consideration of stage 1 in begg technique/certified fixed orthodontic courses by Indian dental academy

A general consideration of
Stage I in Begg Technique.
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INDIAN DENTAL ACADEMY
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Introduction
• General objective of any ortho trt. – to
obtain a result that simulates normal
occlusion.
• With Begg technique objective achieved by
dividing trt. into 3 stages.
Stages I and II – Crown tipping phase.
Stage III – Root tipping phase.
Stage IV – Finishing phase

• Overlapping of the stages must be avoided.
• ie. Objectives of each stage met before
proceeding
• Therefore better results and fewer
problems are encountered.
• Division into stages
– to prevent anchorage failure
– Teaching and learning made easier.

Objectives of Stage I
• Correction of crowding and irregularity
• Closure of anterior spaces.
• Correction of rotations.
• Elimination of deep bites -edge to edge
bite / open bite except in class III

• Openbites  Overbite
relations
• Correction of Mesiodistal
relations of buccal segments
– Class I and Class II  Mild class
III
– Class III  Class I or Class II
• Co-ordination of upper and
lower arches.

• Correction of anterior and posterior cross
bites.
• Axial relation of anchor molars corrected –
upright position.
– Extraction spaces become smaller
– All tooth movements carried out
simultaneously & in both arches.

Orthodontic apparatus in Stage I
• Attachments – Bands, brackets, tubes &
lingual cleats.
• Archwires
• Ligatures.
• Elastics.
• Auxiliaries.- Rotation springs.

• Apparatus applied simultaneously
– to avoid breakage
– Act simultaneously to reciprocal adv. with
each other
• Creeping into trt. avoided  Severe loss of
anchorage.

Archwires
Material –
– 0.016 special AJW – principal wire of Stage I.
– Combination of resiliency, flexibility & stiffness
– Important for bite opening by incisor intrusion
– Developed by rigid control in wire drawing and
heat trt.
– 0.018 special – Molar extraction cases
– 0.014 special – rotating springs.

Parts
• Intermaxillary Hooks – ( IMH )
Small loops for engaging elastics and cuspid ties
– 2 types –
• Boot
• Circle/ Helical
– Adv of Circle hook.
• Mesial & Distal rolling possible
• Less space requirement.
• Less distortion
• Greater stiffness in horizontal and vertical plane.
• Neat & simple

Location
– Well aligned ant. – 1-2 mm mesial to the
cuspid bracket.
– Spaced ant. – Farther mesially.
– Mildly crowded ant. – impinging on the
bracket.
– Severely crowded – multi loop wires.

• Anterior Segment.
– Portion of the wire b/w IMHs
– lies gingival to buccal segment for effective intrusion
– Reverse curve at midline – 2-3 mm elevated form occlusal
plane for even intrusion.

• Cuspid Offset bend.
– Horizontal offset bend mesial to the IMH.
– Proper positioning of the cuspid and the lateral
incisor.
• Cuspid Curve:
– Labial curvature in cuspid area – incorporated
to avoid lingual tipping of canines.
– In narrow arches requiring expansion, definite
offset given.

• Anchorage bends / Tip back bends.
– In buccal segment of the archwire mesial to the
tube with vertex facing occlusally.
Angulation depends on –
– Stage of trt. - as stage progresses.
– Depth of overbite - with bite opening.
– Rate of progress of case.

-Inclination of anchor molars.
– Mild to moderate inclination – slight anchor bend.
– Severe inclination – Initially no anchor bend.
– Later gradually increases anchor bend to upright the
molar.
– No intrusion of anteriors beyond edge to edge or mild
openbite.

• Location depends on
– Time elapsed since commencement of trt. – as
far mesially.
Distal to bicuspid bracket.
In mild open bite and overbite – anchor
curve.
-Depth of overbite.
Greater reduction in overbite if closer to the
molar tube.

• Rate of progress.
• Amount of space remaining.
• Location in looped archwire.
• Non – extn. cases
• 1st molar extn. cases.
• 2nd Premolar extn. cases.
Nearer
the tube

• Toe in and toe out bends.
– Horizontal offset bends combined with anchor
bends.
– Anchorage bend bent lingually – toe in.
– Anchorage bend bent buccally – toe out.

• 4 functions.
– Corrective – to correct existing molar
rotations.
– Preventive – to counteract rotations due to Cl
I elastics.
– Passive – to maintain normal alignment.
– Combination of corrective and passive - to
rotate molar but axis of rotation is at mesial or
distal.

• Molar Stops.
– Limit extent to which wire can slide through
molar tube.
– Indications.
• For preserving space in
Non extn. Trt.
Mixed dentition trt.
3 types.
– Removable locks – easily employed passively.
– Bent into archwire – reduced bulk.
– Coil spring.

Shape and form
– Compromise b/w the shape of the M.O &
normal occlusion.
– Expansion for prevention.
• ¼” in molar area for upper arches.
• ½” in molar area for the lower arches.
– Symmetry and co-ordination.
• 2 types of stage I archwires Plain
Looped

• Plain archwire.
– Deep overbite.
– Asymmetrical arches.
– Mild or no crowding.
• Looped archwies.
– Moderate to severe crowding.
– Consists of vertical loops 6-8mm high & 1 mm
wide in the anterior segment.

• Comparison.
– Levelling and alignment.
• Looped archwire due to greater flexibility is superior
especially in the horizontal plane.
– Bite opening.
• Plain archwire due to lack of flexibility results in
even intrusion of anteriors.
– Maintaning archform.
• Relative inflexibility of archwire enhances overall
inflexibility.
– Patient comfort.
• Greater with plain archwire.

• Decline in the use of looped
archwire due to :-
– Ill effects on anterior teeth.
• Inadequate or uneven bite opening.
• Labial flaring of incisors and buccal
movement of canines.

– Ill effects on posterior teeth.
• Molar rotations
• Anchorage loss.
– Difficulty in construction and adjustment.
– Difficulty maintaining arch form.
– Difficulty in maintaining oral hygiene.

• Newer wires in Begg.
– 0.014 SS, braided, twisted, Niti wires etc.
– Not to be used alone.
– In conjunction with base plain wire.

• Engagement of Archwire.
– Insert into molar tubes and pin easily
accessible incisor brackets.
– Pin the cuspid brackets first in the looped wire.
– Pinning done lightly and ligate loosely all
severly displaced teeth.

• Rotated cuspids not engaged, loosely
ligated & derotated with elastic threads or
spring.
• Archwire loosely attached to premolars by
– Loose ligatures
– Retaining ring

• Cuspid ties.
– Ligature tie from intermaxilary hook to distal
of cuspid bracket.
– Prevents drifting of anterior teeth.
– Loosely tied.
– Precise & controlled tooth movements not
possible if teeth are spaced interproximally.

• Cut the ends of the archwire.
• If cut flush with molar tube round of the
edges.
• Prevents ‘ratchet & pawl ‘ or ‘ trammel
effect’.
• If light forces are used
– Reactivation in next appointment without
removing the archwire.
• If heavy forces are used
– no movement or excessive movement.

• Elastics.
– Hard to overstate the importance of elastics in
Stage I of Begg technique.
– Anterior retraction and antero-posterior
correction of molar relation
• Entirely due to elastic force.
– Posterior crossbite
• Mainly due to elastic force.
– Bite opening.
• Joint influence of archwire and elastic force.

• Types of elastics in Stage I.
– Intermaxillary elastics – 2- 21/2 ounces / side.
• Class II
• Class III.
– Anterior elastics
• For space closure in the anterior region.
• Used only after considerable retraction.
• 1-2 ounces force exerted.
• Criss – cross elastics.

Class II
Class III

• Cross bite elastics.
– Unilaterally or bilaterally.
– Exerts 6-7 ounces vs ¼ - ½ ounce exerted by
archwire.
• Openbite elastics.
– Used in box form.
– Deferred till posterior occlusion is normal.
– Chance of root resorption.
• Elastomeric thread
– For correcting rotation.

• Time interval b/w appointments.
– Inversly proportional to the no. of new forces
introduced.
– Directly proportional to the length of time the
forces should be maintained.

Problems encountered during first
stage and their remedies.
1. Bite not opening.
• Patient not wearing elastics.
• Educate patient and the parents.
• Patient biting out bite opening bends.
• Restore bite opeing bends.
• Check eating habits.
• Lower the level of mandibular molar tubes.
• Move the anchor bends closer to the molar tubes

• Inadequate anchor bends.
• Anchor molars out of occlusion.
• Vertical elastics.
• Horizontal elastics.
• Loose molar band.
• Readapt and recement band.
• Improper angulation of buccal tube or entire
molar band.

2. Molar width narrowing.
• Vertical component of Class II elastic.
• Considerable expansion in molar region.
• Expansion auxiliary in 0.018 SS.
• Prolonged wearing of cross elastics.
• Correct crossbite by other means.- doubled back wire,
vertical elastics or finger springs.
• Distolingually rotated cuspids.
• Engage wire in cuspid bracket after derotation.

• Rotational elastic tie on the lingual from the
bicuspid to the molar.
• Extend archwire to the 2nd molar.
• Toe out bends on the distal end of the arch wire.
• Retie elastic thread from the bicuspid to the arch
wire.
• Rolling of the distal ends of the archwire.
• Place toe in or toe out bends.

3. Adverse tipping of anchor molars.
• No anchor bends ( if tipped mesially )
• Too much anchor bends ( if tipped distally )
• Anchor bends in place for too long.
• Place bracket on first molar and band second
molar
• Improper placement of molar tube or band.
• Loose molar band.
• Excessive elastic force.
• Improper placement of elastics on tooth.
• Oversize archwire
• Replace with 0.016 wire.

4. No appreciable changes.
• Not weqring elastics.
• Archwire bent out of shape.
• Oral habits that counteract forces of
appliances.
• Patient seen too soon.
5. Vertical loops buried in the gingiva.
• Looped archwire left too long.
• Replace it with plain archwire with bayonet bends.
• Misjudgment in direction of loops.
• Modify direction of loops.

6. Elastics which break or do not stay on.
• Excuse for not wearing elastics.
• Elastic not staying on intermaxillary circle.
• Pull elastic distally into circle.
• Open intermaxillary circle vertically.
• Distal end of archwire too short or imbedded
in the gingiva.
• Bend away the wire or make new archwire.
• Elastic hook on the molar band.

7. Lock pins lost.
• Occlusal – incisal forces.
• Use steel pins
• Open the bite.
• Patient picking at them.
• Patient education.
• Bend tails of pins tightly.
• Use ligature wires.
8. Extremely mobile molars.
• Clenching of teeth.
• Chew gum.

• Intermittent wearing of elastics.
• Pathology.
• Take periapical x-ray, refer to periodontist or
physician.
• Excessive force applied to the molar.
• Reduce archwire to 0.016 inch.
• Reduce elastic force.
• Reduce anchor bends.
• No apparent cause.

9. Lower anterior teeth tipping labially.
• Optical illusion.
• Education.
• Binding of archwire in bicuspid brackets.
• Use bypass clamps.
• Remove bicuspid band.
• Binding of ends of archwires inside buccal
tubes.
• Replace with wires of sufficient length.
• Poor diagnosis
• Reconsider the necessity for extraction of teeth.

10. Anterior openbite not closing.
• Patient not wearing anterior vertical elastics.
• Persistent tongue thrust or other adverse
habits.
• Placement of lingually directed spurs on lower
anterior teeth.
• Speech and swallowing therapy.
• Too much anchor bend.
• Reduction of anchor bends.

11.Tooth not rotating.
• Not enough space.
• Check diagnosis or archwire design.
• Not enough activation in the bracket area of the
archwire.
• Elastic threads slipping over the top of the tooth.
• Lower the level of the archwire or lower the lingual
button.
12.Midline discrepancy.
• Asymmetrical tipping of anterior teeth.
• Do nothing.

Summary.
• Opening of the bite.
– Use of 0.016 hard resilient wire.
– Adequate bite opening bend.
– Continual wearing of Class II o Class III
elastics.
• Elimination of anterior crowding.
– Looped archwire.
– Plain wire with coaxial alignment wire.

• Close anterior spaces.
– Plain wire with latex elastic or e-chian.
• Derotation of cuspids & bicuspids.
– Derotation spring or elastic threads.

• Correction of posterior crossbite.
– Modify archwidths of one or both archwires.
– Use of cross elastics.
– RME prior to stage
• Mesiodistal relationship of buccal segment.
– Wearing of class II or class III elastics.
– Proper anchor bends.

CONCLUSION
• Although Begg mechanotherapy has undergone
considerable modifications and refinements,its
division into three stages and the objectives of
each stage have remained largely unchanged.
• It is imperative that the objectives of Stage 1 be
achieved before proceeding onto Stage 2 with the
prime aim of preventing anchorage loss. As a
result, one is able to do away with anchorage
preparation and head gears.
• Moreover, the over correction of most tooth
positions by the end of Stage 1, which is quite
early in the trt, helps in increasing the stability of
the results.

Thank you
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