Refined begg – modifications and their rationale /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
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Refined Begg –
Modifications And
Their Rationale

Introduction.
Change – keyword of every trt. modality
Drawbacks become apparent with passage of time.
Refinements become necessary to incorporate new
concepts and technological progress.

Changes introduced on account of following
reasons:
Change in trt. Philosophy:
AO concept -

acceptance.

reconcile Begg trt. with Andrews six keys to
normal occlusion.
Change in trt. Approach:
Adv. of mixed dentition trt. realized.
profile considerations

imp.


To improve finishing and intrusion of upper ant.
To take adv. of newly introduced materials.
Combine best in Begg + good aspect of other
techniques.


Essentials of Begg – Unaltered.
Light orthodontic forces.
Crown tipping + Root tipping

bodily

movement with least taxation on anchorage.
Brackets – free tipping in initial stages.
Differential forces.
Sequence of trt. stages.

Light intra-oral elastic force.
Enmasse movements of ant. and post. teeth –
overjet & correction of post. Occlusion.
Separation of root moving forces from archwire
forces.
Over corrections of all displacements.
Use of round high tensile wires.

Disadvantages of Conventional Begg.
Round wire – Ribbon bracket combination – no
precise control for fine finishing.
Post – root torque
Rotational control poor.
True intrusion of upper incisors – nil or minimal.

Overuse of Class II elastics
Lack of upper incisor intrusion.
Undesirable proclination of lower incisors.
Tipping of mandibular & occlusal planes.

Uncontrolled tipping –
root resorption.
long third stage.
Overemphasis on tooth material reduction –
ruined profiles.
No fail safe mech. To check tipping or
uprighting / torquing movements.

Begg practice grouped into:
Conventional Begg.
Modified Begg. – brackets other than Ribbon
arch brackets – (combination br., edgewise br, tip
edge br.)
Refined Begg.

‘Conventional’ vs ‘Refined’ Begg.
Changes in concepts.
Improvements in hardware.
Modification in mechanics ( all stages )


Changes in concepts.
‘Theory of Attritional Occlusion’ & Differential
force concept.
challenged overemphasis of extns.
ant. teeth remain stationary under heavy forces –
only till hyalinised areas – eliminated.
Treatment objectives.
static occlusion – Andrew’s six keys goal of Refined Begg.

Functional occlusion – Roth.
 Synchronization of CO & CR.
 Elimination of hanging palatal cusps – upper post.
Teeth.
 Cuspid protected occlusion.
 Incisor guidance.

 Diagnosis
Conventional Begg – few criteria.
ī to A – Pog line
ANB & FMA.
Present broad based diagnosis.

Skeletal, dental & soft tissue analysis.
Growth estimation.
VTO.

Treatment Planning.
Cookbook approach – discarded.
Overempahsised need to extract – previously

Mixed dentition considered

Growth modulation – before or during fixed
appl. phase.

Molar distalization – selected cases.

Avoid extractions when possible.

Extn. options – as dictated by diagnosis – all
4’s/5’s/upper 4’s,lower 5’s/ single arch
extns./single LI.

Biomechanics.
controlled tipping – 1st two stages.
Mollenhauer – root control from 1st stage MAA.
Advantages:
uncontrolled tipping prevented.
third stage shorter.
lingual root torque – canine roots abutting
against labial cortical plate.

Archform.
formerly – no due importance.
present –
maintenance – lower archform.
maintaining or improving upper archform.


Changes in the hardware.
Attachments.
built in adjustments – torque ( Kameda ) &
anti –rotation ( Mollenhauer )
distal offset in molar tubes.

Archwires.
Higher grade Australian wires – Premium,Premium +,
supreme.
Multistranded ( co-ax )
NiTi.
Alpha Ti.
Tandem wires. www.indiandentalacademy.com

Elastics.
Ultra light ( “Roadrunner” of Ormco)
Light elastics ( ‘yellow’ ).
Other components.
Bypass hooks.
power pins.
TPA & Jasper Jumper – when indicated.

Stagewise modifications.
Stage I.
Multilooped archwires avoided.
MAA.
Incisor intrusion –imp. in bite opening.
Bypass wires & distalizing archwires.
Base wire  0.018 as soon as possible.
Open bite cases – 0.014 wire initially.

Stage II.
MAA.
Base wire – 0.020.
Brakes

Stage III.
Base wire – 0.020 premium.
Uprighting springs & torqung aux. – finer higher grades.
Second molar banding.
Head gear when necessary.

Finishing stage.
Rectangular wires.
Later – difft. elastic config. with lighter round wires tight
buccal occlusion.
Pre – finishing ceph.

Retention
Conventional Begg – no emphasis – lower retention.
Now – retention – till relapse tendency due to – growth
or third molars ruled out.

Refinements.
Refinements in
Diagnosis.
Treatment approach.
Hardware.
Mechanics.
Finishing.
Retention.

Refinements in Hardware.
Attachments on teeth.
Brackets. retained original dimensions.
Built in adjustments.
Incisor brackets :

Antirotational adjustments.
Mesial or distal edge raised – ML/DL
correction

Built in torque.
Raising gingival or incisal edge of bracket base away from
tooth surface. (Kameda ).

Placement of attachments.
Upper and lower canine brackets – more incisally placed.
Lower incisor bracket – more gingivally.
U/L PM bracket – more occlusally.
Molar tubes – Upper  occlusally.
Lower  more occl. than conventional
gingival position.

Mesiodistal location.
Usually kept in the M-D center of crowns.
If rotated 1mm closer to the proximal surface rotated
towards the lingual.

 New Material.- Ceramic Begg bracket.
“Ceramflex II

256 Begg” – ( TP Ortho ).

Polycrystalline alumina  Injection molding.
Bonding surface – polycarbonate base.
Enable easy debonding
To avoid enamel fracture.

• Properties.
– High resistance to torsional forces.
– friction.
– debonding characteristics.
– No special adhesives / special instruments for
debonding.

• Pins used – SS/ brass and nylon pins.

Molar tube.
Round tube – 0.036” x 6mm.
Oval tubes – 0.072” x 0.024” lumen, 5mm length.
Combination tube
Round ( gingival ) & Rectangular ( ribbon ) 0.025 x 0.018,
5mm.

Adjustment.
Upper molar tubes – 10° distolingual rotational offset.
when fixed per. To mesial aspect of molar.
Lower molar tube - 5° distolingual rotational offset.

♪ Other attachments.
♪ Hooks:
Buccal hook ( centre of MB cusp. )
Palatal cusp ( Centre of distolingual cusp )

♪ Lingual buttons, cleats or eyelets.
Placed slightly off center – over correcting rotations.

♪ Additional round tubes.
For engaging lip bumpers, head gears, distal ends of U loops
of EVAA appl.

Archwires.
Still used – Round high tensile SS wires of AJW.
Earlier used gradesSpecial plus.
Extra special plus – resistant to bite opening.

Recently – new series of wire grades & sizes.
Superior properties  pulse straightening, as against
spinner straightening of older grades.

Newer grades

Size.

Premium

- 0.020.

Premium +

- 0.010, 0.011, 0.014, 0.016,
0.018.

Supreme

- 0.008, 0.010, 0.011.

Spinner straightening vs Pulse straightening.
Disadv. Of spinner straightening.
Resultant deformation.
Y.S value ( working range, resililency.)

Study by Dr. Abraham Skaria, Dr. Jyothindra
Kumar – following parameters of new grade
wires.
UTS  PS wires – 8 – 10 % higher value.
LDR  10% higher for 0.016 wire.
235% higher for 0.020 wires.

Working range  increased.
Frictional resistance  increased.
Composition  Same.
Stress relaxation  No sig. diff.
Uses.
Supreme grade wire – 0.008 – 0.011
Unravelling crowdede ant. teeth.
Boxed reciprocal torquing aux.
Mini uprighting spring.

Other materials.
Unravelling crowded teeth – early trt. Goals.
Several wires –
1st gen.- Nitinol.
TMA,
Chinese NiTi, Superelastic Japanese Niti.
Recent – Cu Niti.
Max. superelastic range.
Low hysteresis.
Low modulus.
Rough surface ( ion implantation)

Polymeric materials.
to match esthetics of ceramic brackets.
Alpha Ti – finishing stage.
alpha phase – HCP stabilized
sizes – 16x22, 18x22.
Niobium Ti

Refinements in mechanics.
- Stage I.
Objectives – remained same – some added &
elaborated.
Priorities in Stage I:
Overbite before overjet.
Alignment of teeth
proclination to be reduced before applying higher
intrusive force.

Objectives – described under two substages.

Substage I – A.
Create space for correcting crowded teeth / close
spacing if already present.
Alignment – correction of labolingual displ/rotations.
Upper incisor inclination - + 10° of normal.
Rotations / BL positions of upper molars corrected.
PM rotations.
Upper arch brodened in canine – PM area – to permit
mand. advancement.

Substage I – B.
Bite opening.
incisor intrusion,

molar extrusion.

Retraction of upper ant. to eliminate the overjet
with control over the root position.
Mech. of controlled tipping of upper incisors.
Preventing uncontrolled tipping of lower incisor –
during bite opening.
Root control – extreme lingual or labial position of some
ant. teeth.

Mandibular plane angle – controlled.
Correction of midline.
Interarch reln. corrected to Cl I.
Displ. & rotn. of P.M’s corrected – if bonded.


Archwires in Stage I.
Preferred archwire – 0.018 P or P+.
Initially – 0.016 or 0.014 often in combination
with other flexible wires.
Dis adv. of multilooped wires.
Ill effects of ant. teeth.
or uneven bite opening.
Labial flaring.

On post. teeth.
Loss of control over molar position.
Loss of anchorage.

Difficulty in construction & adjustment.
Difficulty in maintaining archform.
Difficulty in maintaining oral hygiene.

Alignment without multiloop.
Space created by sliding the teeth along the arch.
class II elastics – upper arch.
class I elastics - lower arch.
Base wires – reasonably stiff
- Not worsen existing overbite.
- Affect lower arch form.

Base wires 0.016 or 0.014 SS with flexible wires
like NiTi.

• Space created – distal tipping of canine.
– Minor crowding – 0.016 SS with cuspid circle lightly
pressing canine br.
–

crowding ( 1mm ) – 0.014 SS – cuspid circle – 0.5
distal to canine br.

– more severe – sliding canines distally – 0.104 /0.016 SS.
Class II elastics – upper
Class I elastics – lower.

– Excess tipping of canines – controlled by light uprighting
springs.
– Molar stops – prevent mesial movemt of lower molars.

o Ant. openbite casesupper archwire – 0.014 SS.
anchor bends upright mesially angulated
upper molar teeth.

• Closing ant. spacing.
Retracting proclined upper ant. teeth.
- 0.016 SS.
- elastics – class II – upper.
- class I lower.
Spacing to be closed without retracting.
– Fig. of 8 elastomeric tie.

Active space closure – not attempted till intrusion
is accomplished.


• Improving incisor inclination.
• Proclined  class II elastics.
• Retroclined  bite opening bends without elastics.
• Molar position correction.
– Approp. toe in or toe out bends – in SS 0.016 archwire.
– Mild B.L disp. – expansion /contraction in archwire.

Substage I B
Bite opening.
Preference – incisor intrusion & avoiding molar
extrusion.
Conventional Begg –
bite opening – molar extrusion + lower incisor
protrusion.
efficacy in intruding upper incisor – questionable.
stereotype approach – all cases.


• Intrusive force – bite opening bends - acts labially
- labially placed brackets.
Labial crown/lingual root tipping.
Resisted by elastics.
Magnitude & direction of net resultant force intrusive
& elastic.
Anchor bends upper 0.016 wire
= 45 g force/side.
Extrusive comp. of class II elastic = 30 g / side.
Resultant
= 15 g / side.
on 3 teeth
= 5 g/ tooth.
Same combination used irrespective of upper incisor
inclination.

• Excess proclination or retroclination corrected in
1st substage.
• Then intrusive and class II elastic force varied.
- orientation of resultant kept close to C. Res.
Steps.
– Intrusive force applied 45g, CL II force 60g.
– Inclination improves. Intr force - 60g, Cl II - 30g.
– Incisors upright – elastic applcn.- oblique ( ant.
pointing downward direction ).


CR


Gradual increase in intr. force –
anchor bend 30°- 50° - 0.016 archwire
elastic force –using for longer periods –
switching from yellow ( 5/16”) to
Road runner ( 3/8” ) elastics.
Directional changechanging from class II  Class I 
from TPA.
Alternative – ‘power arms’

Power arms.
Long been used in preadusted edgewise appliance.
Trivandrum Intrusion Technique –
Dev. By Dr. K. Jyothindra Kumar.
For selective max. intrusion in the Begg technique.
Analysis of force vectors of pure Begg technique –
– Intrusive vector of the max. arch wire &
– Extrusive vector of the Class II elastics.
Equal & opp.
Class II vector – lower molar extrusion & lingual rolling.
Intrusion, extrusion or no change – incisors.

Present technique:
Problem eliminated – elastics Molar power arm I/M circle anteriorly.
Vectors – same direction
- elastic pull & archwire force unidirectional.
Little mesial molar movement – elastic force close to
the C.R of the molar.
Anteriorly – force vector  close to C.R of ant.
pure intrusion.

Clinical use.
made of 17x25 or larger size wire.
optimal length – 5-7 mm, follows contour of the
alveolus.
Soldered to bands – above molar tubes.
2.0 oz elastic, 0.016 archwire - 40° anchor bend,
 82 g force ( agrees with recommendations of
optimal value for incisor intrusion )

Location of bite opening bends.
( Arch wire design modifications ).
Conventional bite opening bends.
3mm mesial to the molar tube. Intrusion of
upper canines & of LI and CI.
Gable bends – distal to canines.
extrusion of canines, intrusion of LI & CI.
Hocevar’s modification. –
a bend on either side of canines.
CI – intrusion. Canine & LI – extrusion.

Bite opening curve ( anchor & gable bends).
Canines – extrusion, LI and CI – intrusion.
Modification – Dr. Jayade.
Mild gingival curve – midpoint 3mm over the
brackets.
Vertical step up bend – 4 – 5 mm ht., 2 – 3 mm
mesial to the molar tube.
Anchor bend – upper end of the step.

Elimination of Overjet – control over root
positions.
Edge to edge relation – controlled tipping.
Uncontrolled tipping – hasten root resorption( Reitan).

Controlled tipping – upper incisors during retraction.
elastic force alone- uncontrolled tipping.
for controlled tipping – counter moment.
Ratio – b/w 5:1 and 8:1.
intrusive force – counter moment.
Conventional Begg.- low intrusive force,
heavy elastic force.

higher intrusive forces & light or ultra light elastic
forces – incisor intrusion & controlled tipping.
Bite opens -

intrusive force.

Moment augmented – MAA.


• Development of MAA
Mollenhauer –rectangles made in 0.010 “ wire for
reciprocal torque on adjacent incisors (SPECS) too
heavy force
In 1984, on request of Mollenhauer , A. J. Wilcock made
0.009” supreme wire
Initially he used it similar to niti or co-axial wire.
Later boxed aux. named
“ An Aligning auxiliary for ribbon arch bracket”.

• Requirements of MAA
– Must generate very light root moving forces
– when reciprocal torque is required with the adjacent
rectangle must not diverge by more than 450
– Auxiliary should resist deformation (resilient supreme
grade pulse straighten wire)
– Base wire should be able to resist vertical and transverse
reactive forces from MAA


For lingual root torque
Mollenhauer engaged MAA
first & base arch wire piggy
back

but rectangles lift away from
the tooth surface. So,
Thickest possible pins
(ceramaflex) used.

ADVANTAGES OF MAA
– simultaneous intrusion and retraction of incisors
– of rapid bodily alignment of anterior teeth with gentle
forces
– Stable results
– Reciprocablility of torquing forces on instanding laterals
or palatally placed canines.
– Periodontal advantages – gingival dehiscences associated
with prolonged labial root torquing is eliminated

– Short stage three
– Possibility of growing cortical bone at point A & point B.

Various applications of MAA
– bodily alignment of crowded teeth
– To apply labial root torque on lower incisors in growing
brachyfacial cases.
– Can also be used for labial root torque on upper incisors
in class III cases.

– By bending more +ve Torque as a braking
mechanism
– For controlling mesio-distal tipping (MAA
tip)


Modification of MAA
– With available pins holding down the boxes for
lingual root torque was difficult. So, torquing action
of MAA is directly applied on gingival surface of
teeth. For this base wire is engaged first and MAA is
engaged piggy back.


– When reciprocal root torque is required on
adjacent teeth the concerned box rides over
the main arch wire with a cross over bend and
pressed against the incisor surface of the
crown


Preventing uncontrolled tipping of the lower
incisors.
o Brackets bonded – gingivally.
o MAA – labial root torque – lower incisors.
o Ends of lower archwire bend distal – molar tubes.

Root control – extreme lingual or labial psitions
of the ant.
o Labial movement of instanding incisors or caninesMAA.
o Lingual root movement – canines – marked root
prominence – for placing into cancellous bone.

Controlling mandibular plane angle.
open during trt. – molar extrusion – worsening of
Cl II profile.

Correcting midline discrepancy.
upper midline - after alignment, uneven Cl II
elastics.
if both midlines shifted in opp. directions –
midline diagonal elastic.
lower midline alone – unilateral lower Cl I elastic.


Correcting inter - arch relationships to
Class I.
• Growing child – class II – class I – encouraging
the mandibular growth.
• Adults – mesial movement of the lower post.
dental segment.- class II elastics.
• Selected cases – distalizing upper molars

Check list at the end of Stage I.
 Incisors – edge to edge relation.
 Midlines matching.
 Molar & canines – class I.
 Upper and lower arch forms – matching.
 Molar rotations & BL displ. Corrected.
 Good control – root positions & mandibular plane
angle.

Stage II
Objectives.
Common –
– Maintain all corrections – in stage I.
– Close all extraction spaces.

Additional.
– Controlled tipping – space closure – ant. retraction.
– Prevent excess tipping – efficient brakes – space closure
by protracting post.
– 1st pm extn. Cases – rotations & crossbites of 2nd pm
corrected.

Archwires in Stage II of Refined Begg
In extn. & non extn. cases –
0.018” P or P+, or 0.020 P wires.
If stage corrections involved – extreme deep bite,
badly distorted arch forms or severe rotations –
0.020 archwires effective.
Anchor bends
PM bypassed – except when in distobuccal
rotation.

Controlled tipping of the incisors.
MAA – lingual root torque – controlled lingual
tipping – incisors during retraction.
( bite opening force - intrusive force supplemented
with moment – MAA).
Lower incisors – sig. retraction – lingual root
torque.
Canines – excess tipping – 0.010 uprighting springs.

Braking mechanics.
Second PM extn. Cases – excess space closed by
post. protraction.
Good profile at start of trt.
‘Brakes’ – reverse anchorage site – posterior  ant.
Commonly used:
Braking springs: passive uprighting springs – 0.018
wire.
Angulated T pins: prevent further tipping

Combination wires: either of SS or Alpha Ti alloy.
Ant segment. – 0.022 x 0.018 (ribbon mode).
Post. segment – 0.018 round .
Alpha Ti – easier to engage in ant. br. slots.
chance of distortion.
Use SS combination wire - torque than alpha Ti.
Disadv. – expensive.
SS 0.022 x 0.018 sectionals – torqued in ribbon
mode – piggy back over 0.018 base wire.

Strength of elastics –
– Light ( yellow ) Class I or II elastics – ant. retraction.
– Ultra light Class II elastics.
– Stronger ( green ) – class I – posterior protraction.

Check list.
• Spaces closed completely.
• Ant. edge to edge bite or +ve overjet in open bite cases.
• Canine & molar relations – Cl I or super Cl I

Pre Stage III.
Need  PM’s not engaged – extn spaces are closed.
PM’s – different vertical level.
Horizontal offset reqd. – engagement in PM bracket
& molar tube.
Archwire:
0.016 wire – one visit – arch wire engagement in PM
Offset b/w PM & Molar.
Upper wire – gable bend.
Lower wire – mild anchor & gable bend.

Stage III.
Objectives.

Maintain corrections.
To achieve desired root positions.

Addnl. Objectives.( Refined Begg ).

Monitor sagittal & vertical anchorage.
Monitor & correct inclinations of post. Teeth
Correct – 2nd molars – when reqd.
Monitor trt. for undesirable sequels – root
resorption, parafunctional habits

Problems encountered in Stage III.
Undesired sagittal movements.
Mesial movement of upper arch – Corrected Cl I  Cl
II.
Mesial movement of both arches – BMP.
Individual crown movements – crowding.
Mesial & distal crown movement – extn. Site – open
spaces.

Undesired vertical movements.
Undesired transverse movements – upper molars roll
buccally.

Root resorption.

Complications – related to :
1. Amount of lingual root torque needed for
incisors & distal root movement.
2. Amount of force generated – auxiliaries &
springs.
3. Use of weak base wires

Remedies:
Minimize need for root movements.
– Correct diagnosis & carefully planning extn.
– Using efficient brakes.
– Incisors tipped in a controlled manner.

Use of heavy base wires.
– 0.020 P wire , stiffness 3x – Special + wires.

Lighter aux. & Uprighting springs.
– Because of reduced need to torque – 2 spur used.
– 0.012 wire used.
– Uprighting springsmini springs – 0.009
slightly bigger coils – 0.012 wire – canines & PM’s.

Light Class II elastics.
– Because of lighter reciprocal actions.

Reinforcement of the anchorage.
Extreme MO,

Sagittal direction
– reverse torquing in lower incisors.
– Head gear or TPA – upper molars.
– Lip Bumper – lower molars.

Vertical Augmentation.
– High pull head gear, post bite blocks.

Transverse
– 0.020 premium grade wires – enough contraction & toe
in.

Archwires.
 Cuspid circles tightly touching – cuspid brackets.
 Post. segment gingivally in reln. to the ant. seg.
 Contraction & toe in – upper wire And
expansion in lower – less.
decided – looking at original study models.

 Arch wires properly co-ordinated.
 Wire ends – annealed & tightly cinched.

• Elastics:
very light class II elastics.
• Second molars banded midway in third stage.
Completion of third stage:
Degree of uprighting & torquing assessed
–
–
–

Visual inspection
Palpating – roots.
Radiographs –
Lateral Cephalogram.
Panoramic radiograph.
Occlusal film.- labiolingul alignment – LI roots

Torquing auxiliaries.
Torquing auxiliary with Spurs.
Refinements –
0.012 P+ wire (PS).
0.014 or 0.016 special + - used previously.
Inter spur span is curved – not angulated or kept
straight.
Modifications:
Reverse labial torque – one or both laterals.
Torquing boxes – canines for lingual root torque.

Other torquing Aux.
Single root torquing Aux.( Kesling ).
Buccal root torque – upper PM.
Direction of curvature – lingual or buccal root
moving effect.
0.012” P + wire – used.


Reciprocal torquing Aux.( ‘SPEC’ ) .
Two adjacent teeth – torque in opp. Direction.
0.009 or 0.011 wires – Stage I.
0.012” – Stage III.


Reverse torquing Aux – controlling roots of
canines or PM’s.
Franciskus Tan – Nov ’87 JCO.
– Labial root movement – palatally impacted
max.canine.
– Wire used  0.012” P+ with 0.018” or 0.020 base
wire.
– Inserted in molar tube from distal.
– Activated – rotating it 90° .


Buccal root torque on molars.
Lift palatally hanging cusps.
Boot design occlusal extensions
Inserted from mesial..
Boot portion – twisted lingually & toe in given.


Labial root torque – only on LI.
0.012 wire.
Convexity of aux. facing gingivally.
Indication – lower LI – (central & canine – no torque
reqd.)


Uprighting springs.
Earlier springs – 0.016 & 0.014
Mini springs – Mollenhauer – ( 0.009” dia )
Older

Supreme grae wire.
Coil
Differences.

Mini

4 times – wire
dia

2 times.

Stem Radial to coil


Tangential
to coil.

Securing pins.
• Mollenhauer – jamming – with lock pin labial to
base arch wire.
• Ligature – passing lig. Wire – through bracket in
front of archwire – passed behind archwire
outside bracket.
• Sims – insert pin lingual – main wire – after
pinning with Stage III pins.

Stage IV
Finishing with Begg appliance – difficult , not impossible.
Objectives of finishing & detailing.
• Intra arch objectives.
– good interdental contacts, proper faciolingual positioning of
teeth.
– All rotations over corrected.
– Complete space closure.
– Vertical levelling.
– Flat curve of spee.
– Proper tip & torque.
– Maintenance of lower I/Canine dimensions.

• Interarch objectives.
–
–
–

Normal overjet and overbite.
Cl I canine & Molar reln.
Tight interdigitation of all thecusps of post. Teeth.

• Functional requirements.
–
–
–

Matching CO – CR.
No cuspal interference during function.
Cuspid & incisor guidance.

• Control of etiologic factors.
• Soft tissue factors
– Frenectomy , CSF etc.

• Round & Rectangular Finishing wires used.
• Round wires.
–
–
–

0.020 stage II wires used.
Archwires given – ideal shape & co-ordinated.
First order & Second order adjustments made.
First order.
– Labio lingual position of upper laterals.
– Upper canine prominence.
- Molar offset .
- Toe in for U6 – proper Cl I .
- Lower canine ‘tucked in’.

• Second order adjustments.
–
–
–
–

U 2 , shorter in reln to U1 and U3.
Mesial angulation of U6.
U3’s slightly more mesially angulated.
L3 & L2 – levels to be adjusted.

• Rectangular finishing wires.
–
–
–
–

Alpha Ti – 0.022 x 0.018 ribbon wires.
Precise torque – build in ant. segment.
Soft – easy to bend. Harder in mouth.
0.022 vertical dimension – enough clearence – 0.040
vertical slot – vertical settling of the teeth.

• Check list on finish.
– Establish all Andrews six keys.
– Check the midline.
– Check the occlusion – Centric position.
– Occlsuion in functional movements.
– Excellent interdigitation.
– Over correction not required or use 10 ½ / 10 reln.


Conclusion.
Many shortcomings of the Begg appliance have
been highlighted at different points in time ever
since its introduction. But the basic tenets of Begg
mechanotherapy have stood the test of the time
and largely remained unaltered.
The trend in Refined Begg is in the scientific
progression of Dr. Begg’s concepts, especially in
the use of ultra light forces. With the advances in
technology & materials, a better realization of
these concepts has been possible, ultimately
leading to superior results in treatment.

Refined begg – modifications and their rationale /certified fixed orthodontic courses by Indian dental academy

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