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BEDDTIOT BEGGS - EDGEWISE DIAGNOSIS DETERMINED TOTALLY INDIVIDUALISED ORTHODONTIC TECHNIQUE
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Richard.A.Hocevar, D.M.D Dunedin, New Zealand www.indiandentalacademy.com
Why
Edgewise ?
( Hocevar – AJO, Vol – 80, number 3, Sept 1981 )
Adaptations to increase the working range and reduce the force levels in arch wires Ribbon or square rather than Edgewise wires
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Brackets with smaller , e.g 0.018 inch arch wire slots not recommended .
Narrow (1.3 mm) single brackets to increase the span of wire between brackets .
Sectional arch wires and auxillaries
Elastics, elastomeric threads and ligatures.
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Orthodontic force systems: Individualized treatment with open-minded "Begg" technique - Hocevar, AJO-DO 1982 Apr (277-291)
A "COOKBOOK" procedure in which all cases are treated alike. Force of the anchor bends is not normally sufficient for upper incisors - movement is mainly simple tipping. Unbalanced force of the anchor bends may tip the maxillary molar crowns distally. www.indiandentalacademy.com
Control of the directions and types of tooth movement is seriously limited . Auxiliaries that control root movement cannot be employed in the early stages of the technique
Suggested
Check Elastics - anchorage control , bite opening
Passive Torquing and Uprighting springs www.indiandentalacademy.com
The Appliance‌. “ The intent was to incorporate the important advantages, features, and capabilities of many fixed appliances and minimize deficiencies, making the most of current understanding of orthodontic biomechanics and technology â€?. -Hocevar (July 1985, AJO-DO)
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Beddtiot appliance Edgewise appliance
- control and precision (having full torque and angulation built in)
Beggs appliance -
anchorage conservation and rapid tooth movement (of the ''light-wire differential force" approach to biomechanics) by means of attachments that are versatile, simple, economical, and small. www.indiandentalacademy.com
Beddtiot Philosophy
Begg principles are employed in some cases; various edgewise techniques in others. A wide variety of combinations may be employed easily. Treatment is individualized.
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FOUNDATIONS Light wire Gentle long range force systems - for fast , efficient and major movements of the crown and root Minimum bracket size - maximum interbracket arch wire span Light , undersized wires – free play in the brackets Extensive use of elastomeric ligatures and elastics
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Low force levels over great elastic ranges
Light auxiliary round wires.- for alignment of the individual teeth Heavy rectangular base arch wires - Anchor teeth stability and arch integrity. www.indiandentalacademy.com
Differential response to force
Principle Of Lever
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“If the total force is limited to a level that will cause just enough strain in the crestal region to trigger rapid movement there, the strain in the apical region will be insufficient to cause much movement there. The movement of the crown in the direction of the force should be considerably greater than the opposite movement of the apex.�
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Differential response to force
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Translatory movement – strain distribution has to be even throughout the supporting structures of the tooth or teeth Requires considerably heavy force Anchorage conservation is made difficult
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Tipping movement – additional time required for to move the apical portion of the roots. Translatory movement is faster, simpler and more efficient if adequate anchorage is available.
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Beddtiot
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Rx TIME - BEDDTIOT faster than BEGGS ? Uncontrolled Tipping
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BRACKETS
Brackets are narrow, single-width edgewise brackets with 0.022 inch (height) ´ 0.028 inch (faciolingual depth) horizontal arch wire slots. On the lingual side of the bracket is a 0.020 ´ 0.020 inch vertical slot. www.indiandentalacademy.com
The arch wire slots are ''torqued" (cut at such angles to the brackets that they will be oriented parallel to the plane of the arch when the teeth are positioned properly)
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Except for torque, the brackets are all identical.Therefore, they are interchangeable; any bracket may be used on any tooth. Placed with its torque-indicator groove gingival, a bracket provides lingual root torque; with the groove occlusal, it provides lingual crown torque.
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ďƒ˜ Brackets- prewelded on both flat and curved universal bonding pads - provides maximum versatility. ďƒ˜ The pads are of minimal size, and their shape facilitates the placement of the brackets with either end toward the gingiva - may be used for either lingual crown or root torque.
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ďƒ˜ The brackets are milled from solid bars of
stainless steel. ďƒ˜. The brackets are small in all dimensions to ensure optimal appearance and minimal lip and cheek irritation ďƒ˜ This also lessens occlusal interference, enamel surface involved in bonding, and problems with gingival proximity and oral hygiene.
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A. Twin brackets
- Acute bends are required - Can distort the wire B. Narrow brackets - Wire is deformation much less - Force level is much more gentle, - Degree of deflection is more likely to be within the elastic range of the wire
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Arch wire slot allow considerable (but limited) mesiodistal tipping on undersized wires (on 0.016 inch, the usual working wire), as well as limited uprighting on heavier guage wires(0.018-inch arch wire)
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Original Uprighting spring - Helix is farther from the arch wire, - Hook arm is slightly longer www.indiandentalacademy.com
Modified Uprighting spring - Less bulk. - More hygienic, - Less likely to impinge upon or irritate the gingiva, - Less conspicuous in appearance www.indiandentalacademy.com
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Buccal Tubes - 4.5 mm long, 0.022 ´ 0.028 inch "edgewise"tubes - 25° lingual crown torque for lower - 10° for upper first molars - Distal end of the maxillary tube is angulated outward 10° from the welding flanges to maintain the proper rotation ("toe-in") www.indiandentalacademy.com
Deepbites or moderate-to-severe anchorage requirement cases – An additional rectangular tube is carried diagonally across the buccal surface of the basic tube, its mesial end pointing gingivally www.indiandentalacademy.com
Outer tubeIt carries the main (working) arch wires during the biteopening and retraction phases of treatment Inner tube – carry heavy rectangular sectional wires to lock molar and premolar teeth together( prevents tipping, anchorage control) www.indiandentalacademy.com
Correction of Rotations Mild corrections - offset the bracket slightly toward the side of the tooth that is displaced lingually. Simple engagement of the bracket on the arch wire with a small elastomeric ligature will correct the rotation. Moderate to Severe corrections -gentle ligature or elastomeric thread may be used to tie the bracket to the arch wire. - Bayonet bends may also be used
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Torque control with brackets and arch wires - Edgewise wires required for precise control in the larger (0.022 ´ 0.028 inch) brackets were too rigid. - Lighter forces obtained by using more resilient rectangular wires bent as Ribbon arch wires or Square arch wires - Easier for the operator to work with than the heavier edgewise wires. - In most instances the lighter ribbon wires are preferable to square ones. www.indiandentalacademy.com
0.022 ´ 0.016 inch ribbon arch is only one third as forceful as a 0.022 ´ 0.028 inch edgewise wire; yet it can provide the same precise control in the same "edgewise" bracket
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CASE REPORTS
- 20-year-old woman - Class II, Division 1 - 8 mm overjet - 50% overbite, - well-aligned mandibular dentition, - lower incisors were ideally positioned First patient to undergo BEDDTIOT treatment , appliances placed in March 1978 www.indiandentalacademy.com
- Extraction of upper I premolars - Double buccal tubes were placed on maxillary molars to accommodate molar-premolar sectional wires. - Initial maxillary arch wire - 0.014 inch round, - Initial mandibular wire - 0.018 inch arch with a gentle bite-opening curve - Class II elastics delivering 2½ oz of force per side full time. www.indiandentalacademy.com
7 WEEKS INTO TREATMENT
- 0.018 inch round maxillary arch wire placed - Class II elastics continued - Class I max elastics started after 2 months
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6 MONTHS INTO TREATMENT
- Overjet and Overbite fully reduced - Torquing auxillary and Uprighting spring on max laterals and canine for protraction of max posteriors and closure of remaining spaces
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AFTER DEBONDING ( 14 MONTHS )
Appliance removed prior to proper finishing and detailing because of patient non -compliance
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-14 year-old girl - severe Class II, Division 1 - 13 mm overjet - proclined U/L incisors, - moderate crowding of the lower incisors, - Deepbite, with mand incisors impinging palate www.indiandentalacademy.com
Treatment Plan - Extraction of Max I premolars for correction of max proclination - Extraction of Mand lateral incisors for correction of lower crowding
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Treatment started with - 0.016 inch maxillary and - 0.012 inch mandibular SS wires ( replaced to 0.016 SS after 1 month) - anchorage reinforced- rectangular maxillary molar premolar sectional wires - Lower canine to canine elastomeric thread - Check elastics www.indiandentalacademy.com
AFTER 7 MONTHS INTO TREATMENT - Extraction spaces almost closed
- Lower arch changed to 0.019 X 0.019inch SS for control of axial inclination - 0.021 X 0.025 inch Nitinol in max arch for torquing of incisor roots - Check elastics continued www.indiandentalacademy.com
1 YEAR OF TREATMENT
Lower incisors torqued and later stabilized with 0022 X 0.016 inch SS
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18 MONTHS INTO TREATMENT
- 0,018 inch SS with uprighting springs - Incisor root torquing auxillary - Class II elastics www.indiandentalacademy.com
AFTER DEBONDING (2 ½ YEARS)
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- 16-year-old girl - bidental protrusion, -prominent nose and maxilla -overjet was 4 mm -occlusion Class I on the left , and ½ unit Class II on the right www.indiandentalacademy.com
Treatment objectives - Overjet reduction, - correction to Class I occlusion on the right side, - retraction of her incisors to reduce her protrusive appearance Treatment plan -Extract all four first premolars -Use minimum-moderate anchorage mechanics( i.e space closure by reciprocal translation by heavy forces after the alignment and occlusion were corrected.) www.indiandentalacademy.com
- Brackets were selected and positioned to yield ideal final torque and angulation, - Single tubes were used on the first molars. - Upper and lower 0.016 inch arch wires and a Class II elastic of 3 oz on the right side. - After 2 months changed to 0.018 inch SS, elastics stopped
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- 1 month later 0.021 ´ 0.016 inch ribbon arch wires were placed with canine-to-canine elastomeric chains and heavy elastomeric threads tied from canine to molar in each quadrant. - elastomeric threads and chains changed approximately every 6 weeks.
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DEBONDED AFTER 12 MONTHS OF TREATMENT
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These cases illustrate the ease and speed of treatment, anchorage control, and versatility of BEDDTIOT. They demonstrate the importance of having an appliance that facilitates both (1) tipping teeth with light forces and (2) full, precise three-dimensional control on the teeth.
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“ BEDDTIOT was designed to facilitate application of the best modality in every situation, to handle any case, whether it would be treated best with Begg-like biomechanics or one of the many Edgewise approaches � - Hocevar
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