Modern begg – (2) /certified fixed orthodontic courses by Indian dental academy

Modern Begg –
Beddtiot & CAT Techniques.
1www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

Introduction
Conventional Begg – empirical and cook book
trt.
Begg operators
– limitations
- need to diverge from orthodox trt.
Contemporary trt. goals & strategies – incorporated
into Begg practice.
Modern Begg.
Refined Begg.

Modern Begg.
Follows Begg principles – large extent.
Brackets – modified ( other than Ribbon arch
type – used in conventional Begg)

BEDDTIOT.
(Begg Edgewise Diagnosis Determined
Totally Individualised Orthodontic
Technique.)
Offers capacity to employ selected principles and
features of Begg and Edgewise mechanisms –
specific situations – most advantageous.
Primary Goal
Facility to treat each patient’s needs – most
efficient for that individual.

Strong points in Begg Technique:
Proficiency in bite opening.( with  elastics )
Differential response to force.
pitting limited tipping x translation.
optimal ant. movement, anchorage conservation.
Edgewise appl.
Precise control.
Facilitates anch. Expenditure.

Foundations:
Light wire.
Gentle, long range force systems
Min. bracket size – max. interbracket span.
Light undersized wires.

Differential response to force.
Simple horizontal force  Tooth  tip.
Crestal bone – exp. 3x times more force than
apical bone.
Crestal region – force sufficient – rapid tooth
movement.
Apical region – insufficient force.

Less bone around the neck of the tooth
than apex.
strain near the alveolar crest.
Stress
in apical region.
Above factors –
multiply each other.
powerful adv. – very light “simple tipping forces”.

Retraction – tipping + uprighting
Adv. – anchorage conserved.
Effective translatory retraction – greater
force – greater anchorage loss.
Repositioning roots after tipping – reaction
strain – insufficient for anchor loss

Modern orthodontic system – concerned:
Interdental relationships.
Facial str. & appearance.
Orientation of the dentition in the face.
Oral function.
Best approach – determined by diagnosis.
Appliance – versatile.

Brackets.
Dimensions:
Narrow, single width – edgewise br.
( 0.050 inch or 1.3 mm).
Horizontal slot – 0.022” ( height ) x 0.028”
(faciolingual depth).
Vertical slot – 0.020 x 0.020”.
Archwire slots – torqued.
.

Torque values - 0°, 5°, 10°, 15°, 20°.
All brackets identical - except for torque.
Torque indicator groove - gingival – lingual root torque.
- occlusal – lingual crown torque

Brackets:
bonding preferred.
Prewelded – flat/curved – universal bonding pads.
Advantages:
Facially facing archwire slots – engagement of
archwire easy.
Small dimensions –
. lip & cheek irritation.
 occlusal interference.
 bonding enamel surface.
 problems with gingival proximity & oral hygiene.

Interbracket – long resilient span
- archwire.
Wire – less distortion.
Less elastic range requd. force.
Considerable ( limited ) tipping .
0.016 wires - 10° distal crown tipping.
0.018 wires - 5° mesial crown tipping
(uprighting)
“braking” – not required.
Vertical slot
Uprighting springs
Turned 90° - miniature buccal tube.

Uprighting springs.
Original Recent
Original.
Helix farther from archwire.
Hook arm – no extra offset reqd.
Recent
More hygienic.
irritation on gingiva.
Appearance –less conspicuous

Buccal Tubes:
Dimensions:
4.5 mm long, 0.022 x 0.028” – edgewise.
lingual crown torque, 25° – lower.
10° - Upper.
Distal end of max. tube - 10° outward angulation.
( toe- in).
Headgear tube – 0.051” – occlusal & buccal.

In cases with deep bite/ moderate
- severe anchorage req
Addnl. Rect. Tube – diagonally across –
buccal surface of basic tube –
mesial end pointing gingivally.
Dimensions.
4.5mm long, 0.022 x 0.028”.
Outer tube ( Addnl. Tube ) - 15°
angulation to inner tube.

Bite Opening:
Outer tubes – main arch wire – bite opening &
retraction phases.
Gingival angulation – effective built in anchor
bends.( actual bend - - 25° ).
Inner tubes – Rect. sectional wires – lock PM &
Molar.
single large tooth – C.R mesial than - C.R of Molar

Bite opening – more potent – check elastics.
Intrusive force - -
less tendency to tip –
anchor units distally.

Rotations:
Early belief – rotation control difficult.
Offset bracket – side of tooth disp. lingually.
Overcorrection – thickwalled – elastomeric lig.-
placed on wire – before insertion.
Bayonet bends.

Torque control:
Disadv. Of larger slot – 0.022 x 0.028 – large wires
used – precise control – Rigid.
Overcome – resilient rect. Wires – ribbon mode.
Sizes used:
Square wires.
0.019
0.020
0.021
0.022
0.020 x 0.016”
0.021 x 0.016”
0.022 x 0.016” 22www.indiandentalacademy.com

Newer non steel alloy archwires –
Extremely resilient – gentle forces
Approp. size – precise bracket engagement.
Esthetic & Hygienic. ( eliminate – aux.)
Torqued brackets  build trt. into the appl.
Facial root torque – lower incisors – augment
anchorage.
0.022 x 0.016” , 5° torque.
Limit tipping of upper incisors - palatal torque.

Important adv. - BEDDTIOT –
Facility for both 3 dimensional control
& simple bracket
Limited tipping – light forces
Facilitate application of the best modality in every
situation.

Combined Anchorage Technique
Variable Anchorage systems.
Design of the attachment –
provides optimum light wire & straight wire trt.
capabilities.
Four stage light wire appliance  successful
collaboration b/w Begg practitioners & Unitek
Beneficial design features – adv. of Begg & St. wire.

Advantages & Disadv. of the two tech.
Begg light wire appl.
Advantages:
Light optimum force –( 60 – 90 g )
Continuous force.
Min. friction.
Rapid alignment, leveling , rotation of ant. teeth.
Rapid overbite correction.
Simultaneous crown tipping.
Continuous paralleling of roots at extn. sites.
Continuous torquing.
Extra oral force unnecessary.

Disadvantages.
Diff. – co-ordinating max. & mand. arch
Diff. – bilateral symmetry.
Premolar & molar torque control – diff.
Diff. in stabilizing teeth – final artistic
positioning.

Straight wire appliance.
Advantages:
Precise control – PM & M torque.
Bilateral symmetry – BL inclinations – readily
attained.
Bilateral symetry of arch form.
bends in archwires.
Finishing
Self limitation of movmt. & stabilization of teeth-
final detailing.

Disadvantages.
force levels – wider bracket, interbracket
span.
Rapid ant. alignment diff.
Overbite correction diff.
Addnl. anchorage – necessary- friction.
Extra oral force – reqd.
Alignment – incisors & canines – in sequence.

Dynamic & Static anchorage.
Dynamic anchorage
It comprises – physical
forces generated by the
appl. – in a complex
interrelationship – equally
effective forces – biologic
environment.
Light wire
force sys.
Biologic
force sys.
Unipoint
contacts
Muscle action
Anchor bend Tooth morph &
mass.
Archwire Cuspal interlock.
Aux. wire Freeway & fnl.
Paths.
Tipping force Occl. Force &
migr.
Intr forces Bone density
Extrusive forces Growth
Rot. Forces Habits

Static Anchorage.
Increasing the forces – within the appl. Less
effect of the biologic force sys.
CAT – dynamic & static anchorage resistance dev.
- applied – certain stages – trt. program.
Stage I & II  Dynamic.
Stage III  Dynamic / Static.
Stage IV  Static.

Four Stage Light wire Appliance:
 Appl. – vehicle – transmitting force –
teeth &indirectly – bone & soft tissue.
 Design of appl. Elements, positioning, adjustments
& manipulations – imp. – max. trt. efforts.
Caution:
Prudent to use conventional approach – each trt.
stage – as long as progress is good.

 Brackets.
Gingival or Ribbon arch slot – free
tipping, no binding.
Edgewise slot – precise final detailing.
Three bracket types – optimal rotations,
tipping & torque.
Base beveled – friction or binding with
archwire.
Torque, tip, in –out – sp. vary for each
tooth.

Molar tube:
0.036 round tube – gingivally.( Begg )
0.018 x 0.025” or 0.022 x 0.028”.
Tubes - 7° offset – addnl. molar control – Stage II.
0.018 x 0.025 slot – recommended.
Conventional tubes – preferred to convertible tubes.

Placement of brackets & tubes:
All teeth except 2nd
molars – receive attachment –
as soon as practical: increase force control.
Mandibular 1st
molar tubes – placed first.
0.036 tube – gingival margin.
rect. Tube – middle third of crown.
edgewise tube – 3.5 mm – tip of buccal cusp of 1st
molar.
3.5 mm – std. for all brackets,
EXCEPT, Canines & upper LI br.
canine br. – 0.5 mm gingivally,
LI br - 0.5 mm incisally.

Treatment technique:
Trt. divided into 4 stages.
Stage I - Organization.
Overbite correction.
Cl. II or Cl. III correction.
Alignment, levelling, elimination of rotations-
incisors.
Correction of crossbite & archwidth problems.
Overcorrection

Stage II. Consolidation.
Closure of remaining spaces.
Retraction of incisors.
Maintenance of overbite, rotations, antero-post.
corrections.
Overcorrection.
Stage III. Correction of crown & root inclination.
Uprighting & paralleling of roots.
Torquing of ant. teeth.
Maintenance of corrections.

Stage IV. Final detailing.
Attainment – ideal arch form & co-ordination of
archwidth.
Attainment – desired torque.
Precise intercuspation & fnl. harmony.
Optimal facial & dental esthetics.
Commencement of retention.

Stage I.
Archwires:
Initiated – 0.016 round wires – Begg slot.
Cl II elastic force – lingual rolling – lower molar.
Mild exp. – ¼ ” – reqd.
45° anchor bend – 1-2 mm mesial – molar tube.
In severe crowding –
Multiloop – deep bite/ max. anchorage cases.
Niti – shallow bites / min. anchorage req.

Anchor bends-
Intrusive + labial movement.
Extrudes & tips – molars – distally.
Class II elastic force:
Combination of intrusive + retractive forces –
Center of rotn.- more apical – max. lingual
crown tipping.
Elastics:
Very light elastic forces.
2 -3 oz. – 24 hrs a day.

Stage II.
End of stage I – occl. organized appearance.
St. II begins – consolidation of the dentition.
Goals in Stage I – not reduced.
Elastics:
Intrarch elastics – max. ant. retrcn. &
gen. space consolidation. 2-3 oz.
Six elastics – used.
Elastics eliminated – space closed.
Arch wire bent distal to molar tube.

Archwire:
0.018” round wire.
25° anchorage bend, 5° toe in bend.
Toe in bend – counter act rotational moment –
inter arch elastics.

Stage III.
Crown & root coordination/ torquing & paralleling
stage.
All spaces closed.
Crown tipping may be considerable.
All corrections – maintained.
Molars & canine – Class I reln.
post. occlsn. – inter locked – min. anchor loss-
subsequent – torquing & uprighting.

Pre stage III reqd. – occasionally.
Reevaluation of br. ht & posn. – recommended.
Archwires:
Maxillary:
0.020 dia.
Constr. To Omega shape.
Anchor bend 0 - 5°.
Inset bend into molar tube.
Vertical bend – premolar slot.
V bend distal to canines.
Cinched .
Overcorrected.

Mandibular:
0.018 or 0.020 dia.
Exp. ¼ ” bilaterally.
Inset bend – molar tube.
Vertical bend into premolar.
V bend distal to canines.
Anchor bend of 5° - 10°.
Cinched.
Overcorrected.

Auxiliaries:
Uprighting springs.
Two forms.
Safety ligature – hold tooth – archwire.
Safety lock spring – safety extension – holds
wire in gingival slot.
Wire size used – 0.014 or 0.016.
Torquing Aux.
0.016 wire – four spur/ two spur.

Stage III – complicated.
Constant monitoring –reqd.
In CAT – absolute determination – final uprighting,
B-L placement, torque – not reqd.
Straight wire slot – final artistic finishing - teeth.

 Stage IV.
Trt. done in edgewise slot.
Preangulated,pretorqued, in – out
features –
precise crown & root pos’n.
Stage IV – not a substitute – Stage III –
Begg.
Excellent bite opening.
Enmasse retrcn. of incisors – Stage I
& II.
Rapid uprighting – canine & PM roots.
Torque of incisors – Stage III.
All these adv. to be used to greatest extent
– Begg mech. 48www.indiandentalacademy.com

Stage IV:
Primarily to increase – effectiveness & precision- final
detailing.
hygiene problems – auxiliary springs.
Lingual crown torque of post. teeth.
Establish bilateral symmetry – uprighting.
Achieve – proper paralleling & torque.
Coordinate arch form & width.
Second molars:
More optimal occlusal reln.
To obtain best arch form.
Coordinate crown & root torque of post. teeth.

To get levelling - two preliminary – round wires –
0.016 or 0.018 Nitinol wire.
Edge wise slot mech. – alignment adequate.
Wires used.
0.017 x 0.025 NiTi.
0.016 x 0.022 , 0,018 x 0.025 – SS.
Max. torque benefit – 0.018 x 0.025 ss.
Post. teeth good axial incl. –
reduce force levels – 0.018 round .

Final Detailing.
Adjustments / modifications – archwires -
Discrepancies – size, symmetry, fn. of teeth.
Repositioning br. / 1st
order or 2nd
order bends.
Settling – 0.014 wire + vertical elastics.
Finishing & Retention:
Bonded canine to canine – lower.
Hawleys Appliance – Upper.

Advantages of CAT.
Enhances trt. potentials.
Accumulates trt. advantages.
Reduces response time.
Enhances muscular effects.
Simplifies co-operation.
Variable anchorage effects.
Reduced energy losses.
Diversity of three slots.
Controlled tipping & translation.
Goal oriented trt.
Establishes positive profile control

Conclusion.
CAT system is a biomechanical approach to
treatment which enables the clinician to vary the
treatment technique, vary the type of movements
and vary the resistance anchorage to simplify
co-operation and to definitely expand the
opportunity to overcome problems and enhance
success of trt.

Thank you
For more details please visit
www.indiandentalacademy.com

Modern begg – (2) /certified fixed orthodontic courses by Indian dental academy

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