INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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CONTENTS 1.Introduction 2.Philosophy 3.Advantages 4.Disadvantages 5.The appliance components
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INTRODUCTION An
orthodontic technique is defined as
“A systematic sequence of clinical procedures to achieve the correction of malocclusion with a combination of appliance”
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THE PHILOSOPHY Attritional
occlusion
Differential Light
force
continuous force
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1.ATTRITIONAL OCCLUSION
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2.DIFFERENTIAL FORCE Concept Storey
given by – Dr.Begg in 1938
and Smith –
“Optimal range of force values are there, for every tooth that produces the max. rate of tooth movement” www.indiandentalacademy.com
1.To move the canines distally – 150200gms 2.To move the molars mesially -300500gms 3.Forces less than this will cause no discernible bodily movement of the canine www.indiandentalacademy.com
ď ą The
amount of force required to move the teeth is in positive ratio to the surface area of the tooth root, attached to the periodontium
ď ą The
ratio of the area of contact in the canine : molar is appox. 3:8 (Storey and Smith )
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OPTIMAL FORCE VALUES
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ď ą Thus
, by increasing the force values above the optimal force levels , causes decreased rate of distal movement of the canines , which finally approaches ZERO
ď ą Further
increase in the force value causes the molars to move forwards
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THE CONCEPT OF STOREY AND SMITH ď ą The
concept of undermining resorption
UNDERMINING RESORPTION excessive orthodontic forces periodontal membrane and tooth investing bone get compressed Blood vessels compressed www.indiandentalacademy.com
blood supply cut off inadequate blood supply causes necrosis
Almost no tooth movement till hyalinized tissue is removed Movement is intermittent & much slower,when compared to light wire forces www.indiandentalacademy.com
LIGHT FORCES Light forces donot cause pain n discomfort to the patient no loosening of the teeth,and causes frontal resorption Rapid tooth movement www.indiandentalacademy.com
DIFFERENTIAL FORCE In
physics and mechanics –Differential is defined as “DIFFERENCE OF 2 OR MORE MOTIONS OR PRESSURES
Differential
force is defined as forces which aid one another reciprocally when they are used concurrently www.indiandentalacademy.com
ď ąA
force that results in a different rate of tooth movement at one end than the other. (Mollenhauer)
ď ą Location,
rate, and degree of the change is determined by the relative root areas, and mechanics at each end, plus the amount of the force applied
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EXAMPLES FORCE
OF DIFFRENTIAL APPLICATION
1.Reduction of anterior deep bite –
anchor bends are given in upper and lower 0.016’’ round arch wires ,mesial to the molar tubes
Force
is so light that anchor molars do not appear to move at all and nor do they tip. www.indiandentalacademy.com
ď ą Only
clinically discernible movements are, RAPID gingival movements of upper and lower teeth
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2.Closing of extraction spaces – Crowns of the 6-anterior teeth are tipped back simultaneously by horizontal space– closing elastics rapidly without causing much mesial movement of the 1st permanent molars.
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CLOSING OF EXTRACTION SPACES
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ď ą Anchor
bends in the arch wire prevent the mesial tipping of the molars.
ď ą Anchor
bends also give the roots of anchor molars TOE-HOLD in the bone
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TOOTH MOVEMENTS ď ą In
the Begg’s technique, employment of differential forces makes various categories of tooth movements simultaneously and far more efficiently.
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EXAMPLES – 1.Aligning crowded teeth 2.Opening deep bites 3.Closing open bites
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5.Correcting antero-posterior relations 6.Correcting cross-bites 7.Correcting axial relations and 8.Guiding into occlusion unerupted and impacted teeth www.indiandentalacademy.com
ď ą When
several groups of tooth movements are carried out simultaneously with differential forces, each group reciprocally aids all other groups .Thus, each action is more successfully and easily accomplished .
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ď ą Thus,
EXTRA-ORAL ANCHORAGE is not required in the treatment of any cases with this technique (because light and differential forces are used)
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ď ą There
is no need to take arch wires off at each appointment, BECAUSE , the range over which the resilient fine arch wires will move teeth without reactivation is great
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3.LIGHT FORCES ď ą Excessive
forces are unfavorable to the tissues ( Storey and Smith)
ď ą Thus,
round arch wires are used to deliver light forces that result in rapid tooth movement and less patient discomfort www.indiandentalacademy.com
THE BRACKET SELECTION Initially,
TIE-BRACKETS were used ,but they caused binding of thin round arch wires as soon as the teeth tipped mesially or distally
This
binding of arch wires caused excessive loss of anchorage and
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This
required, use of extra-oral anchorage
A
trial was then made with the STANDARD RIBBON ARCH BRACKET
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It
was found too loose with 0.018’’ wire, later 0.016’’ wires were THUS used
In
light wire technique it is necessary to use a bracket that will permit simple labial, lingual, mesial and distal tipping of the crowns of all teeth except the anchor molars www.indiandentalacademy.com
EXTAORAL ANCHORAGE ď ą With
this technique the dental arches are, as a result of applying differential arch force and rubber ligature force values, taken so far back in the jaws that ample allowance is made for the inevitable forward movement of the dental arches
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ď ą This
usually occurs when axial inclinations of the teeth are corrected later in the treatment
ď ą Thus
, extra-oral anchorage is never required.
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DISTINCTIVE FEATURES OF BEGG’S PHILOSOPHY AND TREATMENT 1.Begg’s philosophy recognizes the fallacy of always maintaining the full complement of teeth, concludes that extraction is necessary at times 2.Preparation of anchorage is often unnecessary www.indiandentalacademy.com
3.Differential force 4.Light continuous force 5.Cold drawn, extra-hard , stainless steel round wire, with good resiliency and ZERO-STRESS RELAXATION is used
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6.Modified ribbon arch bracket is used. (Wire and bracket have a single point of contact in the vertical plane and 2-point contact in the horizontal plane)
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7.Two successive tipping movements are required to achieve bodily movement -first to position the tooth crowns and the second to position the tooth roots
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The
Begg technique is divided into 3stages without any over-lapping STAGES
This
is chiefly to prevent anchorage failure
All
tooth movements in each step are done simultaneously www.indiandentalacademy.com
ADVANTAGES ď ą Efficiency
of treatment, as many corrective tooth movements occur simultaneously with little appliance adjustment
ď ą Light
forces are used, causes minimal patient discomfort and tissue trauma www.indiandentalacademy.com
ď ą Rapid
esthetic improvement,achieved by early reduction of over-jet and quick alignment of anterior teeth
ď ą Early
correction of rotations ,probably reducing relapse
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ď ą Short
treatment time due to rapidity of tooth movements and simultaneous execution of of many corrective tooth movements
ď ą Efficient
anchorage control
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Quick and
over-bites
effective opening of deep
En-masse
movement of anterior and posterior groups of teeth
Roots
can be efficiently uprightned and torqued
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ability
to torque a single root without appreciable reciprocal effects on adjacent teeth
Minimal Low
demand of patient co-operation
cost of treatment
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DISADVANTAGEOUS ď ą The
round arch wire and the ribbon arch bracket relationship was unable to give precise control required for fine finishing.
ď ą Posterior
root torque is difficult due to wire-bracket relation
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Rotational
control is poor in 1st and 2nd stages of treatment with the use of under size wire
During
bite –opening, true intrusion of upper incisors was nil or minimal
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ď ą Over-use
of class II elastics caused-
1.Lack of upper incisor intrusion 2.Undesirable proclination of lower incisor 3.Unfovourable tipping of mandibular and occlusal planes
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Uncontrolled
tipping of the teeth which occurs in the 1st and the 2nd stages causes –ROOT RESORPTION
Excess
of uncontrolled tipping in the first two stages necessitated a long 3rd stage for root corrections
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ď ą Over
emphasis on tooth material reduction often resulted in ruined profiles
ď ą There
was no fail safe mechanism to check the tipping or uprighting/torquing movements , because the bracket permitted excessive mesio-distal and labio-lingual movements www.indiandentalacademy.com
THE BEGG APPLIANCE COMPONENTS COMPONENTS
– 1.Modified ribbon arch bracket
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2.Molar tubes a).Round
b).Oval
c).Combination tube
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Round
molar tube – Internal diameter -0.036’’ Length – 0.025’’ Oval
molar tubes – Internal diameter -0.072’’x 0.024’’ Length – 0.200’’
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ď ą Molar
attachments in Begg are designed to permit free mesio-distal tipping
ď ą Usually
1st permanent molars are the anchor teeth
ď ą 2nd
molar is used as the anchor tooth, when 1st molar is missing or indicated for extraction www.indiandentalacademy.com
3.Lock pin a).First stage pins / One point safety lock pins – Head bevel

shoulder Body Tail
Have shoulders that keeps the head of the pin outside the bracket slot www.indiandentalacademy.com

Thus, permits the use of the full height of the slot FULL HEIGHT
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Permitting full freedom for sliding of the teeth over the arch wire and their tipping
Used - in the 1st stage of treatment with 0.016’’ arch wire
Body of the lock pin reduces the arch wire slot to 0.016’’ www.indiandentalacademy.com

Beveled (one-point) under-surface of the head permits free mesio-distal tipping
BEVEL
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b).Second stage safety lock-pin – 
Shoulder on head insures free mesiodistal tipping, safety shoulders prevents binding on arch wire
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Body of the pin ,i.e the labio-lingual width is dimensioned to fit properly in TP 256-500 bracket in conjunction with 0.020’’arch wire ,used during stage II Slot 0.020’’
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3.HOOK PINS –
Used in all teeth which donot require mesio-distal uprighting during stage 3
Also, when more than one wire is to be engaged
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ď ą Absence
of safety shoulder , along with hook-shaped head , assures positive locking of torqueing auxillary and the main arch wire
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4.High hat pin –
Used during any stage when vertical elastics are to be worn, extension over the head facilitates engagement of elastics
Allows free sliding and tipping www.indiandentalacademy.com
5.T-Pin –
Meant to be used as “BRAKES” in the finishing stage when corrected angulations of teeth have to be maintained
There are two types of t-pins Angulated and Non-angulated www.indiandentalacademy.com
ARCH WIRES Australian
arch wire is used (A.J -WILCOCK)
Round
, high tensile strength , stainless steel wires, heat treated and cold drawn are used
The
various grades of AUSTRALIAN WIRES available are 1.Regular (White) 2.Regular plus (Green) www.indiandentalacademy.com
3.Special (Black) 4.Special plus (Orange) 5.Extra special plus (Blue) Recently 3-more newer grades have be added – 6.Premium 7.Premium plus 8.Supreme www.indiandentalacademy.com
PROPERTIES OF AUSTRALIAN WIRE – a).Higher tensile strength b).Greater working range c).Good flexibility /Spring back d).Good resieliency (greater resistance to permanent deformation as well as greater release of energy on deactivation) e)Zero- stress relaxation f)Good toughness www.indiandentalacademy.com
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ď ą The
wire is extremely tough and should be bent slowly or otherwise breaks
ď ąA
quick bend fractures through the metallic crystals ,whereas slow bending gives crystals time to flow into new shapes without fracturing
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ď ą Wire
is more likely Forces to break when the Off-set round beak rather than the flat beak Stressconcentration is used
ď ą With
round beak the two points of stress are directly opposite to each other www.indiandentalacademy.com
ď ą Also
, bending along the flat beak provides a greater area to dissipate the stresses , whereas around the round beak the stress on the crystalline structure is confined to a small area
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OTHER AUXILLARIES USED 1.Elastics –force exerted is 60-70 gms 2.Elastic tie material- To derotate teeth or to guide eruption of teeth 3.Stainless steel ligatures 4.Elastomeric rings -1.5-2.0 mm dia 5.Lingual buttons 6.Ball-end hooks www.indiandentalacademy.com
SUMMARY
Finally , it is the philosophy of Light continuous forces , use of differential forces and balance of arch length and tooth material which is the key foundation of this technique of treatment. Further advances in the material sciences and advent of newer wires has refined this technique to advancement and bettement. www.indiandentalacademy.com
REFERENCES 1.Begg and Kesling -3rd edition 2.Mollenhauer’s manual 3.Fletcher –The Begg appliance and technique 4.Cadman article 5.Refined begg 6.Graber and swain www.indiandentalacademy.com
www.indiandentalacademy.com Leader in continuing dental education
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