Refined begg 1 /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 ,or call

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Refined begg 1 /certified fixed orthodontic courses by Indian dental academy

  1. 1. REFINED BEGG INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. CONTENTS Evolution of Refined Begg’s  Differences b/w Conventional and Refined  Stage I – Substage Ia - Substage Ib  Checklist of Stage I 
  3. 3. EVOLUTION OF REFINED BEGG  Leyman Wagers: Treatment during mixed dentition.  Milton sims: Undesired effects of multiloop  Swain: Advised using of headgear & rectangular wires in certain situations.  Mulie, Ten hoeve & brandt: Need for intrusion of upper incisors during bite opening.
  4. 4.  Hocevar: Difficulty in obtaining upper incisor intrusion.  Kameda :Need to start root torque early.  Thompson: Need for posterior root torque.  Mollenhauer: Inadequacy of the theory of attritional occlusion. Need for obtaining functional occlusion.
  5. 5. DIFFERENCES    CONCEPTUAL CHANGES Theory of attritional occlusion: Questioned by Corrucini. Over emphasis on ext. in the anticipation of crowding. Concept of differential forces: It was thought that light intra or inter arch forces would retract the ant.,whereas heavier forces would make the ant. teeth as anchor teeth & protract only the post.It is now known that when heavy forces are used for protracting the post. the ant. Teeth would remain stationary until the hyalinised tissue is eliminated. Then they would move posteriorly.This resulted in dish in the profile.Now prevented by using sufficient brakes.
  6. 6. TREATMENT OBJECTIVES  For static occlusion: Andrew’s 6 keys.  Functional occlusion: Synchronization of CO & CR.  Elimination of hanging palatal cusps of the upper posterior teeth, which may cause functional disturbances.  Cusped protected occlusion.  Incisor guidance.
  7. 7. DIAGNOSIS  Skeletal, analysis.  VTO dental & soft tissue
  8. 8. TREATMENT PLANNING       COOK BOOK APPROACH DISCARDED. Benefits of treatment during mixed dentition is recognized. Direct & modulate growth by using functional or orthopedic appliances. Conversion of borderline cases in non extraction. ”When in doubt, extract”discarded. Leeway space is used to resolve mild crowding. Interproximal reduction. Upper molar distalization. Asymmetric extractions.
  9. 9. BIOMECHANICS Controlled tipping in 1st two stages followed by root uprighting.  Mollenhauer: Root control from the very 1st stage. MAA- Aligns teeth, exerts ultra light torquing & up righting forces on the anterior teeth.Combines 1st & 3rd stage of begg.3rd stage is shorter.  Prevents undesirable uncontrolled tipping.  Provides labial & lingual root torque. 
  10. 10. ARCH FORM Recognizes the benefits of maintaining the lower arch form.  Improving the upper arch form.  Proper arch form & coordination of upper & lower arch wires is checked at every stage. 
  11. 11. CHANGES IN THE HARDWARE ATTACHMENTS  Basic design of the begg bracket has not changed.  Depth of slot:0.020”,ht.0.045”,base 3mm into 3mm. 
  15. 15. ARCH WIRES Higher grade Australian arch wires like: Premium, Premium plus, Supreme.  Pulse straightened.  Unraveling of crowding: Thin premium plus or supreme wires, multi-stranded (coax) or NiTi wires are used.  For finishing: alpha titanium wires. Rectangular wires.  Tandem wires :combination of rect.& round cross sections in the ant. & post. segment. Braking mechanism. 
  16. 16. STAGE 1: Sub stage1-A & Sub stage1-B  OBJECTIVES of sub stage 1A:Alignment(1-6mon)  To create space for correcting the crowded teeth, or to close spacing if already present.  Alignment of anterior teeth by correcting labiolingual displacements & / rotations.  Anterior crossbites present are corrected.  Improve upper incisor inclination. If they are excessively flared, their proclination is reduced to 112degree to the S-N plane. Retroclined: they are uprighted to 92degree to the S-N plane.
  17. 17. Rotations and bucco-lingual positions of the upper molars are corrected so that a TPA can be fitted. Molar crossbites are also corrected.  Certain types of rotations which can be corrected by using palatal or lingual attachments are corrected.  If the upper arch form in the canine premolar area is narrow, it is broadened to permit mandibular advancement for correcting the class 2 relationship. Distorted archform correction is started as soon as the 0.016 archwire is employed. The lower archform is maintained as a rule unless it is excessively distorted. 
  18. 18. ARCHWIRES IN STAGE - 1
  19. 19. Spacing present /space to be created  The anteriors need to slide over the archwire.0.016”  Correction of malalignment: Wires -light constant forces over long deflections & long time are used. e.g.. NiTi, multistranded wires & SS small dia. wires. Used as sectionals with a S.S wire.  Consideration of ant. overbite in the context of effect of elastics.  Class 2 elastics: stage 1:retracting the upper ant.  Vertical component: extrusion of the upper anteriors & lower molars. Lingual rolling of the lower molars. 
  20. 20.  Preferred wire:0.018”P+ or P because:  provides adequate intrusive force levels on the incisors for true intrusion, after overcoming the extrusive component of class 2 elastics.  Resists the lingual rolling of lower molars.  Open bite: Require extrusion of upper anteriors. Upper archwire:0.014 P or P+ for bite closure.  Archform & rotational control:0.018”  Very efficient in correcting & maintaining the arch form.  Better rotational control. When all teeth are well aligned this wire can be used from the very start.
  21. 21. ALIGNMENT OF CROWDED ANTERIOR TEETH  Initially-Multiloop wire: 0.016 S.S wire
  22. 22. Ill effects on anterior teeth: Inadequate bite opening & labial flaring of incisor teeth & buccal movement of the canine during space creation round tripping.  Ill effects on post. teeth: Loss of control over molar position & failure to maintain anchorage.  Difficult in construction & adjustment. As teeth gradually align the loop orientation may change & cause soft tissue irritation.  Difficulty in maintaining arch form, width & symmetry because of excessive flexibility of the archwire.  Difficulty in maintaining oral hygiene. 
  23. 23. ALIGNMENT IN REFINED BEGG Relief of crowding space opening Sliding the canine crowns distally along the 0.016 S.S wire.  Flexibility: multistranded wires & NiTi wires in sections along with S.S base wires. 
  24. 24. ARCHWIRE-NEGATE THE EFFECTS OF ELASTICS Stiff:0.016”S.S or 0.014” S.S  Canines are malposed: diff. to engage 0.014”S.S-NiTi full length wire+0.014”S.S with anchor bends without cuspid circles. 
  25. 25.  Both are engaged in the same molar tube.  In the ant. reg. the flexible wire is engaged in the canine brackets & as many brackets.  The S.S wire is not engaged in any of the brackets but is ligated to the flexible wire at 3 pts. :midline, b/w the laterals & canines on either side.  The elastics are hooked to the high hat pins in the canine brackets for their distilization.
  26. 26. FULL LENGTH NiTi ARCHWIRES Max. canines are highly placed& also need to be distalized to relieve crowding.  Ultra light class2 elastics are hooked over the canine bracket to move them distally.  Anterior bite does not deepen, since the high position canine absorbs the extrusive component of the class2 elastics. 
  27. 27.  Open bite situation upper full length of flexible archwire with class 2 elastics can be used till the upper crowding gets relieved, since bite deepening effect is desirable.
  28. 28. AMT. OF CANINE DISTALIZATION NEEDED TO CREATE SPACE  O.5mm space required to relieve crowding:0.016” S.S. wire, cuspid circles tightly pressing against the canine bracket, so that the circles push the canine distally to open space.  1mm space, bilateral canine distalization:0.014”S.S. wire, cuspid circles formed 0.5mm distal to the canine bracket. As many teeth as possible are pinned starting with the canine bracket& the malaligned teeth are ligated. This creates a pressure on the canine bracket that distalizes them.
  29. 29.  More amount of crowding: Space is provided by sliding the canine distally along the 0.016” or 0.014” S.S. wire, with class2 elastics for the upper canine & class 1 elastic for the lower canine. The elastics are directly hooked on the canine brackets by the high hat pins. The cuspid circles are omitted.
  30. 30.  Excessive distal tipping of the canine: Light uprighting springs made in 0.010”supreme wire to reduce distal tipping.  Lower archwire: both cuspid circles are omitted for bilateral canine movement, molar stops are bent against the mesial end of the molar tube, thus preventing mesial movement of the lower molar reducing space available for upper incisor correction. Stabilizes the archwire, so that it does not move from one side to another causing change in the location of the anchor bend.  Molar stops are not given in the upper archwire since they hinder of the anteriors. the retraction
  31. 31.  Both cuspid circles are omitted in the upper archwire, its distal ends are lightly bent abt. 1mm away from the distal ends of the molar tube to prevent it from sliding from one side to another. This permits simultaneous uprighting of the molars under the action of anchor bends which are mesially angulated in class2 malocclusions.  When cuspid circle is omitted only on one side in the upper archwire, the wire is stabilized using a cuspid tie to the circle on the other side. Under similar conditions the molar stop may still be required in the lower archwire on the opposite side to resist forward molar movement.
  32. 32. AMOUNT OF WIRE DEFLECTION   Required to engage the archwire in the brackets on crowded and malaligned teeth. Min.1-2mm:0.014”/0.016”S.S.with offset or V bends to align teeth partially. The force exerted is not excessive on the periodontium, nor will it dislodge the bracket. The bends are eliminated in the next visit bringing abt. complete alignment.
  33. 33. Crowding more than 2mm:Flexible wire 0.016” or 0.014”NiTi,0.0165”coax or 0.009” Supreme  Choice: Same dia. co-ax exerts less force than NiTi when deflected over same dist.0.009”S.S. supreme exerts more force than 0.014”NiTi.  NiTi: highest spring back, hardly get permanently deformed when deflected over large distances. S.S. have lesser spring back. The co-ax wires are prone to perm. deformation.  Friction: Least with S.S. they resist sliding of teeth least. NiTi have more& co-ax will offer max. res.  Cost: NiTi more than co-ax & supreme. 
  34. 34. AMOUNT OF ROTATIONAL CORRECTION REQUIRED      The wire should fill the slot as much as possible. The springback of thin supreme is comparable to larger dimension NiTi. Supreme: Labio lingual displacements are to be corrected. NiTi or co-ax wires should be considerer for rotational correction. 0.014”NiTi round wires-permit full engagement in badly malplaced teeth, with min. perm. deformation over large distances .
  35. 35. FLEXIBLE SECTIONALS    NiTi , co-ax or supreme wires in combination with S.S. base wires, since weak to resist the adverse effects of the elastics. Should be started only after the canines have distalized sufficiently to open adequate space to align incisors. The base wire should not be very close to the brackets since they hinder the action of the sectionals. Vertical offsets are given to keep them away from brackets for 1-2 visits. Eliminated when the teeth are sufficiently aligned.
  36. 36. INDICATION FOR USING SINGLE LOOP     When one incisor is crowded out of the arch, remaining incisors & the other side of the canine are well aligned but angulated towards the crowded incisor. Loop-0.014” or 0.016” at the crowded incisor. The cuspid circle touches the canines. Loop is activated by opening it 2mm. Midlines are corrected. In the upper arch uneven class2 elastic force (Road runner on the side of crowding & yellow elastic on the other side)
  37. 37. ANTERIOR OPEN BITE 0.014”S.S.-upper arch-extrusion, Class 2 elastics.  Class 2 cases upper molars are mesially angulated-mild to moderate anchor bends are given.  Lower arch wire is 0.016” S.S. 
  38. 38. OTHER CORRECTIONS CLOSING OF ANTERIOR SPACING  Proclined: simultaneous retraction & space closure.  Well positioned without proclination: Teeth moved mesially to close spaces. (midline diastema) 
  39. 39. RETRACTING PROCLINED OTHERWISE WELL ALIGNED TEETH     S.S. 0.016”,cuspid circle 2mm mesial to the canine bracket & cuspid ties are given. If placed more than 2mm-elastic cuspid tie gets overstretched-tipping of the canine mesially. Class2 elastics-retracting upper anteriors Class1 elastics-retracting lower incisors. Space starts closing-cuspid circles touch the canine brackets, they are rolled mesially every visit till the spaces close.
  40. 40. SPACE CLOSED WITHOUT RETRACTION    Macrognathia & microdontia: Cuspid circle are kept mesially. Spaces are closed by tying the anterior teeth with fig.8 elastomeric tie. SPACED,PROCLINED,MALALIGNED: malalignment is first.0.016” S.S. with mesially placed cuspids.2 stage procedure: part of the space is utilized by teeth undergoing alignment, remaining space must be closed by incisor retraction. Since intrusion of the incisors takes some space active space closure should not be started until intrusion is accomplished, if the existing space is less than 2-3mm on either side.
  41. 41. IMPROVING INCLINATION OF UPPER INCISORS Excessively proclined upper incisors: retracted by class1 elastics with mild to moderate anchor bends.  Retroclined incisors: upright under the effect of bite opening bends.  This part of correction is due to uncontrolled tipping. Beneficial at this stage because it moves the root apices away from the lingual & labial cortical plate. 
  42. 42. MOLAR POSITION CORRECTION Rotated molars: are corrected by toe in & toe out bends in a S.S.0.016” wire.  Mild buccolingual displacement: expansion & contraction in the S.S. wire assisted by cross elastics. More than 2mm of lateral movement should not be attempted with 0.016” archwires. Such movements can be accomplished by 0.7to 0.9mm S.S. wire. T.P.A, Quad helix. Skeletal expansion: mid palatal suture split. 
  43. 43. ARCH FORM CORRECTION Class2-broadened in the canine premolar area by shaping the S.S. 0.016” archwire suitably.  If bite has to be opened by incisor intrusion: premolars are bypassed by having bayonet bends in the archwire b/w the canines & the 1st premolars.  Bite opening: premolar extrusion-anchor curves are given. 
  44. 44. PINS IN SUB STAGE 1A Well positioned incisors: Stage 1 pins: the full ht. of the slot is available(0.045”)for free sliding of these teeth for space opening or closure.  Cuspids need to slide along the archwire to align the crowded incisors, they are engaged in the archwire using high hat pins. They permit free sliding & elastic engagement.  Hook pins: To engage both the sectionals & the base archwire in the brackets to align malposed teeth. 
  45. 45.