Introduced by Dr. PR Begg in 1950. It is based on light wire differential force technique. The Begg technique has been divided into three stages. From a categorical standpoint the treatment is divided into the crown tipping phase which includes the first two stages and the root tipping phase which covers the third phase. From a clinical standpoint, the three phases are characterized by the specific treatment objectives and tooth movements. Stage I: Objectives: Closure of Anterior spaces. Correction of crowding. Overcorrection of rotation of anterior teeth. Overcorrection of Overjet to an edge to edge incisor relation. Overcorrection of Overbite to an edge to edge incisor relation. Correction of Cross bites. Correction of molar relation. Overcorrection of disto-occlusion of the buccal segments. Correction of midline discrepancies. Correction of axial inclination of mandibular incisors. (Usually 4 to 8 months)
Characteristic anterior tooth movements in stage I Labiolingual movements as required for alignment on the anterior curve of the archwire. Over rotating - To positions that are reverse of the original rotation.
Creating space for overlapped teeth or closing spaces as required, so that the incisors and cuspid of each dental arch are placed and maintained in a single segment of six anterior teeth. Intruding the anterior teeth for correction of overbite, all 12 teeth should be intruded evenly. Retracting anterior teeth for correction of overjet and for placing them in a slightly lingual inclination. Proper retraction means that the central incisor crowns tip lingually, lateral incisor crowns tip lingually and distally, and cuspid crowns tip distally.
Characteristic posterior teeth movement The anchor molars are maintained in upright positions throughout treatment. Specifically, mesially inclined molars are overcorrected to mild distal inclinations and distally inclined molars are maintained in mild distal inclinations. These positions are most efficient for molar anchorage requirements. Molar rotations are corrected. Mesiolingual rotations are corrected to mild mesiobuccal rotation and mesiobuccal rotations are maintained as such. Cross bite relationships are overcorrected. Chracteristic archwires and elastics in the first stage Plain or looped archwires. Looped archwires are replaced as soon as possible. In class I and class II cases, class II elastics are used. In class III, class III elastics are used. Bracket Placement:
It may be bandable (welded to the bands which are then cemented to individual tooth) or bondable. They have single vertical slot which faces gingivally. Brackets are centered mesio-distally on the labial or buccal surface with the base of the arch wire slot 4mm from the incisal edge of cusp tips.
Upper arch
Central incisor 4 mm. Lateral incisor 3.5 mm. Cuspid 4.5 mm.
Bicuspid 4 mm.
Lower arch
Central incisor 3.5 mm. Lateral incisor 3.5 mm. Cuspid 4 mm. Bicuspid 4 mm.
Lingual Button:
It is placed directly opposite to the areas of engagement of the archwire on the opposite side of the teeth. This is to permit free mesio distal tipping or uprighting of the teeth. If the lingual button is placed incisal or occlusal to the level of base of arch wire the steel ligature would be loosen or tighten during mesio-distal uprighting.
Buccal Tube:
Molar tubes should be parallel to the occlusal surface when viewed from buccal and parallel with a line bisecting the occlusal surface mesio-distally.
Arch wire:
Different diameters of wire are available but the most commonly used one is 0.016 wire. 0.016 special plus 0.016 special plus extracted. 0.018 - Looped arch wire in any case. - Plain arch wire in extraction cases or in which 1st and 2nd premolars are
Offset bends:
In Anterior segment Vertical offset Horizontal offset In posterior segment Gingival offset - to avoid occlusal distortion and interference with bicuspids - To Intrude or Extrude - To Expand, contract and rotate
Intermaxillary Hooks:
Routinely bent into the arch wire for both the upper and lower arches and are positioned 1mm mesial to the cuspid brackets. The coil Pattern is usually a small helical loop 2 to 2.5mm of outside diameter. The helical Intermaxillary hook two primary and two secondary advantagesArchwire is stiffer and aids in overbite correction. Wire is stiffer in horizontal plane and aids in correction of arch form, width and symmetry.
Helical loops can be formed quickly Helical hook is seldom distorted or broken
If Boot shaped loops are used they are angulated buccally away the vertical in order to avoid any possibility if wedging of distal arm of loop into slot.
Vertical Loops:
Used to supply local increased arch flexibility or used for space opening or closing, stops, rotation or root torque. The most vertical loops to align six anterior teeth are five, one in each interproximal area. Generally loops are made 6 to 8mm long but greater the length of the loop, the more gentle the force on the tooth. The Loop between the maxillary central incisors should be avoided, when indicated the loop is made shorter because
Horizontal bracket area for severly lingually placed tooth is bent 1mm further gingivally than plane of arch wire to prevent elongation of tooth as it tips labially
Contraction Loop in midline with incisor stops to tip crowns of upper centrals
MOLAR STOPS
Molar stops are placed on the archwire in order to limit the extent to which the wire can slide into the molar tube. They are not used expect when it is necessary to preserve space. Molar stops may be bent into the archwire or may consist of removable lock placed on it.
the purpose of anchor bend in upper arch is to prevent mesial migration of the molars; In lower is to supply bodily control of the lower molars as these are moved forward by action of Class II elastics
The degree of anchor bend is influenced by the following factors The stage of treatment- the anchor bend is usually greater in the first stage than for second stage and little if any for the third stage The depth of overbite- the degree of anchor bend in the initial archwire should be such that the archwire lies passively at the mucobuccal fold when the wire is inserted into the buccal tubes The location of extraction space- greater for 2nd bicuspid than for first bicuspid. Inclination of the anchor molar- if one or both the molars are inclined then the anchor bend should be reduced so that the wire will rest evenly and passively in the mucobuccal fold The hazard of occlusal impingement The type of archwire used in looped archwire it is placed far enough forward so that this bend does not slide back into the buccal tube before the looped archwire is discarded.
Bayonet bends:
Commonly used passively to retain overrotation brought about via previously looped arch. It is inadvisable to use bayonet bends for active correction, because of the tendency for round archwire to rotate within bracket slots causing the bayonet bend to become ineffective or supply movement in wrong plane They should be small and offset section is 5 degrees to the line of main arch.
CANINE TIE
They are steel ligature ties (0.008-0.009 inch) from the intermaxillary hook to the canine bracket. If there are no restraints between the intermaxillary hook and the cuspid bracket the cuspid will continue to tip distally away from the lateral. In order to prevent this and to maintain and move the six anterior teeth as a unit the canine ties are given.
ELASTICS
Elastics are used to effect changes in the length, depth and breadth of the dental arches. All anteroposterior tooth movements, including anterior retraction, mesial molar movements, correction of class II or class III occlusion and closure of spaces are entirely due to elastics. In extraction cases, the class II, horizontal, vertical and crossbite elastics average 2-4 ounces (57-113 ) gm In non extraction cases the class II and horizontal elastics average 1 -2 ounces (4271) grams Larger diameter elastics exert lighter force and smaller diameter exert heavier force Reactivation cycle The natural rubber Begg elastics used in the early 1960s exerted 5-8 ounces (142-227) gms and the elastic force was reactivated in four day cycle. Currently, latex elastics are preferred that exert much lower force initially but show less drop off over a 24 hour span. Placement of Elastics: It is impossible for the arch wire to function properly without the proper elastics. In order to determine the size of the elastics the tension gauge is used. The Class II elastics are engaged around the distal ends of the molar tubes or molar hooks and stretched anteriorly to engage the maxillary Intermaxillary hook mesial to the maxillary cuspid. In Class III elastics are worn from the maxillary molars to the intermaxillary hook mesial to the mandibular cuspid bracket. No horizontal (intramaxillary) elastics are applied during stage I.
Antero - posterior relation of cuspids and molars being maintained Individual molar positions being maintained
Stage II: (usually 1 to 4 months) Maintenance of all anterior and posterior overcorrection achieved in stage I Completion of extraction space closure 1. By continuing retraction of anterior teeth 2. Correction of premolar rotations Completion of correction of midline discrepancies Continued correction of Open Bite
Arch wire:
The Archwire pattern is basically that of Stage I treatment 0.016 gauge of wire is used 0.018 is used when there is frequent arch wire distortions or unilateral space closure Anchor bend is made 1mm mesial to the molar, premolar contact point. The pressure supplied by the anchor bends to the molars and incisors is slightly reduced from that employed during Stage I. Because Intermaxillary elastics tend to rotate molars slight toe in bends are made in the molar areas to prevent molar rotation. Intermaxillary hooks are incorporated in both archwire immediately mesial to the cuspid brackets and in contact or very near contact with them. The hooks in upper arch have to bear two elastics which is somewhat difficult for ring pattern. A Z shaped hook makes it easier for the patient to apply two rubbers to the hook.
The 2nd premolar is bypassed from pinning as in Stage I, The wire is held in position by bypass clamp or steel ligature.
Slight horizontal offsets are formed distal to canines to maintain correct buccolingual position of the premolars and canines-they are the premolar offsets
TOE IN AND TOE OUT BENDS They are horizontal offset bends that are often combined with the anchor bends If the wire is bent lingually it is a toe in bend and if it is bent buccally it is a toe out bend Functions Corrective for rotation of molars when required. After insertion, the toein or toe-out bend exerts light force so that the molar tends to rotate and the wire and the tube gradually become parallel. Preventive- preventing the rotation of molars due to elastic force. Passive- to prevent the rotation of anchor molars already in normal alignment.
Inter & Intramaxillary elastics: Lateral Cephalogram is taken and from cephalometric evaluation it is determined whether the anteriors are to be retracted or posteriors are moved for closure of space. The Space closing elastic ( esp. the maxillary) stretching from the Intermaxillary hook to the molar hook against molar lies against the gingiva and irritates the gingiva, to overcome this elastic is twisted one half turn when it is placed Wearing of horizontal elastics tries to rotate the molars distobuccally and this should be counteracted by the toe in bends of the arch wire. If rotation aggravates after giving toe in bends the elastics can be engaged on the lingual hooks. Care should be taken of the second premolar so it doesnt tip when elastic crosses it occlusally.
Correction by movement of individual units or small group after distal tipping of canine Auxiliaries in stage II: The auxiliaries used are passive mesio distal root uprighting springs on the mandibular canines and the lower anterior braking arches. The function of these types of auxiliaries is to establish two point contact between teeth and archwire and prevent free tipping movement of the anteriors.
Check list for stage II: Check the teeth and appliances before treatment progress for
Loosened bands Loosened brackets Patient co-operation in elastic wearing Compare the positions of the teeth on the second stage model with those in mouth Check for desired movements Check for undesired movements or manifestations such as Failure to wear elastics at all times Poor oral hygiene Arch wire projecting out and causing impingement, Contraction or expansion of the arch Asymmetry of dental arch Molars rotating mesiolingually due to use of single elastic on the buccal Anterior class III relation developing Excessive anterior open bite Anchorage bend coming into close proximity
Gingival bend distal to cuspid bracket to counteract the occlusal vectors of force created by anterior lingual root torqueing auxillary.
Helix of spring face towards tooth surface and lie on the gingival aspect of arch wire.
MINISPRING
Made of thinner diameter (0.009) high resilient supreme grade wire. The coil of springs is only twice the size of the wire.
The activation is 100%, the stem and active arm are in one line.
TORQUING AUXILLARY
Torques the root of the maxillary incisors lingually
PROBLEMS ENCOUNTERED DURING STAGE III Maxillary Molars Widening: a. Anchor bends present in maxillary arch wire.
b.Too much bite opening bend between cuspid and bicuspid c. maxillary arch wire too small in diameter. d. Maxillary arch wire too wide. e. Torqueing auxillary not constricted adequately. Mandibular molars narrowing a. Lower arch wire not wide enough b. class II elastics exerting too much force c presence of steel ligature tie from the lingual of the mandibular cuspid to the lingual of the mandibular molar d. lack of support through occlusion of molars- use cross elastics, check symmetry of both arch wires Anterior bite deepening: a. Too much power in the torqueing auxillary b. Maxillary arch wire too thin. c. Patient not wearing class II elastic Teeth not uprighting mesiodistally: A. springs not active B. Arch wire caught on the edge of the bracket - Tighten spring pin to draw arch wire in bracket - Draw arch wire into bracket with a steel ligature tie C. Occlusal interference caused by an elevated tooth. - reposition the bracket. D. Springs placed in backwards Maxillary anterior teeth not torqueing palatally 1. Not enough force from maxillary torqueing auxiliary 2. Maxillary incisal edges caught lingual to lower anterior teeth
Lower anterior teeth labially inclined Normal mesial migration of teeth during third stage. If in middle of third stage give reverse torquing auxillaries Rotation of teeth other than molars 1. Lack of complete bracket engagement 2. Arch wire slot too large. Improper bracket placement Positions of teeth at the end of stage III End of Stage III with perfect parallelism of canine and premolar roots.