.www.indiandentalacademy.com
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    • Additional considerations:Additional considerations: If the maxillary or mandibular anchor molars show signs of rotating distobuccally, tie with 0.012-inch diameter ligature wire lingually from lingual hook on molar to lingual button on cuspid. The end of archwire should not be bent tightly around the distal surface of molar tube here, as molar tube must be free to slide distally to allow the molars to rotate distolingually. www.indiandentalacademy.com
    • TWO SPUR TORQUING AUXILIARYTWO SPUR TORQUING AUXILIARY ( von der Heydt auxiliary )( von der Heydt auxiliary ) When only central incisors reguire the torque, auxillary with two spurs is used. www.indiandentalacademy.com
    • Maxillary lateral incisors are often displaced bodily to the lingual prior to the treatment. During stages I and III, their crowns are tipped labially, leaving their roots far to the lingual. Unless their roots are torqued labially during stage III, their crowns will tend to relapse lingually . RECIPROCAL TORQUING AUXILIARYRECIPROCAL TORQUING AUXILIARY ( SAIN Auxiliary)( SAIN Auxiliary) www.indiandentalacademy.com
    • Dr John Kitchton’s lingual rootDr John Kitchton’s lingual root torquing auxiliary.torquing auxiliary. Can be easily applied and removed. Can be used for torquing central and lateral incisors or only central incisor roots. Capable of exerting a great amount of force, especially when fashioned from 0.016-inch archwire material. www.indiandentalacademy.com
    • Passive state. Activation is increased by bending lever arms further gingivally before placing. www.indiandentalacademy.com
    • Auxiliary can be placed with coils straddling archwire. www.indiandentalacademy.com
    • Auxiliary bent from 0.016-inch archwire to torque the roots of the maxillary central and lateral incisors palatally. Vertical spur bent into heavy main archwire acts as a point of resistance against centre section of auxiliary. www.indiandentalacademy.com
    • Auxiliary modified to apply labial root torque to maxillary lateral incisors only. The resistance spur on main archwire is lingual to centre section of auxiliary. www.indiandentalacademy.com
    • Mandibular Reverse TorquingMandibular Reverse Torquing AuxiliaryAuxiliary.  Indicated if lower anterior teeth are becoming too proclined.  Acts as a source of intra oral mandibular anchorage to inhibit forward movement of mandibular dental arch. www.indiandentalacademy.com
    • ONE TO ONE TORQUEING AUXILIARYONE TO ONE TORQUEING AUXILIARY Indicated when two adjacent teeth require root torque in opposite directions. Tends to deliver excessive force therefore degree of activation between lever arms should be low www.indiandentalacademy.com
    • Auxiliary to correct buccolingualAuxiliary to correct buccolingual axial inclination of premolar.axial inclination of premolar. www.indiandentalacademy.com
    • Use of Class II Elastics. Prevent the force exerted by vertical root torquing spurs in the upper auxillary archwire from moving whole of upper dental arch anteriorly. Prevent the dental arches from reverting to their original class II occlusal relations and keep the incisors in end to end bite. www.indiandentalacademy.com
    • PROBLEMS ENCOUNTERED DURING STAGE IIIPROBLEMS ENCOUNTERED DURING STAGE III Maxillary Molars Widening?Maxillary Molars Widening? Mandibular molars narrowing?Mandibular molars narrowing? Anterior bite deepening?Anterior bite deepening? Teeth not uprighting mesiodistally?Teeth not uprighting mesiodistally? Maxillary anterior teeth not torqueingMaxillary anterior teeth not torqueing palatally?palatally? Lower anterior teeth labially inclined?Lower anterior teeth labially inclined? Rotation of teeth other than molars?Rotation of teeth other than molars? www.indiandentalacademy.com
    • Causes of loss of anchorage in the third stage of treatment. Class II elastics not worn. Use of rectangular archwires to torque tooth roots instead of using root-torquing spurs formed from light round archwire. www.indiandentalacademy.com
    • Conclusion.Conclusion. -One needs a lot of perseverance to reach proficiency in this technique. -Various refinements and modifications in the Begg technique have given the orthodontists innumerable ways of achieving the objectives of the procedure. -We as Orthodontists should go ahead and put them to judicious and profitable use. www.indiandentalacademy.com
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    • Sequence of insertion of Archwires and Auxiliaries The base arch wires are inserted unpinned but fitting well upto the Begg slot Arch wires are cinched distal to the molars to prevent the spaces from opening up Depending on the need for torquing the torquing auxiliary is fabricated www.indiandentalacademy.com
    • In the lower arch only uprighting springs are inserted unless labial/lingual torque is needed direct the lower arms towards the root movement intended insert the vertical leg into the pin slot pull it occlusally so the spring lock holds the archwire firmly bend this vertical leg towards the root movement intended to activate hook the lever arm to the main archwire.www.indiandentalacademy.com
    • After the root tipping movements of the third stage are completed remove the torquing and paralleling auxiliaries and make adjustments in the base archwire to complete the treatment. To flatten the occlusal plane make localized vertical offset bends to level individual teeth To obtain bilateral symmetry make definite localized horizontal offset bends to expand or contract individual teeth and make the arch symmetrical www.indiandentalacademy.com
    • INDIVIDUAL TORQUEING AUXILIARYINDIVIDUAL TORQUEING AUXILIARY  Used for selected upper or lower teeth  Auxiliary should extend at least one tooth pass tooth being torqued, and around curve of arch, for maximum activation.  If placed gingivally, torque the root of the lateral lingually. www.indiandentalacademy.com
    • ASYMMETRICAL TORQUING AUXILIARYASYMMETRICAL TORQUING AUXILIARY  Auxiliary used to produce palatal root torque of the maxillary right central and lateral incisors.  The ends of the auxiliary are terminated distal to the canine brackets.  As the central incisor loop is formed mesial to the bracket and the lateral incisor loop is formed distal to the bracket mesodistal movement of the auxiliary is prevented. www.indiandentalacademy.com
    • Barrer in 1963 suggested the acuteness of the angle between the torquing spur and the horizontal plane www.indiandentalacademy.com
    • Chourie in 1965 in his thesis sugested thatChourie in 1965 in his thesis sugested that length of the torque spur loop exerts anlength of the torque spur loop exerts an affect upon the amount of force deliveredaffect upon the amount of force delivered to the root tip.to the root tip. Newmann in 1963 presented aNewmann in 1963 presented a formula for calculating the force atformula for calculating the force at the apex of the incisorsthe apex of the incisors .. www.indiandentalacademy.com
    • F=ØG¶r4 2Ld Ø is the angle in radians G is the average modulus of rigidity of stainless steel ¶ is a constant L is length of the wire d is the distance from root apex to bracket area r is the radius of the wirewww.indiandentalacademy.com
    • The lingual torquing effect is on account of two factors: 1. Vertical plane changes to horizontal. 2. Smaller circle opens to large. Both these effects force the tips of the spurs to press in a lingual direction against the gingival portion of the crown. Reciprocally, the inter – spur spans of the auxiliary tend to lift away in a labial direction. Thus a force couple is created. The labial forces are resisted by the bracket slots and the base archwire to which auxiliary is tied this accentuates the action of root lingual moving force. www.indiandentalacademy.com
    • Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com