13. Begg's Philosophy.pptx

The Begg light-wire appliance remains unique in the history of orthodontic innovation. Whereas many current self-ligating bracket appliances purport to be low friction or friction free, it is the Begg appliance that best exemplifies low friction, free sliding mechanics.

By creating only a single point of contact between the bracket and the arch-wire Dr Begg was able to greatly decrease resistance to sliding, both by reducing friction between the bracket and the arch-wire and virtually eliminating the binding of the arch-wire in the bracket slot, as is seen in all horizontal slot brackets.

Begg’s bracket design allowed teeth to freely tip mesially and distally as well as lingually and labially. This often gave teeth the appearance of being over tipped during treatment and required considerable diligence by Begg practitioners to keep tooth movement under control.

This freedom of tooth movement allowed unprecedented correction of large overbites and overjets to an edge-to-edge position and rapid closure of extraction spaces by initially tipping the adjacent teeth into the extraction site and uprighting the teeth afterwards.

Individual tooth root correction was managed by the use of fine springs that were designed, and often individually crafted to upright, torque and rotate teeth into their correct positions once the position of tooth crowns had been established.

One key advantage of the appliance set up was the use of light elastic forces for the correction of anterior overbites and overjets. All anchorage could be established intra-orally without headgear, without the need for ancillary appliances such as trans-palatal arches, or needing to set up molar anchorage prior to treatment, as Dr Tweed advocated.

1. Begg’s philosophy Dr. Manasa.P III MDS 1

2. Contents Introduction Theory of attritional occlusion Components of begg appliance Stages in begg technique Conclusion References 2

3. THE BEGG TECHNIQUE “Designed to permit teeth to move towards their anatomically correct position in jaws under the influence of very light forces”. 3

4. Theory of Attritional Occlusion 4

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7. T otal reduction in arch length resulting from attrition amounted approximately to one bicuspid width either side of both dental arches. He argues that if in this present era tooth material is not lost through attrition, it would be reasonable to cause a commensurate reduction artificially through extraction. 7

8. Theory of differential forces The range of light pressures which would cause the teeth to move at an optimum rate with minimal disturbance of the supporting tissues. Pressures below this range  produce a slow rate of response above  reaction within the bone support, referred as “undermining resorption”. 8

9. Concept of undermining resorption Heavy force  Intermittent movement. Light force  Continual flow of uninterrupted tooth movement. 9

10. Some characteristics of the technique All tooth movements: bodily, torquing, tipping, and rotating All forms of malocclusion are treated with this technique. High resiliency arch wires  Active treatment time and chair side time - greatly reduced. tooth moving forces are so light that there is less discomfort to patients and there is less tooth loosening than when heavier arch wire technique are used 10

11. Attachments used in Begg’s technique Brackets & lock pins Bands Molar tubes Ball end hooks Lingual attachments 11

12. Design of bracket & tubes design of attachments  permit free crown tipping by arch wire and elastics during first two stages  permit root tipping by auxiliaries used with arch wire and elastics during third stage 12

13. Brackets Main attachment slot facing gingivally (narrow brackets - permit free tipping in all the directions) It has a slot to carry the arch wire and a vertical slot to carry the lock pin to hold the wire 13

14. Dimensions Depth - 0.020” Height - 0.045” Base dimension - 0.122 x 0.125” 14

15. Classification of brackets Acc to constitution Acc to placement acc anatomical bases 15

16. MESH Mini mesh Smallest base available Same size of bracket More esthetic Super mini mesh Larger than mini mesh Extends slightly beyond the bracket base More bonding surface 16

17. Esthetic brackets Plastic Made of polycarbonates Tooth color or crystal clear plastic Flat - centrals Curved - posteriors Ceramic Ceramaflex II begg (TP labs) having all unique feature of metal brackets Base is polycarbonate for easy debonding 17

18. Lock pins Essential to hold the wire in bracket & allow the force to be transmitted from arch wire and elastics to teeth Made from soft SS or brass ; nylon for ceramic Must be soft for easy bending close to bracket vertical wall 18

19. Molar tubes Weldable, solderable or bondable With hook or without hook 19

20. Round: It is 0.036” I.D. 6 mm in length. Oval: It is 0.024” X 0.072” in internal diameter and 5 mm long. Used when second bicuspids are extracted. 20

21. Lingual attachments Placed on lingual surface of teeth for attachment of elastics, elastic thread, ligature . Placed on m-d center unless severe crowding is present or tooth is rotated. Can be bondable or weldable. 21

22. ELASTICS These are made of synthetic latex and are of uniform sizes and also applying uniform forces when stretched to required length. These elastics are available at different sizes, mainly dependent on internal diameter and thickness of their walls . 22

23. Usual sizes used in light arch wire technique with internal diameter of 5/16 and 3/8 inches. These elastics must exert optimum of 2.5 to 3 Oz pressure when stretched and placed between required 2 points. Heavier  are useful in extraoral technique. Lighter  maintaining the molar position by reinforcing the anchorage, preventing the mesial drift. 23

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25. Archwires Light round wire Regular grade: Regular plus grade Special grade Special plus grade Premium grade: Premium plus grade Supreme 25

26. Bracket positioning 26

27. All the brackets are placed 4mm from the Incisal edges except for the lateral incisor which is placed 3.5mm The brackets are placed at the centre of the crown’s mesiodistal width except in rotated teeth where they are off centered. 27

28. Stages in Begg technique Begg technique is divided into three stages: Stages I and II – Crown tipping phase. Stage III – Root tipping phase.  Overlapping of the stages must be avoided. Objectives of each stage met before proceeding. 28

29. Objectives of Stage I Correction of crowding and irregularity. Closure of anterior spaces. Correction of rotations. Elimination of deep bites, edge to edge bite / openbite except in class III. Correction of Mesiodistal relations of buccal segments Class I and Class II  Mild class III. Class III  Class I or Class II. 29

30. Objectives of Stage I Co-ordination of upper and lower arches. Correction of anterior and posterior cross bites. Axial relation of anchor molars corrected – upright position. NOTE: All tooth movements carried out simultaneously & in both arches. 30

31. Archwires Round austenitic SS - Heat treated and cold drawn. 0.016” special plus  Looped arch wire in any case 0.016” special plus  Plain arch wire in extraction cases or in which 1 st and 2 nd premolars are extracted 0.018”  Plain arch wire in molar extraction cases 31

32. The basic shape of the initial arch  shape of malocclusion The arch wire shape - proportional to the width , the form and symmetry of dental arch. 32

33. Intermaxillary Hooks Small loops for engaging elastics and cuspid ties. 2 types : Boot & Circle/ Helical 33

34. Location of IMH: Well aligned anterior teeth  1-2 mm mesial to the cuspid bracket. Spaced anteriors  Further mesially . Mildly crowded anteriors  impinging on the bracket. Severely crowded  multi loop wires. 34

35. Offset bends In Anterior segment Vertical offset - To Intrude or Extrude Horizontal offset - To Expand, contract and rotate In posterior segment Gingival offset - To avoid occlusal distortion and interference with bicuspids 35

36. Vertical loops 36

37. Stage I The arch form - generally expanded over it’s entire width Ans. counteract the lingual movement of the anchor molars In this technique, no teeth should be held firm Ans . so that they can respond to gentle tooth moving forces. 37

38. Anchorage bends 38

39. Bayonet bends It is inadvisable to use bayonet bends for active correction, because of the tendency for round arch wire to rotate within bracket slots causing the bayonet bend to become ineffective or supply movement in wrong plane Commonly used passively to retain over rotation brought about via previously looped arch. They should be small and offset section is 5 degrees to the line of main arch. 39

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41. Placement of elastics It is impossible for the arch wire to function properly without the proper elastics. No horizontal (intramaxillary) elastics are applied during stage I 41

42. Class II elastics pulling 2 to 3 ounce at the beginning Class III elastics Horizontal ( intramaxillay ) elastic 42

43. STAGE II OBJECTIVES OF THE SECOND STAGE: 1.Maintain all corrections achieved during first stage. 2.close any remaining posterior spaces. All tooth movements that should be performed in the second stage of treatment are carried out simultaneously and must be completed in both dental arches before proceeding to stage III. 43

44. STAGE II ARCH WIRE: The function of arch wires in stage II is maintain the corrections already achieved stabilize the teeth against any adverse reciprocal forces. To achieve this heavier {0.020 inch} upper and lower arch wires are used.. The anchor bends placed in the heavier arch wire must be less than that of the lighter wires. 44

45. WEARING OF ELASTICS DURING STAGE II The wearing of horizontal elastics creates a rotational force on the molars. To prevent this, the distal ends of the archwires can be given a slight amount of toe-in. 45

46. Archwire The Arch wire 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. 46

47. 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 has 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 47

48. TOE IN AND TOE OUT BENDS They are horizontal offset bends that are often combined with the anchor bends Functions: Corrective: for rotation of molars when required. After insertion, the toe-in 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 48

49. Passive- to prevent the rotation of anchor molars already in normal alignment 49

50. Elastics in stage II Lateral Cephalogram is taken cephalometric evaluation  whether the anteriors are to be retracted or posteriors are moved for closure of space. 50

51. Correction of Midline discrepancy: If one arch is involved  shifts more than 2mm is major problem. The application of intramaxillary elastic will complete closure on the side to which midline is shifted The intramaxillary elastic on the side which closes first can be discontinued Minor discrepancies are self correcting 51

52. Diagonal elastics for correction of midline in both the arches 52

53. The auxiliaries used are passive mesio distal root uprighting springs on the mandibular canines and the lower anterior braking arches . The function of of these types of auxiliaries is to establish two point contact between teeth and archwire and prevent free tipping movement of the anteriors . 53

54. Changes observed in stage II All extraction spaces are closed The crowns of the upper and lower anterirs are tipped back further than the first stage The anteroposterior occlusal relations attained in the first stage are maintained The overcorrections of rotations done in the first stage are maintained 54

55. Stage III TOOTH RELATIONSHIPS AT THE START OF STAGE III – 1.Edge-edge incisors –all upper and lower anteriors retroclined . 2.Canines distally tipped and second premolar mesially tipped. 3.Molars upright. 55

56. all spaces closed ,rotations and midline deviations overcorrected. all the teeth should be well-aligned and occluding in slight mesio -occlusion. 56

57. Objectives of stage III 1.MAINTAIN ALL CORRECTIONS ACHIEVED FIRST AND SECOND STAGES Posterior spaces kept closed by bending the distal ends of the archwires around the buccal tubes. Archform and overbite correction maintained by using heavier {0.018 to 0.020 inch} main arch wires. 57

58. 2. ACHIEVE DESIRED AXIAL INCLINATIONS OF ALL TEETH Changes in the mesiodistal inclination of teeth by the use of individual root-tipping springs. Lingual or labial root torque is applied to the anterior teeth through the application of torqueing auxillaries . 58

59. Spur torquing auxillary 59

60. Reverse torquing auxillary 60

61. Advantages of Begg’s appliance Efficiency of treatment- many corrective tooth movements with relative little appliance adjustment Minimal patient discomfort and minimal trauma to the hard and soft tissues Rapid esthetic improvement Early correction and overcorrection of rotations Short treatment time 61

62. Disadvantages of Begg’s appliance Patient cooperation is critical Distortion of the light arch wires by mastication of tough foods or biting hard objects Difficulty - accomplishing detailed finishing procedure Auxiliary used in stage III constitute a hazard to maintenance of oral hygiene 62

63. Tissue trauma at the alveolar crest Root resorption The Begg technique does not lend itself to the intrusion of maxillary incisors when a deep overbite is associated with over eruption of the maxillary incisors Unpleasing flattening of the lips may occur during Stage I and Stage II 63

64. Conclusion 64 The Begg appliance is both comprehensive and versatile , but it is only an instrument which, like a musical one, can be played to good effect only by those with the talent, training and perseverence to do so. Discord and disharmony will haunt those who do not possess these characteristics. It is the operator, not the appliance, who produces the results, acceptable or otherwise, directly in accordance with his ability.

65. References Begg orthodontic theory and technique : Begg and Kesling . Begg:appliance and technique - fletcher. Light wire technique ,American journal of orthodontics Jan vol 47 ,no 1, 1961 Begg , P. R.: Stone age man's dentition, AM. J. Orthodontics 40 Begg , p. R.: Differential force in orthodontic treatment, AM. J. Orthodontics Begg , P. R. : Light arch wire technique, AM. J. Orthodontics 65

66. Thank you 66