Beggs Second Phase of Treatment INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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Contents Objectives of second stage Construction of appliance Treatment procedure Problem encountered
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Reason for second stage To prevent the posterior teeth from being moved too far mesially. ď Ž Insufficient space left in buccal segment to move the anterior teeth far enough back on to basal bone. ď Ž
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Objectives of second stage Maintain all the correction achieved during first stage Close any remaining extraction space Correction of premolar rotation is completed. To correct the Midline discrepancies.
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Characteristic tooth movement of second stage Retracting of anterior teeth Maintaining the anchor molars upright & in Class I Correction of crossbite relationship and rotating bicuspid.
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Characteristic wires and Elastics Plain round wires Horizontal Elastics Class II elastics
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Arch Wire Heavier 0.018 or 0.020 inch arch wire. Anchor bend -1mm mesial to molar tube “Toe in” bend in molar areas Intermaxillary hook are ligated to canine bracket. Arch wire should be held loosely against the buccal aspect of the premolar brackets to prevent buccal or lingual crowding after the extraction space closure
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Cement the premolar .
Slight horizontal offset bents are form distal to the canine to maintain the correct buccolingual position of premolars and canines.
“Stage 2” safety lock pins are used
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Elastics Space closing elastics are called horizontal elastics or intramaxillary elastics. ď Ž Six elastics are worn simultaneously ď Ž
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ď Ž
Twist together the two ends of the ligature wire that holds the arch wire to the buccal surface of the second premolar bracket.
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ď Ž
Wearing of horizontal elastics from the buccal surface of molar creates a rotational force on molars.
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ď Ž
Methods of correcting an anchor molar that has rotated distobuccally.
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Control of Bicuspid Height ď Ž
ď Ž
Use of bypass clamp and reversing them- to bring the bicuspid to the occlusal plane and hold them there ,ready for the arch wire to be placed in the bracket slot. Bicuspid can be rotated with elastic thread & held overrotated with a steel ligature tie.
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Correction of midline discrepancies ď Ž
Anterior intermaxillary cross elastics are used.
Diagonal Elastic
Light intra-maxillary Elastics
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ď Ž
Midline discrepancies disappear during the first stage of treatment as a result of the arch wires being contoured in such a ways as to eliminate a difference in form of one side of the dental arch, compared that of other side.
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Shaping arch wires for correcting asymmetrical dental arch form ď Ž
Eliminated by shaping the arch wire to produce bilateral symmetry of dental arch.
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Breaking mechanics ď Ž
ď Ž
If anterior teeth exhibit a tendency for excessive lingual tipping during stage II use braking mechanics. Passive mesiodistal root uprighting spring on canine & lower anterior braking arches establish anterior anchorage mechanics.
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To further encourage the mesial movement of lower posterior teeth, the strength of the mandibular horizontal elastics is increased from 2 ½ ounces to 6 or 8 ounces. ď Ž This brings into play the principles of differential force. ď Ž
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Shortening length of double-back Arch wires
Timely placement of small vertical takeup loops in the buccal section of arch wire Loops are first made distal to the cuspid brackets. If necessary to shorten the doubled-back arch wire again, similar takeup loops are made just mesial to the anchor bend.
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Teeth Position at the end of second stage of treatment “Tipping back” or “Dishing in”of the six upper
and lower anterior teeth is most favorable state of affair as far as the success of the final result of treatment is concerned.
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Problems that may be encountered during the Second stage and their remedies 1.Ant. Bite closing: Cause
Remedy
A.Not enough bite-  opening bends placed in the archwires.
B.Bite opening bend bitten out or arch wire distorted
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A. Remove arch wires and place proper bite opening bends.
A. Educate patient in the importance of proper diet to prevent further distortion. B. Remove , correct and replace archwire. www.indiandentalacademy.com
1. Ant. Bite closing: Cause
Remedy
C. Patient not wearing intermaxillary elastics properly
A.Educate the patient
D. Anchor molars out of A. Discontinue class II or Cl III. occlusion Use horizontal elastic from molar to inter max hook or inter max elastics from molar to molars to move the molars towards one another. www.indiandentalacademy.com
2. Ant teeth assuming CL III relationship: Cause
Remedy
A. Excessive wearing of CL II elastics
A.Discontinue Cl II elastics
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3. Space developing between ant teeth Cause
Remedy
A. Failure to tie with steel A.Make necessary tie with ligature wires from the inter steel ligature wires. max hook distal to cuspid brackets. B. Intermaxillary circles A.Remove arch wire and roll formed too far apart one or both circles mesially, Replace and tie with steel ligature wire
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4. Anchor Molars rotating distobuccally Cause:
Remedy:
A. Toe-out on arch wire B. Too much force from hz elastics
A. Place toe –in at the distal end of the arch wire A. Use lighter hz elastics B. Tie elastic thread from cuspid lingual button to the lingual hooks on the molars
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5. Posterior spaces not closing Cause:
Remedy:
A.Pt not wearing elastics. A.Educate the patient B.Arch wire not free to slide distally through the buccal tube
A. Remove source of resistance like end of arch wire striking second molar and anchor bend in to molar tube.
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6. Second bicuspid tipping mesially in 1 st bicuspid extraction case Cause:
Remedy:
A. Slight expected mesial movement of anchor molar B. Abnormal loss of anchorage
A. Continue to guard anchorage A. Increase anchor bends B. Decrease elastic force C. Check for loose molar bands or loose molar tubes.
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