TRADITIONAL BEGG PHILOSOPHY INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www. indiandentalacademy.comEVOLUTI FF THE BEGG’S APPL KE. Begg: After graduating from the Melbourne university in 1923, he went to study with Dr.Angle in California. In 1924, coincidentally with Dr.Begg’s arrival in California,Dr.Angle was developing the edgewise mechanism. Dr.Angle took ribbon archwire which was normally inserted vertically from the incisal and turned it on it’s edge-”edgewise” to insert it horizontally. In november 1925,Dr.Begg sailed back to Australia and started practicing orthodontics in Adelaide in 1926. {edgewise mechanism-non-extraction principle}. For 2 years, Dr.Begg faithfully followed Dr.Angle’s teaching of retaining the full complement of teeth. However in many of his patients,he was,nqtsatistied.avith post treatment profile and faced with serious relapses of the treatment results.In february 1928 he began to routinely remove teeth and reduce the mesiodistal width by proximal stripping. He knew from experience and his appreciation of the role, attrition is meant to play in the development of man’s dentition that seeks reduction was often necessary to permit the proper repositioning of the teeth to enhance FUNCTION,STABILITY AND ESTHETICS. Dr.Begg realised that edgewise mechanism was not designed to rapidlyclose extraction spaces and for quickly reducing deep overbites. To facilitate such changes,he began using .020inch round platinised gold rather than rectangular archwire in 1929. www. indiandentalacademy.comIn 1931/32 he started using .018inch round stainless steel wire bending the vertical loops,intermaxillary circles right into the archwire.however he soon realises that if round archwires were engaged in edgewise brackets,indiscriminate and often undesired root moving forces could be created. This prolonged the anterior biteopening and taxed loss of anchorage. In 1933,about 2 years after switching over to round wire,he began treating some cases with ribbon arch bracket.he realised that these relatively narrow brackets with vertically facing slots allowed the teeth to move under very light forces. www. indiandentalacademy.comDr.Begg described a treatment approach based on the following hypotheses which were backed to some extent by his own researches. They were: 1.Theory of attritional occlusion 2.Theory of differential forces 3.The employment of a modified form of ribbon arch bracket and light gauge round archwire. www. indiandentalacademy.comTHE THEORY OF ATTRITIONAL OCCLUSION Dr.Begg founded the concept of correct occlusion based on his studies on the skulls of australian aboriginals.. -He found that the dentitions displayed a considerable amount of attrition ,both occlusally and interproximally. .The dento-alveolar height was maintained by continuous eruption and proximal contact by mesial tooth migration.,facilitated by cuspal wear. -The incisor relationship became edge to edge thereby reducing the chance of lower incisor imbrication through overbite obstruction... The total reduction in arch length resulting from attrition amounted approximately to one bicuspid width either side of both dental arches by the time the aboriginal was 20 years of age... These findings accord with the studies of miss Corisande smyth with her study of anglo-saxon skulls... According to sir Arthur keith,in bronze-age Britain,skulls showerd edge-to- edge incisor relationship was 'CoHiitanisnseemy-comNormal occlusion in young adult of present day Normal occlusion in primitive times. www .indiandentalacademy.comBut in the present age,due to the refined and pre-cooked food,less dental attrition was observed. The absence of attrition along with the presence of mesial tooth migration does not relieve the dental overcrowding ,particularly in the lower incisor region where the modern overbite prevents their escape into edge-to-edge relationship with the uppers. Dr.Begg used the findings from his study of australian aboriginal occlusions as a justification to extraction.He argues that if in this present era tooth material is not lost through attrition ,it would be rweasonable to cause a commensurate reduction artificially.through extraction. However,care should be taken to restrict the employment of extraction within logical limits.. Thus the extraction approach in orthodontic treatment came into existence . Surely,there will be exceptions to the extraction approach just as there were to the non-extraction approach. www indiandentalacademy.comTheory of differential forces. The theory of differential forces in it’s original form was described by dr.Begg in an article AJO{1956} his observation was based to a large extent on the work of Storey and Smith. 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 would produce a slow rate of response while those above incurred a reaction within the bone support,referred as “undermining resorption”. Applying these principles to the begg technique,the force of the intermaxillary elastics used inn stage I of treatment ,was kept light so that the upper labial segment was retracted while the lower anchor molars has negligible mesial movement.later, if it was required that the residual extraction spaces should be closed largely by the mesial movement of the posterior teeth, the elastic forces are increased so that the anterior segment with their relatively small root area received an excess of force sufficient to delay their movement,while the posteriors {noved forward.a.A force of less than 150 grams causes no distal bodily movement of canine. b.A force of 150-200 grams is optimum to move canine distally. c.A force of 300-500 grams causes the molars to move easily.this high force is resisted by the tissues investing the canine root,thus affording anchorage for mesial movement of molars.Concept of undermining resorption According to the concept of undermining resorption,excessive orthodontic forces ,;when exerted on teeth cause the periodontal membrane and tooth- investing bone to be compressed.this causes the occlusion of bloodvessels and the blood supply is cut off in these areas. This inadequate blood supply causes necrosis of the compressed parts of the periodontal membrane and bone..This leads to no tooth movement until phagocytic action removes the necrosed tissues and until new living tissues form.this excessive force also causes pain and loosens teeth. The effect of this process is that teeth do not move continually but intermitently and much slower than when lighter orthodontic force is used. On the other hand,if lighter and appropriate orthodontic force is applied sthe periodontal blood vessels are not occluded so that the bone on the side of pressure is continually and rapidly resorbed and new bone is simultaneously formed on the side of negative pressure without any discomfort and loosening of teeth. heavy force — internmittent movement. light force - continual wiovnditicanatatetmpted tooth movement.THE MEANING OF DIFFERENTIAL ORTHODONTIC FORCE. In physics and mechanics , differential is defined as the difference of two or more motions or pressures.the orthodontic force values used in this technique cause: 1. Minimum discomfort Minimum loosening of teeth. Minimum damage to tooth investing tissues. Rapid tooth movement wo woh Easily controllable forces. www. indiandentalacademy.comThe meaning of optimum orthodontic force The optimum orthodontic force means that force which moves teeth the most rapidly with least discomfort to the patient ,and with least damage to the teeth and other investing tissues. The forces that are most favourable for tooth movement on the standpoint of rapidity and tissue tolerance are according to storey and smith much lower than that exerted by edge wise archwire. According to Halderson,Johns and Moyers ,the force exerted by edgewise archwire is of very high value of over 2 pounds or 900 grams which causes a pathogenic tissue response. hence, they advocated the use of light round wires as 1.It takes as much advantage of tipping movements as is possible. 2.It utilises forces much lighter than are possible with a standard edgewise wire. www. indiandentalacademy.comMaterials ,appliances necessary for the begg technique. The spring quality of the firstmade steel was a great improvement compared to the rectangular gold platinum wire.however,it was either too soft or too brittle. e In 1940’s dr.Begg met Arthur.J.Wilcock who was directing metallurgical research in the university of Melbourne.after many years of research,Mr. Wilcock finally produced a cold drawn heattreated wire that combined the balance between resilience and hardness with the unique property of zero stress relaxation that dr.begg was seeking.this unusualwire permitted dr.begg to open deep anterior overbite while controlling archform and providing molar stability. ‘www. indiandentalacademy.comhowever dr.begg had the same problem controlling the mesiodistalinclination of teeth with ribbon arch brackets that dr.begg had experienced 30 years back. Dr.Begg attempted to modify the ribbon-arch bracket by soldering horizontal band spurs to the labial and buccal surfaces of the bands.when the tooth required mesiodistal tipping,the archwire was permitted to contact the horizontal band spur.the archwire was then deflected towards the bracket with a lockpin or steel ligature.the resultant flexing of the archwire provided a degree of mesiodistal axial control or movement. ‘www. indiandentalacademy.comLOCKPINS 1,One-point safety lockpin: Y first stage of treatment with .016 inch archwire. Y Shoulder on labial surface of the head strikes bracket to prevent impingement of pin and the archwire. ¥ Beveled undersurface of head leaves adequate sp: tipping. 2.Second stage lockpin: Y Safety shoulder prevents binding on archwires . ¥ The bodyof the pinis dimensioned to open 256-500 bracket slot to 0.020 inch to accept larger archwires during stagell. 3.Hook lockpin: ¥ Used on all teeth that dosnatceguizemesiodistal uprighting during stage III.AD TS TO LIGHT RE TE IQUE ¥ ELASTICS: {LATEX OR RUBBER}: Which will exert a force equal to between 60 and 70 grams when they are new and first placed. Y ELASTIC TIE MATERIAL: To provide force to rotate or erupt teeth. The elastomeric materialis more esthetic howeverwhen extremely light pressure is desired ,the elastic thread is generally used. Y STAINLESS STEEL LIGATURE WIRES OF VARIOUS DIMENSIONS. Y ELASTOMERIC RINGS {1.5 TO 2mm} are used to connect the cuspid brackets to intermaxillary hooks to keep the six upper and lower anterior teeth in contact. www. indiandentalacademy.com¥ LINGUAL BUTTONS: used as points of engagement for the following:rubber elastics, ligature wires,specially shaped sections of archwire material and orthodontic elastic thread Y MOLAR HOOKS WITH BALL ENDS:makes the placing of elastics simple for the patient. Y KESLING TOOTH SPACING SPRINGS sy nid ional oeleny Goes jx |BRACKET PLACEMENT Brackets are centred mesiodistally on the labial and buccal surfaces of the teeth with the base of the archwire slots 4 mm from the incisal edges or cusp tips. For lateral incisors,the brackets are set close to the incisal edge, {3.5 mm},to provide the desired esthetic shortening of these teeth in relation to their neighbours. The lingual buttons should be positioned directly opposite the areas of archwire engagement on the opposite side of the teeth. This is necessary to permit free mesiodistal tipping and uprighting of the teeth. www. indiandentalacademy.comBUCCAL TUBE PLACEMENT Molar buccal tubes are oriented parallel to a line bisecting the crown mesiodistallyas viewed from the occlusal and parallel to the occlusal surface as viewed from the buccal. Mandibular molar tubes are attached as far gingivally as possible to keep the archwire away from the occlusal plane.THREE STAGES OF TREATMENT. Begg’s technique is divided into 3 separate and distinct stages that must not be allowed to overlap.it is chiefly with the object of preventing anchorage failure that the technique is divided into 3 distinct stages of tooth movement, 1.STAGE I 2.STAGE II 3.STAGE Il www. indiandentalacademy.comOBJECTIVES OF STAGE I: 1.crowding and irregularity of all teeth are corrected. 2.spaces between anterior teeth are closed. 3.rotations of all teeth are overcorrected to rotations that are the reverse of but less than the original rotations. 4.open the anterior overbite. 5. Anteroposterior occlusal relations of all teeth are overcorrected in class I and class II malocclusions until the posterior teeth reach almost classIII occlusal relations. 6.the contours of both the dental arches are brought to good proportions. 7.the upper and lower extraction spaces becomes more smaller. 8.correct posterior crossbites. www. indiandentalacademy.com 9.the axial relations of the anchor molars are corrected in this stage.STAGE I In order to reduce deep overbite of anterior teeth,anchorage bends are made in the upper and lower 0.016 inch diameter round archwires mesial to the molar tubes so that the anterior parts of the archwires lie gingivally to the anterior teeth. When rectangular edgewise archwires are used for bitreopening,aconsiderable amount of bite opening is obtained by tipping back of the upper and lower molar anchor teeth with elevation of their mesial marginal ridges due to heavy forces. After completion of treatment,the elevated mesial marginal ridge settle back in their sockets resulting in relapse of anterior overbite.. www. indiandentalacademy.comHowever ,in contrast, with the use of round arch wires,due to the light forces employed, only rapid movements of the upper and lower anterior teeth ocuurs gingivally .. There is no movement of the molars.Hence the deep overbite is eliminated and the results,awerstalabatatacademy.comSTAGE I THE ARCH FORM OF THE ARCH-WIRE IN STAGE I IS GENERALLY EXPANDED OVER IT’S ENTIRE WIDTH TO COUNTERACT THE LINGUAL MOVEMENT OF THE ANCHOR MOLARS ANCHOR MOLARS ,ESPECIALLY THOSE IN THE MANDIBLE TEND TO TIP LINGUSALLY AS A RESULT OF VERTICAL COMPONENT OF FORCE FOUND IN CLASS ii INTERMAXILLARY ELASTICS. IN THIS TECHNIQUE,NO TEETH SHOULD BE HELD FIRM..SO THAT THEY CAN RESPOND. TO GENTLE TOOTH MOVING FORCES. ELIMINATION OF ANTERIOR CROWDING: VERTICAL LOOPS BETWEEN CROWDED ANTERIOR TEETH ARE USED WITH BRACKET AREAS MODIFIED FOR DESIRED OVERCORRECTIONS. ARCH LENGTH DESIGNED SAO THAT INTERMAXILLARY CIRCLES REST AGAINST MESIAL SURFACE OF CUSPID BRACKETS. www. indiandentalacademy.comPLAIN ARCHWIRE WITH ELASTIC FROM CUSPID PIN TAIL TO. CUSPID PIN TAIL. CORRECTION OF ROTATION: 1.,0VERCORRECTION OF BRACKET AREAS BETWEEN ANTERIOR VERTICAL LOOPS, 2.USE OF ELASTIC THREAD 3.USE OF ROTATING SPRINGS. (CORRECTION OF POSTERIOR CROSSBITES: 1.MODIFY ARCHWIDTH OF ONE OR MORE ARCHWIRES. 2.WEARING OF CROSS ELASTICS.-USUALLY BILATERALLY. 3.RAPID MAXILLARY OVER EXPANSION PRIOR TO THE BEGINNING OF STAGE |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 IIT. www indiandentalacademy.comSTAGE II ARCH WIRE: THE FUNCTION OF ARCHWIRES IN STAGE II IS TO MAINTAIN THE CORRECTIONS ALREADY ACHIEVED AND TO STABILISE THE TEETH AGAINBST ANY ADVERSE RECIPROCAL FORCES. TO ACHIEVE THIS HEAVIER {0.020 INCH} UPPER AND LOWER ARCHWIRES ARE USED. THE ANCHOR BENDS PLACED IN THE HEAVIER ARCHWIRE MUST BE LESS THAN THAT OF THE LIGHTER WIRES. 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.TOOTH REL. HIP: T THE START OF STAGE III SINCE SOME % OF MANY CORRECTION ACHIEVED IN THE FIRST 2 STAGES IS. LOST IN STAGE III ,IT IS BETTER TO OVERDO ALL OF THEM BY 15% 1,EDGE-EDGE INCISORS —ALL UPPER AND LOWER ANTERIORS RETROCLINED.2.CANINES DISTALLY TIPPED AND SECOND PREMOLAR, MESIALLY TIPPED. 3.MOLARS UPRIGHT. 4.IN ANTERIOR OVERBITE: POSITIVE OVERBITE. 5.ALL SPACES CLOSED ,ROTATIONS AND MIDLINE DEVIATIONS, OVERCORRECTED. ALL THE TEETH SHOULD BE WELL-ALKIGNED AND OCCLUDING IN SLIGHT MESIO-OCCLUSION.