American Journal of ORTHODONTICS

Volume 71, Number 1, January, 1977

ORIGINAL ARTICLES

The differential force method of

orthodontic treatment
P. R. Begg, D.D.Sc., L.D.S., B.D.Sc., and Peter C. Kesling, D.D.S.
Adelaide, South Australia, and Westville, Ind.

Many wish to learn but few the price will pay.

3uveua1, first century A.D.

T his essay is being written to explain the light wire differential force
technique free of unnecessary and incorrect variations. It is hoped that this will
help eliminate the confusion that has been caused by several published accounts
which, while purporting to describe this treatment, actually are misleading be-
cause they contain retrogressive alterations.
Some orthodontists now employing this technique have received only practical
training in the manipulation of the appliances and very little teaching on its
theoretic basis. Therefore, a brief description of Stone Age man’s attritional oc-
clusion, the basis upon which this method was developed, is also included. Unless
this section is carefully studied, the part describing appliance therapy will be of
little value to those using this method to treat patients.
This essay is an abridged and revised version of two lectures delivered at the forty-
fifth annual meeting of the Great Lakes Society of Orthodontists, Oct. 5 to 9, 1974.
We wish to thank all members of the Kesling and Rocke Group of Westville, Ind.
Without their illustrations and records of appliance therapy throughout treatment,
this essay would not achieve its purpose.

Also, to dissuade orthodontists from attempting to employ edgewise brackets

in conjunction with this technique, a brief analysis of root-moving forces de-
livered by the edgewise appliance is included.
In the hope of holding the attention of the more clinically oriented orthodon-
tists and of making this article less dreary, the records of treated cases and recent
improvements in this method will be interspersed throughout its entirety.
1
 Am. J. Orthod.
January 1977

Fig. 1. Tree gtment with the Begg differential force method. This is, from the Sitandpc hint of
the extent of protrusion of the anterior teeth and of excess of tooth subsi &a rice re lative
to t he size of the jaws, the severest condition I (P. R. Begg) have treatec Eight teeth
(the upper and lower right and left first premolars and also the upper anI d lower right
left fir st permanent molars) were extracted prior to appliance therapy. ( TI7ese rc tcords
havi e previc susiy been published in the July, 1961, issue of this JOURNAL.)
 Differential force method 3

Fig. 2. A, Molar band with buccal tube (0.036 inch inner diameter and 0.250 inch long,
0.914 mm. I.D. and 0.635 mm. long) and intermaxillary hook attached to buccal surface.
Note that tube is positioned near the gingival band margin, to help prevent the arch wire
from being distorted from occlusal forces. A ball-ended hook is also attached to the
lingual surface of each molar band to accept elastics or ligature ties, if necessary. 6,
Modified ribbon arch bracket (TP 256-500) especially designed for light wire technique,
prewelded to a preformed band. Will accept 0.016 inch (0.406 mm.) arch wires in Stage
1, and 0.018 or 0.020 inch (0.457 or 0.508 mm.) wires in Stages 2 and 3. Permits free
crown tipping or controlled root torque when required.

The treatment of a severe malocclusion is shown in Fig. 1. This patient’s teeth

were so large, compared with the space available in her jaws, that eight teeth (the
four first premolars and the four first permanent molars) had to be extracted
prior to appliance therapy. Very few patients (2 to 3 per cent) have such severe
malocclusions as to require the pretreatment ext,raction of these eight teeth.

Development of the light wire differential force technique

Early variations of the edgewise technique. This method would not have been
developed if one of us (P. R. Begg) had not been taught by Dr. Edward H. Angle
in 1924-25 to use the edgewise appliance. We owe him a debt beyond repayment.
However, in contrast to the original nonextraction method of using the edge-
wise mechanism as taught by Dr. Angle, I (P. R. Begg) began to extract
teeth prior to treatment, when necessary. This decision was made as a result of
studying Stone Age Australian aboriginal and other dentitions in relation to the
etiology of malocclusion.
In 1928 Australian orthodontists were shown the results of treatment with
the edgewise mechanism after extraction of the four first premolars in those pa-
tients who inherited teeth too large for their jaws. The only change made at that
time in Dr. Angle’s edgewise mechanism was the use of large round buccal molar
tubes instead of rectangular tubes. These round tubes have evolved into the
smaller buccal tubes that we now employ in conjunction with the modified rib-
bon arch brackets (Fig. 2). This change was made so that frictional binding of
arch wires would not prevent horizontal elastics from closing extraction spaces.
Also, many of these patients had to wear headgear. These orthodontists were, with
the exception of Dr. Stanley Wilkinson, noncommittal concerning these treatment
results. They were surprised by the unorthodoxy of pretreatment tooth extrac-
tions.
From 1928 until the present day tooth extraction has continued to be used
as an adjunct to orthodontic treatment whenever this appears to be necessary.
It was recognition of the fact that the lifelong hereditary forces of mesial
migration and continual eruption are very light that led to the discarding of the
 Am. J. Orthod.
Januarf~ 1977

Fig. 3A. Facial photographs before (top) and after treatment (bottom]. Patient was 12
years old at the beginning of nonextraction treatment, which lasted 13 months.

edgewise treatment method. This change was made in order to simulate Nature
by employing light continuous orthodontic force values instead of the heavy in-
termittent forces used in the edgewise technique. A metallurgist, Arthur .J. Wil-
cock of Victoria, Australia, was able, after years of experimentation, to produce
arch wire material suitable for the technique.
The fact that the lighter force values employed cause less loosening of teeth,
less discomfort, and less damage to roots and tooth-invcst,ing tissues is evidence
that these forces arc optimal for tissue tolerance. The records of a patient treated
with this technique, using these light force values and directly bonded brackets,
are shown in Fig. 3.
Those orthodontists who use this method properly, and who formerly used the
edgewise technique, report that their average treatment time is much less than
that previously required. Furthermore, it now takes only one third to one fourth
the chair time for each patient.
This technique and orthodontic ccphalomrtrics were developed concurrently,
but independently of one another. Most anthropologists and biomctricians con
sider that it is impossible to locate landmarks accurately on lateral cephalometric
head films. For this and other reasons, we hare never felt secure in following any
of these concepts in the planning of our patients’ treatment.
 Diferentinl force method 5

Fig. 3, B to D. B, Class II, Division 2 malocclusion prior to treatment. Diagnosis indicated

that this patient could be successfully treated without the extraction of teeth. C, Occlusion at
the end of Stages 1 and 2 (which occur simultaneously in most nonextraction cases). Note
anterior teeth are edge to edge, and molar relationship is Class I. Direct bonded attach-
ments can be seen in place on the six upper anterior teeth. D, Final occlusion. Stage 3 was
relatively short (5 months), as is normally the situation in nonextraction cases. The patient
wore a tooth positioner to help retain treatment results.

Fig. 3, E to G. E, Occlusal views of dental arches before treatment. The presence of slight
spaces in the upper arch plus the location of dental arches relative to basal bone, as
well as the soft-tissue profile, led to the decision to treat this patient without a reduction
of tooth mass. F, Alignment of teeth at the end of Stages 1 and 2. Note the direct bonded
attachments on the six upper anterior teeth. G, Arch form and tooth alignment after the
patient had worn a tooth positioner for 3 months.
 Am. J. O?%hod.
January 1977

Fig. 3H. a and b, Molded

in the treatment of this patient.
to the base of the metal
polycarbonate

bracket
:‘li
b

bracket
c, Small stainless
permits
and special lock pin of the type
steel mesh pad which,
it to be bonded directly
when
to the tooth
spot-welded
surface.
used

Treatment procedures must be based on knowledge gained from studying the

occlusion of Stone Age man. Of primary concern is the difference between un-
worn and attritional tooth mass, together with the realization that everyone has
his own hereditary rate of continual mesial migration and vertical eruption of
the teeth. Treatment planning is made with these concepts in mind. This prop-
dure is more accurate than depending upon static, two-dimensional cephalo-
metrics. The lack of attrition in the presence of mesial migration and continual
eruption indicates the need for reduction of tooth mass in most patients.
Recognition, use, and teaching of the technique

It is fortunate that, 18 years ago, I)r. H. I). Kesling and I)r. (George Dinham
visited my (I’. R. Begg’s) office in Adelaide, observed differential force treatment,
and were impressed with it. They also seemed, in this short time, to get the message
about attritional occlusion, mesial migration, and the continual eruption of teeth.
It was also fortunate that they had the foresight and determination to go back to
their homes in the United States and, in spite of many disappointments, to
persevere with the differential force trcat,ment, using the proper appliances. They
not only used the differential forcr light wire treatment method themselves, but
Dr. H. I). Kesling instilled into his partners in the Orthodontic Group at West-
ville, Indiana, the urge and determination to use this method from that time on.
By the time they had completed their first 100 cases with this technique, the
Orthodontic Center at Westville was completed. Two hundred fifty men were
invited and attended t,hree different showings of this work. From these showings,
there developed a demand for training. In the last 15 years they have given forty
short basic courses to well-attended classes and also more than 100 short refresher
courses.
Hundreds of so-trained men have had this success and report that it has
changed their lives. They are now ablr to achieve more stable results, and both
the patients and their parents are happier and more pleased. Appointments are
usually scheduled at 6- to 8-week intervals. This enables the operator to success-
fully treat more patients and/or have much more leisure time for himself and
his family.
This treatment has been devised so that capable orthodontists can render bct-
 Differential force method 7

Fig. 4A. Before-and after-treatment photographs of the patient whose treatment casts are
illustrated in Fig. 4, B to I. Note improved facial contour and desirable repositioning of
the upper anterior teeth, which permits normal upper lip contour.

ter treatment for all types of malocclusions, mild or severe (Figs. 44 to 41). How-
ever, this is possible only if those who use it have seriously studied its basic bio-
logic foundations. This technique is not intended as a panacea for those who fail
to realize the potentials of other techniques.
Numerous articles properly describing this technique are in print.l-” Five
journals on this technique have been published6 and contain many valuable
articles written by various orthodontists. Two editions of a textbook7-s devoted
exclusively to the theory and technique of this method have been published in
English, French, Spanish, and Italian. There have been many other articles pub-
lished. Some are excellent, but others purporting to describe it are misleading be-
cause, as mentioned before, they introduce retrogressive variations. Some of the
best articles describing treatment have been published by orthodontists practicing
in .Japan.“, lo
However, in order to employ this method successfully, reading alone is not
sufficient-practical training is also required. In addition to the short courses
Fig, 4, B and C. B, Views of the original malocclusion cast. Tissue has been removed from
the labial surfaces of the upper canines to facilitate banding. (Chip on distal line angle of
upper right central incisor is in model only). C, Occlusion at the end of Stage 1. Note
that the original anterior overbite has been completely eliminated. This relationship of an-
terior teeth is absolutely necessary to permit the anteroposterior interarch changes that are
so important, especially in a malocclusion of this type. At the end of Stage 1 in the
differential force technique, all patients’ teeth are similar, regardless of their original
malocclusion.

Fig. 4, D and E. D, The occlusion at the completion of Stage 2. The posterior and anterior
tooth relationships achieved during Stage 1 have been maintained while closing any
remaining buccal spaces. Note that the clinical crowns of the upper central and lateral
incisors appear foreshortened in the anterior view because of their lingual inclinations.
E, Casts made at the completion of treatment. This patient’s treatment required 26 months,
with a total of four arch wires (two maxillary and two mandibular). The patient wore a
tooth positioner for final finishing and retention.
 Ihfferential force method 9

Fig. 4, F and G. F, Occlusal views of the upper and lower arches prior to treatment. The
four first premolars and the upper second deciduous molars were extracted approximately
4 weeks before the appliances were placed. G, Cast taken at the end of Stage 1. Note
anchor molar control and partial closing of extraction spaces.

mentioned previously, orthodontic students are presently being taught the tech-
nique in more than twenty university graduate programs in the United Slates.
Also, universities in Australia, Europe, and *Japan teach the method.
X few of these universities also teach students about attritional occlusion. As
far as we are aware, few, if any, undergraduate dental students are being exposed
to the lessons to be learned from studying the development of the normal oc-
clusion of man.
,4ttempting to teach bthc ~~tlgcnise ilIlt the diffcrcl~tial force: methods simu-
taneously to university graduate orthodontic students is contradictory and, therc-
fore, can be confusing to both teachers and students. Those who teach the diffcr-
ential force method have no choice other than to contradict what is taught by the
edgewise teachers. Attempts to compromise by crolving “midway” treatment
methods produce treatment failures.
Many recent biologic and mechanical findings have been incorporated into
the differential force method. Edgewise-trained operators find it necessary to
discard previously held concepts in order to succeed with t,his relatively new
method.
IXttempting to use the edgewise method on some patients and the differential
force method on ot,hers results in poorer treatment results with both techniques.
Advantages of the differential force treatment method

1111956 many claims were made in favor of this treatment method. Since then
orthodontists using the technique have substantiated these claims. Therefore, it
now takes less courage to repeat and elaborate on these claims than was required
originally.
Fig. 4, H and I. H, Occlusal views of cast made at the beginning of Stage 3. Maxillary
molars are in good position to withstand any adverse pressures from the torquing or up-
righting auxiliaries during Stage 3. Stage 3 was of 9 months’ duration in this patient.
I, Arch form at the completion of treatment. Detailed finishing was accomplished with a
positioner after the teeth had been brought to their proper axial inclinations during Stage 3.

This differential force mcthotl permits early repositioning ot’ the mandible
and maintains it throughout treatment. It is therefore not surprising that there
is, relatively speaking, minimal Ix&treatment relapse with this method.
Universal tooth movements are possible ; sclc~tccl teeth can be held relatively
stationary while others move. The separation of tooth-moving forces from thcl
arch wire, as is the wsc tluring Stages 2 and 3, permits exact control 01’cr the
duration, direction, ant1 magnitude of the forc*c applictl to cnch tooth (Fig. 5).
(This is impossible with any technique that relics on the fit bctncen the arch wire
and the bracket to create a11tl A-liver forcxx)
This ability to tlifferentiate the forces applictl to teeth (even those atljacent to
one another) makes this a most precise orthodontic tccahnique. The tlesign of the
appliance (inc~luiling auxiliaries) also permits all tooth mo~enicnts to be carried
out rapidly a~lcl over great tlistanccs without reac+ivation,
Tooth roots can be efficiently torquccl labiolinguall~- and uprighted mesiotlis-
tally without discomfort to the pa.tients or frequent rcaetivation of the appli-
ances. This has put a new complexion OH the diagnosis ant1 treatment of Class II,
Division 2 malocclusions.
There is greater ~OI~Irol of tooth movement with this method than with others.
Some critics mistakenly regard the rigidity of heavy arch wires iis being syiony
mous with control, nhe~l act~ually such inflexible rigidity limits and restricts tooth
movements. Because the initial rountl ;Irc:h wires nsetl in the differential force
method arc so thin, flexible. tough, ilIlt resilient, :IJ~CI lwnnsc hoaT!- and light
forces can be applied simultaneously, there is greatci* control in all phases of
treatment with this method. This makes possible the maximum movement of the
dental arches posteriorly or antcriorl;v in the jaws, both in patients requiring and
in those not requiring pretreatment reduction of tooth snbstal~(*(~.
Volume
Number
71
1
Diferentinl force method 11

Fig. 5. A, Combination uprighting spring and lock pin (spring-pin), which securely holds
the arch wire in the bracket while uprighting the tooth mesiodistally. Tail of spring is
bent to lock assembly into bracket. B, Spring-pin designed for use in plastic bracket. C,
Upper and lower 0.020 inch (0.508 mm.) preformed arch wires for use during Stage 3.
Prewound 0.012 inch (0.305 mm.) Australian wire torquing auxiliary is in place on the
upper arch wire. The use of these relatively heavy arch wires during Stage 3 provides
precise control over the application of forces from the auxiliary to the individual teeth.

Fig. 6. Treatment of a Class II, Division 1 malocclusion which did not require pretreatment
reduction of tooth substance. The teeth were spaced and the jaws were large enough
to hold all teeth on basal bone. Therefore, it was obvious that the hereditary process of
continual mesial migration would not cause the teeth to become crowded after treatment,
even without prior reduction of tooth substance.
 Am. J. Orthod.
Janunru 19 7 7

Fig. G portrays treatment of a Class II, IIivision 1 malocclusion which did

not require pretreatment reduction of toot.h substance. This patient’s upper and
lower anterior teeth have been moved back bodily on basal bone. Treatment of
malocclusions which do not require pretreatment tooth extractions or the reduc-
tion of mesiodistal tooth widths is easier, simpler, and much more rapid than
when such reductions of tooth mass arc required.
This patient’s treatment is portrayed to refute the opinions of some writers
that it is necessary to extract, mhcn this treatment m&hod is ust~l, in ord~ to
control anchorage. Morement of this patient’s anterior teeth back on basal bone
is evidence that tooth extractions are not required for anchorage purposes.
Far fewer appointnicnt,s are requirrd for treatin, <I*both mild and severe COII-
ditions. Even those severe malocclusions that rcquirr pretreatment removal of
eight teeth (the four first premolars and the four permanent first molars) take
less time from start to finish of treatment and require fewer appliance adjust-
ments than were previously requirctl for the treatment of even noncxtraction
malocclusions by other methods.
50 specific t,ypes of malocclusion and associated jaw anomalies must be
eliminated for trcatmcnt consideratioll with this method.
The great distances OTW which teeth call br movvtl without reactivating arch
wires (if the proper high-quality light Australian wire is used) are hard to be-
lieve and to understand by orthodontists who do not use this method, even if
they have seen the results themselves.
With the differential force method, it is possible simultaneously to apply
hcaryv forces to larger-rooted posterior teeth while smaller-rooted anterior teeth
are being moved by relatircly lightcr forces. These forces are in conformity with
the biologic requirements of orthodontics. This appropriate application of forces
is made possible through the resilicnc)- of the light round arch wires, the general
looseness of fit between the arch wires and the attachments, and the use of auxil-
iaries for the creation and application of all torque forces during the final, third
stage of treatment.
Although many orthodont,ists ha~c nsed this differential force treatment
method for nearly two decades, the biologic concept upon which it is based-
Stone Age man’s tlentition-is still unique. It is also unique as far as its mechan-
ical principle of appliance therapy is concerned. It is tliffcrent from, contrary
to, and at variance with other orthodontic treatment methods and theories.
O?le technique to treat nil malocclusions. Some orthodontists arc of the opinion
that it is not possible to treat all varieties of malocclusion with a single appliance
or technique. These operators treat one type of malocclusion with one appliance,
another with a second, and so on ad infinitum.
Such misconceptions point out the inefficicnc~- or lack of flexibility of the
techniques used or the lack of training or skill of the orthodont,ists.
Bepause every arch wire used to begin treatment with the differential force
method is especially shaped, the technique will accommodate all types of maloc-
clusion. Tt is possible to begin the trcatmcilt of carh CBSCwith a diffcrt~nt mrcha-
nism in the form of arch wires designed specifically for the unique requirements
presented.
Volunze
Number
71
1
DifSerentinl force method 13

The patients receive the best treatment possible-not only because of the
merits of the appliance, but because the operator is able to attain a higher degree
of competency working with one appliance than would be possible if he were using
several techniques simultaneously.

Three stages of treatment with the differential force method

Appliance therapy is divided into three stages of treatment for all forms of
malocclusion. The objectives to be accomplished during each stage are as follows :
Stage 1 objectives
1. Achieve an edge-to-edge anterior tooth relationship.
A. Eliminate anterior overbite.
B. Close anterior open-bite.
C. Eliminate anterior cross-bite.
2. Align upper and lower antcri?r teeth.
A. Unravel crowding.
B. Close spaces.
3. Correct anteroposterior interarch malrelations. Maintain anterior teeth
in end-on bite in Class I and Class II malocclusions.
4. Coordinate upper and lower dental arches. Achieve symmetry.
5. Overcorrect rotations of all teeth except anchor molars.
6. Elevate impacted and unerupted teeth.
‘7. Correct cross-bites of posterior teeth.
The light wire appliances employed to accomplish the corrections mentioned
above can be seen in Fig. 7.
Spaces in the buccal segments created by pretreatment tooth extractions may
partially close; however, this is not a required change during Stage 1.
Many steps are taken to prevent the anchor molars from coming forward
while depressing anterior teeth and tipping them both lingually and distally.
Anchor molars are held upright while the anterior teeth are free to tip in all
directions. All tooth-moving forces from arch wires, intermaxillary elastics, and
auxiliaries are relatively light. These steps, and others, make the use of extraoral
anchorage (and/or the well-known edgewise procedure of setting up anchorage),
not only unnecessary but detrimental to the quality of the result of treatment.
All Stage 1 movements are carried out simultaneously, and all of them must
be completed before proceeding to Stage 2.
Stage 2 objectives
1. Maintain all dental and interarch changes achieved during Stage 1.
2. Close any remaining spaces in the posterior segments.
The proper relationships of the teeth at the beginning of Stage 2 and the ap-
pliances used during this stage of treatment (except for intraoral elastics) can
be appreciated by studying Fig. 8.
With the exception of slight restraining forces placed on the teeth by the
larger-diameter arch wires (0.020 inch, 0.508 mm.), which maintain major cor-
rections achieved during Stage 1, all forces applied to the teeth during Stage 2
are generated from intraoral elastics.
It is chiefly during the second stage that both dental arches are placed in
 Am. J. Orthod.
14 Begg and Keslixg January 1977

Fig. 7. Appliances (with the exception of elastics) in place at the beginning of treatment,
start of Stage 1. A, The vertical loops in the lower arch wire will align the lower anterior
teeth. B and C, The anchor bends in the arch wires will eliminate the anterior overbite
and maintain the anchor molars in upright positions throughout treatment. Also, note
that the arch wires do not engage the premolar bracket slots but are free to slide distally
through bypass clamps placed on these teeth. D and E show the rotating springs in place
on the upper and lower right second premolars and the lower right canine. All these
teeth should be overrotated at the patient’s next visit 6 weeks later.

their most favorable positions anteroposteriorly in the tooth-bearing parts of the

jaws. Differential forces are utilized to close any posterior spaces chiefly by mov-
ing the anterior teeth posteriorly ; however, the posterior teeth can be moved an-
teriorly, according to the requirements of each patient.
Because of the tendency for mesial migration, it takes relatively (but not ab-
solutely) less orthodontic force to move large-rooted molars mesially than is re-
quired to move anterior teeth distally. Paradoxically, excessively heavy forces
Volume 71 Diferentia.1 force method 15
Num her 1

fig. 8. Typical relationship of teeth at the beginning of Stage 2. A, Original 0.016 inch
(0.406 mm.) arch wires are replaced with essentially passive 0.020 inch (0.508 mm.) arch
wires. These larger-diameter arch wires are retained with Stage 2 lock pins which permit
continued free tipping. B and C, Anchor bends (reduced) are still present, and the arch
wires slide distally through the bypass clamps on the second premolars as the extraction
spaces close. The upper left second premolar has the arch wire pinned into the slot, as
the extraction space in that quadrant has closed during Stage 1. D and E, The other
second premolars that were rotated in Stage 1 are held in positions of overrotation by
steel ligature ties to the molars. Bayonet bends are placed in the arch wires to hold the
overcorrections of anterior teeth and also to ensure a proper buccolingual relationship
between the canines and second premolars as these teeth come in contact as spaces
close during Stage 2.

retard tooth movement. This phenomenon is sometimes exploited to hold the

small-rooted anterior teeth almost stationary while moving the larger-rooted pos-
terior teeth mesially with relative speed.
In mild discrepancy cases the “brakes” must be put on to prevent the six
upper and lower anterior teeth from tipping and to ensure that the molar anchor
 Am. J. Orthod.
Jcmawy 1977

Fig. 9. Stage 3 appliances in place. A, Prewound (0.012 inch, 0.305 mm. Australian wire)
upper anterior torquing auxiliary in place with 0.020 inch (0.508 mm.) upper and lower
main arch wires. B and C, Individual spring-pins in place to upright mesiodistally the lateral
incisors, canines, and second premolars, as is normally required in malocclusions having
pretreatment extraction of the four first premolars. Size and degree of activation of
spring-pins can be varied to coincide with uprighting requirements of each tooth. This
is one example to illustrate the precise nature of this technique which distinguishes it
from others. D and E, The occlusal views indicate maintenance of the bayonet bends to
hold overrotations until the end of fixed appliance therapy. Arch wires are bent around
the distal ends of the molar tubes to prevent spaces from opening while teeth upright
during Stage 3. A different lower arch wire, with prewound anterior torquing auxiliary,
was placed on the typodont before photograph E was taken.

teeth are able to move forward in Stage 2. In contrast to this, in severe discrepanq
cases, the six upper and lower anterior teeth must be allowed to tip freely, both
lingually and distally, during Stage 2 in order to ensure that molar anchorage
is not lost and that the upper and lower anterior teeth will be positioned properly
over basal bone at the end of treatment.
 Di#erentinl force method 17

Fig. 10. Intraoral photographs of Stage 3 appliances. A, Front view of positions of teeth
just before completion of paralleling tooth roots. 6, Side view of setup before tooth roots
are paralleled. C, Stage 3 setup showing prewound torquing auxiliaries on both upper
and lower preformed arch wires. D, End of third stage, when axial inclinations of the
teeth have been corrected. Upper prewound torquing auxiliary had been cut off previously
because the roots of the upper anterior teeth were properly torqued.

In order to bring the dental arches forward as a whole, or to keep them back,
it is necessary to use brackets of the ribbon arch type. Tie brackets (now wrongly
called edgewise brackets) do not afford sufficient freedom of tooth movement to
facilitate the repositioning of the dental arches anteroposteriorly in the jaws, as
may be required.
In other words, tie brackets, if employed instead of ribbon arch type brackets,
automatically “put the brakes on.” As a result the teeth of many patients are in
bimaxillary protrusion at the conclusion of treatment.
Of course, in the differential force method, the well-known and long-recog-
nized efficient means of creating stationary and simple anchorage is also em-
ployed. This is the holding of anchor teeth upright to resist tooth-moving forces
while permitting all other teeth to tip freely.
Even if an orthodontist were to use no other appliances than those recom-
mended for this technique, he would have many treatment failures unless he also
strictly adhered to the proper sequence of tooth movements. For instance, if the
orthodontist prevented free tipping of teeth and commenced root movements
before the end of the second stage of treatment, he would lose anchorage con-
trol.
 A?n. J. Orthod.
Jcmo.m-1/1977

Fig. 11. Retraction of protruding upper anterior teeth in the mixed dentition by means of
a removable palatal plate having a circumferential wire. Fixed appliance therapy is
started in these patients after eruption of the succedaneous teeth.

Stage 3 0bjectitqe.s
1. Maintain a.11 dental and interarch changes achieved during Stages 1
and 2.
2. Correct, or overcorrect, the axial inclinations of all teeth.
Appliances used to maintain the corrections of Stages 1 and 2 and to correct
the axial inclinations of the teeth during Stage 3 can be seen in Fig. 9. Interarch
elastics are worn as required to maintain the anteroposterior relationship of the
dental arches.
Recent improvements in the tec,hnique permit the use of heavier (0.018 or
0.020 inch, 0.357 or 0.508 mm., diameter) arch wires during Stages 2 and 3. This
change to heavy, rigid arch wires was made to prevent even the slightest amount
of “wandering.” At the present time it is only in t,he first stage of treatment that
the lighter 0.016 inch (0.406 mm.) arch wires are used. The use of heavy round
arch wires during Stages 2 and 3 in no way violates the principles of the differen-
tial force method. The arch wires used during these latter stages are passive re-
tainers holding the teeth in the positions to which they have been brought in
Stage 1. The tipping springs, torquing auxiliaries, and rubber elastics are the sole
sources of tooth-moving forces in the final or third stage of treatment (Fig. 10).
The anchor molars which have been held upright since the beginning of treat-
ment, are maintained in these positions throughout Stage 3.
Limited trea.tmext in the mixed dentitiox For reasons of esthetics, function,
and possible trauma, it is wrong to leave upper anterior teeth protruding until all
deciduous teeth are lost and replaced by their successors.
Fig. 11 portrays a simple method for early retraction of upper anterior teeth
in the mixed dentition by means of a removable plate. This method is far more
rapid and more comfortable than the use of headgear.
It is seldom necessary to use fixed appliances so early in life, except in Class
III treatment. Of course, rapid palatal expansion (palatal splitting) can be used,
especially during the mixed-dentition period, as an adjunct to the differential
force method.
Vozunze 71 Di#erential force method 19
Number 1

Fig. 12. Attritional occlusion of an Australian aborigine. There is a postmortem loss of

tooth enamel.
Fig. 13. Occlusal view of attrition of teeth of Australian aborigine. The upper right
third molar is not fully erupted. The distocclusal angle of this tooth occluded with the
lower right third molar.
Fig. 14. Attrition of the teeth of an old Australian aborigine. The crowns of the premolars
and first molars were almost worn away.

Stone Age man’s attritional occlusion-The basis of present advances in orthodontics

Man has existed for millions of years at the Stone Age cultural level. The
genetic, anatomic, functional, and developmental pattern of his dentition has
existed thousands of times longer than that of civilized man.
The occlusal and proximal tooth relations in “textbook normal” occlusion are
not correct for man. They are a product of civilization and actually constitute
a gross malocclusion.
Figs. 12 and 13 portray attritional occlusion of the teeth in Australian
 Am. J. Orthod.
Jnmuary 1977

Fig. 15. Plaster casts of the teeth of two elderly white men who lived most of their
lives with Australian aborigines. Eating the aborigines’ food, the crowns of their teeth
have worn away and edge-to-edge occlusion of the anterior teeth has developed. The
occlusal surfaces of the posterior teeth have worn obliquely, so that their occlusal planes
slope downward from lingual to buccal-a characteristic of attritional occlusion.

aborigines. Much more information on this form of occlusion than can be given
here is available.l* ?, 7, *, I1 After reading these accounts of Stone Age man’s denti-
tion, some shrug off the evidence presented as only an artifact of the past. This is
absolutely false; everyone, whether he wishes to accept it or not, has inherited
predetermined rates of mesial migration and vertical eruption of the teeth.
The occlusal and proximal surfaces of Stone Age man’s deciduous and perma-
nent teeth gradually became worn through the enamel to the dentin. In old age
the crowns of most of the teeth wore completely away (E’ig. 14). Deposition of
secondary dentin prevented pulp exposure in most instances, so that these in-
dividuals had efficient masticatory mechanisms free from the diseases of dental
caries and periodontitis. As occlusal attrition proceeded, the teeth continued to
erupt, thus compensating for the wcarin, 11away of their crowns. Simultaneously,
the teeth migrated mesially, thus maintaining proximal contact as the mesiodistal
widths of their crowns wcrc reduced.
The average amount of at,tritional reduction in the mesiodistal length of each
dental arch, upper and lower, in Stone Age man was about 23 mm. which is al-
most 1 inch, by the age of about 25 to 30 years. Therefore, as age advances, the
natural position for each tooth in the jaw is farther and farther mesiall;.
In order to occupy their proper posit,ions at all ages, it is necessary for the
molars to migrate over much greater distances than t,hc anterior teeth. Of course
the premolars, being intermecliatc, woultl normally migrate a distance somewhere
between the estrcmcs reprcscntrd by anterior teeth ant1 molars.
Thus, we have a long-standing precedent of millions of years for the reduc-
tion for orthodontic purposes of the lengths of dental arches in most patient,s.
This is done by the cxtrattion and/or reduction of the mcsiodistal widths of
selected teeth.
Civilized man’s teeth normally cannot migrate mesially because of their con-
stant mesiodistal widths. The persistence, to a degree, of the hereditary forces
of mesial migrat,ion, cvcn in the absence of attrition, produces crowding and ir-
regularity of the teeth. On the other hand, unrcstrained freedom to migrate,
which may occur after the loss of a tooth, permits posterior teeth to assume posi-
Volume 71 Diferential force method 21
Number 1

Fig. 16. Plaster casts of a 56-year-old white farmer who has lived his entire life in the
United States. Extensive attrition and creation of “Stone Age man’s dentition” has been
caused by a “diet” of coarse chewing tobacco for nearly 40 years. The pulp of the upper
right central incisor became exposed because the tooth was devitalized from a blow
many years ago and, therefore, there was no secondary dentin formation. Note that the
anterior teeth have been worn past their height of contours [greatest widths). Therefore,
incisal attrition has also caused a reduction of mesiodistal tooth dimensions.

tions farther mesial in the jaws than would occur under conditions of gradual at-
trition.
Genetic pattern of man’s dent&on developed &a attritional environment.
Most individuals, by natural selection, evolved larger teeth than could be ac-
commodated in their jaws in the absence of continual attritional reduction. This
ensured Stone Age man sufficient tooth substance for mastication after matura-
tion.
Civilized man’s dentition has the same genetic pattern as Stone Age man’s
and is “programmed” for the development of attritional occlusion. The only miss-
ing link is an abrasive diet. Fig. 15, which portrays the teeth of two white men
who lived with the Australian aborigines, and Fig. 16, which portrays the OC-
elusion of a current tobacco chewer, are evidence of this fact.
It is impossible for a hereditarily new and very different form of dentitiou
as textbook normal occlusion to have evolved in such a short time. Man’s denti-
tion evolved to a form that has a high survival value under Stone Age conditions
of use. However, in civilization it is subject to disease and malformation.
Figs. 12 through 16 make it obvious that if the roots of man’s teeth had not
evolved to be mesiodistally narrower than the crowns, continual mesiodistal nar-
rowing of the crowns by attrition, coupled with the hereditary process of mesial
migration, would have caused the roots of approximating teeth to come into con-
tact and would have destroyed the interradicular septa of alveolar bone through
resorptive atrophy. It may be discreet not to contemplate the fate of the fibers of
the periodontium.
Dental caries in Stone Age man was almost nonexistent ; thus, it would appear
that the sense of pulpal pain did not evolve to warn our Stone Age ancestors to
visit the nonexistent dentist. Pulpal pain, however, had survival value. It warned
man to retard the rate of tooth attrition by shifting his food to different teeth
and thus allow time for deposition of the secondary dentin in the sensitive teeth.
Fig. 17. Relationships of lips and upper and lower anterior teeth in attritional occlusion.
Edge-to-edge anterior occlusion permits the lower lip to rest directly on both the upper
and lower anterior teeth. Lower anterior teeth tip labially into an arc equal to that of
the upper anterior teeth; this, plus continual reduction of mesiodistal tooth widths, results
in low incidence of anterior tooth crowding in Stone Age man.
Fig. 18. Normal positions of lips and anterior teeth in civilized (nonattritional) occlusion.
Lower lip presses against labial surfaces of the upper anterior teeth. This force is trans-
mitted to the lower anterior teeth, which are trapped lingual to the upper incisors due
to persistence of juvenile anterior overbite. These factors, plus lack of proximal attrition
in the presence of continual mesial migration, account for the lower anterior tooth
crowding usually found in civilized man’s dentition.

In old age some individuals WOW away their teeth faster than the rate of dcposi-
tion of secondary dentin; the result was pulp exposure and the development of
caries in the pulp chamber.
Anterior tooth relntionships mtd lip balance in attritioml occlusion. Stone
Age man’s deciduous and permanent anterior teeth changed from an initial over-
bite to end-on occlusion. It is wrong to call the four upper and lower anterior
teeth “incisors.” Their function in man’s properly developed dentition is not to
incise food. Only carnivores use their anterior teeth, especially the canines, for
this purpose. Their anterior teeth remain sharp. This retention of an anterior
overbite throughout life by civilized man holds the six upper anterior teeth t,oo
procumbent and the lower anterior teeth too recumbent. In these positions the
bone over the labial surfaces of the upper anterior teeth is often too thin for
adequate support.
The attritional loss, in both the deciduous and permanent dentitions, of
Stone Age man‘s anterior overbite, together with the wearing away of the cusps
of all of his teeth, freed the lower dental arch from the upper, permitting it to
move anteriorly. The whole mandible was also free to move in relation to the
maxilla. This often resulted in a Class III (Angle) occlusion of the teeth which,
in civilized man, is regarded as malocclusion but which is actually the proper
evolutionary occlusion for man. With this change in anteroposterior relationships
of Stone Age man’s teeth and jaws, the upper and lower anterior teeth formed
arcs of equal size as they assumed an end-on occlusion.
Fig. 17 portrays the relationships of the lips and upper and lower anterior
teeth in Stone Age man. The assumption of an end-on occlusion of the anterior
 Differential force method 23

teeth resulted in the lower lips pressing directly against both the upper and the
lower anterior teeth. Therefore, the upper anterior teeth retained their correct
axial relations and the lower anterior teeth experienced far less crowding than
civilized man’s Of course, continual proximal attrition and mesial migration also
contributed to the low incidence of dental caries and anterior tooth irregularity
in Stone Age man.
Fig. 18 portrays the abnormal relationships of the lips and the anterior teeth
in civilized man.
Civilized man’s lower lip presses against the upper anterior teeth which, in
turn, press against the lower teeth. The lower anterior teeth, being pressed in a
lingual direction by both the lower lip and the upper teeth, are therefore held
upright. The tips of the overbiting upper anterior teeth abnormally intervene
between the lower lip and the lower anterior teeth. This abnormal occlusion is
conducive to crowding of the lower anterior teeth. Of course, the absence of
interproximal attrition in civilized man’s teeth increases the force which con-
tributes to lower anterior tooth crowding.
It ceases to be a mystery to those who have studied Stone Age tooth attrition
why so many people have overlapping lower anterior teeth and why this situation
increases in severity with age. Research projects to determine the correct amount
of anterior overbite can arrive at no valid conclusions, because the retention of
an overbite throughout life is, in itself, an abnormality.
Much attention has been given to what constitutes the correct curve of Spee
in the lower dental arch and the less pronounced compensating curve in the
upper dental arch. In attritional occlusion and the absence of an anterior over-
bite, there is no difference between these anteroposterior curves in the dental
arches. This is one example of the many mistakes that have been made and are
still being made because of the acceptance of civilized man’s nonattritional oc-
clusion as correct for man.
;l1alocclusion in Stone &e man. Malocclusions and jam deformities in Stone
Age man were not entirely eliminated by natural selection because his dental
apparatus did not have to be as efficient as that of Stone Age man’s prehominid
and prearboreal forebears. His hands and brains had usurped many of the func-
tions of his teeth and jaws.
Stone Age man had Angle Class I, Class II, and Class III malocclusions with
their associated jaw deformities, but their incidence was lower than in civilized
man, This lower incidence of malocclusion in Stone Age man was, of course, due
to attritional reduction of dental arch lengths, cusps, and anterior overbites-and
the requirement of an efficient dentition to survive.
There were also some Stone Age individuals whose teeth were so relatively
large that extensive attrition did not eliminate tooth crowding.

Simulation of the Stone Age dentition in the differential force method of

orthodontic treatment

In the differential force method Stone Age man’s end-on occlusion is simulated
in the treatment of Class I and Class II malocclusions (which comprise approxi-
mately 95 per cent of all malocclusions). The overerupted upper and lower an-
Fig. 19A. Facial photographs of the patient taken before treatment (top) and after treat-
ment (bottom). Note improved lip balance after treatment.

terior teeth are depressed into their sockets, thus giving them an edge-to-edge
bite. These end-on relations are held until removal of the appliances. We do this
depressing of upper and lower anterior teeth because the pretreatment deep an-
terior overbite in civilized man is caused by overeruption and bypassing of his
unworn upper and lower anterior teeth. The records of the treatment of a pa-
tient who originally had a deep anterior overbite are shown in Figs. 19A to 19C.
During treatment, attritional occlusion was simulated (as nearly as possible with-
out actually attriting the teeth), at the completion of Stage 1.
The retention by civilized man of deep anterior overbite and the persistence
throughout life of deep interlocking tooth cusps prevent the wide lateral mastica-
tory excursions of the mandible that occur in Stone Age man. In support of this,
it is found that in the skulls of Australian aborigines with attritional occlusion:
the glenoid fossae are flattcncd, large, and shallow (Fig. 20). However, in
aborigines who live on civilized man’s food, the heads of the condyles are smaller,
deeper, and not so flat and the glenoid fossae are smaller and hollowed or cupped
out instead of being shallow.
Also, in Class I and Class II malocclusions, the mandible is often repositioned
Fig. 19, 6 to D. B, Right side and front views of models of the original Class II, Division
2 malocclusion. Note the more than 100 per cent anterior overbite. The lower left second
premolar was congenitally absent. Both lower second deciduous molars were extracted
prior to treatment, as well as the lower right first premolar and the upper right and left
first premolars. C, Cast made at the completion of Stages 2 and 3, which occurred
simultaneously in this patient. This is often the situation in cases that have extreme
overbites or overjets or do not require a reduction in tooth mass. Note that the anterior
teeth have been brought edge to edge, and the molar occlusion is an overcorrected
Class I. With this technique, all occlusions are essentially the same at the beginning of
Stage 3, which greatly simplifies treatment procedures. D, Cast made at the completion
of treatment. Axial inclinations of all teeth have been corrected by auxiliaries applied
at the beginning of Stage 3. Heavy (0.020 inch, 0.508 mm.) arch wires merely act as
retainers while teeth are uprighted by auxiliaries.

mesially during treatment. As far as can be ascertained radiographically, in the

region of the head of the condgle and the glenoid fossa, the mandible is moved
into and held in almost Class III relations. The glenoid fossae are gradually
molded farther forward during treatment. Remolding farther forward of the
teniporomaIlclil)ular joints occurs durin, w treatment of Class I and Class II condi-
tions because, with the differential force method, Class II elastics are worn almost
continually from start to finish of treatment.
il research project by a graduate orthodontic student is reportedI? in the
AMERICXX ,JOURNM, OF ORTHODONTICS (November, 1971) to have demonstrated
on a macaque monkey that Class II intrrmasillarp elastic force brought about
forward repositioning of the heads of the mandibular condyles.
Maintaining both the end-on occlusion of the anterior teeth and the forward
position of the mandible during treatment of Class I and Class II malocclusions
contributes greatly to the posttreatment, stability obtained by this treatment
method. This is because the upper and lower jaws arc being allowed to occup,~
Fig. 19, E to G. E, Occlusal views of the dental arches prior to treatment. Lower right first
and second premolars are unerupted; lower left second premolar is congenitally absent.
F, Casts made at the end of Stages 1 and 2. The upper central incisors are more upright.
This can be appeciated by comparing with E, in which a greater portion of their labial
surfaces is visible from the occlusal. G, Arch form and alignment of teeth after treat-
ment. Degree of torque on upper central incisors can be appreciated by comparing view of
lingual surfaces with view of labial surfaces in E.

the anteroposterior relations which havr been normal for man for millions of
years, as compared to relations they have occupied for no more than a few thous-
and years.
&terior ovcrbitc corrcctiw~ ([MI retention. After treatment the anterior teeth
return to overbite relations t,hat arc considered normal and, indeed, the best pos-
sible with unworn teeth. Eiowerer, the over-all retention of the total overbite
correction is excellent. The reasons for this are fourfold :
1. The lower jaw and teeth arc overcorrected and held throughout treat-
ment in almost Class III interarch relationships in both Class I and
and Class II malocclusions. This helps ensure proper anteroposterior
relations of the anterior teeth after the appliances have been remored.
2. Anterior overbites are corrected mainly by depressing upper and lower
anterior teeth with arch wire forcvs, not by using hitc plates to permit
temporary orercruption of posterior teeth.
3. The crowns of the upper and lower teeth are placed in positions of
balance between the lips and the tongue.
1. ‘l!he axial inclinations of the anterior teeth a.re brought to angulations
of “overcorrtdon” to eliminate any detrimental effects of the slight
“settling” that always acvompanics the removtil of fixed appliances.
Fig. 21 portrays treatment, with the differential force method of a scvcre
Class II, Division 1 malocclusion. When the original malocclusion is a severe
 Differential force method 27

Fig. 20. Temporomandibular joint of an Australian aborigine whose teeth exhibited ex-
tensive attrition. The mode of function, which included wide anteroposterior and lateral
masticatory excursions of the mandible, caused this joint to flatten. This is evidence
that the forces of function largely influence the shape and size of temporomandibular
joints. In view of this, it is reasonable to consider that continual wearing of Class II
elastics likewise determines the positions and shapes of temporomandibular joints.

Class III or an open-bite, the anterior teeth are moved to relatively deep overbite
relations to assist in posttreatment retention.
Posttreatment stability. A unique characteristic of this treatment is that, from
the very beginning, each t,ooth is moved toward its final position. This reduces
treatment time and greatly enhances posttreatment stability. All tooth movements
are purposely overdone and held in positions of overcorrection throughout treat-
ment. When the appliances are removed, any tendency for relapse will be toward
the ideal and in harmony with any corrections being attempted by a retainer or
tooth positioner.
Prior to treatment, the amounts of tooth attrition and mesial migration that
occurred in Stone Age man must be visualized. With this in mind, the diagnosis
of each case will be proper, to ensure that posttreatment mesial migration will
not cause tooth crowding.
Even today, some orthodontists first treat “borderline” extraction malocclu-
sions without prior reduction of tooth substance. They do not make allowance for
the process of mesial migration in the absence of tooth attrition causing con-
tinually increasing crowding of the teeth with the passage of time. Then, after
relapse, they have the four first premolars extracted and start treatment again.
Proper study of Stone Age man’s dentition could prevent this mistake.
Misconceptions about this and other techniques

Fallacy of combining techniques. In order to treat patients properly with this

technique, it is absolutely necessary to employ the proper attachments to achieve
the desired tooth movements throughout all three stages of treatment. Treatment
will not progress properly, and results will be substandard, if brackets are used
that prevent free tipping in all directions in Stages 1 and 2 and that transmit
root-moving forces to adjacent teeth during Stage 3. At the present time the best
 Am. J. Orthocl.
,Jnnunry 1977

Fig. 21. Class II, Division 1 malocclusion with pronounced excess of tooth substance. The
four first premolars were extracted just prior to appliance therapy. Treatment time was
16 months. The lengths of the clinical crowns became greater as the patient grew older,
as shown in the final photograph, and is evidence of continual tooth eruption.

bracket for this technique is the modified ribbon arch type (Fig. 22). Edgewise
brackets are among those least suited for this light wire technique. At the present
time some orthodontists who are using light round arch wires in edgewise brackets
claim to be using a “light round edgewise technique.” This is an impossibility,
because the arch wires which they USC,being round, have no edges. This miscon-
ception has occurred because the original tic bracket invented by Edward H.
Angle has gradually become known as the “edgewise bracket.”
Angle placed his “tiny” ribbon arch wire on its “edge” so that it could be in-
serted into the tic brackets from the labial or buccal, rather than from the incisal
or occlusal as was the csasewith the ribbon arch brackets. The original greater
vertical dimension of the ribbon arch wire (0.028 inch) became the horizontal
dimension of the new edgewise arch wire.
Tic brackets prevent free tipping of tooth crowns (even when round arch
wires arc cmployxl) , because they have relatively long mesiodistal dimensions.
Therefore, even when small round wirrs arc used, all the teeth tend to receive the
same amount of Corcc. k’rect tipping in all directions (which is required for all
teeth except anchor molars) is impossible. This prolongs treatment, causes a loss
of intraoral anchorage, often making extraoral anchorage necessary, and reduces
the efficiency of this method to such a degree that the over-all quality of treatment
is lowered.
 Diaerentinl force method 29

Fig. 22. A, Modified ribbon arch bracket (TP 256-500) designed specifically for this tech-
nique. It accepts 0.016 inch (0.406 mm.) or 0.020 inch (0.508 mm.) arch wires and all
the various auxiliaries for individual tooth movement described in this article. B, Safety
lock pin with beveled underside of head, for maximum tipping during Stage 1. C, Safety
lock pin designed to work in conjunction with 0.018 or 0.020 inch (0.457 or 0.508 mm.)
arch wires during Stage 2. D, Third-stage lock pin used whenever teeth do not require
mesiodistal uprighting.

Fig. 23. A, When

main
teeth.
and causes
technique,
arch wire,
Not only
T
unnecessary
one or more
0A
root-moving
undesired
is the pressure
and/or

periodontal
teeth
forces

transmitted
are generated
inappropriate

changes
can be uprighted
to the
and
lateral
patient
and delivered
forces

mesiodistally
are often
incisor
discomfort.
by deflection
applied
excessive,

or torqued
of the
to adjacant
it is undesired
8, In the light
labiolingually
wire

without the application of tooth-moving pressures to adjacent teeth. This ability to apply
the desired amount of force to each tooth, independent of its neighbors, is one of the
reasons why the Begg technique is the most precise orthodontic technique.

Tie brackets also make it impossible to control the application of tooth-moving

forces on adjacent teeth (Fig, 23). When modified ribbon arch brackets are used,
each tooth can receive the desired amount and direction of force and is free to
move independently from its neighbor.
From the foregoing, it should be clear that it is even more difficult to attempt
this light mire technique with tie brackets than it is to attempt the edgewise tech-
nique with round arch wire. Some orthodontists have actually condemned the
differential force method after having failed to obtain good treatment results by
merely using light round arch mires with tie brackets. The conclusion they should
have reached is that one cannot USC the edgewise technique without employing
edgewise arch wires.
 AWL. J. O&hod.
30 Begg and Keslillg January 1977

Fig. 24. Individual root-tipping spring-pins in place at the beginning of Stage 3. Springs
are wound from wires of different diameters to deliver varying amounts of force related
to requirements of individual teeth. Force values are given to show variety possible
and are not necessarily those recommended for each tooth. Note third-stage lock pins
in place on central incisors to prevent undesired free tipping.

“The lewd tril)“-l!‘)l?r~crrrrrlzled lr&*erse crificism. The differential force meth-

od has been criticized because upper and lower anterior teeth arc taken on the
round trip-tipping the crowns of the teeth lingually and later torquing their
roots distally. The critics of this procedure assume that harm is done to the roots
of the teeth by this procedure. There is no evidence to support this assumption.
In fact, less force is escrtcd on the teeth by moving them back in this manner
than is required if they are moved bodily. Also, teeth move more rapidly when
they are first tipped and then uprightcd.
Actually, the edgewise technique can take teeth on a greater “round trip”
than is done with the differential force method. For example, anchorage prepara-
tion in the edgewise technique often requires the USCof Class III intermaxillary
elastics in order to help the tip-back bends tip t,he crowns of all lower anterior
and posterior teeth posteriorly. Fnrthcrmorc, during this edgewise anchorage
preparation, headgear is used to restrain all of the teeth of the upper dental arch
from being moved forward by the force exerted by the heavy Class III inter-
maxillary elastics.
Extraoral forces are also used in the edgewise techniqut to move the maxillary
posterior teeth distally in the correction of many nonextraction Class II maloccln-
sions. IIowcver, because mesial migration is the natural mode of movement for
the human dentition, it is not surprising that malocclusions treated in this manner
often tend to rclapsc when the extraoral force is removed.
Relative disproportionnte of tooth root-moving
rr~~~~liccxtio~~~ forces by edgewise
arch wire. When the edgewise technique is used, the arch wires, the brackets, and
the molar tubes arc rectangular so that, all CJf the teeth in each dental arch arc
tightly fettered together. They hccomc WC single, rigid unit. When the edgewise
arch wire is utilized to upright teeth mesiodistally or torque them labiolingually,
the smaller-rooted anterior teoth receive the greatest amount of force. Conversely,
the large molar teeth on the extrcmc ends of an edgewise arch wire receive the
lightest torque forces, and these forces remain active through greater ranges of
movement.
An occlusion best suited to the root-moving forces delivered by the edgcwisc
mechanism would br one in which the larger-rooted anchor molars were in the
 Diferential force method 31

Fig. 25. Treatment of a severe Class II, Division 2 malocclusion. The four first premolars
were extracted 3 weeks before placing appliances. This type of malocclusion was
previously regarded as the most difficult to treat, and relapse was common. The introduc-
tion of the light wire differential force method has made it simple to treat because of
the ease with which deep anterior overbites are corrected and root torque over great
distances is accomplished.

midline and the smaller-rooted incisors at the distal ends of the dental arch. Of
course, it is ridiculous to suggest such a. drastic rearrangement of man’s teeth so
that the forces generated by an orthodontic appliance are properly distributed.
Fig. 24 depicts the manner by which root-moving forces are related to the re-
quirements of each individual tooth in the light wire technique.
Furthermore, since each tooth has its own periodontal membrane, it is ca-
pable of a rate and degree of movement independent of its neighbors and antago-
nists. This is another reason for not holding the teeth in each dental arch rigidly
together as a single unit.
Reflecting on the above, it is not surprising that it is necessary to use extra-
oral force to control tooth movements with the edgewise technique. It is also un-
derstandable why many “edgewise men” have begun to use round wire. Of course,
as was mentioned before, without rectangular wire there is no edgewise tech-
nique-and the tie bracket has nothing to offer the operator, except perhaps
familiarity and an unwarranted sense of security.
Correction of severe anteroposterior dental and interarch relationships

The dental arches can be moved anteriorly or posteriorly in the jaws, ac-
cording to the requirements of each individual case. Under some circumstances
one dental arch, either upper or lower, can be moved anteriorly while the opposite
 Am. J. Orthod.
Jamuarll 1977

dental arch is moved posteriorly in the jaw. This is brought about by utilizing ap-
propriate variations in tooth-moving force values, as well as by changing the di-
rections in which the forces are applied.
Obviously, severe Class II conditions such as those shown in Fig. 25 cannot
be completely corrected by merely moving the anterior teeth back through boric.
If this were attempted, the apices of the roots of these teeth would hart to ht‘
mored 14 or 15 mm. posteriorly. Such great changes in the bodily positions of
upper anterior teeth are impractical and unnecessary, if not impossible.
If tho mandible itself (including the C(Jndykir heads) were not brought JOY-
ward in the treatment of severe Class II malocclusions, the lower anterior teeth
would be moved so far forward that their roots would be denuded of their perio-
dontal tissues. In short, the lower anterior teeth would be extracted by being
moved out through the labial cortical plate of bone before their crowns could
occlude with the upper anterior teeth, if t,he mandible were not repositioned.
It is obvious, then, that the successful treatment of a severe Class II, IXvision
1 malocclusion (as shown in Fig. 26) is the result of moving the upper dental
arch posteriorly and the lower dental arch and mandible anteriorly.
In order to accomplish permanent anterior repositioning of the mandible by
orthodontic treatment, it is necessary to wear Class TI intermaxillary elastics
through almost the entire period of treatment. The correction must be made at
the beginning of trratmcnt atltl maintainrtl to permit remotlcling of articnlar sur-
faces and adaptat,ion of muscles and their attachments. If headgear treatment
replaces, q)r appears t,o rcducc, the need for Class II elastics tluring treatment,
the desired permanent forward movement of the mandiblr will be lost. Of c?ourse,
the use of Class III elastics for anc~horagv preparation or in an attempt, to correct
a midline dental discrc~pancy will also prthvcxnt this desirctl pcrmancnt, mandibular
repositioning.
The pulling forward, by means of rc’vttrsc headgear, 01’ tlcntal arches with
well-occluding small t,ectti in persons who have prominent chin points and noses
and tight thin lips is incorrect and prone to relapse. These patients have prob-
lems which might better be solved by plastic surgeons. This apparent backward
position of the dental arches, although displeasing to those who like full lips, is
correct for the patients. When their dental arches arc pulled forward in the jaws
by reverse headgear, the IalGal surfaces of the roots of their anterior tvt)th ma>
bccomr denuded of tooth-sul)l)ortilig tissues.
Failure to reduce t,hcxappropriate amount of tooth substance in both dental
arches lcads to posttrcatmcnt relapse. Nonextrac*tion treatment as taught by Angle
resulted in a far higher incidcncc of relapse and impaction of third permanent
molars t,han occurs in paticxnts totlay \vho ha\r pretreatment removal of a suffi-
cient amount of tooth substance. The avoiclancc, tlven today, of prctreatmcnt tooth
reduction by sonic orthodontists because a full-mouthed appearance is consideretl
to be attractivr is the cause of many relapses.

Ideal sequence of force values delivered by fully activated light arch wires
and auxiliaries

It is imperative to use the best quality of arch wire material produced by

Arthur .J. Wilcock. This light arch wire, being very resilient, moves tee01 over
 Differenfial force method 33

Fig. 26. Treatment of a Class II, Division 1 malocclusion with severe bimaxillary protrusion
and marked excess of tooth substance relative to jaw size. This is a mutilation maloc-
clusion because the upper right and left second premolars had been extracted years before
this patient presented for treatment. Note that the upper first permanent molars were
in proximal contact with the upper first premolars. Just prior to appliance therapy the
two upper first permanent molars and the two lower first premolars were extracted.
Treatment time was 17 months. Only five arch wires (three upper and two lower) were
used during treatment. The two upper third molars erupted into normal occlusion after
completion of active appliance therapy.

long distances without having to be frequently reshaped for continued activation.

If Mr. Wilcock had not persevered until he produced arch wire with the neces-
sary properties, this treatment method could not have been evolved.
When first applied, arch wires and auxiliaries deliver their maximal forces
and, as the teeth move, these forces gradually decrease. Fortunately, this
sequence of force value application is ideal for maximum rates of tooth move-
ment.
Frequent reshaping of arch wires is detrimental because it causes minute
changes in the directions of force, which reduce the rate at which the teeth more.
Rectangular arch wires must, because of their rigidity, be frequently reacti-
vated during treatment. Therefore, when first changing to the differential force
method, operators must discard their habits of seeing the patients every 3 or 4
weeks for adjustments. Not being familiar with the appearance of teeth as they
respond to the initial arch wires, they may be tempted to reactivate them. Of
 Am. J. Ovthod.
Jan.uary1977

Fig. 27. Treatment of a patient with Class II, Division 1 malocclusion. The four first pre-
molars were extracted. The same upper and lower arch wires of 0.016 inch (0.406 mm.)
diameter were used throughout treatment without once being removed from the mouth.
Active treatment time was just under 10 months. For further explanation, see text.

course, if an arch wire becomes distorted, it is imperative to correct it as soon

as possible because tooth movements are so ra.pid that such distortions could
rapidly move teeth far from their correct paths, Normally, appointments with
this method are at intervals of 6 weeks.
Fig. 27 portrays treatment of a patient with a Class II, Division 1 maloc-
clusion. The four first premolars were extracted 3 weeks before the start of ap-
pliance therapy. The same upper and lower arch wires of 0.016 inch (0.406 mm.)
diameter were used throughout treatment without once being removed from the
mouth. Two adjustments vvcre made durin, 0‘ treatment-first, to place the arch
wires in the slots of the brackets of the four second premolars after the extraction
spaces were closed and, second, to place uprighting springs and torquing auxil-
iaries at the beginning of the final stage of treatment. The distal free ends of the
arch wires were kept cinched tightly against the molar tubes to prevent rc-
opening of extraction spaces during the final stage. Treatment time was under
10 months. When the most powerful canine root-tipping springs made from 0.018
inch (0.457 mm.) Australian wire are used, canine roots can be tipped back even
farther and more rapidly than was done for this patient.
The benefits of placing fully activated arch wires and auxiliaries are mani-
fold :
 Differential force method 35

Fig. 28. Drawings of fully activated 0.016 inch (0.406 mm.) arch wires actually used to
begin treatment of the Class II, Division 1 extraction case (A) and the Class II, Division 2
nonextraction case (8) shown. The amount of bite opening or anchor bends in the arch
wires can be appreciated by noting where the anterior portions of the arch wires rest on
the models at the left. Casts in the center show the arch wires engaged in the anterior
brackets. Casts at the right show the results of treatment for each case.

1. The rates of tooth movement are increased.

2. Reciprocal forces are caused to become more efficient.
3. Variations in both the values and directions of tooth-moving forces
(changes which retard tooth movement and are inevitable whenever
appliances are reactivated) are eliminated.
4. Chairside time is reduced.
5. The number of appointments required throughout treatment is re-
duced.
6. The over-all treatment time is greatly reduced.
The initial arch wires made from Wilcock stainless steel wire for two maloc-
clusions are portrayed in Fig. 28. They are so resilient that, when properly acti-
vated, they can deliver the proper tooth-moving forces for up to 3 months without
being reactivated.
 Am. J. Orthod.
36 Begg cmd Keslillg JamuarU 19 7 7

The forces exerted by these arch wires are proportionate to the requirements
of each individual tooth. They cause far less discomfort to patients than the
forces from rigid rectangular arch wires which have to be frequently reactivated
throughout treatment. Also, the fact that these highly resilient wires can deliver
the desired forces over a great range of tooth movement eliminates the need for
frequent adjustments. This also adds greatly to the patient’s comfort.
In this method, arch wires and tooth-moving auxiliaries still have tooth-
moving forces in them at the completion of treatment. Therefore, the appliances
must be removed before too much ovcrmovement occurs.

Attritional occlusion-The key to future advances in dentistry

Textbook normal occlusion is erroneously accepted as the foundation, the

starting point, the basis, the one grand object of dentistry as a whole. Because of
this, advances in many branches of dentistry, including orthodontics, have been
retarded or misdirected.
The refined soft food of civilized man is accelerating the rate of evolutionary
reduction and degeneration of his teeth because the teeth now have a lower sur-
vival value than in Stone Age man. It is hard to imagine that the whole method
of modern food production will be modified in order to promote dental and perio-
dontal health.
Some day, as a partial solution to this problem, orthodontists ma.y augment
their mechanotherapy with some form of equilibration and continual reduction
of tooth substance.
This could be accomplished by mechanical stripping and grinding at regular
intervals carefully related to each patient’s rates of eruption and mesial migra-
tion. Patients could bc instructed to use chewing gum containing varying
amounts of tough roughage and carborundum dust to wear away cusps and
proximal surfaces.
If civilized man’s teeth were subject to such controlled attrition, orthodontists
would not have the problem of orthodontic extraction spaces sometimes remaining
slightly open after treatment. There would be no intcrdigitating tooth CUSPS to
interfere with closure of these sma.11spaces by the hereditary process of mrsial
migration.
Tears ago a dentist reported that he gave a patient chewing gum with a
gritty substance incorporated into it in order to equilibrate his teeth. The pa-
tient’s occlusion began to improve, but this treatment was quickly discontinued as
soon as interproximal attrition was observed. The dentist feared that loss of onc-
point proximal contacts would, according to G. V. Black’s teaching, be harmful.
The roots of civilized man’s teeth cannot migrate closer together because their
crowns do not become narrower mesiodistally. This prevents the fibers of the
periodontal membranes from becoming shorter with increasing age, as occurs
naturally in Stone Age man. Therefore, the transseptal fibers of the periodontal
membrane in civilized man are subjected to ever-increasing and presumably de-
structive stretching forces. Periodontists who complain that artificial reduction
of the widths of teeth causes harmful compression of periodontal membranes and
their fibers need to study Stone Age dentitions.
Volunae 71
Nwmber 1 Diflerentinl force method 37

CIVILIZED PRIMITIVE MAN

A m:,escel,m ’

A A

m 4 n ‘Maturity

A~AECC
A n A&

Fig. 29. Diagrammatic comparison* of the changes at different ages of the teeth and
gingiva of primitive man and civilized man to show how primitive man remained free
from periodontal disease. Friction from his crude food kept the gingival trough (A to B)
too shallow to harbor bacteria. The interproximal space was kept small by interproximal
attrition. The triangles represent the relative sizes, at different ages, of the interproximal
space. A, Free gingival margin. B, Level of soft-tissue attachment to tooth. C, Interproximal
gingival papilla. A to B, Height of gingival trough. (From Begg, P. R.: Am. J. Orthod.
Oral Surg., October, 1945.)

Civilized man’s dentition is pathogenic. It contracts diseases, dental caries,

and periodontitis in the stagnation regions protected by plaque. The sites of these
stagnation regions (namely, proximal surfaces and occlusal pits and fissures)
were pointed out by G. V. Black.
Because of their lack of knowledge of Stone Age attritional occlusion, univer..
sity dental research workers are not aware that plaque formation is caused by the
absence of abrasive and cleansing properties in civilized man’s food. When they
realize this true cause of plaque, it should be useful to them in discovering means
to prevent both dental caries and periodontal disease.
In Stone Age man proximal attrition wore away the contact points of his
teeth and turned them into flat, continually enlarging contact surfaces. The pro-
cess of mesial migration kept his teeth in proximal contact as their mesiodistal
widths were being continually reduced. Consequently, the interdental space re-
mained small and frequently became smaller as the teeth continually erupted.
In civilized man the triangular interproximal space, as portrayed in Fig. 29,
becomes gradually larger with age in the absence of tooth attrition. The apex of
this space is the point of contact of the neighboring teeth, and the walls of the
neighboring teeth comprise the two sides. The base is defined by the transseptal
fibers.
This pyramidical interproximal space continually enlarges in civilized man
as the teeth erupt and the transseptal fibers move toward the necks of the teeth.
The interdental papilla continues to proliferate ; however, the space finally be-
comes so large that the papilla can no longer fill it.
This unnatural interdental space in civilized man, continually increasing in
 Am. J. Orthod.
January 1977

size, is a stagnation region where plaque forms and is protected from dislodgmcnt
by sheltering of the walls of the teeth and the papilla.
Reduction of the mesiodistal widths of adults’ teeth can eliminate existing
interproximal periodontitis. Simultaneously, small areas of recurrent dental
caries at the gingival margins of proximal fillings are eliminated. Mention of
this ability to prevent caries and periodontal disease by simulating tooth attrition
has been made here to draw to the attention of the dental profession as a whole
the fact that advances can and must be made in other branches of dentistry
through the application of knowledge gained from studying Stone Age attrition.
For instance, proximal fillings should have flat contact surfaces. Original tooth
widths should not be increased by restorations, as this may cause periodontitis,
interproximal caries, and increased tooth crowding.
Fixed bridgework is limited in the number of years of service because its
mesiodistal length is not continually reduced and the abutment teeth cannot
migrate mesially at different rates. Normally the posterior teeth must migrate
farther and, therefore, travel at a greater rate than the anterior teeth. Also, be-
cause of continual tooth eruption, the entire bridge moves occlusally and the abut-
ment teeth develop unfavorable clinical crown/root ratios. This results in reduced
alveolar support and the teeth become more susceptible to occlusal and lateral
stresses. Therefore, the abutment, teet,h become mobile and the bridge, as well as
the supporting teeth, must be removed to avoid accelerated alveolar loss from
periodontal disease and ultimate exfoliation.
Simulation of attritional occlusion’s relatively flat occlusal plant and cdge-to-
edge anterior tooth relationships would add greatly to complete denture stability.
Flat occlusal surfaces with relatively sharp edges have long ago proved to be the
most efficient masticatory apparatus.
Unworn cusps and fossae have no more place in artificial dentures than they
do in the natural adult dentition. The lateral forces created by cusps are un-
necessary and may actually bc a contributing cause of denture instability.
A recent article’” indicates that progressive minds in other branches of den-
tistry are beginning to examine attrit,ional occlusion as a guide to both diagnosis
and treatment planning. Drs. H. 3. Cooperman and 8. B. Willard studied the at-
tritional planes of occlusion of Eskimos, Australian aborigines, Mexican Indians,
Zulus, and Europeans. They noted the reduction in the curve of Spee, the absence
of cusps, the loss of incisal edges and anterior overbite, and the forward position
of the mandible. On the basis of this study, they have outlined a method to de-
termine the correct (attritional) occlusal plane for each patient from landmarks
on an upper model. They believe that the use of this plane can aid in diagnosis,
increase stability, and simplify denture construction and oral reconstruction.

Summary

Knowing how to execute differential force treatment with the proper ap-
pliances gives the orthodontist a great advantage, and treatment of any type of
malocclusion, including mutilated cases and those not requiring reduction of tooth
substance, becomes simple.
In order to derive such benefits from the differential force technique, one
Volume 71
Number 1 Differentin force method 39

must use it exclusively and not attempt the simultaneous use of other methods,
which leads to confusion in both diagnosis and appliance design. It is absolutely
necessary to use the cold-drawn, heat-treated, highly resilient wire as produced
especially for this method by A. J. Wilcock of Australia. Failures are caused by
the use of other wire.
The knowledge gained from the study of Stone Age attritional occlusion must
be applied as much as is possible during orthodontic treatment. It will affect the
diagnosis, amount and method of tooth mass reduction (if indicated), and final
positions of teeth for maximum stability and esthetics. To date the differential
force method is the only orthodontic technique that was developed to fit the true
biologic requirements of man.
The practice of the other branches of dentistry must also be related as nearly
as possible to the principles found in the natural evolutionary development of
man’s dentition, as found in his Stone Age attritional occlusion. To date we have,
in orthodontics, the light wire differential force treat,ment method which is in
accordance with this principle. The future must bring similar changes in many
other branches of dentistry and, it is hoped, even more in orthodontics.
REFERENCES
1. Begg, P. R.: Progress report of observations on attrition of the teeth in its relation to
pyorrhea and tooth decay, Aust. 5. Dent. 42: 3X-320, 1938.
2. Begg, P. R.: Stone Age man’s dentition, AM. J. ORTHOD. 40: 298-312, 373-383, 462-475,
517-531, 1954.
3. Begg, P. R.: Differential force in orthodontic treatment, AM. J. ORTHOD. 42: 481-510, 1956.
4. Kesling, H. D.: Have recent technical advances in orthodontics made possible successful
treatment for more people8 Dent. Clin. North Am., pp. 821-829, November, 1960. W. B.
Saunders Company, Philadelphia.
5. Begg, P. R.: Light arch wire technique, AM. J. ORTHOD. 47: 30-48, 1961.
6. Kesling, P. C. (editor) : Begg J. Orthod. Theory and Treatment, July, 1962; April, 1963;
September, 1964; January, 1968; June, 1969.
7. Begg, P. R., and Kesling, P. C.: Begg Orthodontic Theory and Technique, ed. 1, Phil-
adelphia, 1965, W. B. Saunders Company, pp. 5-51.
8. Begg, P. R., and Kesling, P. C.: Begg Orthodontic Theory and Technique, ed. 2, Phil-
adelphia, 1971, W. B. Saunders Company, pp. l-57.
9. Enoki, K.: Begg light wire technique, Jap. Dent. Rev., pp. l-27, January, 1964.
10. Motohashi, K., Ohno, T., Shimizu, K., Shimoyama, K., Yamamoto, Y., and Ohtsuka, E.:
Eight teeth extraction cases treated wit,h the Begg technique, .J. Jap. Orthod. Sot. 32:
321-343, 1973.
11. Begg, P. R.: Some aspects of the etiology of malocclusion of the teeth, unpublished thesis
presented by P. R. Begg to University of Adelaide, 1935.
12. Payne, G. S.: The effect of intermaxillary elastic force on the temporomandibular articula-
tion in the growing macaque monkey, Am J. ORTHOD. 60: 491-504, 1971.
13. Cooperman, H. N.: HIP plane of occlusion in oral diagnosis, Dent. Survey 51: 60, 62, 1975.

Dr. Begg: North Terrace (5000)

Dr. Kesling: Orthodontic Center (46391)