The kamedanized begg technique /certified fixed orthodontic courses by Indian dental academy

Modern Begg
The Kamedanized
Begg Technique
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education

Kamedanized Begg Technique
 One of the modern Begg technique
 Akira Kameda
 Started Begg Practice in 1966
 Encountered failures
 Started improving the Tech. from 1972

Drawbacks or Incomplete Parts of Orig. Begg
Tech.
 No secure ∆
 Unnecessary & over tipping of all teeth including
anchor molars
 Collapse of arch form
 Rotation & mesial tipping of 2nd PM during stage II
 Complicated & unstable Stage III
 Gummy face due to clockwise rotation of occ. plane

Diagnosis
 Trt. Goal of max. protrusion
computed in 1981 from aver. mean of 400
treated cases of max. prot.
 Trt. Goal of mand. protrusion
calculated in 1982 from aver. mean of 900
treated cases of mand. prot.

If Sn- Md > 40º treatment goal  reducing the
exceeded amount of Sn-Md with in the limits of
U1 – Sn 10º & L1 – Md 10º
Treatment
Goals
Class I & II
(Sn-Md < 40º)
U1- Sn 97º
U1- L1 136º
L1- Md 90º
ANB ≤ 4º
Class III
(Sn-Md < 40º)
U1- Sn 100º
U1- L1 130º-
140 º
L1- Md 85º

Cephalogram corrections obtained
separately
 As the movement distance of L & U inc. are
reproduced on model at 0.9 times on a search
for avail. space for U & L.
 Arch length discrepancy (ALD) of U & L is to be
separately computed from discrepancy between
avail. space & req. space.

 Criteria of selection of extn. site by ALD in
conjunction with ceph. correction
0 mm
-3 mm
-6 mm
-9 mm
2nd PM extn.
1st PM extn.
1st or 2nd PM extn
Non extn.

 Judging criteria on occasion of ALD
between 6mm – 9mm
Selection of extn. site
ALD
Anchorage
value
Growth
tendency
Soft tissue
analysis
Organized
occlusion

More concretely speaking
 Trt. is for child or adult
 High or low angle case
 Expected extruding volume of I.M elastics & AB
 Size of ANB, Growth dir. of mandible

 Degree of transformable state of maxillary alv.
process
 To consider drawback of 1st PM extn. 
dished-in appearance
 Dual bite due to lack of growth of mandible &
excessive use of class II elastics

 Special attention paid to occl. organized by trt.
with extn. of teeth
 In 1st PM extn. Case – ht. of contact points
between 3 & 5 become diff. (proximal contact
relation inferior)

 In 2st PM extn. Case – ht. of contact points
between 4 & 6 become diff. (proximal contact
relation inferior) & 1st PM trigger off a DB rotation
after ortho. trt.
 D of 3, M of 5 stripped off in- In 1st PM extn. Case
 D of 4, M of 6 stripped off in- In 2nd PM extn. Case

 Characteristics of technique
KB tooth movement
 Most M.Os - Lab.ling. align. problems
md axial inclination problems consti. minor part.
So to carry out ortho trt.
md tipping X
Lab. Ling movement 

To control necessary md tipping
 Principle of horizontal bar’s tooth movement
from stage I (1981)
 Co-Ax wire or sectional 0.010” supreme wire
used in conjunction with main arch wire,
locking 2 arch wire with safety T-pins.
 Single wire with 90º T-pin.
 Prevent md tipping, but
permit labling. tipping by
taking adv. of round wire.

 The mechanical implication- it obviates the need
for extensive uprighting in stage III,so less
anchorage loss.
Philosophy of
friction free
Philosophy of
Low friction

Another important diff. is reorganization of discrete
stages of pure Begg technique to aim at making
the technique simple, secure & accurate.
Traditional torquing aux. replaced by inbuilt torque/rev.
torque brackets with ribbon arch in stage II. So in stage III
uprighting
Stage I
Stage II
Stage IIIuprighting
Space closure + torquing
Leveling +bite opening
Ribbon arch wire
Round and/or ribbon arch
Round wire

I
II
III
I
II
III
Conventional Begg
K B Technique
This arrangement lightens the work load of clinician
and excessive demand in patient cooperation
towards the end of treatment.www.indiandentalacademy.com

Brackets (1983)
 The classical begg bracket configuration
 Class II malocclusion
U - 20º torque brackets
L - 10º reverse torque bracket
 Depending on the position of u l.i non torque,
10º reverse torque or 20º torque bracket
Upper teeth Lower teeth

Class III malocclusion
L - 20º torque brackets
U - 10º reverse torque bracket (U1-Sn>100º)
or
non-torquing brackets (U1-Sn<100º)
Upper teeth
Lower teeth

Buccal tube (Dec. 1986)
In pure begg tech. round tubes with round wires
friction free mechanics
But problems
 Anchor molars tends to roll in
 Correcting ling. inclined molars diff.
 Directing force of anchorage bend is diff.& bite
opening efficiency will ↓
The KB tube - oval (ribbon arch type with
inside margin rounded)

Philosophy of
friction free
Philosophy of
Low friction
Round wire
+
Round tube
Round or ribbon wire
+
K-B type tube

Lumen diameter 0.028” x 0.0215” and 0.250” long
Vertical slot – uprighting spring to augment
anchorage
6º distal offset to prevent distobuccal rotation

Accordingly
 This tube can be used for KB technique
 B-l inclination of molars can be corrected or
prevented
 Extraction spaces are not prevented from
closing because of low friction between wire
tube
 Possible to effciently direct the force of AB & bite
opening bends

Biomechanics of KB technique
Pre Stage I :- twisted ribbon arch wires (0.022”
x0.016”) or round wire to
Remove crowding
Guide the erupting teeth to occl. plane
Arch leveling
T pins are used from this point itself.

Stage I
0.016” ESP plain archwire with Co-Ax wire or
sectional 0.010” supreme wire & locked safety
T-pins.
This is done for following reasons
Arch form of ant. segment is more fav. with dual
wires.
Force of bite opening bends or AB can be easily
oriented & bite opening can be speedy & efficient.
 When bite opening is diff. – sectional rect. twist wire
can be added to ant. seg. to orient depressing force

Bite opening
 To cope with diff. of bite opening- Bite opening
bends distal to canine is addition to AB (1982)
Bite opening for
incisors
St. anchorage for molar
Bite opening for canines
Role of bite opening bend Role of anchorage bend

0.016” 0.018”/combination Ribbon
maximum 40º 30º 5º
moderate 30º 20º 3º
minimum 20º 10º 2º
0.016” ESP wire upper lower
Maximum. bite opening 30º 20º
Moderate. bite opening 20º 10º
Anchorage Bend
Bite opening bend

Ultra light Class II elastic force
 Depending on degree of overjet & overbite class II
elas. divided into 3 steps called ultra light elastic
force.
No elastic 40- 50 g elas. 60-70 g elas.

Class II div. 1 with large overjet & large
overbite
 Ultra light (40 – 50 g) for about 2 mon. at
beginning of stage I
 Then switch on to normal light (50 – 60 &
60 -70 g)
 Apex of u & l inci. roots will depressed towards
wider sites of trough of cancellous alv. bone.

 if u & l inci. sufficiently depressed to ↓ ob and
then lingual inclination of incisors including alv.
process , a gummy face will prevented & risk
of root resorption will minimize.

 For a start during stage I it is pref. to
depress, root apex to wider areas of trough of
cancellous bone (intrusion is high resistance
movement compared to palatal tipping of crown)
and then move lingually
Conv.Begg
KB Technique

Way to distalizing canine
 Not to tip the canine distally during stage I
 It is to move canine naturally in distal direction
while o.bite is being ↓ by bite opening bends.
 Bite opening of inci. is conducted with fulcrum
of cani., and cani. are not allowed to tip
distally
D=I x sin (θ -90º )

Treatment Goal of stage I
 Establishing overjet & overbite close to 2 mm
 Lower incisors positions should be brought to
the vicinity of normal value (Md 85º)
 If lower incisors are flared out– horizontal
elastics only in mandi. arch.
 Once l.i position attained lower arch wire may be
changed for combination wire or .022” x.016”
ribbon wire control over l.i position

 It is also important to conduct stage 1 longer
than usual to
Correction of midline discrepancy
Est. of class 1 relation of canine
 Stage 1 is finished by getting overjet & overbite
close to 2 mm , Change .016”wire to .018”&
extend up to 2nd molars after placing the buccal
tube

Stage II
 Major goals
Torquing of upper and lower incisors roots
The closure of extraction space
The use of traditional torquing aux. replaced by
inbuilt torque/rev. torque in the base of brackets
with ribbon arch in stage II.

why only torque has been built in KB brackets?
Torque control is the weak point of begg bracket as
begg bracket are vertically long permitting easy
tipping.
Building in tip also, could strain anchorage need
of extra oral anchorage.

Use of torque in stage II is justified by
 Torquing by use of ribbon arch wire & torquing brackets
 crown torquing  ↑ overjet  bimax. protrusion so
torquing during space closure mitigate against this
undesirable movement.
 Uprighting the teeth during stage III is more successful
once the tooth roots are placed well in cancellous bone.
 Has a sound biological basis because in pure Begg the
simul. use of both uprighting & torquing tooth roots are
likely to touch the cortical plate and roots would not
upright. www.indiandentalacademy.com

0.018” arch wire with control bar used in
stage II
 If first control bar & then .018”archwire were
inserted into slot and locked with T- pin total
vertical ht.> depth of bracket slot
 So locking become insecure & torquing of canine,
not effective

 Combination wires ant. rectangular (.018” X
.026”)& post. oval (0.018”) – AJ Wilcock
 Combination wire alpha titanium ,it hardens by
adsorbing intra oral free H ions titanium
hydride under 37º C and 100% humidity show
powerful effect as stabilized wire.

 These days instead of 0.026” X
0.018”, 0.022” X 0.018” ant. portion for
combination wire to better securing of T pin
and better torque control.

 By pass Loop (1986)
 Before extn. space closure & ribbon arch wires are used
from stage II , for 3 dim. control of 2nd premolars
 This to prevent 2nd PM from subsiding, rotation, from
mesially inclining on occasion of extn. space closure.
 Combination of bypass loop& T pin with a m & d eyelets
through which the arch wire is threaded & 2nd PM is safely
bypassed
 2nd PM easily controlled in all dir. when extn. spaces are
closed.

 As regards torque & enmass tooth movement of
U & L ant. E - links or a .010”sectional supreme
light wire is inserted into bracket from 3-3 to
maintain distance between 3-3
 U& L ribbon arch wire .022” x .016” (.022” x .018”
to enhance torque efficiency) locked with T pins

 Use of power pins (have low profile
gingival head portion with 15º
labial inclination, made of 0.015”
ss) to slipped lingual to the ribbon
arch with T-pins, elastics can be
hooked without circular hook
 Position of incisal edge can be held
by use of horizontal elastics during
stage II during torquing

 E links running from molar button to a lingual
button on 3 can also be used to make up for
drawback in slow speed of closing extn. Space
during stage II
 In this way easier to control molar rotation also.
 In KB tech. Tipping amount is very much
controlled and small from beginning of treatment
through the end of stage II.

 The tipping of canine and PM next to extn. space is
4º - 7º

Stage III
 Uprighting by means of uprighting springs is only
left
 Then active treatment is completed by holding
over uprighting teeth with 10º T-pins

Critical review
 Kb technique is very demanding tech.
 Bulky brackets – inventory problems
 Stage I relatively simple
 In stage II deepening of bite - constant problem
 E- links have to be constantly checked as
breakage or loss, is followed by incisor flaring or
space opening.

 E- links – poor substitute for cuspid ties for
holding ant. together, as they stain, break or
some time cause ext./intr. of incisors depending
on where they rest
 Rotational control of tech. is good
 Uprighting with rect. wires prolong the 3rd stage

Few valuable concepts that can be use in
pure Begg :
 Use of T-pin - in 2nd PM, mild protrusion as they
diminish amount of tipping
 Use of torque brackets for blocked out laterals.
 Rational use of class 2 elastics.

Unavailability of KB material is an impediment to
usage of this tech. in India.
Following modifications can be done-
 For tubes - use standard 0.022” X 0.028” edgewise
tubes by turning them over vertically to ribbon mode and
solder then on band.
 For torquing brackets- use wedges made of band
material and weld them between bracket base and bonding
mesh.
 For ribbon arch- bend blanks from 0.016” X 0.022”
straight length by using arch turrets.

Conclusion
 Dr. Kameda has been constantly updating his
technique as evident in change of appliance
components and thinking.
 Aim is to have a simple, secure and accurate
treatment method which results in minimum
treatment time, optimum results and max. post-
treatment stability.
 No appliance described to date is perfect and
KB is no exception. The search continues…

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The kamedanized begg technique /certified fixed orthodontic courses by Indian dental academy

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