A vade mecum for the Begg technique: Treatment procedures - George R.

Cadman AJO- VOL 67, MAY 1975

DEVI KANTH.L PG Student DEPT OF ORTHODONTICS

INTRODUCTION: v Cadman part-I : Principles Advantages Disadvantages Appliance construction

v Cadman part II : Appliance adjustment Finishing procedures Problems frequently encountered

Treatment procedures:

Relatively few adjustments required Arch wires, auxiliaries made correctly Co-operative patient

Adjustments found during various stages of treatment: Stage I: 1) After anterior crowding and rotation correction - loop arch wires 0.016 plain arch wires - cuspid circle 0.5mm mesial to canine bracket

2) Maintain constant elastic force 3) Horizontal bayonet bends over correction of original rotations

4) Inspection for sufficient anchorage bends Amount of bend depends to some extent on bite opening desired. Shallow over bite less anchorage bend Deep over bite more anchorage bend Open bite sufficient bends particularly in cl II traction

5) Location of anchorage bends should be moved mesially as required Anchorage bend binding in tube cessation of anterior retraction loss of over bite control loss of molar control 6) Correcting arch wire distortion frequently needed adjustment 7) Examination at each appointment for the establishment and maintenance of corelated arch forms

STAGE II: During stage II , horizantal as well as inter maxillary elastics are used Treatment procedures: Mainly as those of stage I with particular attention to adjustment of toe in bends.

v As each extraction space closes the horizantal elastics are discontinued. v molar is ligatedto PM & canine with 0.011 / 0.012 steel ligatures

v root uprighting and tourquing

mesial movement of all teeth

v To over come this in stage III, Incisors and canines are tipped farther than desired

v Exceptionally in border line extraction cases patients with flat profiles large nose / chin

extraction space is desired to be closed by more than usual mesial molar movement

v Brakes in mandibular arch uprighting springs on canines and or lateral incisors torquing auxillaries on incisors

v Minimally activated preventing arch wire distortion v v Uses: distal and lingual bodily movement of canines and laterals mesial bodily movement of molars mesial tipping of 2nd premolars

v Because of increased resistance of anterior teeth 2-4 ounce horizantalelastic force and 2-3 ounces class II elastic force may be used

STAGE III: v Requires fewest adjustments v v Supervising patient co-operation , springs , auxiliaries v 1) Torquing auxiliary: tested for action at each appointment roots palpated

2) Uprighting springs: when hooks of Pm and canine approach each other - springs with short / long arms left active till over correction then made passive unilateral springs mid line shift

3) Correction of mid line deviations: Usually occur in the stage I & II when extraction spaces close

Results from incisor crown tipping ,root apices correctly placed Presence after stage II Skeletal asymetry Crown size discrepancy Unilateral anchorage loss

v Uprighting springs can be used after the crowns of the incisors are tipped to their correct positions if the root apices were displaced from the midline also. v v v

Mid line discrepancy corrected in 1 / 2 months with anterior diagonal elastics - 1 to 2 ounces force 12 to 14 hrs/ day

v Mid line should be over corrected before uprighting springs are placed

v Reciprocating action of uprighting springs can be countered with anterior diagonal elastics additional intermaxillary elastics

Second molar adjustment: Not banded routinely

Buccally erupting maxillary 2nd molar corrected spontaneously - if not ; corrected by extending distal end of arch wire - molar area constricted for compensation Marked buccoversion banding and cross elastics Insufficient space for correction 3rd molar extraction 2nd molar extrction

Second molars in cross bite: arch wire distal extension and lingual finger spring bite plate seldom required

Rotated / mesially tilted banded with conventional buccal tubes threaded with 0.014/0.016 wire

v Discrepancy in occlusal levels of mandibular 1st & 2nd molars extrusion of 1st molar cl II elastics

v This marginal ridge discrepancy is transitory and disappears after 2nd molar eruption

Mesial marginal ridges(2st molar) higher than distal(1st molar) prolonged stage 1& stage 3

Finishing procedures: During finishing uprighting springs and torquingauxiliaries are not removed till over correction of axial inclination This is to over come 1)rebound tendency 2)band space closure

Most frequently encountered conditions requiring attention during this stage were a) Undesired tooth rotations b) Iatrogenic open bite c) Improper arch forms

Undesirable tooth rotations: a) bracket distortion b) excessive pressure on bracket c) occlusal forces d) improper use of plier producing excessive force when engaging arch wire in bracket slot.

Iatrogenic open bite: Desired to have an edge to edge incisor relationship Original malocclusions with excessive deep bite maintained on shallow bite - v bends - discontinuing class II elastics

If continued class II elastics were to be continued for neotroocclusion - triangular elastics use is preferable Occasionally box elastics might be required.

Improper arch form: - large mirror - Arch wires correlated - cross & vertical elastics

Problems ecountered during treatment and their causes: 1) Failure to correct deep bite - not wearing class II elastics continuously - arch wire distortion - insufficient anchorage bends - anchorage bend too far mesially - use of horizantal elastics, torquing auxillaries uprighting springs

2) Maxillary anterior teeth not retracting satisfactorily a) patient co-operation b) arch wire binding c) pins bent distally d) occlusal interference of incisors and canines e) canines forced against cortical plate f) habits g) excessive loop expansion

3)Mandibular molar tipping lingually a) insufficient arch expansion b) excessive class II elastic traction c) incorrectly formed anchorage bends d) distorted arch wire e) prolonged looped arch wire use

4) Mandibular molars tipping mesially a) arch wires distortion b) excessive classII elastic traction c) insufficient anchorage bends d) arch wire caught under premolar bracket 5) Mandibular molar rotating (usually mesio-lingually) a) incorrect anchorage bend b) distorted arch wire c) horizantal elastics in stageI d) incorrectly located molar tube

6) Anterior spacing 7) Difficulty in correcting or over correcting anterior rotations

8) Maxillary molar rotating or tipping a) incorrect anchorage bend b) bend too far c) arch wire distortion d) incorrect buccolingual molar tube angulation

Problems in Stage II: 1) molar rotation 2) bite deepening 3) extraction spaces do not close

Problems in stage III: 1) Bite deepening - Insufficient gingival bow in incisor region - Excessive torque 2) Re-appearence of overjet 3) Maxillary molars tipping buccally - Torquing auxiliary not constricted enough in form - Excessive or prolonged torquing force

4) Anterior spacing 5) class III incisor relation 6) Opening of the extraction spaces ligatures < 0.011 tying lingual cleats Hooks of uprighting springs prevented from sliding freely 7) Failure to upright tooth

8) Failure to achieve incisor torque 9) canines rotating mesiolingually/ distolingually - Lingual cleats or buttons ligated too tightly - Uprightingspring helix distal to bracket and exerting pressure lingually against distolabial surface of canine - Arm of uprighting springs not parallel to arch wire in horizontal plane - Rings in contact with canine brackets at beginning of Stage III

10) Rotated incisors loop of the auxilliary not contacting the center of the tooth

Critical appraisal of Begg technique - AJO 1968

Class II elastics are contraindicated in hyperdivergent faces The Begg technique is ideal for treatment of hypodivergent types.

- Unpleasing flattening of the lips - Cases findings in his histologic investigations - In a tipping movement the tooth will act as a two-armed lever. - The active force is always greater than the force applied and is concentrated in a small area near the alveolar crest. - In a bodily movement the force applied is distributed over the whole side of the root.

 It has been further pointed out that so-called light forces are not necessarily so because it is the moment generated that produces the root, pressure to createbiologic changes in alveolar bone.

The third stage of treatment is unquestionably the most injurious to root and bone.

CONCLUSION:

Maximum mechanical advantage can be achieved with the Begg system by virtue of its almost frictionless closed system of mechanics. By gaining a, greater awareness of its limitations and determining a proper selectivity in its application, it is possible to achieve excellent results

References: 1)Differential force in orthodontics AJO 1956 P.R.Begg

2)The hidden force; Angle Orthod1967 - Mc Dowel 3)Reciprocal reverse torquing auxillary for beggtechnique Sain - J.Pract.Orthod 1969 4)Correspondence teaching ; Brandt Austr.Orthod.Bull -1967 5)Begg orthodontic theory and technique ; Begg & Kesling 6) Graber & Swain ; current orthodontic concepts and techniques