INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Problem Shooting
in
Begg
&
its Management
www.indiandentalacademy.com


Begg technique – Unique Approach



Dominating specialty since it’s introduction
 Simplicity
 Versatility
 Modifiab...


However Begg appliance is not without any
problems.



A thorough knowledge of
 Basic mechanics involved
 Manifestat...
Problem Encountered During Begg Trt.
Problems can occur in any stage or can either
be
 Poor tissue response
 Lack of pat...
Extra dia. aids – valuable in analyzing trt.
results
A large mirror can reflect occ. surface of
either arch , Sym.
 A to...
Stage I (Objectives)
Vertical plane
Opening of ant. overbite (closure in ob)
A-p plane
 Overcorrect md relationship of b...
Problems encountered during first stage and
their remedies.
1.Bite not opening.
 Poor elastic co- operation.
 Educate pa...
Orthodontist has responsibility in seeking pt.
cooperation with elastics
 Should be worn conti. except brushing
Instruct...
 Patient biting out bite opening bends.
 Remove aw, restore bite opening bends.
 Check eating habits.
 Lower the level...
Inadequate anchor bend force
 Remove AW, place proper AB
 Use stiffer 0.018” pr +p.s wire with adeq. AB

 ↓of AB force...
Anchor molars out of occlusion.
 Vertical elastics from U-m to L-m.
 Horizontal elastics from most pos. place molar
 m...
 Loose molar band.
 Readapt and recement (same band if fit
proper) band.

 Improper angulation of buccal tube or
entire...
 A W binding due to bicuspid ligature or
clamp which is too tight
 Make sure PM are not ligated tightly

 Binding & fri...
 Use of elastics that are too loose
 Exert insufficient retraction force to keep lin.
surface of U-I in contact with inc...
 Binding of archwire in tube
 If wire does not extend through distal of tube,
may catch on inside wall & gouge sufficien...
 Grinding & clenching
 Palpate teeth for undue mobility
 Depress molar with blunt instrument, for sign
of loosening or ...
 Excessive force due to habitual biting of
lip & tongue
 Prevents retraction U-ant. teeth stepping
up process
 Patient...
2. Molar width narrowing (usually L – M)
 Vertical component of Class II elastic
 Considerable AW expansion in molar reg...
 Distolingually rotated cuspids.
 Engage wire in cuspid bracket after derotation.

 PM rotational elastic tie on the li...
 Rolling of the distal ends of the AW.
 Place toe in or toe out bends.

3. Adverse tipping of anchor molars .
 No AB ( ...
 Improper placement of M tube or band.
 Loose molar band. (m mes.)
 Excessive elastic force. (m mes.)
 Use sensitive...
4. No appreciable changes.
 Not wearing elastics.
 Archwire bent out of shape.
 Oral habits that counteract forces of
a...
5. Vertical loops buried in the gingiva .
 Looped archwire left too long.
 Replace it with plain archwire with
bayonet b...
6. Elastics which break or do not stay on.
 Excuse for not wearing elastics.
 Educate patient

 Elastic not staying on ...
 Distal end of archwire too short or
imbedded in the gingiva.
 Make new archwire or bend the wire.
 Elastic hook on the...
 Patient picking out them.
 Patient education.
 Bend tails of pins tightly.
 Use ligature wires.

8. Extremely mobile ...
 Pathology.
 Take IOPA x-ray, check med.-dental
history, refer to periodontist, general dentist
or physician.

 Excessi...
 No apparent cause.
 Remove AW and elastics for 8-10 weeks,
molar should tighten. Resume trt.

9. Lower anterior teeth t...
 Binding of ends of AW inside buccal
tubes.
 Replace with wires of sufficient length.

 Poor diagnosis
 Reconsider the...
 Persistent tongue thrust or other adverse
habits.
 Patient education.
 Placement of lingually directed spurs on lower
...
11. Tooth not rotating.
 Not enough space.
 Check diagnosis or archwire design.

 Not enough activation in the bracket
...
 Elastic threads slipping over the top of
the tooth.
 Use bypass clamp to lower the level of AW
 Lower the lingual butt...
Stage II (Objectives)

 Maintain all corrections achieved during 1st
stage

 Closure of remaining posterior space
Proble...
 Bitten out bite opening bends, arch wire
distorted
 Pt. edu. for proper diet
 Remove, correct & replace archwire

 An...
 Patient not wearing I.M elastics properly
 Educate patient

2. Ant. teeth assuming class III relationship
Excessive wea...
 Pseudo bite opening
 When AB are insufficient & pt. wears class
II elas. properly,  edge to edge bite of ant.
but post...
3. Spaces dev. between ant. teeth.
 Failure to give cuspid tie
 Intermax. circles formed too far apart
 Roll one or bot...
 Too much force from horizontal elastics
 Use lighter hor. Elastics
 Tie elastic thread from 3 lingual button to
lingua...
5. Canine roots bulging on labial plate of
alv. bone
 Normal distal tipping of canine crown slig.
mesial movement of api...
 Poor arch form
 Poor bracket placement
 if bracket is to far gingival tooth will supra
erupt. Inclined plane relations...
6. Posterior space not closing
 Poor elastic co- operation.
 Educate the patient
 Make sure that pt. can hook the elast...
 A W pinned or caught in PM bracket slot
 Unpin archwire, remove from slot
 Place bypass clamp

 Pt. placing tongue or...
 Ant. teeth not free to tip distally
 Use proper brackets
 Make sure AW is not pinned too tightly
 Make sure AW is sea...
7. Mesial tipping of 2nd PM
 Slight, expected mesial movement of
anchor molar
 proceed with stage II, conti. to guard an...
8. Mand. ant. teeth achieving desired
lingual inclination before space closure
 Careful preservation of anchorage
 Apply...
9. Relapse of crowding
 Intermax. circles not abutting to canines
 Pins dislodged from brackets

www.indiandentalacademy...
10. Too much retraction of U –incisors
resulting in gummy smile
 Uncontrolled tipping of incisors
 Use MAA

 Not attain...
Anchorage loss during stage I & stage
II
 Vertical loop touching the labial surface
of the teeth

 Proper arch wire fabr...
 Vertical loop impinging on the gingival
tissue
(If impinge on gingiva become imbedded by next
visit, Prolong stage I & I...
 Intermaxillary hooks not cranked out
(Vertical portion of I.M.H resting snugly against
the canine  +ve braking mechanis...
 Distal leg of I.M.H sliding against the lock
pin & becoming engaged in canine bracket
(Prevents free and simple tipping ...
 Elastic over the I.M.H engaging the labial
surface of canine
(Due to using thick elastics or two elastics)
 Modify I.M....
 Lock pin binding the arch wire in bracket
(prevent free tipping of teeth)

 Use special safety lock pins
 If conv. pin...
 Cuspid forced out into buccal plate
(Improper arch wire form, Causes drag teeth
can not tip freely)

 Place the distal...
 Too strong elastic force
 Use proper intermaxillary elastic force
 2-2½ ounce

 Wearing more than one elastic
 Pt. m...
 Elastics not worn continuously
(Intermittent wearing causes anchor tooth to
become loose, Ant. teeth hardly move, Prolon...
 Arch wire accidentally engaged in the
slot of second premolar
(Increases friction, In mes.ling molar rotation wire
may a...
 Arch wire binding in buccal tube
(If arch wire too short to protrude through the
distal end of molar tube,
When cut to p...
 End of arch wires striking the second
molar
(Retards and sometimes stops the distal sliding
of arch wire (usually in upp...
 End of arch wire penetrating gingival tissue
(Usually distal end of lower arch
Gingival tissue (bone) prevent free slidi...
 Anchorage bends engaging buccal tube
(Once entered in molar tube free sliding is prevented
due to three point contact)
...
 Ligating premolar too tightly to arch wire
Arch wire can not slide distally
 Ligate the arch wire lightly so that arch ...
 Insufficient anchorage bend in first arch
wire when first applied
 Incorporate enough AB to cause the ant.
section to l...
 Distorted anchorage bend
(Seen in negligent pt. mesial to lower molar tube,
esp. when lower 2nd premolars are not presen...
 Too much anchorage bend
 May cause distortion of arch wire
 May cause arch wire to rotate in molar tubes
rotate the m...
 Proper amount of toe in or toe out  by
placing the AW in molar tubes & in ant.
brackets

 The wire should pass st. for...
 Arch wire too soft
 AW material must have higher resiliency
 Other wise Rx time will increase  more
anchorage loss

...
 Overactivated expansion loops or
improperly bent arch wires
 Cause rapid initial labial tipping and spacing of
ant. tee...
 Wrong type of bracket
 Do not use edge wise bracket
 May allow ample tipping labiolingually but
it restricts mesiodist...
 Bend – over free end of lock pin
impinging on arch wire
 Use short lock pin
 Cut the lock pin tail off flush with the ...
 Arch wire rolling in buccal tube
 Avoid too much anchorage bend
 and/or too much toe in bend

www.indiandentalacademy....
 Improper arch wire form
 Arch wire should keep all teeth in the cancellous
through of alveolar bone

 Arch wire must b...
 Upper and lower arch wire forms not
coordinated
 Teeth will assume faulty relationship
 Ant. or pos. cross bite  cusp...
 Internal diameter of buccal tube too
small or large
 Best internal diameter 0.036” for 0.016” wire
 If less free slid...
 Length 0.20” – 0.25”
 Shorter tube  lessens molar control & force of
anchor bend,

 Longer tube  more control, reduc...
 Retaining looped arch wire longer than
necessary

 Danger of

loops moving into such positions that
they press against ...
 Binding of doubled-back arch wire in flat
oval tube
 Binding will occur by having the legs too far
apart

 May be due ...
 Curving arch wires between expansion
loops
 Make the arch wire st. between the loops
 If need to modify the form make ...
 Improper ligature tie at canine
 do not pass ligature ties on canines over the
incisal of brackets  prevents free tipp...
 Anchorage bend too far mesially
 Ideal location at the mesial of anchor molar
 It may become restricted by ligature ti...
 Anchorage curves instead of bends
 Gently curved anchor bend can be initially
placed so far mesially in the arch wire t...
 Using 0.014” instead of0.016” wire
 insufficient force from its AB to prevent the
anchor molars from being tipped mesia...
 Loosening of anchor molar bend
 Pull the affected molar forward
 Anterior teeth are not depressed

www.indiandentalaca...
Stage III (Objectives)

 Maintain all corrections achieved during 1st
& 2nd stage

 Achieve desired axial inclination of...
 Too much bite opening bend between
cuspid & bicuspid
 Remove AW, reduce the degree of bend

 Max. AW too flexible (sma...
 Torquing auxiliary not constricted adequately
or extended too far distally
 Remove & modify, narrow in post. region,
sh...
 Presence of s.s lig. tie from lingual of 3 to
lingual to molar
 Remove lig. tie, hold space by bending the
ends of AW a...
3. Ant. bite deepening
 Overactivated torquing auxiliary
 lessen activation
 Make with smaller wire (0.012”pr + p.s)

...
 Bite opening bend not placed between
canine & premolar
 Place necessary bend

 Bite not truly open at beginning of sta...
 AW caught on the edge of bracket
 Tighten spring pin to draw AW in bracket
 Draw AW into bracket with ss lig. Tie(0.00...
 Residual deciduous root fragment against
root being upright
 Reevaluate situation, either remove surgically,
or settle ...
 Intermax. hook butting on mesial end of
canine bracket
 leave 1 mm space ant. to canine bracket

 Lack of alv. bone be...
5. Max. ant. teeth not torquing palatally
 Not enough force from torquing auxiliary
 Remove & reactivate
 Make new aux....
 Not enough time
 Be patient & wait

6. Mand. ant. teeth labially inclined
 Normal mesial migration during stage III
 ...
7. Rotation of teeth other than molars
 Lack of complete bracket engagement
 Seat AW completely in bracket slot using
sp...
 Bracket off center on buccal surface of
tooth
 Observe carefully, may be maintenance of
overcorrection achieved during ...
 Interference from hooks of opposing
uprighting spring
 Use short arm uprighting springs

 Brackets of opposing tooth l...
9. Canine rotate mesiolingually
 Intermax. circles tied too tightly
 lingual attachments ligated too tightly
 Incorrect...
 Distortion or incorrect placement of uprighting
spring, with helix distal to bracket & exerting
pressure lingually
 Arm...
11. Buccolingual torque of molars is not
possible
 Use of round wire in round wire
 Use of 0.018” x 0.022” or 0.020” sq....
Anchorage loss in stage III
one of the main problem of stage III
 In stage III, Begg used eq. resistance i.e high
resista...
 Anchorage loss by II ing auxiliaries
 when ever possible the ii ing aux. should be
opposed to one another
 Even though...
 Anchorage loss due to rectangular wire for
torquing
 Force exerted by rectangular wire so great roots
resist being move...
Chair side vector analysis of trt. problems
 Employs direct measurement & observation
to differentiate between causes of ...
 Also employs inferences to differentiate
between causes of trt. problems
(Inferential diagnosis is form of reasoning in ...
 When seeking cause of problem in trt.
 It is helpful to know typical signs of abnormal force,
such as distal tipping of...
Conclusion
A thorough knowledge of basic principles
involved in Begg mechanotherapy is
essential to avoid any form of prob...
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Problem shooting /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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Problem shooting /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Problem Shooting in Begg & its Management www.indiandentalacademy.com
  3. 3.  Begg technique – Unique Approach  Dominating specialty since it’s introduction  Simplicity  Versatility  Modifiability  Affordability  Ability to resolve serious MO www.indiandentalacademy.com
  4. 4.  However Begg appliance is not without any problems.  A thorough knowledge of  Basic mechanics involved  Manifestations of various problems  Causes  Remedies highly essential for succ. completion of each and every case. www.indiandentalacademy.com
  5. 5. Problem Encountered During Begg Trt. Problems can occur in any stage or can either be  Poor tissue response  Lack of patient cooperation  Poor mechanics Identification of problem is imp. for producing successful results. www.indiandentalacademy.com
  6. 6. Extra dia. aids – valuable in analyzing trt. results A large mirror can reflect occ. surface of either arch , Sym.  A tongue blade or base plate sheet for checking defi. in level of ind. teeth  Study models  Caliper or various gauges www.indiandentalacademy.com
  7. 7. Stage I (Objectives) Vertical plane Opening of ant. overbite (closure in ob) A-p plane  Overcorrect md relationship of buccal segment  Proper overjet relationship Transverse plane  Correction of existing cross bite & Mid line deviation Individual tooth abnormalities  Correction of spacing & crowding  Overcorrection of rotation www.indiandentalacademy.com
  8. 8. Problems encountered during first stage and their remedies. 1.Bite not opening.  Poor elastic co- operation.  Educate patient and the parents.  Lack of co-operation can be discovered  Purposely not providing enough elastics  Making it impossible for patient to hook elastics  Discovering the patient without elastics on www.indiandentalacademy.com school or other places
  9. 9. Orthodontist has responsibility in seeking pt. cooperation with elastics  Should be worn conti. except brushing Instruct patient carefully where to attach elastics, after inst., have him place E himself  Make sure patient can place elastic easily & remain in place without slipping off & undue breakage  Caution the patient not to allow lower jaw to come forward in response to pulling forces www.indiandentalacademy.com exerted by class II elastics
  10. 10.  Patient biting out bite opening bends.  Remove aw, restore bite opening bends.  Check eating habits.  Lower the level of mandibular molar tubes.  Move the anchor bends closer to the molar tubes  Over retention of looped archwire  Replace looped AW with plain AW as soon as possible www.indiandentalacademy.com
  11. 11. Inadequate anchor bend force  Remove AW, place proper AB  Use stiffer 0.018” pr +p.s wire with adeq. AB  ↓of AB force by toe- in bend or buccal offset bend  MD tubes should be at proper position (toein bend tends to rotate in tube  vertex of AB displaced buccally & vertical force  www.indiandentalacademy.com
  12. 12. Anchor molars out of occlusion.  Vertical elastics from U-m to L-m.  Horizontal elastics from most pos. place molar  molar mesially  occ.  Poor quality AW or that has become weaker  Use stiffer 0.018” pr +p.s wire with adeq. AB www.indiandentalacademy.com
  13. 13.  Loose molar band.  Readapt and recement (same band if fit proper) band.  Improper angulation of buccal tube or entire molar band.  Remove molar band, correct angulation (tube II to occ.& buccal surface of molar) www.indiandentalacademy.com
  14. 14.  A W binding due to bicuspid ligature or clamp which is too tight  Make sure PM are not ligated tightly  Binding & friction among anterior teeth due to pinning or ligating too tightly  make sure pins or ligatures are loose enough www.indiandentalacademy.com
  15. 15.  Use of elastics that are too loose  Exert insufficient retraction force to keep lin. surface of U-I in contact with incisal edge of L-I stepping up process is weak  Assure class II force is adequate  Use of elastics that are too tight  Mesial tipping of lower molars (if AB force inadequate)  Assure class II force is adequate www.indiandentalacademy.com
  16. 16.  Binding of archwire in tube  If wire does not extend through distal of tube, may catch on inside wall & gouge sufficiently  ant. teeth forward & excessive distal tipping of molars. The end of wire can move forward not backward when forces are released ”Ratchet & Pawl” or ‘Trammel” effects  Replace with longer arch wire  Bend distal end of wire www.indiandentalacademy.com
  17. 17.  Grinding & clenching  Palpate teeth for undue mobility  Depress molar with blunt instrument, for sign of loosening or extrusion pumping of molar or trumpet valve effect for their tendency to rise again after depressed. Reciprocal movement reflects influ. of excessive class II force & clenching.  Prescribe sugar less gum  Patient education ”keep lips together & teeth apart” www.indiandentalacademy.com
  18. 18.  Excessive force due to habitual biting of lip & tongue  Prevents retraction U-ant. teeth stepping up process  Patient education  Patients habit of holding jaw forward in class I  To ↓ discomfort & self cons. about facial esth.  Caution the patient not to allow lower jaw to come forward in response to pulling forces exerted by class II elastics www.indiandentalacademy.com
  19. 19. 2. Molar width narrowing (usually L – M)  Vertical component of Class II elastic  Considerable AW expansion in molar region.  Expansion auxiliary in 0.018 SS.  Prolonged wearing of cross elastics  Discontinue cross elastics  Correct cross bite by other means- doubled back wire, vertical elastics or finger springs. www.indiandentalacademy.com
  20. 20.  Distolingually rotated cuspids.  Engage wire in cuspid bracket after derotation.  PM rotational elastic tie on the lingual from bicuspid to the molar.  Extend archwire to the 2nd molar.  Toe out bends on the distal end of the arch wire. www.indiandentalacademy.com  Retie elastic thread from the PM to the arch wire.
  21. 21.  Rolling of the distal ends of the AW.  Place toe in or toe out bends. 3. Adverse tipping of anchor molars .  No AB ( if tipped mesially )  Too much AB ( if tipped distally )  Proper AB in place for too long. (tipped distally )  Place bracket on first molar and band second molar www.indiandentalacademy.com
  22. 22.  Improper placement of M tube or band.  Loose molar band. (m mes.)  Excessive elastic force. (m mes.)  Use sensitive tension gauge, if force delivered proper, see whether pt. is wearing more elas.  Improper placement of elastics on tooth.  instruct patient proper placement, provide hooks in desired areas  Oversize archwire (m dis) www.indiandentalacademy.com  Replace with 0.016 hard aus. wire.
  23. 23. 4. No appreciable changes.  Not wearing elastics.  Archwire bent out of shape.  Oral habits that counteract forces of appliances.  Identify & eliminate the habit ,if possible  Patient seen too soon.  Dismiss pt. for at least 6 weeks www.indiandentalacademy.com
  24. 24. 5. Vertical loops buried in the gingiva .  Looped archwire left too long.  Replace it with plain archwire with bayonet bends.  Misjudgment in proper direction of loops.  If ant. are still crowded or irregular modify direction of loops. www.indiandentalacademy.com
  25. 25. 6. Elastics which break or do not stay on.  Excuse for not wearing elastics.  Educate patient  Elastic not staying on Intermax. circle .  Instruct pt. to pull elastic distally into circle.  Open I.M circle vertically. www.indiandentalacademy.com
  26. 26.  Distal end of archwire too short or imbedded in the gingiva.  Make new archwire or bend the wire.  Elastic hook on the molar band. 7. Lock pins lost.  Occlusal – incisal forces.  Use steel pins, if brass pins previously  Check AB to facilitate opening the bite. www.indiandentalacademy.com
  27. 27.  Patient picking out them.  Patient education.  Bend tails of pins tightly.  Use ligature wires. 8. Extremely mobile molars.  Clenching of teeth.  Prescribe sugar less gum  Intermittent wearing of elastics.  Patient education www.indiandentalacademy.com
  28. 28.  Pathology.  Take IOPA x-ray, check med.-dental history, refer to periodontist, general dentist or physician.  Excessive force applied to the molar.  Reduce archwire to 0.016 inch.  Reduce elastic force to 21/2 oz.  Reduce anchor bends. www.indiandentalacademy.com
  29. 29.  No apparent cause.  Remove AW and elastics for 8-10 weeks, molar should tighten. Resume trt. 9. Lower anterior teeth tipping labially.  Optical illusion with roots moving ling.  Education of both pt. & orthodontist  Binding of archwire in bicuspid brackets.  Use bypass clamps.  Remove bicuspid band temporarily. www.indiandentalacademy.com
  30. 30.  Binding of ends of AW inside buccal tubes.  Replace with wires of sufficient length.  Poor diagnosis  Reconsider the need for extn of teeth. 10.Anterior open bite not closing.  Patient not wearing ant. vertical elastics .  Patient education. www.indiandentalacademy.com
  31. 31.  Persistent tongue thrust or other adverse habits.  Patient education.  Placement of lingually directed spurs on lower anterior teeth.  Refer to speech and swallowing therapy spec .  Too much anchor bend.  Reduction of anchor bends. www.indiandentalacademy.com
  32. 32. 11. Tooth not rotating.  Not enough space.  Check diagnosis or archwire design.  Not enough activation in the bracket area of the archwire.  Remove AW and activate bracket area between vertical loops www.indiandentalacademy.com
  33. 33.  Elastic threads slipping over the top of the tooth.  Use bypass clamp to lower the level of AW  Lower the lingual button. 12. Midline discrepancy.  Asymmetrical tipping of anterior teeth.  Do nothing, study situation carefully to confirm that space closure & ultimate uprighting of teeth in 3rd stage will correct midline. www.indiandentalacademy.com
  34. 34. Stage II (Objectives)  Maintain all corrections achieved during 1st stage  Closure of remaining posterior space Problems encountered during second stage and their remedies. 1.Ant. bite closing  Lack of bite opening bends  Remove AW, place proper bite-opening bends www.indiandentalacademy.com
  35. 35.  Bitten out bite opening bends, arch wire distorted  Pt. edu. for proper diet  Remove, correct & replace archwire  Anchor molar out of occlusion  Discontinue Class II or Class III elastics  Horizontal elastics from most pos. place molar  molar mesially  occ.  Vertical elastics from U-m to L-m www.indiandentalacademy.com
  36. 36.  Patient not wearing I.M elastics properly  Educate patient 2. Ant. teeth assuming class III relationship Excessive wearing of class II elastics  Discontinue Class II elastics till teeth are in edge to edge relation  place class III elastics, discontinue class III elastics when ant. teeth are edge to edge www.indiandentalacademy.com
  37. 37.  Pseudo bite opening  When AB are insufficient & pt. wears class II elas. properly,  edge to edge bite of ant. but post. teeth will not occlude, Ant. will assume class III with under bite.  Place proper bite opening bends  Place class III elastics, until ant. teeth are edge to edge & pos. teeth are in occlusion www.indiandentalacademy.com
  38. 38. 3. Spaces dev. between ant. teeth.  Failure to give cuspid tie  Intermax. circles formed too far apart  Roll one or both circles mesially, tie with steel lig.  if space is too large, close space with hor. elastic from 3-3 4. Anchor molars rotating distobuccally  Toe-out on arch wire  Remove arch wire & place toe in bend www.indiandentalacademy.com
  39. 39.  Too much force from horizontal elastics  Use lighter hor. Elastics  Tie elastic thread from 3 lingual button to lingual hook on molar.  Elastics pulling on distal of molar tube  Place the hook properly  Edu. pt. to place elastic on hook rather than around tube. www.indiandentalacademy.com
  40. 40. 5. Canine roots bulging on labial plate of alv. bone  Normal distal tipping of canine crown slig. mesial movement of apices, ( canine is corner tooth) bulging of labial plate of alv. bone. will disappear during stage III  Do nothing www.indiandentalacademy.com
  41. 41.  Poor arch form  Poor bracket placement  if bracket is to far gingival tooth will supra erupt. Inclined plane relationship with opposing teeth  rotate mand. cuspid crowns lingually  roots labially www.indiandentalacademy.com
  42. 42. 6. Posterior space not closing  Poor elastic co- operation.  Educate the patient  Make sure that pt. can hook the elastics  AW not free to slide distally through tube  Remove source of resistance  End of wire striking 2nd molar  AB in molar tube  Arch wire short & caught on burr inside tube www.indiandentalacademy.com
  43. 43.  A W pinned or caught in PM bracket slot  Unpin archwire, remove from slot  Place bypass clamp  Pt. placing tongue or pencil in space  Educate patient  Occlusal interference  ↑ AB to open bite  Check bracket level www.indiandentalacademy.com
  44. 44.  Ant. teeth not free to tip distally  Use proper brackets  Make sure AW is not pinned too tightly  Make sure AW is seated in bracket slot, not caught on flange of bracket  If tongue habit, place spurs on lingual surface of teeth, refer to speech and swallowing therapy spec. www.indiandentalacademy.com
  45. 45. 7. Mesial tipping of 2nd PM  Slight, expected mesial movement of anchor molar  proceed with stage II, conti. to guard anchorage  Abnormal loss of anchorage  Remove AW, ↑ AB  ↓ elastic force  Check for loose molar band or tubes www.indiandentalacademy.com
  46. 46. 8. Mand. ant. teeth achieving desired lingual inclination before space closure  Careful preservation of anchorage  Apply braking mechanics  Apply 6- 10 oz. horizontal elastics with braking mechanics  Excess space present at beginning of trt. (Cong. small or missing teeth or space from trauma or caries)  Clinical experience & education of patient www.indiandentalacademy.com
  47. 47. 9. Relapse of crowding  Intermax. circles not abutting to canines  Pins dislodged from brackets www.indiandentalacademy.com
  48. 48. 10. Too much retraction of U –incisors resulting in gummy smile  Uncontrolled tipping of incisors  Use MAA  Not attaining proper intrusion of U - incisors  Use of Power arms or TPA for wearing class I elastics www.indiandentalacademy.com
  49. 49. Anchorage loss during stage I & stage II  Vertical loop touching the labial surface of the teeth  Proper arch wire fabrication  Proper location of loops & limitation of the number of loops  Slightly labial inclination of loops in severe crowding cases www.indiandentalacademy.com
  50. 50.  Vertical loop impinging on the gingival tissue (If impinge on gingiva become imbedded by next visit, Prolong stage I & II)  Careful modification of loops  Slightly labial inclination of loops when arch first applied  Do not modify the loop without removing from mouth www.indiandentalacademy.com
  51. 51.  Intermaxillary hooks not cranked out (Vertical portion of I.M.H resting snugly against the canine  +ve braking mechanism)  I.M.H should be cranked out before arch wire is applied  Use horizontal circle www.indiandentalacademy.com
  52. 52.  Distal leg of I.M.H sliding against the lock pin & becoming engaged in canine bracket (Prevents free and simple tipping of canine crown Usually happen when loop arch wire are used to unravel ant. crowding)  I.M.H should be cranked far enough labially, engage against the mesial surface of bracket  Use horizontal circle www.indiandentalacademy.com
  53. 53.  Elastic over the I.M.H engaging the labial surface of canine (Due to using thick elastics or two elastics)  Modify I.M.H so that elastic not produce undesirable pressure  Use horizontal circle www.indiandentalacademy.com
  54. 54.  Lock pin binding the arch wire in bracket (prevent free tipping of teeth)  Use special safety lock pins  If conv. pins, tails should be bend before head strike the arch wire www.indiandentalacademy.com
  55. 55.  Cuspid forced out into buccal plate (Improper arch wire form, Causes drag teeth can not tip freely)  Place the distal ends of arch wire in molar tubes, see if wire lies so far labially in canine region www.indiandentalacademy.com
  56. 56.  Too strong elastic force  Use proper intermaxillary elastic force  2-2½ ounce  Wearing more than one elastic  Pt. must be properly educated in Function of elastics Danger of wearing more elastics www.indiandentalacademy.com
  57. 57.  Elastics not worn continuously (Intermittent wearing causes anchor tooth to become loose, Ant. teeth hardly move, Prolong Rx  anchorage loss)  Proper patient education www.indiandentalacademy.com
  58. 58.  Arch wire accidentally engaged in the slot of second premolar (Increases friction, In mes.ling molar rotation wire may acci. engage)  Use of bypass clamp  Remove the premolar band for first 6 weeks www.indiandentalacademy.com
  59. 59.  Arch wire binding in buccal tube (If arch wire too short to protrude through the distal end of molar tube, When cut to proper length, cause internal burring (not removed by ordinary polishing)  Make always slightly longer than necessary  Do not cut the end of wire until all modifications and bends www.indiandentalacademy.com
  60. 60.  End of arch wires striking the second molar (Retards and sometimes stops the distal sliding of arch wire (usually in upper molar)  Extend the arch wire farther distally buccal to 2nd molar  If impossible, cut it short enough to allow it to slide freely until next visit www.indiandentalacademy.com
  61. 61.  End of arch wire penetrating gingival tissue (Usually distal end of lower arch Gingival tissue (bone) prevent free sliding)  instruct pt. to visit orthodontist if they feel discomfort or can not engage elastics www.indiandentalacademy.com
  62. 62.  Anchorage bends engaging buccal tube (Once entered in molar tube free sliding is prevented due to three point contact)  Check the situation every visit  If necessary remove the arch wire, st. it and, make new AB mesially www.indiandentalacademy.com
  63. 63.  Ligating premolar too tightly to arch wire Arch wire can not slide distally  Ligate the arch wire lightly so that arch is free to slide www.indiandentalacademy.com
  64. 64.  Insufficient anchorage bend in first arch wire when first applied  Incorporate enough AB to cause the ant. section to lie against the floor of mucobuccal fold when distal ends of arch wire is threaded into molar tubes. www.indiandentalacademy.com
  65. 65.  Distorted anchorage bend (Seen in negligent pt. mesial to lower molar tube, esp. when lower 2nd premolars are not present)  Examine the arch wire closely  If distorted ,remove from mouth, eliminate the distortion www.indiandentalacademy.com
  66. 66.  Too much anchorage bend  May cause distortion of arch wire  May cause arch wire to rotate in molar tubes rotate the molars  failing to depress molars  Improper toe in  Results in loss of control of anchor teeth & failure to reduce ant. deep bite. www.indiandentalacademy.com
  67. 67.  Proper amount of toe in or toe out  by placing the AW in molar tubes & in ant. brackets  The wire should pass st. forward & occlusally as it leaves the tube by action of AB. www.indiandentalacademy.com
  68. 68.  Arch wire too soft  AW material must have higher resiliency  Other wise Rx time will increase  more anchorage loss  Starting stage II too soon  If ant. teeth are not in genuine end to end contact, not free to tip under the forces of horizontal elastics www.indiandentalacademy.com
  69. 69.  Overactivated expansion loops or improperly bent arch wires  Cause rapid initial labial tipping and spacing of ant. teeth  More force & time spend to recover original lab.ling. inclination of ant. teeth  Loss of anchorage www.indiandentalacademy.com
  70. 70.  Wrong type of bracket  Do not use edge wise bracket  May allow ample tipping labiolingually but it restricts mesiodistal tipping and causes loss of anchorage www.indiandentalacademy.com
  71. 71.  Bend – over free end of lock pin impinging on arch wire  Use short lock pin  Cut the lock pin tail off flush with the side of bracket  Bend all pins tail to mesial www.indiandentalacademy.com
  72. 72.  Arch wire rolling in buccal tube  Avoid too much anchorage bend  and/or too much toe in bend www.indiandentalacademy.com
  73. 73.  Improper arch wire form  Arch wire should keep all teeth in the cancellous through of alveolar bone  Arch wire must be bilaterally similar in form or should be so shaped as to eliminate any asymmetry of arch www.indiandentalacademy.com
  74. 74.  Upper and lower arch wire forms not coordinated  Teeth will assume faulty relationship  Ant. or pos. cross bite  cuspal interference  prolonged Rx time www.indiandentalacademy.com
  75. 75.  Internal diameter of buccal tube too small or large  Best internal diameter 0.036” for 0.016” wire  If less free sliding will reduced  If more  molar control lessen, depression force on ant. lessen www.indiandentalacademy.com
  76. 76.  Length 0.20” – 0.25”  Shorter tube  lessens molar control & force of anchor bend,  Longer tube  more control, reduces the distance of arch wire between mesial end of molar tube and premolar bracket operational difficulties during stage 3. www.indiandentalacademy.com
  77. 77.  Retaining looped arch wire longer than necessary  Danger of loops moving into such positions that they press against labial surface of ant. teeth  Not transmit tooth depressing force as accurately as an arch wire without loop  Cuspid will depress more than incisors www.indiandentalacademy.com
  78. 78.  Binding of doubled-back arch wire in flat oval tube  Binding will occur by having the legs too far apart  May be due to too large a radius where the arch wire returned on itself, or too long a vertical section extending from the hook that is wound around the arch.  Legs of double back are not ll. www.indiandentalacademy.com
  79. 79.  Curving arch wires between expansion loops  Make the arch wire st. between the loops  If need to modify the form make bends in the loops  When engaged, loops become distorted  rotations of the sections of archwire  If curved three point contact  inhibit free lab.ling. tipping www.indiandentalacademy.com
  80. 80.  Improper ligature tie at canine  do not pass ligature ties on canines over the incisal of brackets  prevents free tipping  It should pass directly distally across the labial surface of canine www.indiandentalacademy.com
  81. 81.  Anchorage bend too far mesially  Ideal location at the mesial of anchor molar  It may become restricted by ligature tie on bicuspid, preventing free distal sliding  Arch wire will be projected towards the occlusal plane and be deformed by occlusal forces. www.indiandentalacademy.com
  82. 82.  Anchorage curves instead of bends  Gently curved anchor bend can be initially placed so far mesially in the arch wire that it is unnecessary to remove the arch wire from mouth in order to make a new bend farther . www.indiandentalacademy.com
  83. 83.  Using 0.014” instead of0.016” wire  insufficient force from its AB to prevent the anchor molars from being tipped mesially .  Ant. Deep bite will also not open  Thumb or finger sucking, lip sucking, tongue thrusting and abnormal sleeping habits  Habit breaking measures www.indiandentalacademy.com
  84. 84.  Loosening of anchor molar bend  Pull the affected molar forward  Anterior teeth are not depressed www.indiandentalacademy.com
  85. 85. Stage III (Objectives)  Maintain all corrections achieved during 1st & 2nd stage  Achieve desired axial inclination of all teeth Problems encountered during third stage and their remedies. 1. Max. molars widening  AB present in max. AW  Remove max. AW, eliminate or ↓ AB bends www.indiandentalacademy.com
  86. 86.  Too much bite opening bend between cuspid & bicuspid  Remove AW, reduce the degree of bend  Max. AW too flexible (small in diameter)  use stiffer archwire (0.020” premium p.s)  Max. AW too wide  Remove & modify AW www.indiandentalacademy.com
  87. 87.  Torquing auxiliary not constricted adequately or extended too far distally  Remove & modify, narrow in post. region, shorten so that ends between cuspid & bicuspid 2. Mand. molars narrowing  Mand. AW not wide enough  Remove & widen distal ends of AW  Class II elastics exerting too much force  use lighter elastics ( 2- 2 ½ oz.) www.indiandentalacademy.com
  88. 88.  Presence of s.s lig. tie from lingual of 3 to lingual to molar  Remove lig. tie, hold space by bending the ends of AW around distal end of buccal tube.  Lack of support through occlusal contact with max. molars  Use posterior cross elastics  Check sym. of both arch wires www.indiandentalacademy.com
  89. 89. 3. Ant. bite deepening  Overactivated torquing auxiliary  lessen activation  Make with smaller wire (0.012”pr + p.s)  Max. AW too thin  use heavier (stiffer) AW (0.020” premium p.s)  Patient not wearing class II elastics  Patient education www.indiandentalacademy.com
  90. 90.  Bite opening bend not placed between canine & premolar  Place necessary bend  Bite not truly open at beginning of stage III  Remove all torquing mechanism, return to stage I 4. Teeth not uprighting  Springs not active  Remove & activate spring  use 0.010” supreme for incisors & 0.012”pr+p.s for canines & PM www.indiandentalacademy.com
  91. 91.  AW caught on the edge of bracket  Tighten spring pin to draw AW in bracket  Draw AW into bracket with ss lig. Tie(0.009” – 0.010”), before placing uprighting springs  Occlusal interference due to elevated tooth  Review bracket position & correct it  Lack of room mesiodistally  St. AW distal to tube, or remove ligature tie www.indiandentalacademy.com
  92. 92.  Residual deciduous root fragment against root being upright  Reevaluate situation, either remove surgically, or settle for present amount of uprighting  Improper placement of spring  Remove & replace properly  ligature tie on wrong side  Always use lig. tie on the side toward which crown is to be tipped www.indiandentalacademy.com
  93. 93.  Intermax. hook butting on mesial end of canine bracket  leave 1 mm space ant. to canine bracket  Lack of alv. bone between cortical plates due to prolonged resorption of ridge or loss of cortical plate during extn. of tooth  Remove uprighting springs  Achieve best occlusion possible with tooth in present inclination www.indiandentalacademy.com
  94. 94. 5. Max. ant. teeth not torquing palatally  Not enough force from torquing auxiliary  Remove & reactivate  Make new aux. from heavier wire  Fashion different type of torquing auxiliary  U-incisal edge caught lingual to L ant. teeth  Open bite, by AW modification or bracket repositioning  Consider incisal reduction with diamond stone www.indiandentalacademy.com
  95. 95.  Not enough time  Be patient & wait 6. Mand. ant. teeth labially inclined  Normal mesial migration during stage III  If near end, do nothing  If in middle, place reverse torquing auxiliary www.indiandentalacademy.com
  96. 96. 7. Rotation of teeth other than molars  Lack of complete bracket engagement  Seat AW completely in bracket slot using spring pins, ss ligature or lock pin  Arch wire slot too large (labiolingually)  Replace bracket with proper size slot  Remove AW, place bayonet bends to compensate for lack of proper fit www.indiandentalacademy.com
  97. 97.  Bracket off center on buccal surface of tooth  Observe carefully, may be maintenance of overcorrection achieved during stage I  Reposition bracket 8. Extn. space opening  Improper cinching of AW  Improper ligated lingual attachments  use at least 0.011” ligature wire www.indiandentalacademy.com
  98. 98.  Interference from hooks of opposing uprighting spring  Use short arm uprighting springs  Brackets of opposing tooth located too far gingivally, resulting in plunger cusp action  Reposition brackets www.indiandentalacademy.com
  99. 99. 9. Canine rotate mesiolingually  Intermax. circles tied too tightly  lingual attachments ligated too tightly  Incorrect bracket placement  Incorrect base AW form in canine area  Bracket slot enlarged 10. Canine rotate distolingually  Incorrect bracket placement www.indiandentalacademy.com
  100. 100.  Distortion or incorrect placement of uprighting spring, with helix distal to bracket & exerting pressure lingually  Arm of uprighting not II to AW  Incorrect base AW form in canine area  Bracket slot enlarged  Intermax. circles in contact with canine bracket at beginning of stage www.indiandentalacademy.com
  101. 101. 11. Buccolingual torque of molars is not possible  Use of round wire in round wire  Use of 0.018” x 0.022” or 0.020” sq. alpha titanium wires (torque incorporated in wire) with combination tubes (Consist of gingival round tube 0.036”diametre x 6.2mm long & rectangular (ribbon) occlusal tube 0.025”x 0.018” dia x 5.5 mm ) in stage IV www.indiandentalacademy.com
  102. 102. Anchorage loss in stage III one of the main problem of stage III  In stage III, Begg used eq. resistance i.e high resistance slow response movements of ant. torquing & IIing against high resistance slow response movements of PM & molars.  Although resistance & response are eq. type, seldom equal in magnitude considered main cause of anchor loss in stage III 71.2% anchorage loss in 3rd stage (Swain) www.indiandentalacademy.com
  103. 103.  Anchorage loss by II ing auxiliaries  when ever possible the ii ing aux. should be opposed to one another  Even though forces exerted by springs equal, II ing may not occur at same rate (cuspid root is often larger)  In 2nd PM cases complete reciprocity not possible because more II ing spring in front of extn. space than behind www.indiandentalacademy.com
  104. 104.  Anchorage loss due to rectangular wire for torquing  Force exerted by rectangular wire so great roots resist being move lingually  more crown labial movement.  Class II elastics also can not prevent forward movement due to use of rect. wires  Anchorage loss due to lack of elastic wearing  If class II elastics are not worn, U –arch as a whole move too forward while roots of teeth of dental arches are uprighted. www.indiandentalacademy.com
  105. 105. Chair side vector analysis of trt. problems  Employs direct measurement & observation to differentiate between causes of trt. problems  Question pt. about elastic cooperation, use tongue blade  Measure elastic force with strain gauge  Measure AB force by disengaging lock pins  Observe pt. cheek & temples for periodic bilateral muscular contraction of clinching www.indiandentalacademy.com  Measure changes in arch width
  106. 106.  Also employs inferences to differentiate between causes of trt. problems (Inferential diagnosis is form of reasoning in which the presence or absence of causative factor is assumed from presence or absence of equal & opp. reaction force.)  Orthodontist can use inference to detect the pres. of abnormal force when trt. is unsatisfactory. www.indiandentalacademy.com
  107. 107.  When seeking cause of problem in trt.  It is helpful to know typical signs of abnormal force, such as distal tipping of L- molar due to poor elastic cooperation  It is imp. to know other causes of problem & how to diff. between them  To acknowledge that imposition of orthodontic force may augment some existing forces &resistance for others  Complex problem may arise, & analysis of many variables in each indiv. req. observation, measurement & differential deduction www.indiandentalacademy.com
  108. 108. Conclusion A thorough knowledge of basic principles involved in Begg mechanotherapy is essential to avoid any form of problems during treatment. An awareness of all possible problems help us in every stage of treatment, leading to excellent treatment results. www.indiandentalacademy.com
  109. 109. www.indiandentalacademy.com

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