BEGG’S STAGE II AND ITS MECHANICS/endodontic courses

BEGG’S STAGE II ANDBEGG’S STAGE II AND
ITS MECHANICSITS MECHANICS
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.comwww.indiandentalacademy.com

Objectives of Stage IIObjectives of Stage II
 With the correction of crowding andWith the correction of crowding and
achieving edge to edge bite in anteriors itachieving edge to edge bite in anteriors it
will be reasonable to presume that furtherwill be reasonable to presume that further
hindrance to the tooth movement is takenhindrance to the tooth movement is taken
care of and it will be reasonable to reassesscare of and it will be reasonable to reassess
the treatment requirement, evaluate andthe treatment requirement, evaluate and
redefine the objectives of the remainingredefine the objectives of the remaining
treatment and decide the steps for Stage 2treatment and decide the steps for Stage 2
and Stage 3 phase.and Stage 3 phase.

 The objectives of Stage II are asThe objectives of Stage II are as
follows :follows :
1.Maintaining all corrections achieved during stage I.1.Maintaining all corrections achieved during stage I.
2.Closing all remaining posterior spaces.2.Closing all remaining posterior spaces.
 Ideally, it will be wise to procure newIdeally, it will be wise to procure new
radiographs and clinical records and apply one’sradiographs and clinical records and apply one’s
mind whether remaining extraction spaces mustmind whether remaining extraction spaces must
be closed by distal driving of all anteriors orbe closed by distal driving of all anteriors or
whether to allow the posteriors to drift mesiallywhether to allow the posteriors to drift mesially
into the extraction space or both.into the extraction space or both.

Achieving theAchieving the
Objectives Of stAge iiObjectives Of stAge ii

1. Maintain all corrections1. Maintain all corrections
 Edge-to-edge relationship of anteriorsEdge-to-edge relationship of anteriors : -: -
– Continuation of bite opening bends orContinuation of bite opening bends or
reduced anchor bends and wearing ofreduced anchor bends and wearing of
Intermaxillary elastics as required.Intermaxillary elastics as required.
 Alignment of Anterior teethAlignment of Anterior teeth : -: -
– Plain arch wire with bayonet bends (ifPlain arch wire with bayonet bends (if
necessary) engaged in the central and lateralnecessary) engaged in the central and lateral
incisor brackets.incisor brackets.
 Anterior Space ClosureAnterior Space Closure : -: -
– Cuspid ties, electrometric rings or ligatures.Cuspid ties, electrometric rings or ligatures.

 Over-rotated teethOver-rotated teeth : -: -
– Engagement of arch wire in offset brackets onEngagement of arch wire in offset brackets on
cuspids or bicuspids.cuspids or bicuspids.
– Ligature ties from bicuspid brackets to buccalLigature ties from bicuspid brackets to buccal
or lingual side of molars.or lingual side of molars.
 Normal or over-corrected bucco lingualNormal or over-corrected bucco lingual
relationship of posterior teethrelationship of posterior teeth : -: -
– Continual wearing of cross bite elastics.Continual wearing of cross bite elastics.
– Constrict and/or expand the arch wire.Constrict and/or expand the arch wire.
 Overcorrected or normal mesiodistalOvercorrected or normal mesiodistal
molar relationshipmolar relationship : -: -
– Wearing of inter maxillary elastics as requiredWearing of inter maxillary elastics as required
during posterior space closure.during posterior space closure.

2. Close any remaining spaces2. Close any remaining spaces
 Wearing horizontal elastics or more often,Wearing horizontal elastics or more often,
tie elastic thread across spaces until theytie elastic thread across spaces until they
are closed.are closed.

MechAnics Of stAge iiMechAnics Of stAge ii

 The use of 0.020” gauge arch wire is better as it givesThe use of 0.020” gauge arch wire is better as it gives
more rigidity to appliance and increased resistance tomore rigidity to appliance and increased resistance to
damage by patients, particularly in cases requiringdamage by patients, particularly in cases requiring
unilateral extraction space closure, this thicker archunilateral extraction space closure, this thicker arch
wire is better. Anchor bends and toe- in bends in thiswire is better. Anchor bends and toe- in bends in this
stage of the treatment are of slightly lesser degree andstage of the treatment are of slightly lesser degree and
hence less pressure is applied on anteriors andhence less pressure is applied on anteriors and
posteriors.posteriors.
Stage II Arch WiresStage II Arch Wires

 The only function of these arch wires is to maintainThe only function of these arch wires is to maintain
the corrections achieved( bite opening, arch formthe corrections achieved( bite opening, arch form
& tooth alignment), and to stabilize the teeth& tooth alignment), and to stabilize the teeth
against any adverse reciprocal forces that mayagainst any adverse reciprocal forces that may
occur as a result of application of elastics oroccur as a result of application of elastics or
auxiliaries.auxiliaries.
 Symmetry and correlation of the upper and theSymmetry and correlation of the upper and the
lower arch is still maintained. Expansion in thelower arch is still maintained. Expansion in the
molar region is also maintained. Care is taken tomolar region is also maintained. Care is taken to
avoid intercanine expansion as in the Stage I.avoid intercanine expansion as in the Stage I.

 Coordinated upper andCoordinated upper and
lower arch wires forlower arch wires for
Stage 2.Stage 2.
 They maintain theThey maintain the
intercanine width andintercanine width and
expansion in the molarexpansion in the molar
region.region.

Edge-to-edge anterior relationship and 1st molar in Class I relationship withEdge-to-edge anterior relationship and 1st molar in Class I relationship with
anteriors tipped distallyanteriors tipped distally
POSITION OF TEETH AT THE END OF STAGE IPOSITION OF TEETH AT THE END OF STAGE I
(BEGG MECHANOTHERAPY)(BEGG MECHANOTHERAPY)

 Wearing of Elastics during stage 2Wearing of Elastics during stage 2

 The space closing elasticThe space closing elastic
sometimes irritates the gingiva, tosometimes irritates the gingiva, to
avoid this , twist together the twoavoid this , twist together the two
ends of the ligature wire that holdsends of the ligature wire that holds
the arch wire to the buccal surfacethe arch wire to the buccal surface
of the second premolar bracket.of the second premolar bracket.
 Then seat the space- closingThen seat the space- closing
elastic occlusally to the premolarelastic occlusally to the premolar
bracket in the space between thebracket in the space between the
coil ligature wire and the toothcoil ligature wire and the tooth
band. The space- closing elasticband. The space- closing elastic
when held in this position cannotwhen held in this position cannot
irritate the gingival tissue.irritate the gingival tissue.

 In the end of Stage 1, the incisor relationship is edgeIn the end of Stage 1, the incisor relationship is edge
to edge and buccal occlusion is either Class I or mildto edge and buccal occlusion is either Class I or mild
Class III relationship with fairly distributed space atClass III relationship with fairly distributed space at
extraction sites. Use of Intermaxillary Class I elastics,extraction sites. Use of Intermaxillary Class I elastics,
tend to have the greater effect on lower incisors,tend to have the greater effect on lower incisors,
which are having smaller root area, and are readilywhich are having smaller root area, and are readily
retracted than the upper incisors, thereby recreatingretracted than the upper incisors, thereby recreating
the overjet. To avoid this, class II inter- maxillarythe overjet. To avoid this, class II intermaxillary
elastics can be used, which will reinforce the forceselastics can be used, which will reinforce the forces
of retraction for upper incisors, at the same timeof retraction for upper incisors, at the same time
giving added mesial pull to the posteriors in the lowergiving added mesial pull to the posteriors in the lower
arch to have a mesial bodily movement.arch to have a mesial bodily movement.

 The wearing of horizontalThe wearing of horizontal
elastics from the buccalelastics from the buccal
surfaces of the molarssurfaces of the molars
creates a rotational forcecreates a rotational force
on the molars. If thison the molars. If this
tendency for molars totendency for molars to
rotate under the pull ofrotate under the pull of
horizontal space-closinghorizontal space-closing
elastics is notelastics is not
counteracted by arch wirecounteracted by arch wire
modification or othermodification or other
means, the molars willmeans, the molars will
rotate distobuccally.rotate distobuccally.

Correction of Anchor Molar RotationCorrection of Anchor Molar Rotation
 To prevent the molars from rotating, the distalTo prevent the molars from rotating, the distal
ends of the arch wires can be given a slightends of the arch wires can be given a slight
amount of toe-in. This is usually required more inamount of toe-in. This is usually required more in
the maxillary arch than in the mandibular arch,the maxillary arch than in the mandibular arch,
because lower molars tend to become slightlybecause lower molars tend to become slightly
displaced lingually during the first stage. Thedisplaced lingually during the first stage. The
vertical components of force in Class IIvertical components of force in Class II
Intermaxillary elastics cause the mandibularIntermaxillary elastics cause the mandibular
anchor molars to roll or tip lingually.anchor molars to roll or tip lingually.

 If the distal ends of theIf the distal ends of the
arch wire have been toed-arch wire have been toed-
in but the rotation of thein but the rotation of the
molar is not correcting ormolar is not correcting or
actually increasing, thenactually increasing, then
other measures can beother measures can be
taken:-taken:-
 1) The horizontal elastics1) The horizontal elastics
can be engaged on thecan be engaged on the
lingual hooks rather thanlingual hooks rather than
on the buccal.on the buccal.

 Another way to correctAnother way to correct
a rotated molar duringa rotated molar during
Stage 2 is to tie anStage 2 is to tie an
elastic thread ligatureelastic thread ligature
from the lingual buttonfrom the lingual button
On the cuspid to theOn the cuspid to the
lingual hook (or button)lingual hook (or button)
on the molar.on the molar.

Correction of midline discrepanciesCorrection of midline discrepancies
 When the central line correction is planned during thisWhen the central line correction is planned during this
stage, often one uses Class II Intermaxillary elastics onstage, often one uses Class II Intermaxillary elastics on
one side and Class III on the other side. Sometimes anone side and Class III on the other side. Sometimes an
anterior elastic from the Intermaxillary hook mesial toanterior elastic from the Intermaxillary hook mesial to
upper canine to the Intermaxillary hook mesial of theupper canine to the Intermaxillary hook mesial of the
lower canine on opposite side is used.lower canine on opposite side is used.

This means, during the Stage 2, on each side totalThis means, during the Stage 2, on each side total
three elastics are used which forms a shape ofthree elastics are used which forms a shape of
letter ‘Z ‘letter ‘Z ‘

Position of teeth at the end stage 2 (BeggPosition of teeth at the end stage 2 (Begg
Mechanotherapy)Mechanotherapy)
All the extraction spaces have been closed and theAll the extraction spaces have been closed and the
anteroposterior occlusal relationships of the dental archesanteroposterior occlusal relationships of the dental arches
have been maintained by Class II Intermaxillary elastics in thehave been maintained by Class II Intermaxillary elastics in the
Class I relations, with tipped back anteriors.Class I relations, with tipped back anteriors.

 This tipping back, or “dishing in” as it is called, is aThis tipping back, or “dishing in” as it is called, is a
most favorable state of affairs as far as the success ofmost favorable state of affairs as far as the success of
the final result of treatment is concerned. Thisthe final result of treatment is concerned. This
“dishing in” is evidence that the upper and lower“dishing in” is evidence that the upper and lower
dental arches, as whole units, have not been broughtdental arches, as whole units, have not been brought
anteriorly in relation to the jaws during the treatmentanteriorly in relation to the jaws during the treatment
procedures that have been carried out to close theprocedures that have been carried out to close the
extraction spaces.extraction spaces.
 More than this, it is evidence that the upper andMore than this, it is evidence that the upper and
lower dental arches as whole units are situated fartherlower dental arches as whole units are situated farther
posteriorly in the jaws than they were beforeposteriorly in the jaws than they were before
appliance therapy was started, although the teethappliance therapy was started, although the teeth
distal to the extraction spaces may have been moveddistal to the extraction spaces may have been moved
slightly mesially.slightly mesially.

Control of Bicuspid HeightControl of Bicuspid Height
 During Stage 2 it is necessary to bring all teeth mesialDuring Stage 2 it is necessary to bring all teeth mesial
to the anchor molars to the occlusal plane. Usuallyto the anchor molars to the occlusal plane. Usually
the teeth involved are the second bicuspids—morethe teeth involved are the second bicuspids—more
often the mandibular than the maxillary.often the mandibular than the maxillary.
 These teeth are encouraged to erupt through theThese teeth are encouraged to erupt through the
application of light forces. As soon as the teeth haveapplication of light forces. As soon as the teeth have
erupted sufficiently to permit banding, bands witherupted sufficiently to permit banding, bands with
ribbon arch type brackets are cemented.ribbon arch type brackets are cemented.

 At this time, the teeth are usually quite lowAt this time, the teeth are usually quite low
gingivally and arch wire engagement would begingivally and arch wire engagement would be
both impractical and uncomfortable.both impractical and uncomfortable.
 It would be impractical because this mightIt would be impractical because this might
cause friction which could prevent free distalcause friction which could prevent free distal
tipping of the anterior teeth, and it would betipping of the anterior teeth, and it would be
uncomfortable because the greater flexing ofuncomfortable because the greater flexing of
the arch wire gingivally would result in morethe arch wire gingivally would result in more
force on the tooth.force on the tooth.

 Through the use ofThrough the use of
bypass clamps andbypass clamps and
reversing them after onereversing them after one
or two appointments, it isor two appointments, it is
simple to bring them intosimple to bring them into
the occlusal plane.the occlusal plane.

ALTERNATIVE METHODS AND STEPS TOALTERNATIVE METHODS AND STEPS TO
CARRY OUT ASYMMETRIC SPACE CLOSURECARRY OUT ASYMMETRIC SPACE CLOSURE
 1. Use heavier arch wire,1. Use heavier arch wire,
give molar offset and heightgive molar offset and height
adjustment bend on the sideadjustment bend on the side
with closed extractionwith closed extraction
space. This will hold thespace. This will hold the
second premolar snugly insecond premolar snugly in
the arch and will not allowthe arch and will not allow
change of centre line.change of centre line.
 Figure showing molar offsetFigure showing molar offset
and height adjustment bendsand height adjustment bends
in the arch wire on the sidein the arch wire on the side
with closed extractionwith closed extraction
space.space.

 2. Giving passive2. Giving passive
uprighting spring onlyuprighting spring only
on the canine where noon the canine where no
distal movement ofdistal movement of
canine is desired. Thiscanine is desired. This
will resist the use ofwill resist the use of
Intermaxillary pull onIntermaxillary pull on
the same side thus notthe same side thus not
resulting in unwantedresulting in unwanted
overcrowding andovercrowding and
pushing the secondpushing the second
premolar lingually.premolar lingually.

 3. Use heavy Intermaxillary elastics with passive3. Use heavy Intermaxillary elastics with passive
uprighting springs on canine. This will compel theuprighting springs on canine. This will compel the
posteriors to move mesially thus avoiding overposteriors to move mesially thus avoiding over
retraction of anteriors.retraction of anteriors.
 4. Use of Intermaxillary elastics with uprighting springs4. Use of Intermaxillary elastics with uprighting springs
on second premolar will make the distal side moreon second premolar will make the distal side more
resistant to mesial drift thus over closure of extractionresistant to mesial drift thus over closure of extraction
space is avoided.space is avoided.

 Passive uprighting springPassive uprighting spring
on second premolar willon second premolar will
make posterior quadrantmake posterior quadrant
more resistant to mesialmore resistant to mesial
movement thus achievingmovement thus achieving
extraction space closureextraction space closure
with distal movement ofwith distal movement of
anteriors.anteriors.

 5. Passive root torquing5. Passive root torquing
arch wire in the lowerarch wire in the lower
anteriors will preventanteriors will prevent
further retraction offurther retraction of
lower anteriors and thuslower anteriors and thus
the remaining extractionthe remaining extraction
space will be closed onlyspace will be closed only
by mesial drift ofby mesial drift of
posterior teeth in theposterior teeth in the
lower arch.lower arch.

Auxiliaries sometimes used in StageAuxiliaries sometimes used in Stage
IIII
 Passive mesiodistal root uprighting springs (on lowerPassive mesiodistal root uprighting springs (on lower
canines).canines).
 Lower anterior braking arches.Lower anterior braking arches.
The function of these types of auxiliaries is toThe function of these types of auxiliaries is to
establish a two point contact between the teeth andestablish a two point contact between the teeth and
arch wire to prevent further free tipping. Thesearch wire to prevent further free tipping. These
auxiliaries may be used separately or together. Onceauxiliaries may be used separately or together. Once
teeth are no longer free to tip, they begin to functionteeth are no longer free to tip, they begin to function
as anchor teeth. In Stage 2 it is sometimes desirable toas anchor teeth. In Stage 2 it is sometimes desirable to
halt the distal tipping of the anterior teeth and movehalt the distal tipping of the anterior teeth and move
the molars mesially. The passive springs or brakingthe molars mesially. The passive springs or braking
auxiliary establish anterior anchorage mechanics.auxiliary establish anterior anchorage mechanics.

Passive Uprighting SpringPassive Uprighting Spring
 Passive uprighting springPassive uprighting spring
in place on mandibularin place on mandibular
canine during Stage 2.canine during Stage 2.
 This is necessary only inThis is necessary only in
those rare instances whenthose rare instances when
it is desirable toit is desirable to
purposely move thepurposely move the
anchor molars mesially.anchor molars mesially.

Lower Braking AuxiliaryLower Braking Auxiliary
 AA : Lower braking auxiliary in: Lower braking auxiliary in
place. It rests against the labialplace. It rests against the labial
surfaces of the four lower incisors,surfaces of the four lower incisors,
preventing any further free lingualpreventing any further free lingual
tipping of their crowns.tipping of their crowns.
 BB: Anterior view of lower braking: Anterior view of lower braking
arch in place. Braking arches andarch in place. Braking arches and
passive uprighting springs are usedpassive uprighting springs are used
very rarely by experiencedvery rarely by experienced
orthodontists, for they appreciateorthodontists, for they appreciate
that usually the lower anterior teeththat usually the lower anterior teeth
must be tipped to the lingual tomust be tipped to the lingual to
prevent their being positioned tooprevent their being positioned too
far labially as a result of the loss offar labially as a result of the loss of
anchorage that normally occursanchorage that normally occurs
during Stage 3.during Stage 3.

 To further encourage the mesial movement ofTo further encourage the mesial movement of
lower posterior teeth, the strength of thelower posterior teeth, the strength of the
mandibular horizontal elastics is increased frommandibular horizontal elastics is increased from
2 1/2 ounces to 6 or 8 ounces.2 1/2 ounces to 6 or 8 ounces.
 This brings into play the principles ofThis brings into play the principles of
differential force.differential force.

Design of uprighting springsDesign of uprighting springs
 Individual root spring orIndividual root spring or
mesiodistal uprightingmesiodistal uprighting
spring:spring:
 Shorter lever arms withShorter lever arms with
larger more resilient coils.larger more resilient coils.
 Self retainingSelf retaining
 Do not interfere withDo not interfere with
springs on adjoining teeth.springs on adjoining teeth.

ReferencesReferences
I.I. Kesling P.C. Begg Orthodontic TheoryKesling P.C. Begg Orthodontic Theory
And Techniqe: 3 rd edition; B. SaundersAnd Techniqe: 3 rd edition; B. Saunders
Company; Page No. 112 – 130.Company; Page No. 112 – 130.

BEGG’S STAGE II AND ITS MECHANICS/endodontic courses

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