A vade mecum for the Begg technique:Treatment procedures - George R. Cadman AJO- VOL 67, MAY 1975

DEVI KANTH.LPG StudentDEPT OF ORTHODONTICS

INTRODUCTION:

Cadman part-I : Principles

Advantages

Disadvantages

Appliance construction

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.

As each extraction space closes the horizantal elastics are discontinued.

molar is ligated to PM & canine with 0.011 / 0.012” steel ligatures

root uprighting and tourquing

mesial movement of all teeth

To over come this in stage III,

Incisors and canines are tipped farther than desired

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

Brakes in mandibular arch

uprighting springs on canines and or lateral incisors

torquing auxillaries on incisors

Minimally activated – preventing arch wire distortion

Uses:

distal and lingual bodily movement of canines and laterals

mesial bodily movement of molars

mesial tipping of 2nd premolars

Because of increased resistance of anterior teeth

2-4 ounce horizantal elastic force and

2-3 ounces class II elastic force may be used

STAGE III:Requires fewest adjustments

Supervising – patient co-operation , springs , auxiliaries

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

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.

Mid line discrepancy – corrected in 1 / 2 months with anterior diagonal elastics

- 1½ to 2 ounces force 12 to 14 hrs/ day

Mid line should be over corrected before uprighting springs are placed

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

Discrepancy in occlusal levels of mandibular 1st & 2nd molars –

extrusion of 1st molar – cl II elastics

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 torquing auxiliaries 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 neotro-occlusion

- 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

- Uprighting spring 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

- Case’s 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 Orthod 1967 - Mc Dowel

3)Reciprocal reverse torquing auxillary for begg technique 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