Finishing & Retention in Begg Appliance www.indiandentalacademy.com
INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com
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INTRODUCTION Finishing is the last step ,before active treatment is discontinued Ensuring that the teeth and related structures are positioned in such a way as will lead to better stability of results, enhancement
of
esthetics,
optimized
functions of stomato-gnathic system and an improvement of health of periodontium . www.indiandentalacademy.com
Greatest blow to popularity to begg technique came from realization that obtaining precision finishing with Begg appliance was difficult. But these deficiencies can be overcome, if one is prepared to put in some extra effort.
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There was no separate finishing stage documented by Dr. Raymond Begg. The proper time for appliance removal is when all the teeth have been moved beyond the positioned they are finally intended to occupy.
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After that upper & l appliances were removed as a whole unit Dr. Begg used to give only upper retainer containing circumferential wire around all teeth No lower retention was used
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Objectives Intra Arch Objectives Good inter dental contacts Proper facio-lingual positioning of all teeth All rotations over corrected to a small extent Complete space closure Proper vertical leveling of all teeth for well aligned marginal ridges & flat curve of spee Proper tip & torque of all teeth for esthetics and function Proper arch form Maintenance of lower intercanine dimensions www.indiandentalacademy.com
Inter Arch Objectives Normal overjet & overbite Class I molar, premolar & canine relationship Tight inter-digitation of all cusp of posterior teeth Mid line should coincide
Functional Requirements matching CO-CR without any anterior or lateral glide No cuspal interference during function Normal cuspid and incisor guidance Healthy & well functioning TMJ www.indiandentalacademy.com
Control of etiological factors Soft tissue factors taken care of by Frenectomy or CSF etc. Most of over corrections held of 11/10 relationship (10% overcorrection) during treatment ďƒ 10½ /10 relation (5% overcorrection) during finishing stage www.indiandentalacademy.com
So the Objectives can be summarized Establishment of Andrews six keys of normal occlusion Midline alignment & fine tuning Stabilization of all the movements achieved until stage III
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Prerequisites Meticulous conduct in earlier stages Pre finish Cephalogram objectives framed at the commencement of trt. has been achieved Gives one more opportunity to review and achieve the goals of various previous stages if still unachieved. Occlusogram Esp. in lower arch , enable disposition of roots & relation to symphyseal anatomy Appropriate I,2,3 order bend www.indiandentalacademy.com
Pre finishing stage models Requirements for first, second and third order corrections of every tooth & group of teeth Esp. useful for checking the levels of marginal ridges & lingual and palatal cusps, lingual occlusion, Amount of overcorrection –rotations planned & executed Bracket positions should be just right Loose bands should be recemented Sevens if not banded earlier should be banded at this juncture. www.indiandentalacademy.com
Different modalities for Finishing According to Dr. Swain After root tipping movement of stage 3 completed torquing & IIing aux. are removed & in base arch wire adjustments are made
To flatten occlusal plane localized vertical offset bends to level ind. Teeth & generalized curve to level segments www.indiandentalacademy.com
To obtain bilateral symmetry if wire is symm. but arch is not, definite localized horizontal offset to expand or contract individual teeth If both wire and dental arch are asym., make wire sym. or with slight compensatory asymm .
Overrotations & other over corrections are maintained. Edge to edge relationship of deep bite cases is maintained www.indiandentalacademy.com
Point of band removal Depends upon nature of movements still unfinished (positioner not efficient for root movements or rotation of round teeth) Patients record of cooperation
Closing space with elastic or elastomeric threads When bands are removed impression is taken for positioner and molar bands replaced www.indiandentalacademy.com
In maximum anchorage cases additional retraction is done by placing elastic or elastomeric threads around the dental arch In minimum discrepancy cases retraction is undesirable If over rotation is present do not close the space
After this positioner is delivered www.indiandentalacademy.com
Tooth positioner Described by H. D. Kesling in 1945, a one piece resilient appliance made from rubber or plastic that fills the free-way space and covers the clinical crowns of the teeth and a portion of gingiva, both buccal and lingual. No adjustment is required for this appliance Dr. begg did not use tooth positioners P.C kesling used for finishing & retention www.indiandentalacademy.com
Eugene L. Gottlick in 100 cases to test efficacy 60% success,26% partial success & 14% Failure Inherent elasticity to move teeth slightly to their final position
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Construction Tooth positioner is constructed over a predetermined pattern the – setup. Teeth that are repositioned in the patients mouth are removed from the patients models and placed in desired positions. The gum area of the setup is contoured to normal form after changing the teeth. www.indiandentalacademy.com
Positioners are then formed often of elastic material above the arches in rest position. Result in upper and lower teeth are slightly separated and lower arch slightly distal to upper. Space closure with in reason can be accomplished with tooth positioner. Within limitation positioners can be used to help maintain or change the amount of anterior overbite.
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Adv. Fixed appliance can be removed quickly than with use of finishing wires Gingival stimulation – rapid return to normal gingival contour
Disadv. Considerable amount of lab fab. time (expensive) Settling with it increases overbite >eq. settling with light elastics Does not maintain correction of rotated teeth well Good cooperation is essential www.indiandentalacademy.com
Indications gingival condition with more than usual degree of inflammation & swelling Open bite tendency, settling by mild depression of post. teeth
Contraindications Severe malalig. And rotated teeth Deep bite tendency Uncooperative patient www.indiandentalacademy.com
Duration of wear first 2 days full wear After that 4 hours during day time & during Sleep
In cooperative patients produce results in 3 weeks after that acts as retainer (not good retainer)
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Finishing Wires in Begg Trt. Round Finishing Wires 0.020”,0.018” premium grade 0.020” sectional wire (with settling elastics) Rectangular wires 0.022” x 0.018” ribbon (alpha titanium) 0.019” x 0.025” (blue elgiloy) 0.020” Sq. (alpha titanium) mollenhauer www.indiandentalacademy.com
Round wires (Fabrication) 0.020” normally 0.018” vertical movement req. 0.020” sectional closing open bites Often req. to continue aux. Ach wire fabricated according to individual arch form www.indiandentalacademy.com
First Order Bends Upper arch
To tuck in lateral incisors Canine offset (diff. in lab.lin. Thickness of U-2 &U- 3) Offset between premolars and molars (to compensate for diff. in buccal contour) Toe in bend for 1st & 2nd molars for good class I molar (not req. for cases finished in class II) Flat segment between U-3 & U-6 www.indiandentalacademy.com
Lower arch To tuck L – 3(minimize relapse of lower crowding) diff. in thickness of L-3 & L-2 pushes L-3 slig. Ling. without offset (no offset in well alig. Or mild crowding cases) in severely crowded cases inset between L-2 & L-3 and offset between L-3 & adj. premolar Offset between premolars and molars www.indiandentalacademy.com
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Second order Bends If necessary to intrude U-2 vertical step Mild occlusal (tip down) bend in U molar region (slig. Mesial ang. Of U-6 for seating its D.B cusp against M.B cusp of L-7 A slig. Distal tip of L-6 for proper fit against U-6 takes place its own (AB) Continue uprighting spring on U-3 so cusp tip occlude with distal half of lab. surface of L-3
Third order Correction Over correct all teeth 10-15% in 3rd stage if not possible during 3rd stage continue stage III aux. www.indiandentalacademy.com
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Rectangular wires Dr. Mollenhauer suggested and popularized rectangular wires for finishing The original tech. consisted in converting the round tubes by crimping using a template into ribbon tubes . He recommended use of 0.020” sq. or 0.018” x0.022” alpha titanium wire
Adv. of rectangular wires Bucco-lingual root torque particularly for post. Seg. Eff. Applied
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Extent of overcorrection can be reduced Individual tooth positions in terms of in out, rotations and overcorrection easily established Root & crown movements are stabilized Arch form, arch coordination & occlusal relationships can be fine tuned Retention is likely to be more stable Gnathological/functional occlusal relationships can achieve better Stabilizing wires for orthognathic surgery Debonding & debanding easier (less mobile teeth) www.indiandentalacademy.com
The strap up Combination tubes Consist of gingival round tube 0.036”diametre x 6.2mm long & rectangular (ribbon) occlusal tube 0.025”x 0.018” dia x 5.5 mm long it has 6º offset Second molars can be banded with this tube or only ribbon tubes good Quality Begg Brackets (thick walled)
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Wire Selection (directly related to modulus of elasticity) Based upon- cases that req. only passive torque & stabilization (0.020”sq. or 0.018” x 0.022’ alpha titanium) cases that req. active torque (ss or elgiloy alloy)
Alpha Ti has modulus of elasticity intermediate to ss & TMA . It has adv .of intraoral adjustment shows ↑ in str. in oral cavity due to absorption of H ions but it become brittle (due to vanadium content) in 6 weeks of insertion. www.indiandentalacademy.com
Incorporation of torque Best way in ant. Segment with 0.022” torquing turret (permit 20º torque) either torque or reverse torque Individualized torque – Rose torquing plier. General rule 15º and 25º buccal root torque in U & L pos. respectively First and second order bends are placed as in round wires www.indiandentalacademy.com
Fabrication and placement of arch wire A st. length of app. 8� of .018 x.022 wire
Placed in turret so that middle of wire coincides with centre mark on turret Turret is given firm & brisk turn for arch form 1st & 2nd order bends place with Tweed plier Individual torque when req.– Rose torquing plier. Place the arch wire in slots and pin them securely with steel T pins www.indiandentalacademy.com
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Checklist on finishing
Establish all the Andrews keys of normal occlusion Midline should coincide Cheek occlusion in centric position Cheek occlusion in functional movements Cheek for excellent interdigitation, where needed section archwire & place W or M elastics to settle the teeth Overcorrection generally not req. or at most 10½ / 10 overcorrection www.indiandentalacademy.com
Finishing to achieve Gnathological goals Gnathological Objectives A stable CR of the mandible and to have the teeth intercusp maximally at this mandibular position. All centric stops should hit equally and simultaneously and the stress of closure should be directed, down the long axes of the posterior teeth. There should be no actual contact of the anterior teeth in centric closure (.0005" clearance). Incisal guidance adequate to disclude the posterior teeth as the mandible glides forward from centric position. There should be sufficient overbite and overjet at the maxillary incisor tips to allow for a gentle glide path. www.indiandentalacademy.com
The cuspids should be the main gliding inclines on lateral excursion and the six maxillary anterior teeth should articulate with the six mandibular anterior teeth and the mandibular bicuspids (first bicuspid in nonextraction cases), so that the protrusive load is spread over 14 teeth." mutually protective" occlusal
The teeth should no way interfere with the normal envelop of border movement www.indiandentalacademy.com
A centrically related occlusion and a mutually protective excursive occlusal scheme are dependent upon: 1. Proper individual tooth positioning. 2. Knowing when the mandible is in centric and when it is not. 3. Coordination of arch form and arch width. 4. Control of the vertical dimension. 5. Anteroposterior correction between maxilla and mandible. 6. Clinical awareness of excursive interferences. www.indiandentalacademy.com
Roth Accepts the Six Keys to normal occlusion and adds his functional req. 1. Lower incisors at the +1 to A-Po; for facial esthetics, for planning anchorage control, and for selection of mechanotherapy. 2. Tips of the upper incisors 2-2.5mm below the lip embrasure of the upper and lower lips, when the lips are closed with no lip strain. 3. No more than 1 mm of attached gingiva showing upon a full smile. www.indiandentalacademy.com
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4. App. 2.5mm overjet-overbite relationship (.0005" clearance with the lingual surface of the upper incisor.) 5. A flat occlusal plane, at the end of therapy that would return to a 1 to 1.5mm curve, at its deepest point, after appliance removal and settling of the occlusion 6. A curve of Wilson that would allow seating of centric cusps, but clearance upon excursions. www.indiandentalacademy.com
7. Lower incisors aligned contact point-to-contact point with the roots in the same plane, when observed from the occlusal, and a mesioaxial inclination of 2 degrees. 8. L- 3 crowns angulated mesially 5 degrees, with the incisal tip 1mm higher than the incisal edge of, the lateral incisors. The lower cuspids should have a slightly exaggerated mesial rotation in extraction cases. www.indiandentalacademy.com
9. The lower bicuspids should be uprighted 1 degree from their normal mesial inclination and should have a slight distal rotation (more so on an extraction case). The contact point should be adjacent to the contact point on the lower cuspid distal surface.
10. The lower molars should be uprighted 1 degree from their normal 2-degree mesial inclination, and should have a slight distal rotation. www.indiandentalacademy.com
11. The lower buccal segment should have progressive torque close to Andrews' measurements for establishing the curve of Wilson, and there should be no rotations or spaces. 12. The upper 1st molars should have sufficient distal rotation, mesioaxial inclination, and buccal root torque, so as to fit with the lower 1st molars,. The same would follow for the upper 2nd molars. (14 degrees torque and 0 degrees tip). www.indiandentalacademy.com
13. The upper bicuspids should be uprighted to 0 degrees from their normal 2-degree mesial inclination, with no rotation.
14. The U-3 must have its contact points adjacent to the contact points of the upper bicuspid and lateral incisor, to establish proper length for cuspid guidance. ( +11 to +13 degrees of mesial crown tip) www.indiandentalacademy.com
15. The U-2 & U-1 should be almost equal in incisal edge length, with no more than 0.5mm height differential.
16. There should be no rotations or spaces in the upper arch, and the buccal segments from the cuspids distally should have 14 degrees nonprogressive buccal root torque. www.indiandentalacademy.com
17. The arch form should be a modified catenary curve consisting of five separate radii — one for the front of the arch form, one for each cuspid-bicuspid area and one for each buccal segment from the first bicuspid distally. The widest point of the lower arch would be at the mesiobuccal cusp of the mandibular first molars and at the first bicuspids. The widest point of the maxillary arch would be at the mesiobuccal cusps of the first molars. www.indiandentalacademy.com
Attainment of Gnathological Goals in Begg Technique Banding the 2nd molar in early stage 3 to prevent hindrance in arch form establishment, leveling of curve of spee & to prevent occlusal interference in lateral excursions. ď ś control there b-l torque with ribbon Alpha titanium wires in finishing stage. www.indiandentalacademy.com
To prevent loss of incisal guidance and under torque incisors Establish 1 mm overjet and 1 mm overbite To control torque use torqued ribbon arch wires or torqued brackets
Lack of torque in upper and lower molars ďƒ balancing and centric interferences ď ś torque with ribbon Alpha titanium wires www.indiandentalacademy.com
In begg roots of lower incisors are not uprighted enough Roots should be in same plane with apices divergent. Lower cuspid should have crown torque enough to give cuspid guidance Individual root torquing Auxiliary with ribbon wire
Pantamorphic arch form can be used in begg in Alpha titanium wires or 0.019 x0.25 blue elgiloy
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Vertical control anchor bend extrusion (high angle cases) alteration in centric • Molar fulcrum either an anterior open bite or postero-inferior displacement of condyles relapse • Judiciously avoiding classII elastics in cases Molar fulcrum is likely to produce
Towards the end of trt. Test following Excursions : protrusive, left & right lateral excrusions,see 2nd molar interference www.indiandentalacademy.com
Most important entities to establish are Anterior group function Minimal posterior disclusion Cuspid guidance in lateral excursion Absence of balancing interferences www.indiandentalacademy.com
Gnathological positioner objective of place the appliance over the patient's maxillary teeth and hinge the patient's mandible on the centric relation arc into the lower portion of the appliance, have the teeth seat into the sockets without the necessity of the mandible moving forward off of the centric relation arc. www.indiandentalacademy.com
Retention Retain (L retinere, Re + tenere - to hold) Means to hold back or to hold secure. “The holding of teeth in ideal, aesthetic and functional position.” - Richard A. Riedel
History of retention Hellman “we are in almost complete ignorance of specific factor causing relapse” Diff. Philosophies have developed, present day concept combine several of these theories www.indiandentalacademy.com
The occlusal school – Kingsley –” the occlusion of teeth is the most potent factor in determining the stability in new position”. Other authors also agree on it.
Apical base school – In 1920’s Axel Lundstorm – “apical base was one of the most important factors in correction of malocclusion and maintenance of correct occlusion” McCuley – “intercanine and intermolar width should be maintained as of originally present.” www.indiandentalacademy.com
Nance- “Arch length may be permanently increased only to limited extent”
Mandibular incisor school – Grieve and Tweed – “mandibular incisors must be kept upright &over the basal bone.”
Muscular school – Rogers considered the necessity of establishing of proper functional muscle balance.
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Theories of retention Riedel summarized the different concepts & philosophies into nine theorems.
Moyers added another theory mentioned as 10th theorem
Theorem I – “Teeth that have been moved tend to return to their former original position”. Reasons for this can be- muscular, apical base, trans septal fibers and bone morphology. www.indiandentalacademy.com
Theorem II – “Elimination of cause of malocclusion will prevent recurrence”. This can be applied where cause is obvious.
Theorem III – “malocclusion should be over corrected as a safety factor”
Overcorrection of class II to edge to edge bite may be result of overcoming muscular balance rather than absolute tooth movement Over rotation is usually carried out but little evidence of its success in preventing relapse www.indiandentalacademy.com
Theorem IV – “Proper occlusion is a potent factor in holding teeth in their corrected positions”. Orthodontist should not restrict trt. to good intercuspation but aim for good functional occlusion It is doubtful that proper intercuspation of interlocking is the most potent factor in retention
Theorem V – “Bone and adjacent tissues must be allowed time to reorganize around the newly positioned teeth”. www.indiandentalacademy.com
Theorem VI – “If lower incisors are places upright over the basal bone they are more likely to remain in good alignment”. Uprighting means bringing lower incisors perpendi. to mandibular plane or some specific angulation to occlusal plane or F.H plane But it is difficult to specify where basal bone begins or ends
Theorem VII – “Corrections carried during periods of growth are less likely to relapse”.
Orthodontic trt. Should be initiated at the earlier age possible www.indiandentalacademy.com
Theorem VIII – “The farther the teeth have been moved the less the likelihood of relapse”.
Little real evidence. Opp. May be true, more desirable through guidance of eruption and early interception of skeletal dyspla. to minimize the need of future extensive tooth movement.
Theorem IX – “Arch form particularly in the
mandibular arch cannot be permanently altered by appliance therapy”. www.indiandentalacademy.com
So arch form should be maintained presented by original malocclusion
Theorem X – “Many treated malocclusions require permanent retaining device”.
This is true only in cases that have not been treated to achieve occlusal goals that stand for stability
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Why retention is necessary? Gingival and periodontal fibers, req. time to reorganize themselves after trt. Teeth may be in unstable position after trt, so soft tissue pressure may produce relapse tendencies Changes produced by growth
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Elastic recoil of gingival fibers
Intra arch irregularity
Cheek/lip /tongue pressure
Changes in Occlusal relationship
Differential jaw growth www.indiandentalacademy.com
Reorganization Of Periodontal & Gingival Tissues Widening of PDL and disruption of collagen bundles Even if the orthodontic tooth movement stops before appliance is removed restoration of normal periodontal architecture will not reoccur as long as the tooth is strongly splinted to its neighbors. Reorganization of PDL occurs over a 3 to 4 months. Teeth will be unstable in the face under occlusal and soft tissue pressure. www.indiandentalacademy.com
Gingival Fibers Both collagen and elastic fibers occur in gingiva and reorganization occurs slowly than PDL. Collagen fibers In 4 to 6 months Elastic supra crestal fibers >1 year. (In patient with severe rotation, sectioning the supra crestal fibers around rotated teeth )
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Principles of retention against intra arch stability Teeth tend to come back because of elastic recoil of gingival fibers & tongue and lip forces. Full time retention for first four months after fixed orthodontic appliance is removed except during mastication to promote PDL reorganization Because of slow response of gingival fibers , -continue for at least 12 months if teeth were irregular initially -can be reduced to part time after 3 to 4 months. www.indiandentalacademy.com
After 12 months discontinued in non growing patient. Patient who will still grow, continue the retention until growth has reduced to low level
Occlusal Changes Related To Growth Continuation of growth is troublesome whose initial malocclusion results from pattern of skeletal growth.
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Transverse growth is completed first and long term transverse changes are less of a problem clinically than changes from antero-posterior and vertical growth. Tendency of skeletal problem to recur, because most patients continue to their original growth pattern as long as they are growing. In late adolescence continued growth in the pattern that caused class II, class III deep bite, or open bite , is the major cause of relapse. www.indiandentalacademy.com
Timing of retention Essential full time wear of First 3-4 months, except while eating (unless periodontal bone loss or other special circumstances req. permanent splinting) Continued on part-time bases for at least 12 months If significant growth remains, continue part time until completion of growth In case of skeletal dispro. part time use of functional appliance or extraoral force. www.indiandentalacademy.com
Eliminating Lower Retention (Raleigh Williams) Six treatment keys First Key The incisal edge of the lower incisor - A-P line or 1 mm in front of it.
optimum position l. i stability www.indiandentalacademy.com
Creates optimum balance of soft tissues in the lower third of the face. The angulation of lower incisors has not proven to be relevant to their stability. If the l. incisor advanced too far beyond the A-P lineďƒ relapse and crowding www.indiandentalacademy.com
Second Key The lower incisor apices should be spread distally to the crowns apices of the l lateral incisors > c incisors. l incisor roots convergent, or ll, crowns tend to bunch up and a fixed lower retainer is usually needed www.indiandentalacademy.com
Third Key The apex of the lower cuspid - positioned distal to the crown The occlusal plane, used as a positioning guide. reduces the tendency of cuspid crown to tip forward into the incisor area. www.indiandentalacademy.com
Fourth Key All four lower incisor apices must be in the same labiolingual plane Maintain labiolingual apical control during the spreading process— using uprighting springs in the third stage of Begg treatment - safety bar
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Fifth Key The lower cuspid root apex must be positioned slightly buccal to the crown apex. If the apex of the l. cuspid is lingual to the crown at the end of trt., the forces of occlusion can more easily move the crown lingually toward the space reserved for the lower incisors www.indiandentalacademy.com
Sixth Key The lower incisors should be slenderized as needed after treatment. Flattening lower incisor contact pointsďƒ flat contact surfaces, resist labiolingual crown displacement.
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Types of retention (Clinically) Retention planning is divided into
Limited retention
Moderate retention in terms of both time and appliance wear
permanent or semi permanent retention
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Limited retention
corrected cross bites anterior and posterior
dentition treated by serial extraction
correction achieved by retardation of maxillary growth (dental or skeletal) after patient has pass through growth period
maxillary and mandibular teeth have been separated to allow for eruption of teeth previously blocked out. www.indiandentalacademy.com
Moderate retention
Class I non extraction cases with protrusion and spacing (req. until normal lip & tongue fun. achieved)
Class I and class II extraction cases
Corrected deep over bites
Early correction of rotated teeth (before root formation)
Class II div 2 cases www.indiandentalacademy.com
Permanent or semi permanent retention cases with expansion, particularly in mandibular arch cases with considerable generalized spacing severe rotation midline diastema Expanded arches in cleft cases Patients exhibiting abnormal musculature or www.indiandentalacademy.com tongue habits
Retainers Retainers are passive orthodontic appliances that help in maintaining and stabilizing the position of teeth long enough to permit reorganization of supporting structures after active phase of orthodontic therapy
Criteria of good retainer Retain all teeth that have been moved in desired position Should permit normal fun. forces to act freely on the dentition Self cleansing &permit oral hygiene maintenance www.indiandentalacademy.com As inconspicuous as possible
Types of retainers Removable Fixed Active
Removable retainers Hawley retainers – most common Designed in 1920 by Charles Hawley Classic design consists of clasps on molar and a short labial bow extending from 3-3 having adjustment loops www.indiandentalacademy.com
Modifications
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Begg wrap around retainer – Consists of labial wire extends till the last erupted molar and curves around it to get embedded in acrylic that spans palate. Dr. begg advocated only U retention plate and in rare instances in L retainer (open bite due to enlarged tongue)
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It facilitates closure of space following band removal. Adv. over Hawley retainer that its wire does not keep crowns of premolars and canine apart. It permits the occlusion to adjust vertically, while offering restraint against anteroposterior and bucco-lingual relapse. www.indiandentalacademy.com
The labial bow holds the upper anteriors firmly and lower anteriors are prevented from proceeding further by the degree of interincisal angle Can be used as working retainer, when ever teeth are slightly out of position it can be use to correct the fault Over moved tooth should not be moved back and held in position of over movement until retention plate is discarded www.indiandentalacademy.com
Newer type of Begg Retainer Tightening loop at the mesial to last erupted (or about to erupt molar) Thicker wire used (0.9mm) in ant. region Adv. Simplicity of construction and reduced risk of irritation of buccal frenum A large hole in plate to improve retention An inclined plane is incorporated In passive manner to control class I & to provide strength through bulk in ant. region www.indiandentalacademy.com
Positioner as retainer Can be used as retainer For routine use not a good retainer because Pattern of wear of positioner does not match the pattern usually desired for retainers because of bulk diff. in wearing full time Do not retain incisor irreg. & rotations as well as standard retainer because retainer is needed initially full time wear. www.indiandentalacademy.com
Removable wrap around retainer Also called clip on retainer Consists of plastic bar (usually wire reinforced) along the labial & lingual surface of teeth
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Fixed retainers Maintenance of lower incisor position during the late growth Fixed lingual 3-3 retainer can be fabricated with bands on canines or bonded to lingual surface
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Bonded is prf. Unless bands were used during active trt. band space can be problem Labial side of band tend to trap plaque (gingival margin) decalcification 0.030” ss wire is used
Flexible spiral wire (0.0175” or 0.0215”) in which all teeth in a segment are bonded www.indiandentalacademy.com
Diastema maintenance
Maintenance of extraction space closure in adult
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Maintenance of pontic space
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Active retainers Spring Retainers Used to realignment of irregular incisors Interproximal width of lower incisors are reduced before realigning them Decrease the amount of space req. to align Flatten contact area ďƒ increase stability Removed with abrasive strips or thin disks in hand piece
Canine to canine clip on is used as active retainer to realign www.indiandentalacademy.com
Clip - on Retainer Made of wire frame work that runs labially over the incisors and passes between the canine and premolar and recurved to lie on lingual surface. both labial & lingual wire segments are embedded in strip of clear acrylic Fabricated on a cast wherein teeth are placed in ideal position www.indiandentalacademy.com
Modified functional appliances as active retainer Correction of occlusal discrepancies Activator (maxillary & mandibular retainer joined together by occlusal bite block) Used in adolescents that had slipped back 2-3 mm towards class II relationship Not indicated if more than 3mm occlusal correction is sought www.indiandentalacademy.com
Adjuncts to retention Reproximation Pericision or circumferential supra crestal fiberotomy Frenectomy Occlusal equilibration www.indiandentalacademy.com
Conclusion Begg Tech. is a versatile tool in resolution of severest malocclusion Its Weaknesses have been eliminated from time to time
steadily
Finishing with begg appliance is slightly difficult but not impossible Use of rectangular wires in finishing make this stage smooth and comfortable. www.indiandentalacademy.com
As to foreseeable future, the elimination of present mode of retaining appliances is certainly an aim and objective of clinical & experimental research.
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