Components of begg appliance /certified fixed orthodontic courses by Indian dental academy


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Components of begg appliance /certified fixed orthodontic courses by Indian dental academy

  2. 2. INDIAN DENTAL ACADEMY Leader in continuing dental education
  4. 4. Requirements for a light wire brackets Ease of arch wire engagement A means to guide both the tail and head of lock pin during locking Positive retention of arch wire in all 3 stages Free tipping and sliding on arch wire Ability to effect and hold rotation Ability to prevent accidental tipping in stage III. These brackets are fabricated from stainless steel strips, hence it is economical.
  5. 5. TYPES A. 1. Full flange 2.Half flange B. 1. Bondable 2. Weldable Full flange brackets will have more friction with arch wire and hence hindrance to smooth tipping movement of anterior. in half flange brackets, contact of the flange with arch wire is minimal , thus friction is also minimal.
  6. 6.
  7. 7. ARCH WIRE
  8. 8. AUSTRALIAN ARCHWIRES Round austenitic stainless steel wire of 0.016 inch diameter, which has been heat treated and cold drawn down to its proper diameter, in order to give it the required properties of resiliency, toughness and tensile strength It was made thin enough, to distribute force at an optimal level for tooth movement over a considerable period of time, over long distance and with minimal loss of force intensity while doing so.
  9. 9. SIX TYPES OF AUSTRALIAN WIRE 1. REGULAR GRADE: - Lowest grade – easy to bend - Used for practice bending and forming auxiliaries. 2. REGULAR PLUS: - Easy to form, more resilient than regular grade - Used for auxiliaries and arch wires when more pressure and resistance to deformation as desired. 3. SPECIAL GRADE: - Highly resilient yet can be formed into shape.
  10. 10. SPECIAL PLUS GRADE: - Hardness and resiliency of 0.016” wire, is excellent for supporting anchorage, and reducing deep overbites. - Must be bent with care. EXTRA SP ECIAL PLUS GRADE : - Also called premium plus - This grade is unequalled in resiliency and hardness. - More difficult to bend and more subjected to fracture.
  11. 11. SUPREME GRADE: - It is ultra light tensile fine round stainless steel wire. - It was initially introduce in 0.010” diameter and then further reduced to 0.009 diameter. -It is primarily used in the early treatment for rotation. Alignment and leveling. - Although supreme exceeds the yield strength of E.S.P, it is intended for use in either short section or full arches where sharp bends are not required.
  12. 12.
  13. 13. BAND MATERIAL These bands made of stainless steel strips of different size and thickness are recommended for different teeth. These available on 8 feet rolls or cut of 2 inches to 2.5 inches. 1. For incisors - 0.125 x 0.003 inch 2. For canines, premolars – 0.150 x 0.004 inch 3. For molars - 0.150 x 0.005 or 0.180 x 0.006 inch
  14. 14. SEVEN SYNERGISTIC COMPO NENTS 1. A diagnosis and treatment plan that recognizes the persistence of hereditary forces of mesial migration and vertical eruption of teeth and has its objectives the over correction of malrelationships of both teeth and jaws. 2. The simultaneous movement of all teeth. From the beginning of treatment each tooth is directed towards its final position in the dental arch. 3. The total separation of root moving forces from arch wire forces during the final third stage of treatment. 4. The application of proper elastic forces to create the desired differential movement of the teeth.
  15. 15. 5. The use of light round continuos arch wires bent from the hardest wire possible – Not only must the wire be of highest quality, but the aech wire have proper form, including bite opening bends, to control the vertical dimension. 6. The use of molar attachments that prevent free mesiodistal tipping and yet permit the arch wire to slide freely mesio distally. This permits the rapid retraction of the anterior teeth. 7. The use of attachments on all teth, except anchor molars, that control rotations yet permit free tipping in the desired direction and free sliding along arch wires.
  16. 16.
  17. 17. The method consist essentially of tipping movements of the teeth. Two successive tipping movements are required to achieve bodily movement. The first to position the tooth crowns and second to position the tooth roots. As a result of these tipping movements, complemented by intrusion, extrusion and rotation of teeth whenever required, optimal occlusion, axial positioning and alignment of the teeth are secured.
  18. 18.
  19. 19. Objectives ►Correction of Deep Anterior Over Bite ►Correction of Proclination of the Anteriors ►Correction Of Crowding and irregularities ►Correction of Rotations
  20. 20. ►Corrrection of Buccolingual and Labiolingual Crossbites ►Axial Relations of the Anchor molars corrected ►Correction of Anteriorposterior Occlusal Relationship of the Buccal Segments ►Closure of spaces between Anterior teeth
  21. 21. Stage I arch wire
  22. 22. : - Made from 0.016 heat treated high tensile stainless steel wire. incorporate -: anchor bends, intermaxillary hooks, vertical loop. Canine contours
  24. 24. Functions -: Correction of Crowding ,spacing,Rotations of Central and Lateral Incisors, Stops 1) 2) 3) Cautions Not given distal to Canines Should not impede on tissues Removed as soon as Function has been served
  25. 25.
  26. 26. ANCHOR BENDS
  27. 27. Initially called Tip back Bends Functions :- 1)to activate the archwires so that they can depress the upper and lower anterior in their sockets thus helping in opening the bite 2) To bestow upon the anchor molars the power to resist forward pull of class II elatics
  28. 28. Factors that effect Anchor bends 1) Degree of Deep –Bite 2) Diameter of the wire 3) Meio-Distal inclination of the anchor molars 4) Position of the anchor bends Checking For Degree of Anchor bend…
  29. 29. Adverse effects of excessive anchor bends 1) Greater tipping forces exerted on anchor molars  cause them to tip-back and elevate their MMR pseudo bite opening 2) Causes rotation of arch wire in molar tube
  30. 30. Intermaxillary Hooks
  31. 31. Intermaxillary Hooks
  33. 33. Application of the appliance The arch wire is engaged into the bracket slots and secured in position with stage i lock pins The segment of the arch wire between hooks made to lie gingival to distal segment  more effective intrusive force on Incisors Arch wire should assume the 6 o’clock – 12 o’clock positions in molar tubes when arch wire is contracted for placement .
  34. 34. 2-3 mm through distal aspect of molar tubes if not  ends lie in MT  frictional binding hindrance to free distal tipping of canines.
  35. 35. Lingually Locked out Teeth
  36. 36. Lingually Locked out Teeth It may be difficult to engage the wire in the brackets at times if the space between proximating teeth is less than the length of the bracket area for a blocked out tooth The ligate the arch wire to the bracket of blocked out tooth….
  37. 37. TOE - IN BENDS: Incorporated in the arch wire as anti – rotational bends. The toe in bends should never exceed more than 5 degree. TOE – OUT BENDS To correct the disto – buccal molar rotation.
  38. 38. Tying Intermaxillary hook to cuspid bracket
  39. 39. If there is no restraining ties between intermaxillary hooks and cuspid brackets cuspid teeth will continue to tip distally and slide along the arch wire resulting in spacing Ligation done in figure of eight and always pass ligature through circle and not through crevice….
  40. 40. Achieving objectives Correction of deep bite - Intrusion of the upper and lower anteriors via anchor bends Correction of overjet - Class II elastics which bring about tipping of the six upper and lower anteriors - Force used 60-70 gms. each side
  41. 41. Importance of simultaneous using of class II elastics and anchor bends Correction of Molar relation Alignment of teeth Elimination of crowding -: by way of using Vertical loops Correction of crowding
  42. 42. Rotations Need to eliminate rotations Methods which may be employed to eliminate rotations 1)using section of wire between vertical loops 2)using elastic ligature, thread or coil spring 3)using spring auxillary
  43. 43. Correction of rotations of labial segment… achieved by way of adjusting the horizontal section of the arch wire between two vertical loops…. Corrections may be maintained by way of bayonet bends.
  44. 44. Rotations of Cuspid and Bicuspid 1)Elastic ties 2)Rotating springs
  45. 45. Rotation of molars Slightly rotated -: incorporate toe-in or toeout bends Moderately rotated -: elastic ligature ties Severely rotated -: Bayonet /Toe-in bend
  46. 46. Closure of anterior spaces -: 1) Contraction Loops Dig 107 pg111
  47. 47. 2) Plain Arch wire in conjunction with elastics….adv… eliminates need for loops dig 108 pg 111and 109 pg 112
  48. 48. Correction of crossbite  Resulting from local tooth displacements or angulationscorrected with the use of cross-elastics between the buccal hooks on the lower molar and buttons/cleats on lingual surface of the uppers
  49. 49.
  50. 50. Problems Failure to correct deep overbite Patient not wearing elastics Arch wire getting distorted Insufficient anchorage bends Anchor bends positioned too far mesial from MT Bends displaced in MT Use of Torquing and uprighting springs
  51. 51. 8) Arch wire in premolar bracket, By pass clamp … 9) Incorrect bracket placement Insufficient retraction of maxillary anterior teeth Patients not wearing class II elastics Binding of arch wire
  52. 52. 3) Hinderance to free tipping of teeth :- loops, pins, wedging of class II elastics 4) Occlusal interferences :- bite, arch form,bracket placement 5) Flaring of incisors caused by excessive expansion of loops in initial arch wire Mandibular molars tipping lingually 1) Insufficient expansion in arch wire 2) Excessive and improperly placed anchor bends 3) Prolonged use of loops 4) Excessive traction from class II elastics
  53. 53. Rotation of Mandibular molars 1) Incorrectly formed anchor bends 2) Distortion of arch wire 3) Incorrectly placed molar tubes 4) Excessive elastic traction Anterior Spacing 1)Intermaxillary hooks not tied back to canines 2)Excessive expansion of loops initially
  54. 54. Maxillary Molar Rotation or Tipping 1)Incorrectly formed anchorage bends 2)Anchorage bends formed too far mesially 3)Arch wire distortion 4)Incorrect Buccolingaul angulation of molar tube
  55. 55.
  56. 56. Objectives Maintainence of corrections achieved thus far Closure of extraction spaces :-partially by retraction of anteriors and partially by movement of posteriors Correction of midline discrepancies
  57. 57. Arch wire 0.020 inch wire is used Usually plain arch wire with intermaxillary hooks anchor bends premolar offsets Arch wire kept expanded wire not engaged in premolar bracket but important to ligate to the wire Use Stge II lock pins
  58. 58. MD molar relation is maintained. Spaces between anterior teeth prevented form opening Maintaining the bite opening achieved Maintainence of corrected rotations … incisors by use of bayonet bends bicuspids …replacing elastics with ligature threads
  59. 59. Closure of extraction spaces Achieved partially by retraction opf anteriors and partially by mesial movement of posteriors…best judge of this would be lateral ceph. Need for over retraction of labial segment while closing of extraction spaces.
  60. 60. How is this space closure achieved Space closure achieved by wearing class I or horizontal elastics. Worn from intermaxillary hook to molar tube of same arch on same side caution….tend to cause molar rotation
  61. 61. Intermaxillary elastics also worn…reasons
  62. 62. Braking Auxillaries
  63. 63. Arch Symmetry
  64. 64. END OF STAGE II
  65. 65. Problems in Stage II Anterior bite closing Insufficent /distortion of anchor bends Patient not wearing class II elastics Anchor molars out of occlusion Anterior teeth assuming class III relation Excessive wearing of class II elastics
  66. 66. Opening of anterior spaces Intermaxillary hook not ligated to cuspid Hooks formed too far apart Distobuccal rotation of Anchor molars Insufficient molar toe-in bends Too much force from horizontal elastics Elastics pulling on distal of molar tubes
  67. 67. Posterior spaces not closing Binding of arch wire…thus not free to slidde distally through buccal tube Lack of wearing of class I elastics Anterior teeth not free to tip distally Occlusal interferences
  68. 68.
  69. 69. STAGE III OBJECTIVES: 1. Maintain all corrections achieved during first and second stages. 2. Achieve desired axial inclinations of all teeth.
  70. 70. Arch Wire 0.020 arch wire is used Functions -: maintenance transmitting forces stabilizing against adverse reciprocal forces
  71. 71. Form -: upper …constricted Lower …expanded Anchor bends-: decreased in magnitude Molar offsets Bends in vertical plane in premolar-molar area to compensate for vertical discrepancy in bracket – tube position
  72. 72. Auxillaries 1) Uprighting springs 2) Anterior root torqueing auxillaries-:upper lower 3) Reverse torqueing auxillary 4) Pre-Wound torqueing auxillary 5)
  73. 73. Uprighting springs
  74. 74. Uprighting springs Function -:serve to correct the mesiodistal inclination of the teeth …i.e for paralleling of the roots Springs to be made from the most resilient wires Diameter of wire used will depend on the tooth being uprighted…differential force concept
  75. 75. Upper and lower canines-0.016inchor 0.018inch,2- coil Upper and lower second premolars- 0.016 inch , 2- coil Upper lateral incisors – 0.014 inch,2- coils Lower lateral incisors – 0,014 inch ,3- coils
  76. 76. Important to take into account reciprocal action of springs. Arch length held by either -:lingual ligature cinching arch wire round MT Use spring – pin combination
  77. 77. Consists of a leg to fit through the vertical slot in the attachment,a helical loop and an arm into which a hook is incorporated running parallel to the main arch When hook end latched to base wire make sure lever arm lies parallel with the wire
  78. 78.
  79. 79. Function -:to torque the roots of maxillary anterior teeth. 0.014 inch or 0.016 inch arch wire is used vertical spurs 3-4 mm in height are bent into the the arch wire to conform to points just distal to the central and lateral incisor brackets. Force generated from horizontal section of the auxillary when spurs are appplied to the labial surface ….and transmitted via the spurs
  80. 80. The spurs must be angled to the labial surfaces of the incisors the ends should terminate 2-3mm distal to the cuspid brackets Activation is done by forming it into an arc smaller than that of the anterior portion of the patients dental arch. Reason for constricted arch form thus inclination of teeth govern-: degree of
  81. 81. Reverse Torqueing Auxillary Uses -: to upright labially inclined mandibular incisors -: to retard further forward shift of the mandible
  82. 82. Lower Lingual Torqueing Auxillary
  83. 83. Bite deepens-: 1 ) class II elastics not worn 1 excessive torque force on maxillary incisors 1 excessive force of caninie and premolar uprighting springs 1 insufficient gingival bow in base arch wire
  84. 84. Reappearance of overjet -: class II elatics not worn excessive torquing force Maxillary molars tip bucally 1) not adequate constriction of base arch wire,torquing auxillary 2)excessive or prolonged torquing force
  85. 85. Base arch wire cinched back without the required compensation in arch wire form Molars rotate mesiolingually Incorrect placement of molar bucal tube Distortion of arch wire in area of molar Chinching back of arch wire without required compensation
  86. 86. Anterior spaces opening Intermaxillary hooks contacting the canine brackets Intermaxillary hooks not ligated to the canine brackets Labial force of lowers against upper Incisors if bite has deepened ClassIII incisor relation…prolonged wearing of or excessive traction from classII elastics
  87. 87. Extrusion of teeth being uprighted Failure to ligate base arch wire too mesial positioning of anchor bends Failure of teeth to upright Related to springs….incorrectly formed,placed,distortion,interference in their free sliding ligature tied on wrong side overclosure of extraction spaces… causing bands of neighbouring teeth to get caught on one another
  88. 88. Failure to achieve incisor torque Insufficient force from torquing auxillary Binding of arch wire Maxillary incisors locked behind mandibular incisors Rotaion of canine/premolar Incorrect bracket placement Distortion or improper placement of uprighting spring arm of spring not parallel to wire.
  89. 89. Leader in continuing dental education