Modern Begg - The Kamedanized Begg Technique

Kamedanized Begg Technique One of the modern Begg technique

Developed by Dr. Akira Kameda. He started Begg Practice in 1966. Initially he encountered
failures but he started improving the Tech. from 1972

Drawbacks or Incomplete Parts of Orig. Begg Tech.

No secure diagnosis
Unnecessary & over tipping of all teeth including anchor molars
Collapse of arch form
Rotation & mesial tipping of 2nd PM during stage II
Complicated & unstable Stage III
Gummy face due to clockwise rotation of occlusal plane

Diagnosis
Treatment Goal of maxillary protrusion - computed in 1981 from average mean of 400 treated
cases of maxillary protrusion.
Treatment Goal of mandibular protrusion - calculated in 1982 from average mean of 900 treated
cases of mandibular protrusion.
Class III
Class I & II (Sn-Md < 40º)
(Sn-Md < 40º)
U1- Sn 100º
Treatment U1- L1 130º-
U1- Sn 97º Goals
U1- L1 136º 140 º
L1- Md 90º L1- Md 85º
ANB ≤ 4º

If Sn- Md > 40º treatment goal  reducing the exceeded amount of Sn-Md with in the limits of
U1 – Sn 10º & L1 – Md 10º

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Cephalogram corrections obtained separately
-As the movement distance of L & U inc. are reproduced on model at 0.9 times on a search for
available space for U & L.
-Arch length discrepancy (ALD) of U & L is to be separately computed from discrepancy
between available space & req. space.

Criteria of selection of extraction site by ALD in conjunction with cephlometric correction

0 mm
Non extn.

-3 mm
2nd PM extn.

-6 mm

1st or 2nd PM extn

-9 mm
1st PM extn.

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Judging criteria on occasion of ALD between 6mm – 9mm

Selection of extn. site

ALD Anchorage Soft tissue

Growth Organized
value tendency
analysis occlusion

More concretely speaking

Treatment is for child or adult
High or low angle case

Expected extruding volume of I.M elastics & AB

]
Size of ANB, Growth dir. of mandible

Degree of transformable state of maxillary alveolar process

To consider drawback of 1st PM extraction  dished-in appearance

Dual bite due to lack of growth of mandible & excessive use of class II elastics

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Special attention paid to occlusion organized by treatment with extraction of teeth
In 1st PM extraction Case – ht. of contact points between 3 & 5 become diff. (proximal contact
relation inferior)

In 2nd PM extraction Case – ht. of contact points between 4 & 6 become diff. (proximal contact
relation inferior) & 1st PM trigger off a DB rotation after orthodontic treatment

Distal of 3, M of 5 stripped off in- In 1st PM extraction Case

Distal of 4, M of 6 stripped off in- In 2nd PM extraction Case

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Characteristics of technique

KB tooth movement
Most Malocclusions- Labiolingual alignment problems
Mesiodistal axial inclination problems constitute minor part.

So to carry out orthodontic treatment

Mesiodistal tipping X
Lab. Ling movement 

To control necessary mesiodistal tipping

Principle of horizontal bar’s tooth movement from stage I (1981)
Co-Ax wire or sectional 0.010” supreme wire used in conjunction with main arch wire, locking 2
arch wires with safety T-pins.

Single wire with 90º T-pin.

Prevent mesiodistal tipping, but permit labiolingual tipping by taking adv. of round wire.

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The mechanical implication- it obviates the need for extensive uprighting in stage III, so less
anchorage loss.

Philosophy of
friction free

Philosophy of
Low friction

Another important diff. is reorganization of discrete stages of pure Begg technique to aim at
making the technique simple, secure & accurate.

Leveling +bite opening Stage I Round wire

Space closure + torquing Stage II Round and/or ribbon arch

uprighting Stage III Ribbon arch wire

Traditional torquing auxiliary is replaced by inbuilt torque/reverse torque brackets with ribbon
arch in stage II. So in stage III uprighting

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 I
K B Technique
II

III

I
II
Conventional Begg III

This arrangement lightens the work load of clinician and excessive demand in patient
cooperation towards the end of treatment.

Brackets (1983)

The classical begg bracket configuration

Class II malocclusion
U - 20º torque brackets
L - 10º reverse torque bracket
Depending on the position of upper lateral incisor non torque, 10º reverse torque or 20º torque
bracket

Upper teeth lower teeth

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Class III malocclusion
L - 20º torque brackets
U - 10º reverse torque bracket (U1-Sn>100º)
Or
Non-torquing brackets (U1-Sn<100º)

Upper
teeth
Lower teeth

Buccal tube (Dec. 1986)

In pure begg tech. round tubes with round wires friction free mechanics
But problems
Anchor molars tends to roll in
Correcting ling. inclined molars diff.
Directing force of anchorage bend is diff. & bite opening efficiency will ↓

The KB tube - oval (ribbon arch type with inside margin rounded)
Lumen diameter 0.028” x 0.0215” and 0.250” long

Vertical slot – uprighting spring to augment anchorage

6º distal offset to prevent distobuccal rotation

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Accordingly
This tube can be used for KB technique
B-l inclination of molars can be corrected or prevented
Extraction spaces are not prevented from closing because of low friction between wire tube
Possible to effciently direct the force of AB & bite opening bends.

Round or ribbon wire

+
K-B type tube

Philosophy of
friction free
Philosophy of
Low friction

Round wire
+
Round tube

Biomechanics of KB technique

Pre Stage I: - twisted ribbon arch wires (0.022” x0.016”) or round wire to
Remove crowding

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 Guide the erupting teeth to occlusal plane
Arch leveling
T pins are used from this point itself.

Stage I
0.016” ESP plain archwire with Co-Ax wire or sectional 0.010” supreme wire & locked safety
T-pins.
This is done for following reasons
Arch form of anterior segment is more favorable with dual wires.
Force of bite opening bends or AB can be easily oriented & bite opening can be speedy &
efficient.
When bite opening is diff. – sectional rect. twist wire can be added to anterior segment to
orient depressing force

Bite opening
To cope with diff. of bite opening- Bite opening bends distal to canine is addition to AB (1982)

Role of bite opening bend Role of anchorage bend

Bite opening for St. anchorage for molar

incisors Bite opening for canines

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 0.016” 0.018”/combination Ribbon

maximum 40º 30º 5º

moderate 30º 20º 3º

minimum 20º 10º 2º

Anchorage Bend

Bite opening bend

0.016” ESP wire upper lower

Maximum bite opening 30º 20º

Moderate bite opening 20º 10º

Ultra light Class II elastic force
Depending on degree of overjet & overbite class II elastics divided into 3 steps called ultra light
elastic force.

No elastic 40-50 g elastics 60-70 g elastics

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Class II div. 1 with large overjet & large overbite
Ultra light (40 – 50 g) for about 2 month at beginning of stage I
Then switch on to normal light (50 – 60 & 60 -70 g)
Apex of upper & lower incisor roots will depressed towards wider sites of trough of cancellous
alveolar bone.
If upper & lower incisor sufficiently depressed to ↓ overbite and then lingual inclination of
incisors including alveolar process, a gummy face will prevented & risk of root resorption will
minimize.

Conv.Begg

KB
Technique

For a start during stage I it is pref. to depress, root apex to wider areas of trough of cancellous
bone (intrusion is high resistance movement compared to palatal tipping of crown) and then
move lingually

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Way to distalizing canine
Not to tip the canine distally during stage I
It is to move canine naturally in distal direction while over bite is being ↓ by bite opening bends.
Bite opening of incisors is conducted with fulcrum of canine, and canine are not allowed to tip
distally

D=I x sin (θ -90º)

Treatment Goal of stage I

-Establishing overjet & overbite close to 2 mm
-Lower incisors positions should be brought to the vicinity of normal value (Md 85º)
-If lower incisors are flared out– horizontal elastics only in mandibular arch.
-Once lower incisors position attained lower arch wire may be changed for combination wire
or .022” x.016” ribbon wire control over l.ower incisors position
-It is also important to conduct stage I longer than usual to
Correction of midline discrepancy
Establishment of class 1 relation of canine

Stage 1 is finished by getting overjet & overbite close to 2 mm, Change .016”wire to .018”&
extend up to 2nd molars after placing the buccal tube

Stage II
Major goals
Torquing of upper and lower incisors roots
The closure of extraction space

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The use of traditional torquing auxiliary replaced by inbuilt torque/reverse torque in the base of
brackets with ribbon arch in st

Why only torque has been built in KB brackets?

Torque control is the weak point of begg bracket as begg bracket are vertically long permitting
easy tipping.
Building in tip also, could strain anchorage need of extra oral anchorage.

Use of torque in stage II is justified by

-Torquing by use of ribbon arch wire & torquing brackets  crown torquing  ↑ overjet 
Bimaxillary protrusion so torquing during space closure mitigate against this undesirable
movement.
-Uprighting the teeth during stage III are more successful once the tooth roots are placed well in
cancellous bone.
-Has a sound biological basis because in pure Begg the simultaneous use of both uprighting &
torquing tooth roots are likely to touch the cortical plate and roots would not upright.

0.018” arch wire with control bar used in stage II

If first control bar & then .018”archwire were inserted into slot and locked with T- pin total
vertical ht.> depth of bracket slot
So locking become insecure & torquing of canine, not effective

Combination wires anterior rectangular (.018” X .026”) & posterior oval (0.018”) – AJ
Wilcock

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Combination wire alpha titanium, it hardens by adsorbing intra oral free H ions titanium
hydride under 37º C and 100% humidity show powerful effect as stabilized wire.

These days instead of 0.026” X 0.018”, 0.022” X 0.018” anterior portion for combination wire to
better securing of T pin and better torque control.

By pass Loop (1986)

-Before extraction space closure & ribbon arch wires are used from stage II, for 3 dimensional
control of 2nd premolars
-This to prevent 2nd PM from subsiding, rotation, from mesially inclining on occasion of
extraction space closure.
-Combination of bypass loop& T pin with a mesial & distal eyelets through which the arch wire
is threaded & 2nd PM is safely bypassed
-2nd PM easily controlled in all dir. when extraction spaces are closed.

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As regards torque & enmass tooth movement of Upper & Lower anterior E - links or
a .010”sectional supreme light wire is inserted into bracket from 3-3 to maintain distance
between 3-3
U& L ribbon arch wire .022” x .016” (.022” x .018” to enhance torque efficiency) locked with
T pins

Use of power pins (have low profile gingival head portion with 15º labial inclination, made of
0.015” s.s) to slipped lingual to the ribbon arch with T-pins, elastics can be hooked without
circular hook

Position of incisal edge can be held by use of horizontal elastics

during stage II during torquing

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E links running from molar button to a lingual button on 3 can also be used to make up for
drawback in slow speed of closing extraction Space during stage II
In this way easier to control molar rotation also.
In KB tech. Tipping amount is very much controlled and small from beginning of
treatment through the end of stage II.
The tipping of canine and PM next to extraction space is 4º - 7º

Stage III
Uprighting by means of uprighting springs is only left
Then active treatment is completed by holding over uprighting teeth with 10º T-pins

Critical review
-Kb technique is very demanding tech.
-Bulky brackets – inventory problems
-Stage I relatively simple
-In stage II deepening of bite - constant problem
-E- Links have to be constantly checked as breakage or loss is followed by incisor flaring or
space opening.
-E- Links – poor substitute for cuspid ties for holding anterior together, as they stain, break or
some time cause extrusion/intrusion of incisors depending on where they rest

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-Rotational control of tech. is good
-Uprighting with rect. wires prolong the 3rd stage

Few valuable concepts that can be use in pure Begg:

-Use of T-pin - in 2nd PM, mild protrusion as they diminish amount of tipping
-Use of torque brackets for blocked out laterals.
-Rational use of class 2 elastics.

Unavailability of KB material is an impediment to usage of this tech. in India.

Following modifications can be done-
-For tubes - use standard 0.022” X 0.028” edgewise tubes by turning them over vertically to
ribbon mode and solder then on band.
-For torquing brackets- use wedges made of band material and weld them between bracket
base and bonding mesh.
-For ribbon arch- bend blanks from 0.016” X 0.022” straight length by using arch turrets.

Conclusion
Dr. Kameda has been constantly updating his technique as evident in change of appliance
components and thinking.
Aim is to have a simple, secure and accurate treatment method which results in minimum
treatment time, optimum results and max. Post-treatment stability.
No appliance described to date is perfect and KB is no exception. The search continues…

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