Anda di halaman 1dari 60

INDIAN DENTAL

ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
www.indiandentalacademy.com
BEDDTIOT
BEGGS - EDGEWISE
DIAGNOSIS DETERMINED
TOTALLY
INDIVIDUALISED ORTHODONTIC
TECHNIQUE
www.indiandentalacademy.com

Richard.A.Hocevar, D.M.D
Dunedin, New Zealand
www.indiandentalacademy.com

Why Edgewise ?
( Hocevar AJ O, Vol 80, number 3, Sept 1981 )



Adaptations to increase the working range and
reduce the force levels in arch wires

Ribbon or square rather than Edgewise wires



www.indiandentalacademy.com
Brackets with smaller , e.g 0.018 inch arch wire
slots not recommended .

Narrow (1.3 mm) single brackets to increase the
span of wire between brackets .

Sectional arch wires and auxillaries

Elastics, elastomeric threads and ligatures.


www.indiandentalacademy.com
Orthodontic force systems: I ndividualized
treatment with open-minded "Begg" technique
- Hocevar, AJO-DO 1982 Apr (277-291)

A "COOKBOOK" procedure in which all cases are
treated alike.

Force of the anchor bends is not normally sufficient
for upper incisors - movement is mainly simple
tipping.

Unbalanced force of the anchor bends may tip the
maxillary molar crowns distally.


www.indiandentalacademy.com
Control of the directions and types of tooth
movement is seriously limited .

Auxiliaries that control root movement cannot be
employed in the early stages of the technique

Suggested

Check Elastics - anchorage control , bite opening

Passive Torquing and Uprighting springs

www.indiandentalacademy.com

The intent was to incorporate the important
advantages, features, and capabilities of many
fixed appliances and minimize deficiencies,
making the most of current understanding of
orthodontic biomechanics and technology .
-Hocevar (J uly 1985, AJ O-DO)
The Appliance.
www.indiandentalacademy.com

Beddtiot appliance

Edgewise appliance - control and precision (having full
torque and angulation built in)


Beggs appliance - anchorage conservation and rapid tooth
movement (of the ''light-wire differential force" approach to
biomechanics) by means of attachments that are versatile, simple,
economical, and small.







www.indiandentalacademy.com

Begg principles are employed in some cases; various
edgewise techniques in others. A wide variety of
combinations may be employed easily.
Treatment is individualized.
Beddtiot Philosophy
www.indiandentalacademy.com



FOUNDATIONS
Light wire
Low force
levels over
great elastic
ranges
Gentle long range force systems - for
fast , efficient and major movements
of the crown and root

Minimum bracket size - maximum
interbracket arch wire span

Light , undersized wires
free play in the brackets

Extensive use of elastomeric
ligatures and elastics
www.indiandentalacademy.com

Light auxiliary round wires.- for alignment of the individual
teeth

Heavy rectangular base arch wires - Anchor teeth stability and
arch integrity.

www.indiandentalacademy.com
Differential response to force
Principle Of Lever
www.indiandentalacademy.com
www.indiandentalacademy.com
I f the total force is limited to a level that will cause
just enough strain in the crestal region to trigger
rapid movement there, the strain in the apical region
will be insufficient to cause much movement there.
The movement of the crown in the direction of the
force should be considerably greater than the
opposite movement of the apex.

www.indiandentalacademy.com

Differential response to force
www.indiandentalacademy.com

Translatory movement strain distribution has to
be even throughout the supporting structures of the
tooth or teeth

Requires considerably heavy force

Anchorage conservation is made difficult

www.indiandentalacademy.com
Tipping movement additional time required
for to move the apical portion of the roots.

Translatory movement is faster, simpler and
more efficient if adequate anchorage is
available.
www.indiandentalacademy.com
Beddtiot
www.indiandentalacademy.com




Rx TIME - BEDDTIOT faster than BEGGS ?

Uncontrolled Tipping
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com
www.indiandentalacademy.com

Brackets are narrow, single-width edgewise brackets
with 0.022 inch (height) 0.028 inch (faciolingual
depth) horizontal arch wire slots. On the lingual side of
the bracket is a 0.020 0.020 inch vertical slot.
BRACKETS
www.indiandentalacademy.com
The arch wire slots are ''torqued" (cut at such angles to
the brackets that they will be oriented parallel to the
plane of the arch when the teeth are positioned
properly)
www.indiandentalacademy.com
www.indiandentalacademy.com
Except for torque, the brackets are all
identical.Therefore, they are interchangeable; any
bracket may be used on any tooth.

Placed with its torque-indicator groove gingival, a
bracket provides lingual root torque; with the
groove occlusal, it provides lingual crown torque.


www.indiandentalacademy.com

Brackets- prewelded on both flat and curved
universal bonding pads - provides maximum
versatility.

The pads are of minimal size, and their shape
facilitates the placement of the brackets with
either end toward the gingiva - may be used for
either lingual crown or root torque.
www.indiandentalacademy.com
The brackets are milled from solid bars of
stainless steel.

. The brackets are small in all dimensions to
ensure optimal appearance and minimal lip
and cheek irritation

This also lessens occlusal interference, enamel
surface involved in bonding, and problems with
gingival proximity and oral hygiene.
www.indiandentalacademy.com

A. Twin brackets - Acute bends are required
- Can distort the wire
B. Narrow brackets - Wire is deformation much less
- Force level is much more gentle,
- Degree of deflection is more likely
to be within the elastic range of
the wire

www.indiandentalacademy.com
Arch wire slot allow considerable (but limited)
mesiodistal tipping on undersized wires (on 0.016
inch, the usual working wire), as well as limited
uprighting on heavier guage wires(0.018-inch arch
wire)

www.indiandentalacademy.com

Original Uprighting spring - Helix is farther from
the arch wire,
- Hook arm is slightly longer

www.indiandentalacademy.com

Modified Uprighting spring
- Less bulk.
- More hygienic,
- Less likely to impinge
upon or irritate the gingiva,
- Less conspicuous in
appearance




www.indiandentalacademy.com
www.indiandentalacademy.com

Buccal Tubes
- 4.5 mm long, 0.022 0.028 inch "edgewise"tubes
- 25 lingual crown torque for lower
- 10 for upper first molars
- Distal end of the maxillary tube is angulated
outward 10 from the welding flanges to maintain
the proper rotation ("toe-in")
www.indiandentalacademy.com
Deepbites or moderate-to-severe anchorage requirement
cases

An additional rectangular tube is carried diagonally
across the buccal surface of the basic tube, its mesial end
pointing gingivally
www.indiandentalacademy.com

Outer tube-
It carries the main (working) arch wires during the bite-
opening and retraction phases of treatment
Inner tube carry heavy rectangular sectional wires to
lock molar and premolar teeth together( prevents tipping,
anchorage control)
www.indiandentalacademy.com

Correction of Rotations
Mild corrections - offset the bracket slightly toward
the side of the tooth that is displaced lingually. Simple
engagement of the bracket on the arch wire with a
small elastomeric ligature will correct the rotation.

Moderate to Severe corrections
-gentle ligature or elastomeric thread may be
used to tie the bracket to the arch wire.
- Bayonet bends may also be used
www.indiandentalacademy.com
Torque control with brackets and arch wires
- Edgewise wires required for precise control in the larger
(0.022 0.028 inch) brackets were too rigid.

- Lighter forces obtained by using more resilient rectangular
wires bent as Ribbon arch wires or Square arch wires

- Easier for the operator to work with than the heavier
edgewise wires.

- In most instances the lighter ribbon wires are
preferable to square ones.




www.indiandentalacademy.com

0.022 0.016 inch ribbon arch is only one third as
forceful as a 0.022 0.028 inch edgewise wire;
yet it can provide the same precise control in
the same "edgewise" bracket

www.indiandentalacademy.com

- 20-year-old woman
- Class II, Division 1
- 8 mm overjet
- 50% overbite,
- well-aligned
mandibular dentition,
- lower incisors were
ideally positioned

First patient to undergo BEDDTIOT treatment ,
appliances placed in March 1978
CASE REPORTS
www.indiandentalacademy.com
- Extraction of upper I premolars

- Double buccal tubes were placed on maxillary molars
to accommodate molar-premolar sectional wires.

- Initial maxillary arch wire - 0.014 inch round,

- Initial mandibular wire - 0.018 inch arch with
a gentle bite-opening curve

- Class II elastics delivering 2 oz of force
per side full time.


www.indiandentalacademy.com
7 WEEKS INTO TREATMENT

- 0.018 inch round maxillary arch
wire placed

- Class II elastics continued

- Class I max elastics started
after 2 months
www.indiandentalacademy.com
6 MONTHS INTO TREATMENT
- Overjet and Overbite fully reduced

- Torquing auxillary and Uprighting
spring on max laterals and canine
for protraction of max posteriors
and closure of remaining spaces


www.indiandentalacademy.com
AFTER DEBONDING ( 14 MONTHS )
Appliance removed prior
to proper finishing and
detailing because of
patient non -compliance
www.indiandentalacademy.com
-14 year-old girl

- severe Class II, Division 1

- 13 mm overjet

- proclined U/L incisors,

- moderate crowding of
the lower incisors,

- Deepbite, with mand
incisors impinging palate
www.indiandentalacademy.com
Treatment Plan

- Extraction of Max I premolars for correction of max
proclination

- Extraction of Mand lateral incisors for correction
of lower crowding
www.indiandentalacademy.com
Treatment started with

- 0.016 inch maxillary and
- 0.012 inch mandibular SS wires ( replaced to 0.016 SS
after 1 month)

- anchorage reinforced- rectangular maxillary molar
premolar sectional wires

- Lower canine to canine elastomeric thread

- Check elastics
www.indiandentalacademy.com
AFTER 7 MONTHS INTO TREATMENT
- Extraction spaces almost closed

- Lower arch changed to
0.019 X 0.019inch SS for
control of axial inclination

- 0.021 X 0.025 inch Nitinol in
max arch for torquing
of incisor roots

- Check elastics continued
www.indiandentalacademy.com
1 YEAR OF TREATMENT
Lower incisors torqued and later stabilized
with 0022 X 0.016 inch SS
www.indiandentalacademy.com
18 MONTHS INTO TREATMENT
- 0,018 inch SS with uprighting springs
- Incisor root torquing auxillary
- Class II elastics
www.indiandentalacademy.com
AFTER DEBONDING (2 YEARS)
www.indiandentalacademy.com

- 16-year-old girl

- bidental protrusion,

-prominent nose and maxilla

-overjet was 4 mm

-occlusion Class I on the left ,
and unit Class II on the right
www.indiandentalacademy.com
Treatment objectives
- Overjet reduction,
- correction to Class I occlusion on the right side,
- retraction of her incisors to reduce her protrusive
appearance

Treatment plan
-Extract all four first premolars
-Use minimum-moderate anchorage mechanics( i.e
space closure by reciprocal translation by heavy
forces after the alignment and occlusion were
corrected.)
www.indiandentalacademy.com
- Brackets were selected and positioned to yield ideal
final torque and angulation,

- Single tubes were used on the first molars.
- Upper and lower 0.016 inch arch wires and a Class II
elastic of 3 oz on the right side.

- After 2 months changed to 0.018 inch SS, elastics
stopped
www.indiandentalacademy.com
- 1 month later 0.021 0.016 inch ribbon arch wires
were placed with canine-to-canine elastomeric chains
and heavy elastomeric threads tied from canine to
molar in each quadrant.
- elastomeric threads
and chains changed
approximately
every 6 weeks.
www.indiandentalacademy.com
DEBONDED AFTER 12 MONTHS OF TREATMENT
www.indiandentalacademy.com
These cases illustrate the ease and speed of
treatment, anchorage control, and versatility of
BEDDTIOT.
They demonstrate the importance of having an
appliance that facilitates both (1) tipping teeth with
light forces and (2) full, precise three-dimensional
control on the teeth.
www.indiandentalacademy.com
BEDDTIOT was designed to facilitate application of
the best modality in every situation, to handle any case,
whether it would be treated best with Begg-like
biomechanics or one of the many Edgewise approaches
- Hocevar
www.indiandentalacademy.com
THANK YOU
www.indiandentalacademy.com
Leader in continuing dental education
www.indiandentalacademy.com

Anda mungkin juga menyukai