modifiedbegg.pptx

Contents
• Introduction
• Shortcomings of conventional Begg
• Changing concepts
• KB Technique
• The modular self locking system
• Combination anchorage technique
• BEDDTIOT
• Lingual light wire
• technique Tip-edge
• Atkinson’s 3D universal bracket system
• Conclusion
• reference

Introduction
No treatment modality is ever perfect. With the
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.
The present day Begg differs considerably from the
original teachings of Dr Begg. It has evolved in two
distinct forms.
Refined Begg
Modified Begg

REFINED BEGG
In this technique treatment is done using the same inverted
ribbon arch brackets but incorporating improvements in
mechanics.
MODIFIED BEGG
Here the core light wire philosophy has remained the same
but the bracket designs have changed.

Disadvantages
Disadvantages of conventional Begg included,
• The round wire-ribbon bracket relationship was
unable to give the precise control required for a fine
finishing.
• Posterior root torque was very difficult, again, due to
the same wire-bracket relationship.
• Rotational control was poor with the use of under
size wires in the first and the second stages of
treatment.

• During bite opening ,true Intrusion of
upper incisors was nil or minimal.
• Overuse of class II elastics caused
a. Lack of upper incisors intrusion,
b. Undesirable proclination of lower incisors,
c.Unfavorable tipping of the mandibular and occlusal
planes.

There was no conscious effort to tip the teeth in a
controlled manner in the first and second stages of
treatment. Uncontrolled tipping is know to be associated
with root resorption.
An excess of uncontrolled tipping in the first two stages
necessitated a long third stage for root corrections.
The relatively heavy torquing and uprighting forces
employed during the third stage created many
mechanical problems, besides enhancing the root
resorption possibility.

Changing concepts
During the earlier days the Begg appliance and the
theory of attritional occlusion were considered
inseparable.
Today Begg treatment reconciles with present day
objectives like
Andrews six keys to normal occlusion as the
treatment goal for static occlusion.
A broad based diagnosis is made by taking into
account patients skeletal, dental and soft tissue
characteristics.

Treatment is carried out during mixed dentition phase to
utilize growth changes and leeway space to relieve
crowding.
When extraction has to be carried out, their effect
on the patients profile is considered.
Arch form considerations are given a lot of
importance.

In order to overcome the deficiencies in traditional Begg
treatment , Begg mechanics have been suitably
modified.
Attempts have been made to combine the best in Begg
with the good aspects of other techniques.

Kamedanized Begg
A series of improvements have been made in the Begg
Technique not only from a diagnostic but also from a
technical stand point. One of these improved
techniques is called the K B Technique.
The K B Technique was derived after 25 years of
experience by AKIRA KAMEDA. Kameda practiced
pure Begg from 1966 to 1970 but was unsatisfied with
the results. He felt that Begg Technique had certain
drawbacks.
Kameda A.: An Outline Of The Kamedanized Begg Technique And Tip Edge System, J Ind Orthod
Soc. 1989;20:154-182.

The drawbacks he felt were
 Empirical diagnosis
 Unnecessary overtipping of teeth in the mesio-
distal or labio-lingual planes including anchor
molars
 Collapse of arch form
 Rotations and mesial tipping of 2nd premolars
 Mechanically taxed stage III with many side
effects
 Gummy smile with canting of occlusal plane
Kameda A.: An Outline Of The Kamedanized Begg Technique And Tip Edge System, J Ind Orthod Soc.
1989;20:154-182.

Dr. Kameda also designed and
developed brackets with
angulated bases for torquing
and reverse torquing.
Kameda A.: An Outline Of The Kamedanized Begg Technique And Tip Edge System, J Ind Orthod Soc.
1989;20:154-182.

 The amount of torque built-in was 20° for the upper incisors
and -10° for the lower incisors.
 these brackets are to be used according to the specific
clinical problem.
 The usual pattern of usage is as follows:
 Upper incisors Lower incisors
1. Class II malocclusion 20° -10°
2. Class III malocclusion -10° 20°
Maxwell S. Fogel, Jack M. Magill.: The Modular Self-Locking Appliance System- A Variation in the
Combination Technique, J Clinical Orthod. 1976 Sep: 653 660

K B TUBE AND TORQUING BRACKETS
In the K B Technique it is necessary to use rectangular
buccal tubes for the anchor molars. Round wires in
round tubes reduce friction but have certain drawbacks
like.
A. Anchor bends tend to roll in.
B. Correcting lingually inclined molars is difficult.
C. Directing the force of anchorage bends and bite
opening bends is difficult.

THE MODULAR SELF LOCKING
APPLIANCE SYSTEM
This technique was introduced by FOGEL and
MAGIL in 1976.
The rationale behind the development of this system
was that, an appliance should be a natural power plant
from which long range continuous energy can be
derived.

The modular self locking system
key objective was to treat
Greater numbers,
Better, faster, and easier,
Lower cost,
To utilize highly trained paraprofessionals wherever
possible

It should be able to correct malpositions like rotations,
intrusions, extrusions, crossbites, midline disharmonies
and locked out or partially erupted teeth.
This is essentially a light wire system using a single
pivotal bracket or twin self locking, low functional
attachments.
Both single and double insert brackets with self
locking components are present.

The principle module is the insert bracket, which is
made of a special soft stainless steel.
The elements of the insert bracket are
Arch wire chamber (0.025”)
the round arch wire floats freely in the
0.025”chamber. This chamber permits adequate
tipping of the arch wire.
Beaks
these are flared and form a funnel shaped
entrance for the wire. The beaks can be
opened for holding or releasing the wire.

Insert slot (0.020”) --- Entrance formed by the shape of
beaks and allows easy access for arch wire.
Slot apex (0.012”) --- This is the constricted portion of the
funnel. It permits snapping in and retention of the wire
prior to closure of the beaks.
Seat --- Base of insert bracket which rests in the
grooved wing of the receptacle for stability.
Stem --- Extension of insert bracket which fits into the
vertical slot and holds insert bracket in position when bent
at right angle.

Fig. 2 Light wire insert bracket parts and dimensions
INSERT BRACKET
Bracket head(0.070” x 0.070”). General thickness (0.018”). Overall length (0.235”).

Different sizes of receptacle are
Small ---- .150”
Medium ---- .180”
Wide ---- .200”

Placement of the insert bracket
The stainless steel insert bracket easily fits into the
vertical slot of the receptacle. The stem is cinched and
bent laterally and pressed snugly under the wing.
The receptacle is contoured for specific teeth in the
anterior and posterior segments.
The 3 vertical slots accommodate insert brackets and
auxiliaries.

A single slot is used in the initial stages and mesial
and distal slots are used in the finishing stages.
The receptacles are spot welded to the bands.
Archwires used = 0.014”, 0.016”, 0.018”
Closure of the bracket is accomplished by using Howe’s
plier. The cuspid insert brackets are closed first followed
by the incisors.

In this technique, they have completely eliminated the
edgewise archwire with its constricting influences, the
wire ligation and the binding effects of ligation.
A natural progression of this self-locking, snap-in
technique demonstrating the modular system, begins
with the single insert bracket used in the Combination
Technique and changes to a double insert bracket in the
same receptacle.

This leads to relatively low frictional, high performing
biomechanical tooth movement process to the
completion of treatment.
It is suggested that the receptacle be placed toward the
incisal edge of the band in order to provide sufficient
metal backing for the insert bracket.
Receptacles are also available in either clear or
tooth-colored plastic.
Clear plastic brackets are well accepted by adult
patients

Removal of the arch wire
If the arch wire is not to be reused , the wire can be cut
and each segment can be slipped out separately.
If the wire has to be reused, the insert can be opened
with an insert spreader which is an 0.012” flat bladed
instrument.

Molar Tube Attachment
The oval or slightly flat molar tube with mesial hook is
an important component of the Modified Combination
Technique.
The action of the tip-back bend in the light round wire
as it behaves in the buccal tube and its effect on the
positioning of the molars is directly related to the shape
of the buccal tube.

Combination anchorage technique (CAT)
-Thompson
A technique of orthodontic mechanics called
Combination Anchorage Technique (CAT) introduced by
Dr. William J. Thompson in 1988
Use of the two different bracket slots provides a simple
and efficient means to vary
(1) anchorage (dynamic or static)
(2) movement (tipping or bodily),
(3) technique (light wire or straight wire),
(4) resistance (one tooth or multiple teeth)
(5) treatment compensation (skeletal or dental)
Thompson WJ. Combination anchorage technique: an update of current mechanics. Am J Orthod
Dentofacial Orthop. 1988 May;93(5):363-79. doi: 10.1016/0889-5406(88)90095-9. PMID: 3284330.

C A T BRACKET DESIGN
Designed to be comfortable , esthetically pleasing to
the patient.
The dual capability of the appliance system is due to a
combination bracket design
lower 1/3rd of bracket- Begg bracket (0.022 x 0.035
inch)
upper 2/3rd of bracket- 18x25 straight wire slot with
in-out positioning, pre angulated and pre torqued.

Vertical slot incorporated into bracket for use with
uprighting , rotating springs and auxillaries, elastics and
surgical fixation hooks and attachment of the tandem or
double arch wire.
Brackets are color coded on the disto-gingival
aspect.
Maxillary – red
Mandibular – blue

BRACKET AND TUBE PLACEMENT
Placement is similar to that used in straight wire
appliance.
Normally recommend to place the rectangular tube
3.5 mm from the cusp tip, all other teeth should be at the
same level except canines and upper lateral incisors.
These are altered to provide clearance during mandibular
excursions.
The edge wise slot should be located 4 mm from
cusp tip on canines and 3 mm on maxillary lateral

BEDDTIOT
It is the abbreviation of Begg – Edgewise – Diagnosis –
Determined – Totally – Individualized – Orthodontic –
Technique, developped by Hocevar.
The appliance system offers the capacity to employ
selected principles and features of Begg and edgewise
mechanism in specific situations in which they are more
advantageous.
The primary goal was the facility to treat each patients
needs in the manner most efficient for that individual.
Hocevar RA. Begg-edgewise diagnosis-determined totally individualized orthodontic technique: foundations,
description, and rationale. Am J Orthod. 1985 Jul;88(1):31-46. doi: 10.1016/0002-9416(85)90105-8. PMID:
3860011.

The system uses
narrow, single brackets
with 0.020 X 0.028
inch edgewise arch
wire slots and 0.020 X
vertical
various
0.020 inch
slots for
auxiliaries.
3860011.

The brackets and bonding pads are small in all
dimensions to ensure optimal appearance and
interbracket archwire spans and minimal lip and cheek
irritation.
This also lessens occlusal interference, enamel surface
involved in bonding and problems with gingival
proximity and oral hygiene.
3860011.

The basic buccal tubes
are conventional
4.5mm long, 0.022X
0.028 inch torqued
edgewise tubes.
3860011.

A buccal tube assembly with a similar additional
rectangular tube carried diagonally at a 150 angle across
the buccal surface of the basic tube in extraction cases
with deep overbites or moderate to severe anchorage
requirements.
The angulated outer tube carries the main archwire
during the bite opening and retraction phases of
treatment.
3860011.

Uprighting springs may
be inserted in the
0.020” x 0.020”
vertical slot.
3860011.

One of the most important advantages of the
BEDDTIOT appliance is its facility for both three
dimensional control and limited tipping with light forces
using a simple bracket.
BEDDTIOT is not a compromise technique. The
operator does not need to make any significant sacrifices
with this appliance system.
3860011.

In 1982, Paige introduce a lingual lightwire technique
with a horizontally slotted unipoint combination bracket
and both round and ribbon wire
Paige SF. A lingual light-wire technique. J Clin Orthod. 1982 Aug;16(8):534-44. PMID: 6757267.
LINGUAL LIGHT WIRE
TECHNIQUE

BRACKET DESIGN CRITERIA
.
Interbracket distance is reduced on the lingual. Therefore,
the bracket must be designed to be as narrow as possible
mesiodistally.
Keeping the buccolingual distance minimal would also have
advantages, since a small buccolingual dimension will
increase interbracket distance

Cuspid and bicuspid uprighting after closure of
extraction spaces requires efficient mechanisms for
uprighting. A possible solution to this problem is the use
of vertical slots for arch auxiliaries.

The bracket currently in
use is the Unipoint
combination bracket
(Unitek), with the slot
oriented in the occlusal-
incisal direction. The
horizontal slot is not
routinely used during
treatment and is used
only to aid in unraveling
of crowded anteriors.

MOLAR TUBE AND DESIGN
A squashed oval tube
design is recommended
as it is
comfortable,
molar control
allows
and
takes in a ribbon arch.

The oval tube is
centered mesio-distally
and should be placed as
occlusally as possible
on the band.

TIP EDGE BRACKET
In 1986, a change in the design of the arch wire slot
made by Dr. P.C. Kesling, corrected all these problems.
The modification was the removal of diagonally opposed
corners from the conventional edgewise slot to permit
either mesial or distal crown tipping.
Graber T.M, Vanarsdall R.L. Orthodontics current principles and techniques. 3rd Edi. , St Louis. Mosby, Inc; 2000
TIP EDGE
Richard Parkhouse,tip-edge orthodontics,2003

By removing predetermined, diagonally opposed corners
from the conventional edgewise archwire slot, the Tip-Edge
bracket is created.
This permits the desired distal crown tipping required for
differential tooth movement.
Pre-adjusted in three dimensions, the Tip-Edge slot permits
the use of straight archwires in the majority of cases: both
extraction and non-extraction.

Various components of the Tip-Edge bracket are
1. Uprighting and torque control surfaces (pre-adjusted).
2. Central ridges for vertical control.
3. Wings for rotational control
4. Notches or vertical slot to accept Side-Winder springs

Not only do the archwire slots permit initial crown
tipping but also they are preadjusted to provide the
desired final degrees of crown tip and torque.

MOLAR TUBES
The Tip Edge molar
tubes are of double
configuration. A longer
is
Round tube
positioned gingivally
And a shorter rectangular
Tube occlusally at the
level of the premolars
bracket.

ATKINSONS 3D UNIVERSAL
BRACKET SYSTEM
Since its development by DR SPENCER ATKINSON
in 1928, the universal appliance has undergone periodic
refinements without losing its essential characteristics.
Though the brackets performed efficiently, deficiencies
did exist. JORGE FASTLIGHT felt that lateral
extending tabs or wings too bulky and that the central
vertical shaft was too narrow and shallow to
accommodate the arch wires and ligatures.
Dr. Jorge fastlicht 1974 , the 3D universal bracket J Clinical Orthod:149-159

The solution was to eliminate the lateral wings and
make a bracket that was wider mesio-distally and had
more room bucco-lingually.
The resulting bracket was simpler to use with greater
built in levelling, rotation and torquing potential. It had
more room for ligating. There was more space for
uprighting springs.

Elimination of the lateral wings provided the welding
tabs with more welding space. The bracket was called the
3 D universal bracket because of its tridimensional
mechanical principle.

BRACKET DESIGN
Essentially a vertical shallow shaft with 2 lateral
welding tabs. The vertical shaft has 2 slot openings.

The horizontal one opens labially at the gingival
third and accommodates 0.008 to 0.016 base wire.
The vertical slot opens incisally near its base and
extends gingivally 1/3rd of the bracket height.
It can accommodate a single wire , either ribbon or
flat from 0.008 x 0.020 to 0.016 x 0.028.

ADVANTAGES
 Efficiency in leveling and correcting
rotations and mesio-distal incisal
inclinations.
 Permits bodily movement of teeth in a
mesio- distal direction.
 Torques automatically in most cases.

CONCLUSION
No bracket system is perfect. All systems have there
advantages and drawbacks. It is upto the clinician to use
his skills and to overcome the deficiencies.
In this seminar various appliance systems have been
presented. It is the belief of the creators of these
appliances that the best aspects of Begg and Edgewise
appliances is incorporated in the appliance which is
efficient, easy to use and gives consistently good results.

1. Kameda a.: An outline of the kamedanized begg technique and tip edge system, j
ind orthod soc. 1989;20:154-182.
2. Maxwell s. Fogel, jack m. Magill.: The modular self-locking appliance system- a
variation in the combination technique, j clinical orthod. 1976 sep: 653 660
3. Thompson wj. Combination anchorage technique: an update of current mechanics.
Am j orthod dentofacial orthop. 1988 may;93(5):363-79. Doi: 10.1016/0889-
5406(88)90095-9. Pmid: 3284330.
4. Hocevar .: begg-edgewise diagnosis-determined totally individualized orthodontic
technique, am. J. Orthod. 1985 jul: 31 46.
5. Paige sf. A lingual light-wire technique. J clin orthod. 1982 aug;16(8):534-44.
Pmid: 6757267.
6. Graber t.M, vanarsdall r.L. Orthodontics current principles and techniques. 3rd
edi. , St louis. Mosby, inc; 2000
7. Dr. Jorge fastlicht 1974 , the 3d universal bracket j clinical orthod:149-159
8. Richard Parkhouse,tip-edge orthodontics,2003
Reference

modifiedbegg.pptx

Recommended

Recommended

More Related Content

Similar to modifiedbegg.pptx

Similar to modifiedbegg.pptx (20)

More from PrashantBaviskar10

More from PrashantBaviskar10 (10)

Recently uploaded

Recently uploaded (20)

modifiedbegg.pptx