Refined begg technique

WHY BEGG?WHY BEGG?
Nature of malocclusions encountered inNature of malocclusions encountered in
an average Indian practicean average Indian practice
Limited scope for growth modulationLimited scope for growth modulation
(or) orthognathic surgery(or) orthognathic surgery
General level of awarenessGeneral level of awareness
Cost of the treatmentCost of the treatment
www.indiandentalacademy.com

WHY BEGG LOST POPULARITY IN OTHERWHY BEGG LOST POPULARITY IN OTHER
COUNTRIESCOUNTRIES
Wrong projectionWrong projection
- Simple technique that was capable of- Simple technique that was capable of
producing miracles with minimum effortsproducing miracles with minimum efforts
- Easy technique requiring a simplistic- Easy technique requiring a simplistic
diagnosis & stereotype treatmentdiagnosis & stereotype treatment
- “cook book” treatment- “cook book” treatment
Overemphasis on extractions, based onOveremphasis on extractions, based on
“theory of attritional occlusion”“theory of attritional occlusion”
Vested commercial interests further hastened theVested commercial interests further hastened the
downfall of begg appliancedownfall of begg appliance

ADVANTAGES OF BEGG TECHNIQUE
1. Light continuous force to move teeth over long
distance without excessive strain on the anchorage
2. Greater interbracket distance –lighter force
generated
3. Both extraction and nonextraction treatment plan
applied effectively
4. Highly resilient wires – gentle force over a long period
of time
5. Root torquing and root uprighting is separated from
the main arch wire by the use of auxillaries
6. Less taxing on anchorage
7. Through the application of differential force it is easy
to close the space at any location in the arch
8. Can be used in lingual orthodontics
9. Cost effective www.indiandentalacademy.com

DISADVANTAGES OF CONVENTIONAL BEGG
1.Unable to give precise control
2.Posterior torque difficult
3.Rotational control was poor with use of under size wires in
1st & 2nd stages of treatment
4.During bite opening, true intrusion of upper incisors was nil
or minimal
5.Overuse of class-ii elastics:
- Lack of incisor intrusion
- Undesirable proclination of lower incisors
- Unfavorable tipping of mandibular & occlusal planes

MISCONCEPTIONS ABOUT THE BEGG
TREATMENT
1. Does not require a great deal of precision
2. Does not require a great deal of skill
3. Predominantly an extraction treatment based on
theory of attritional occlusion
4. Results in flat or concave profile
5. Lacks control
6. “cook book” approach

AA. Conceptual changes. Conceptual changes
1.1. Theoretical foundation resting on “theory ofTheoretical foundation resting on “theory of
attritional occlusion” & “differential forceattritional occlusion” & “differential force
concept”.concept”.
2. Treatment objectives2. Treatment objectives
- static occlusion – Andrew’s 6 keys- static occlusion – Andrew’s 6 keys
- Functional occlusion – Gnathologic- Functional occlusion – Gnathologic
objectivesobjectives
3. Diagnosis3. Diagnosis
- profile
- VTO
4. Treatment planning4. Treatment planning
5. Biomechanics5. Biomechanics
6. Arch form6. Arch form
REFINEMENT IN BEGG’S ….AT A GLANCE…….

B. Refinements in components
a. Brackets
- Ceramic brackets
- brackets with built-in torque and derotation
- tip edge brackets
b. Tubes
- Kameda’s oval tube with small diameter and combination
tubes
c. Elastics
- lighter force elastics – road runner elastics
- elastic force in different direction
- check elastics
- differential vertical elastics

SUGGESTED MODIFICATIONS PERTAINING TO
BEGG TREATMENT
1. Leyman Wagers : Mixed dentition treatment
2. Milton Sims : Inadequacy of anchor bend . Undesired
effect of multilooped wires
3. Swain : Head gear , rectangular wires
4. Mulie , Ten Hoeve and Brandt, Hocevar : intrusion of
upper incisors
5. Kameda : root torque early in the treatment ,
rectangular wires in Begg brackets with in built torque
6. Thompson : Posterior root torque
7. Mollenhauer : control root positions from early stage
- rectangular finishing wires
- VTO
- Higher grades of Australian wireswww.indiandentalacademy.com

STAGE 1
1. Decline in the use of multilooped arch wire –
New ultrafine Australian wire , NiTi wires ,
multibraded wires were used along with 0.016”
base arch wire
2. Use of MAA for controlled tipping
3. More importance to true incisor intrusion
during bite opening
4. Modified designs of arch wires are routinely
used
5. Switch to 0.018” arch wire as early as possible
STAGE II
1.Base arch wire changed to 0.018”
2.MAA continued for controlled tipping
3. Excessive tipping avoided by use of braking
mechanics www.indiandentalacademy.com

STAGE III
1. Base arch wire is 0.020” premium for resisting
unfavorable reactions of springs
2. Uprighting springs made of finer higher grade wires
3. Inclusion of second molar in appliance
4. Headgear may be used for reinforcing anchorage
STAGE IV : FINISHING STAGE
1. Use of rectangular wires in ribbonmode
STAGE V : RETENTION PHASE
1. Use of wrap around retainers
2. Lower fixed retainerwww.indiandentalacademy.com

HOW MUCH OF BEGG IS RETAINED IN REFINED
BEGG ???
1. Light orthodontic force
2. Crown tipping followed by root tipping movement
3. Brackets – free tipping movements in the initial
stages
4. Differential forces
5. Definite sequence of treatment stages
6. Light intraoral elastic force
7. Enmasse movement of anterior and posterior teeth
for overjet reduction and correction of posterior
occlusion
8. Overcorrection of all displacements
9. Use of round , tensile wires

BEGG – STAGE III
- problem stage of Begg treatment
- It is rightly said that at the end of stage II
there is only one exit – the third stage with no
appliance having such capability of extrication

Pre Stage III Adjustments
The pre stage III is a stage that decides how well the
teeth are tuned to receive the all important stage III
The pre stage III is supposed to begin with the end of
stage II when all the teeth have assumed proximal
contact without any desirable intra – arch and inter – arch
relationships in existence

1. Round Molar tubes
2. Lingual attachments in molar
3. Premolars to be bracketed
4. Arch form considerations
upper arch wire
☻ 0.018 “ wire to be used
☻ Molar offset – BL – 2-2.5mm
- 2-3 mm mesial to the mesial end of the molar
tube
☻Toe – in
☻ No contraction / expansion
☻ Vertical offset between mesial and distal legs of the horizontal
molar offset
☻ Gable bend /bite opening bend distal to the intermaxillary circle
☻ Rainbow curve in the anterior segment of the arch wire
☻ No anchor bend

Lower arch wire
☻0.018” arch wire
☻Vertical offset
☻ 10 – 15 degrees of anchor bend
☻ Toe – in
☻ Add a little expansion in the lower arch
(to compensate for class II elastics )
☻Gable bend distal to intermaxillary circle
☻ Co ordination of arch wires
☻ Cinching vs tie back
☻ Heat treating the wires

The pre stage III adjustments are usually
completed within one month
New impressions are taken at the beginning of pre
stage III
OPG and lateral ceph – to assess the degree of root
movement in third stage
The pre stage III ensures that all teeth are in the
needed positions – without any untoward movements
in any plane of space before adding the anchorage
sensitive root moving auxiliaries
The arches are well socked – in, coordinated ,the
wires rigid enough to ease the patient into the
oncoming pressures exerted by he root moving
auxiliaries in stage III

Objectives of stage III
1.To Maintain correction achieved during the two
stages
2.To achieve the desired root positions
Additional objectives for the Refined Begg
1.To carefully monitor the sagittal and vertical
anchorage
2.To monitor and correct the inclinations of the
posterior teeth ,specially the molars
3.To correct the position of the molars whenever
required
To monitor the treatment for undesirable sequlae –
root resorption and para – functional habits due to
cuspal interference

Mechanics of stage III
1. Lingual root torquing auxiliaries – labial crown
movements ,extrusion of the anteriors ,intrusion
& buccal crown movement of posteriors
2. The uprighting springs for distal root movement –
similar effects as lingual root torquing auxiliaries
in all the 3 directions

Problems encountered in stage III
1. Undesired sagittal movements
a. class II malocclusion – interarch relation
reverts back from corrected class I to
class II
b. Reversal of bimax protrusion correction
– mesial movement of both the arches
c. Individual crown movements in a mesial
direction can crowd incisors & affect
rotational correction
d. Mesial & distal crown moving tendencies
in teeth adjacent to extraction sites - open
extraction spacing, closed earlier at end of
2nd stage

2 . Undesired vertical movements2 . Undesired vertical movements
- cause anterior deepbite to return partially or- cause anterior deepbite to return partially or
fully.fully.
- 2nd premolar & first molar extraction cases, an- 2nd premolar & first molar extraction cases, an
open bite may develop in molar area.open bite may develop in molar area.
3 . Undesired transverse movements3 . Undesired transverse movements
- cause the molars (especially uppers) to roll out- cause the molars (especially uppers) to roll out
buccally & rotate - serious functional disturbances.buccally & rotate - serious functional disturbances.
4 . Root resorption4 . Root resorption possibilities are substantialpossibilities are substantial
during 3rd stageduring 3rd stage

GE
Genesis of Third stage complications
1. Amount of lingual root torque and distal root
movement needed – reciprocal reactions in all 3
planes
2.Force generated by auxillaries and springs – root
resorption
3.Weak base wires

How 3rd stage problems are overcome:How 3rd stage problems are overcome:
1)1) Minimise root movements in 3rd stageMinimise root movements in 3rd stage
A)A)By diagnosing case correctly & by carefully planningBy diagnosing case correctly & by carefully planning
extraction decision, , over retraction of incisors isextraction decision, , over retraction of incisors is
avoided.avoided.
B)B) By using efficient brakes ,the molars can beBy using efficient brakes ,the molars can be
protracted in those cases where extractions wereprotracted in those cases where extractions were
dictated by such factors as caries, trauma ordictated by such factors as caries, trauma or
periodontal conditions rather than space requirementperiodontal conditions rather than space requirement
considerations.considerations.
C) By using improved mechanics in first 2 stages, incisorsC) By using improved mechanics in first 2 stages, incisors
are tipped in a controlled mannerare tipped in a controlled manner

2) use of heavy base wires2) use of heavy base wires
- 020” premium grade, almost 3 times stiffer than- 020” premium grade, almost 3 times stiffer than
previous .020” special plus wiresprevious .020” special plus wires
- very effective in resisting vertical & transverse reactions- very effective in resisting vertical & transverse reactions
of auxiliaries & springsof auxiliaries & springs
3) lighter auxiliaries & uprighting springs3) lighter auxiliaries & uprighting springs
- Reduced need to torque incisor roots - torquing auxiliary- Reduced need to torque incisor roots - torquing auxiliary
often used is a 2 spur auxiliary.often used is a 2 spur auxiliary.
- The spur design auxiliaries having two, four or six spurs- The spur design auxiliaries having two, four or six spurs
are made in .012” wireare made in .012” wire
- Uprighting springs are also made in very light wires- Uprighting springs are also made in very light wires
- low load deflection rate - tax anchorage in all 3- low load deflection rate - tax anchorage in all 3
directions much less & are also less likely to cause rootdirections much less & are also less likely to cause root
resorptionresorption

4) Light class II elastics4) Light class II elastics
- eliminating problems associated with use of heavy cl-II- eliminating problems associated with use of heavy cl-II
elasticselastics
5) Reinforcement of anchorage5) Reinforcement of anchorage
- Reverse torquing auxiliary on lower incisors for- Reverse torquing auxiliary on lower incisors for
augmenting anchorage in sagittal directionaugmenting anchorage in sagittal direction
- Headgear or TPA may be used to upper molars , lip- Headgear or TPA may be used to upper molars , lip
bumper to lower molarsbumper to lower molars
- Molar uprighting springs reinforce anchorage in sagittal- Molar uprighting springs reinforce anchorage in sagittal
& vertical directions in 2nd premolar or first molar& vertical directions in 2nd premolar or first molar
extraction cases.extraction cases.
- Base wire made in .020” premium grade are adequate for- Base wire made in .020” premium grade are adequate for
transverse anchorage, provided enough contraction & toe-transverse anchorage, provided enough contraction & toe-
in is built in wires.in is built in wires.

Start of stage IIIStart of stage III – Teeth well aligned and well levelled– Teeth well aligned and well levelled
and all spaces completely closedand all spaces completely closed
- Upper molar distal tipping , if caused during bite- Upper molar distal tipping , if caused during bite
opening , should be eliminatedopening , should be eliminated

Finish of stage IIIFinish of stage III - Many of corrections , achieved in- Many of corrections , achieved in
first 2 stages, is always lost during 3rd stage.first 2 stages, is always lost during 3rd stage.
- Better to overdo them by about 15% at end of 2nd- Better to overdo them by about 15% at end of 2nd
stage, to compensate for loss during stage IIIstage, to compensate for loss during stage III
-Degree of uprighting and torquing – assessed by visualDegree of uprighting and torquing – assessed by visual
inspection , by palpating their roots and by radiographinspection , by palpating their roots and by radiograph
- pre finishing panoramic radiograph , lateral ceph ,pre finishing panoramic radiograph , lateral ceph ,
occlusal filmocclusal film - to assess labio lingual alignment of the- to assess labio lingual alignment of the
lower incisor rootslower incisor roots

Archwires in stage-IIIArchwires in stage-III
-- cuspid circles tightly touching cuspid bracketscuspid circles tightly touching cuspid brackets
- Posterior segments of arch wires are kept gingivally- Posterior segments of arch wires are kept gingivally
in relation to anterior segmentsin relation to anterior segments
-The amount of contraction in upper archwire (as also-The amount of contraction in upper archwire (as also
toe-in) or expansion in lower archwire is much lesstoe-in) or expansion in lower archwire is much less
using .020” premium wires than previous .020” specialusing .020” premium wires than previous .020” special
plus wires.plus wires.
- About 2mm of contraction in relation to upper molar- About 2mm of contraction in relation to upper molar
tubes is adequate when a 2 spur auxiliary is in .012”tubes is adequate when a 2 spur auxiliary is in .012”
wire is usedwire is used

In lower archwireIn lower archwire
- 2-4mm expansion is adequate.- 2-4mm expansion is adequate.
- The amount of gable bend in upper wire &- The amount of gable bend in upper wire &
anchor bend & gable bends are decided accordinganchor bend & gable bends are decided according
to degree of overbite in original malocclusionto degree of overbite in original malocclusion
-Wire ends are annealed and tightly cinched-Wire ends are annealed and tightly cinched
Upper & lower arch wires must be properly co-Upper & lower arch wires must be properly co-
ordinated.ordinated.

Elastics in stage-IIIElastics in stage-III
- very light cl-II elastics such as TP yellow are- very light cl-II elastics such as TP yellow are
adequate for maintaining inter arch relationshipadequate for maintaining inter arch relationship
- Blue or red elastics in distal vertical or box- Blue or red elastics in distal vertical or box
configuration may be used to prevent tipping ofconfiguration may be used to prevent tipping of
upper & lower molarsupper & lower molars
- Heavier inter arch elastics, TP green or or blue- Heavier inter arch elastics, TP green or or blue
may be used when extraction spaces tend to openmay be used when extraction spaces tend to open

Banding 2nd molarsBanding 2nd molars
When 2nd molars malaligned, they are banded midwayWhen 2nd molars malaligned, they are banded midway
during 3rd stageduring 3rd stage
A sectional wire in .012” or .014” is used in tubes of 1stA sectional wire in .012” or .014” is used in tubes of 1st
& 2nd molars to align them bucco-lingually or vertically.& 2nd molars to align them bucco-lingually or vertically.
After they are reasonably aligned, a continuous wire in .After they are reasonably aligned, a continuous wire in .
016” size along with main base wire is employed towards016” size along with main base wire is employed towards
end of 3rd stage.end of 3rd stage.
First molar tubes accommodate both wires, while .016”First molar tubes accommodate both wires, while .016”
alone continues into 2nd molar tube.alone continues into 2nd molar tube.
The .016’ wire need not be engaged in bracket slots butThe .016’ wire need not be engaged in bracket slots but
it is tied to main base wire at 2 places on either side.it is tied to main base wire at 2 places on either side.

TORQUING AUXILLARIES AND UPRIGHTING SPRINGS
The separation of root moving forces from the crown
movement was a significant contribution of Dr.P.R.Begg; this
concept having a very promising mechanical advantage
This is mainly because the unwanted reciprocal forces
generated are spread over by the rigid base wire , and not
felt on the adjacent teeth
Secondly , the moment arm utilized is greater than that
offered by a twisted rectangular wire
Finally , light continuous forces can be maintained which
would be more physiologicwww.indiandentalacademy.com

The torquing auxillary with spurs
Action : Lingual root torque
Reaction :
 Sagittal plane – labial crown movement of
anteriors
Vertical plane – Extrusion of anteriors and
intrusion of posteriors
Transverse plane – Buccal crown movement
of posteriors

The lingual torquing effect is on account of
two factors
1. The vertical plane changed to horizontal
plane when fully tied to the arch wire
2. When the torquing auxillary is opened to
the larger arc of the anterior portion of the
arch wire , it rolls inwards
-Both these effects force the tips of the
spurs to press in a lingual direction against
the gingival portion of the crowns
- Reciprocally, the inter – spur spans of the
auxillary tend to lift away in a labial
direction
- The labial forces are resisted by the
bracket slots and the base arch wire to
which the auxillary is tied – accentuating
the effect of the root moving forces

Other torquing auxiliary designsOther torquing auxiliary designs
1.1. single-root torquing auxiliary –keslingsingle-root torquing auxiliary –kesling
 Indicated on upper premolar, which needs buccalIndicated on upper premolar, which needs buccal
root torque to eliminate cuspal interference fromroot torque to eliminate cuspal interference from
its hanging palatal cuspits hanging palatal cusp
 The long arm should extend three to four adjacentThe long arm should extend three to four adjacent
teeth when engaged in bracketsteeth when engaged in brackets
 Depending on curvature auxiliary is tied - torqueDepending on curvature auxiliary is tied - torque
generated will have lingual or a buccal root movinggenerated will have lingual or a buccal root moving
effecteffect
 Effect is transmitted by vertical extension ofEffect is transmitted by vertical extension of
auxiliary through bracket pillar onto tooth,unlikeauxiliary through bracket pillar onto tooth,unlike
other auxiliaries which exert force directly onother auxiliaries which exert force directly on
tooth surfacetooth surface
 .012” premium plus ,but can be made in thinner wires.012” premium plus ,but can be made in thinner wires
for smaller teeth like lower incisors.for smaller teeth like lower incisors.www.indiandentalacademy.com

2.Reciprocal torquing auxiliary ( ‘spec’ ) design2.Reciprocal torquing auxiliary ( ‘spec’ ) design

when two adjacent teeth require root torque inwhen two adjacent teeth require root torque in
opposite directionsopposite directions
 .009” 0r .010” wires, for controlling root.009” 0r .010” wires, for controlling root
movements in stg-1 & 2movements in stg-1 & 2
Made in .012” wire ,in stage-iiiMade in .012” wire ,in stage-iii
Box on tooth requiring labial root torque isBox on tooth requiring labial root torque is
placed incisal to main wire while box on otherplaced incisal to main wire while box on other
tooth requiring lingual root torque sitstooth requiring lingual root torque sits
piggyback on main wire.piggyback on main wire.

3. Reverse torquing auxiliary for controlling roots of3. Reverse torquing auxiliary for controlling roots of
canines & premolarscanines & premolars
 Franciskus tanFranciskus tan, for labial root movement, for labial root movement
of palatally impacted maxillary canine,of palatally impacted maxillary canine,
whose crown has been aligned but root iswhose crown has been aligned but root is
still placed palatally & needs labial rootstill placed palatally & needs labial root
torquetorque
.012” p+ wire fitted in conjunction with ..012” p+ wire fitted in conjunction with .
018” or .020” base wire018” or .020” base wire
It is inserted in molar tube from distalIt is inserted in molar tube from distal
endend
 An offset is placed in auxiliary to bypassAn offset is placed in auxiliary to bypass
main wiremain wire

4. Buccal root torque on molars4. Buccal root torque on molars
Used in cases, other than with oval tubesUsed in cases, other than with oval tubes
with double back ends where molar crownswith double back ends where molar crowns
roll buccallyroll buccally
 .014” size wire fitted in molar tubes along.014” size wire fitted in molar tubes along
with main archwirewith main archwire
 boot design occlusal extension on molarsboot design occlusal extension on molars
Boot portion is twisted lingually & given aBoot portion is twisted lingually & given a
toe-in, & whole auxiliary is suitablytoe-in, & whole auxiliary is suitably
contracted.contracted.
It can be ligated to main wire at 2-3 placesIt can be ligated to main wire at 2-3 places
on either side.on either side.

Mouse trap auxiliary
☻Dr.Mollenhouer
☻Torquing posterior teeth
☻Base arch wire – 0.020 “ premium
☻Auxiliary – pulse straightened 0.010” or 0.012” Supreme
Base arch wire :
- Midline V bend facing gingivally
- offers anchorage for auxillary
- ensures greater rigidity
Auxillary :
- has a vertical arm and horizontal arm

Advantages of full Mouse Trap mechanism :
1. Molar torque is reciprocal to anterior torque
2. cuspids may also be torqued to place the apices in the
alveolar trough , for more efficient uprighting with
uprighting springs
3.Molar torque is achieved earlier (stage III) for greater
stability rather than as a final activity in the finishing
stage
Disadvantages :
1. Time consuming to bend
2. Extremely difficult to bend for non – extraction cases
3. Does not extend upto 2nd
molars

UPRIGHTING SPRINGSUPRIGHTING SPRINGS
Actions : Root movement in distal direction
Reactions :
 Sagittal plane – mesial crown movement
 Vertical plane – Extrusion of concerned
teeth and intrusion of teeth distal to it
 Transverse plane – buccal crown
movement of teeth distal to it

Mollenhauer introduced mini springs made in .Mollenhauer introduced mini springs made in .
009” supreme grade wire009” supreme grade wire
Differences with older springsDifferences with older springs
1. The coil of springs is only twice as the size of1. The coil of springs is only twice as the size of
wire,in contrast to size of former springs thatwire,in contrast to size of former springs that
was 4 times the wire diameterwas 4 times the wire diameter
2. The stem of spring run tangential to coil, unlike2. The stem of spring run tangential to coil, unlike
previous springs in which stem was radial to coilprevious springs in which stem was radial to coil
3.Activation is 100%, stem & active arm make an3.Activation is 100%, stem & active arm make an
angle of 180 deg compared to earlier 135 degangle of 180 deg compared to earlier 135 deg
angulationangulation
New springs are ‘mini’ because inner diameterNew springs are ‘mini’ because inner diameter
of coil is only twice size of wire diameterof coil is only twice size of wire diameter

Third stage in the Refined Begg still involves the same
amount of wire bending as in conventional Begg
However mechanics has become much more predictable
and easily manageable
Hence , there is no excuse now for not attempting the
third stage
Without third stage , treatment becomes a mockery and
disservice to the patient

Refined begg technique

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