INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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CONTENTS Introduction Instruments
used in Begg technique Bracket and Buccal-tube placement Case - selection STAGE I :-
1. Stage-I arch wire formation 2. Objectives of stage-I 3. Biomechanics of stage-I Conclusion (Picture at the end of stage I) References www.indiandentalacademy.com
INTRODUCTION Begg
“ LIGHT WIRE DIFFERENTIAL FORCE TECHNIQUE ”is a unique technique of moving teeth using simple tipping movements to bring about correction of malocclusions
Based
on the theories of 1. Attritional occlusion 2.The theory of differential pressures 3. Light round wire forces www.indiandentalacademy.com
BEGG INSTRUMENTARIUM ďƒ˜
THE LIGHT WIRE PLIER
1.The main plier in Begg technique 2.Is a refined version of an original plier designed by E.H Angle for S.S White company 3.Referred to as No. 139 or BIRD BEAK PLIERwww.indiandentalacademy.com
BIRD BEAK PLIER S.S WHITE No.-130 T.P-No.139
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Dr.
Begg found it necessary to reduce the size of the beak in order to make delicate bends eg. The boot hooks and the vertical loops
Design
– 1.Has one round and one square beak 2.The beaks are tapering 3.A groove at ½ to 1 mm
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ďƒ˜ Uses
– 1.Arch wire bending (S.S White No.139)
2.Placing lock pins (Longer beak-T.P No.130) www.indiandentalacademy.com
ARCH
WIRE CONTOURING PLIER
1.No. 128 pliers
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2.Used to develop “cuspid-curves� 3.Improperly formed arch wire results in NARROWING of the cuspids.
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ARCH FORMING PLIERS/ RIBBON ARCH PLIERS Originally
designed to bend RIBBON ARCH and EDGE-WISE arch wires
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Beaks
are ground to be parallel at appox .020’’
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ďƒ˜ Used
to firmly grasp both wires when wrapping the end of an arch wire when completing the bending of a double – back end
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PIN AND LIGATURE CUTTING PLIERS
Originally
designed by Dr. E.H Angle USED TO – 1. Cut and remove lock pins 2.To cut ligature wires www.indiandentalacademy.com
TWEED LOOP FORMING PLIER Plier
No. 442
Used
to make cuspid circles and verticle loops
The
2nd step of the plier is used (2mm )
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Cuspid circle 2 mm
1 2step 3
BRACKET and MOLAR TUBE PLACEMENT
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BRACKET PLACEMENT Is
of utmost importance
Brackets
can be 1.Weldable 2.Bonded
High
flange bracket preferred;possess wider area of welding www.indiandentalacademy.com
ďƒ˜ Jigs- helps
position
to place brackets in proper
Bracket positioning jig
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Bracket placed at 4mm from the incisal edge
www.indiandentalacademy.com Bracket centered mesio-distally
Brackets
are placed on all teeth except the molars
Are
- CENTERED MESIO-DISTALLY
Base
of the bracket slots - 4 mm from the incisal edges or the cusp tips
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Only
exception –Maxillary lateral incisor, placed at 3.5 mm (for desired esthetic shortening), but if it’s lingually placed bracket positioned 4mm
If
the tooth is rotated originally the bracket is placed Off-centered brackets off-center 1
2
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BANDING THE 2nd BICUSPIDS ? Banding
stage
the 2nd bicuspids - optional in first
Disadvantage
– long length of unsupported archwire , liable to get distorted Unsupported arch wire
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ďƒ˜ Banding
the 2nd bicuspids , placing brackets on them along with bypass clamps provide protection and support to the arch wire against buccal rolling and gives firmer bodily control over the anchor molars. Bypass clamp guides the arch wire
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ďƒ˜ Second
bicuspid brackets should not be placed , if they contact the distal of the buccal cusps of the Mx molar in class II relation , when class II traction is used
ďƒ˜ Second
bicuspids should be banded before the final act of space closure in order to 1. Avoid the possibility of over closure 2. Possible exclusion of these teeth from the dental arch www.indiandentalacademy.com
ďƒ˜ The
lingual button – placed directly opposite to the areas of arch wire engagement.
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BUCCAL TUBE PLACEMENT
Molar tube At center of M-B cusp
Lower molar tube positioned more gingival to avoid occlusal interference www.indiandentalacademy.com
Molar tube to be
tube beocclusal surface Molar tube to be Molar parallel toto the
Ball end hook
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MOLAR OFF-SETS ďƒ˜ As
suggested by SWAIN
1.Upper molar tubes fixed
perpendicular to the mesial aspect of the Mx-molar bands , which results in appox.10 degree distolingual rotational offset
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ďƒ˜ LOWER
MOLAR
TUBES 1.Lesser off-set of appox. 5 degrees distolingual rotational offset 2.Off-sets are placed to maintain the relation of the M-B and the D-B cusps www.indiandentalacademy.com
POSITION OF THE BRACKETS AND THE TUBES
4 mm
3.5 mm
4 mm
4 mm 3.5 mm 4 mm
4 mm
4 mm
4 mm
4 mm
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BRACKET AND TUBE ARRANGEMENT
Brackets centered mesio-distally Off-centered brackets on rotated teeth
Mx molar offset- 5-10 Md molar 5-7
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Molar tube off-set
CASE SELECTION Begg
appliance offers a comprehensive mechanical system suited for almost all forms of mal-occlusions
Most
effective in extraction cases which provide a margin of excess of space
Can
be successfully used in non-extraction cases as well www.indiandentalacademy.com
1.Well suited in cases of Class I with marked bi-dental Bi-max protrusion 2.Class II div. 1 and div. 2 with deep bite 3.Cases with severe Marked over-jet and bite crowding 4.Cases with pronounced over-jet and excess anterior spacing www.indiandentalacademy.com
Bi-max protrusion Incompetent lips
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WHETHER TO EXTRACT OR NOT? Depends on – 1.Type and severity of mal-occlusion 2.Treatment goals 3.Ability and experience of the operator 4.Age of the patient 5.Condition of the teeth 6.Anticipated patient co-operation 7.Skeletal pattern 8.Patient’s preferences www.indiandentalacademy.com
REQUIREMENTS Accurate
diagnosis and treatment plan Good study models OPG and lateral cephalogram Good set of facial photographs
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RELATIONSHIP
OF THE LOWER INCISORS TO THE A-P LINE (A Diagnostic aid) –A.J.O , May 1969 Will alignment of the lower teeth relocate the incisal edges of the lower incisors too far ahead of the A-P line?
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ďƒ˜ Will
leveling of the curve of spee in the in the lower arch move the incisal edges of the lower incisors too far ahead of the A-P line ?
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ďƒ˜ Will
correcting the molar relation consume so much anchorage that the incisal edges of the lower incisors are moved too far ahead the A-P line?
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ďƒ˜ Will
remodeling of the point –A ,change the location of theA-P line ,resulting in the incisal edges of the lower incisors being too far ahead of the A-P line ?
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ďƒ˜ Will
the growth or repositioning during treatment, change the location of the A-P line , and result in the incisal edges of the lower incisors being too far ahead of the A-P line ?
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If
the answers to all the above is “NO” - non-extraction
If
1 or more answers are “YES” – reduction of tooth mass is must
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BEGG TECHNIQUE - STAGE I ďƒ˜ OBJECTIVES
1.Open the anterior over-bite 2.Over-correct the mesio-distal relationship of the buccal segments 3.Close any anterior spaces 4.Eliminate any anterior crowding 5.Over-rotate teeth requiring correction 6.Correct posterior cross-bite www.indiandentalacademy.com
APPLIANCE CONSTRUCTION Arch
wire with vertical loops – 0.016’’ 1.used to unravel crowded teeth and rotate anterior teeth 2.One loop between two teeth 3.Never placed distal to the canines 4.Bracket area www.indiandentalacademy.com
CONSTRUCTION
In inter-dental areas
For a lingual positioned tooth
1 mm short
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The
arch wire is modified in the BRACKET –AREA to over-correct the anterior teeth
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FINISHED STAGE-I ARCH WIRE WITH VERTICAL LOOPS
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When anterior teeth are spaced and irregular Contraction loop VERTICAL CONTRACTION LOOPS ARE USED Difference –arch wire is shifted to the left stops
Loops activated (opened) Intermaxillary circles tied distally against the cuspids www.indiandentalacademy.com
PLAIN ARCH WIRES TO CLOSE ANTERIOR SPACES ďƒ˜ Developed
KESLING
by- P.C
1.Using plain arch wire with elastics OR
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2.Two small elastic scan be used rather than one large elastic
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ROTATING CUSPIDS AND BICUSPIDS ďƒ˜ Rotated
using elastic thread from the lingual button to the arch wire
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Or using ROTATING SPRINGS
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ďƒ˜ If
along with the premolar the molar also needs rotation, an elastic – tie can be given between the molar and the premolar
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ELASTIC - TIE
MOLAR ANCHORAGE BENDS Bite-opening
bends/Tip-back bends/Anchor-bend
Facing occlusally
Bend
faces vertical occlusally (if not , toe-in or toe-out is placed )
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LOCATION OF THE ANCHOR BENDS 3
mm mesial to the mesial end of the molar tube
The
wire enters at 6 o’clock and exits at 12 o’clock when the anterior segment is pulled incisally www.indiandentalacademy.com
ANCHOR BEND
3 mm
DEGREE OF BITE OPENING BEND Amount
of bend is 30-50 degrees
Correct
amount of bend judged by anterior segment deflection of the wire in the vestibule
Upper
arch wire should be- in vestibule Lower - mid-way between the teeth and vestibule www.indiandentalacademy.com
30-50 degrees
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PRECISELY MEASURING THE FORCE ďƒ˜ Measured
using a DIAL-GUAGE , especially when the intrusive force requirement is critical
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ďƒ˜A
nearly 20 mm displacement of the upper arch wire will result in 1.5 ounces of depressive force (nearly 42.49grms)
ďƒ˜ 14
mm of displacement of the lower wire produces 1.2 ounces of depressive force www.indiandentalacademy.com
CHANGING TO AN ARCH WIRE WITHOUT VERTICAL LOOPS It’s
Desirable to discard the arch wire with vertical loops as soon as possible
Reason
– Vertical loop increases the flexibility of the arch wire in the vertical plane and thus interferes with the anterior bite–opening (vertical – control) www.indiandentalacademy.com
Class II elastics and Dontrix
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CLASS III ELASTIC IN PLACE
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Plain
arch wire with –Bayonet bends , intermaxillary hooks ,anchor bends and elastics
Bayonet
bends hold the teeth in overcorrected positions
Intermaxillary
circles hold the intercuspid arch length
Elastics
to correct mesio-distal relation www.indiandentalacademy.com
INTRA-ORAL PHOTOGRAPHS Right buccal End of stage I Frontal
Left buccal
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AT THE END OF STAGE I Correction
of over-bite to edge-to-edge
Correction
of over-jet to edge-to-edge
Correction
of crowding
bite
Over-corrections
anteriors
of rotations of
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Closure
of anterior spaces
Corrections Beginning
rotations
of cross-bites
of correction of pre-molar
Over-corrections
of disto-occlusion (mesio-distal molar relations ) www.indiandentalacademy.com
Partial
corrections of mid-line discrepancies
Correction
incisors
Beginning
of axial inclinations of Md
correction of open - bite
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MECHANICS OF TOOTH MOVEMENT STAGE I 1.INTRUSION In conventional Begg BITE-OPENING occurred mainly due to molar extrusion (Major weakness of conventional Begg) Little
is attributed to lower incisor intrusion
In
Begg treatment all the 6-anteriors are intruded together (a unique www.indiandentalacademy.com feature)
ďƒ˜ Bite-opening
force is derived from the ANCHOR BEND
ďƒ˜A
moment generated by the anchor bend in the molar tube , is automatically balanced by the generation of an intrusive force on the anteriors , and an extrusive force on the molars in order to establish equilibrium www.indiandentalacademy.com
Moments and counter-moments generated
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Depending
on the direction of intrusive force –The tooth under-goes varying degree of intrusion as well as labial crown-lingual root tipping (rotationUNDESIRABLE)
This
is resisted in case of Mx-incisors by CLASS II elastics in stage I.
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Class
II elastics, not only have a HORIZONTAL FORCE component but also have a VERTICAL FORCE COMPONENT
The
vertical force component, reduces the magnitude of intrusive force of the archwire
The
horizontal force component , affects the net resultant direction of force www.indiandentalacademy.com
CONSIDERATION OF MAGNITUDE OF INTRUSIVE FORCE Optimum
force required for intrusion of is appox. 15-30 grms/ incisor(slightly higher values for canines)
Anchor
bend exert force of appox. ; 1. 1.5 oz in Mx (intrusive) – at mid-line 2. 1.2 oz in Md (intrusive) – at mid-line
Class
II elastics – 1 oz (extrusive) www.indiandentalacademy.com
Thus
, the net intrusive force in the Mx incisors is – 0.5 oz (at mid-line) or appox. 14.16 gms for three teeth i.e nearly 5 grms of force /tooth , which is far below the optimal force suggested
For
active intrusion the Mx incisors should receive appox. 60-70 grms of net force in the mid-line after negating the extrusive component of the class II elastics www.indiandentalacademy.com
PROBLEMS ENCOUNTERED DURING STAGE I ďƒ˜ BITE
NOT OPENING 1.Patient not wearing elastics a).Remedy-Educate the patient and parents 2.Biting of the bite-opening bends a).Remedy-Remove arch wires and restore bite-opening bends www.indiandentalacademy.com
b). Check positions of the anchor bends (if too far mesial ,move them closer) c). Check the level of Md molars (lower , if necessary) d). Check eating habits www.indiandentalacademy.com
3.Failure to place proper bite –opening bends Remedy –Place proper amount of biteopening bends in the arch wires 4.Anchor molars out of occlusion (most common in perm. 1st molar extractions) a).Remedy- Placement of vertical elastics from molar to molar b).Place a horizontal elastic www.indiandentalacademy.com
EXCEPTION TO THE RULE
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5.Loose molar bands Remedy- re-cement the band 6.Improper angulation of the buccal tube or the entire molar band Remedy-Tube should be parallel to the occlusal and the buccal surfaces www.indiandentalacademy.com
ďƒ˜ MOLAR
WIDTH NARROWING (USUALLY MANDIBULAR ) 1.Vertical component of class II elastic force Remedy-Form Md arch wider in the posterior segment b).Add wide auxilliary arch wire 2.Prolonged wearing of posterior cross -elastics www.indiandentalacademy.com
3.Disto-lingually rotated canines Remedy- Donot engage the arch wire in the cuspid brackets until these teeth have been ratated by elastic thread or other means 4.Bicuspid rotational elastic tie on the lingual from the bicuspid to the molar Remedy – Extend the main arch wire to the buccal surface of the 2nd molar www.indiandentalacademy.com
b).Place toe-out on the distal-end c).Re-tie elastic thread from the bicuspid to the arch wire d)All 5.Rolling of the distal ends of the arch wire , causing the anchor bend to turn into a rotational force on the molar Remedy- Place toe-in or toe-out at the anchor bend www.indiandentalacademy.com
ďƒ˜ ADVERSE
TIPPING OF THE ANCHOR
MOLARS 1.No anchor bends (if tipped mesially) Remedy- Remove archwire and place proper anchor bends 2.Too much anchor bends (if tipped distally) Remedy-Remove the arch wire and reduce the amount of anchor www.indiandentalacademy.com bends
3.Proper anchor bends , but placed for a long time (anchor molar tips distally) REMEDY-Having recognized the problem, cont. OR if severe than band the 2nd molar and it acts as the anchor molar now and place an ordinary bracket on the 1st molar
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4.Loose molar bands (mesial tip) 5.Improper placement of the tube or/and the band (may tip mesially or distally) 6.Excessive elastic force (molar tip mesially)
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7.Improper placement of elastics . (If not placed in the ball-end hook and placed elsewhere, elastic will not slip as the tooth moves and the force is not applied in the centre of resistance and hence the tooth would tip (mesially) REMEDY- Instruct the patient in proper placement of elastics
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ďƒ˜NO APPRECIABLE CHANGES 1.Not wearing elastics REMEDY-Educate the patient 2.Arch wire(s) bend out of shape REMEDY- Rebend the arch wires b).Check eating habits
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c).Check the level of the Md molar tube (lower them , if necessary) d).Check the position of the anchor bends (if far mesially , move them closer to the tube)
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3.Oral habits present that counteract the forces of the appliances REMEDY- Identification of the habit 4.Patient seen too soon REMEDY- Dismiss the patient for atleast 6-weeks
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ďƒ˜ VERTICAL
LOOPS BURIED IN THE GINGIVA
1.Original, looped arch wire left in the mouth for too long REMEDY-Remove it and replace with plain arch wire with bayonet bends
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2.Misjudgement in placement of the vertical loops in the proper direction REMEDY-If anterior teeth are still crowded and irregular , remove , modify the direction of the loops and replace
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ďƒ˜ELASTICS WHICH BREAK OR DONOT STAY 1.May be an excuse for not wearing elastics REMEDY-Educate the patient 2.Elastic will not stay on the intermaxillary circle REMEDY-Open the inter-maxillary circle vertically And distally engage into the ball-hook www.indiandentalacademy.com
LOCK PINS LOST
1.Occluso-incisal forces REMEDY-Use steel pins , if brass used earlier b).Check anchor bends to facilitate opening of the bite 2.If missing at random ,throughout the mouth (patient must picking them ) REMEDY-Educate the patient b).Use ligature instead of pins www.indiandentalacademy.com
EXTREMELY MOBILE MOLARS 1.Clenching of the teeth REMEDY- Educate the patient or suggest to chew sugar free gum to break the habit 2.Intermittent wearing of the elastics REMEDY-Patient education 3.Pathology REMEDY-Treatment of the pathology www.indiandentalacademy.com
4.Excessive force applied to the molars REMEDY- Reduce arch wire size to 0.016’’ b).Reduce elastic force to 2 1/2 oz c).Reduce degree of anchor bends 5.No apparent cause REMEDY-Remove the arch wires and elastics for 8-10 wks and obsreve ; the molars should tighten www.indiandentalacademy.com
LOWER ANTERIOR TEETH TIPPED LABIALLY 1.May be an optical illusion with roots actually moving lingually REMEDY-Educate the patient 2.Binding of the arch wire in the bicuspid brackets REMEDY-Use by-pass clamps b).Remove bicuspid band temporarily www.indiandentalacademy.com
3.Binding of the ends of the arch wire in the distal end of the buccal tube REMEDY-Remove the wires and correct 4.Poor diagnosis REMEDY-Reconsider the necessity for extraction
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ANTERIOR OPEN-BITE NOT CLOSING
1.Patient not wearing anterior vertical elastics REMEDY- Patient education 2.Persistent tongue-thrust or other adverse habits REMEDY- Educate the patient b).Habit breaking appliance www.indiandentalacademy.com
c).Place lingually directed spurs on lower anteriors 3.Too much anchor bend REMEDY-Reduce the degree of the anchor bends
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TOOTH NOT ROTATING 1.Not enough space REMEDY- Check diagnosis and the arch wire design 2.Not enough activation in the bracket area of the arch wire REMEDY- Remove the arch wire and activate the vertical loops www.indiandentalacademy.com
MID-LINE DISCREPANCY 1.Asymmetrical tipping of the anterior teeth REMEDY- Do nothing , but study the situation carefully and the ultimate uprighting of the teeth in the 3rd stage will correct the mid-line
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CONCLUSION The Begg technique is divided into various stages with the purpose of anchorage preservation and every stage has some specific objectives to attain. And for the success of the technique is mandatory to follow and attain all the objectives in the specified stage , before entering into the next stage www.indiandentalacademy.com
Right buccal
Frontal
Left buccal
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REFERENCES 1.Begg and Kesling –Orthodontic theory and technique -2nd edition 2.Fletcher 3.Vade maecum of Begg technique-Cadman 4.Molleanheaur’s advanced manual 5.Refined Begg by V.PJayade
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www.indiandentalacademy.com Leader in continuing dental education
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