Stage iii of begg’s technique changed /certified fixed orthodontic courses by Indian dental academy

Good Morning..Good Morning..
www.indiandentalacademy.com
INDIAN DENTAL ACADEMY
Leader in continuing dental education

Presented By:
Dr. Pritam Dhoka.
Department Of Orthodontics And Dentofacial Orthopaedics
A.B.Shetty Memorial Institute Of Dental Sciences

END OF STAGE II

Stage II Records.
 Points to be evaluated:
1) Bite opened.
2) Edge to edge incisor contact.
3) All rotations, anterior and posterior properly
overcorrected.
4) Molar relationship overcorrected.
5) Good, well supported intercuspal posterior
occlusion.
6) All space closed.
7) Buccolingual relationship of posterior teeth
properly established.
8) Anterior teeth sufficiently retracted to allow for
some relapse.

STAGE III
OBJECTIVES:
1. Maintain all corrections achieved
during first and second stages.
2. Achieve desired axial inclinations of
all teeth.

Pre-stage III archwire..
The highly resilient 0.016 inch archwires
should be used in gaining bicuspid bracket
engagement preparatory to the placement
of the heavier and less resilient 0.020-inch
stage III archwire.
This precaution avoids the imposition of
excessive alignment forces on the
bicuspid teeth.

Maxillary base arch wire
0.020-inch round stainless steel Australian heat-
treated arch wire is used.
Purpose -: 1}Maintening proper dental arch
form.
2}Maintaing bite-opening that has
been obtained.
3}Stabilizing(counteracting)
against adverse reciprocal forces.www.indiandentalacademy.com

Intermaxillary hooks.
-Located 1mm mesial
to each canine
bracket.
-Formed with middle
step of Tweed’s loop-
forming pliers. (2mm
diameter)
-Ligation of hooks to
canine brackets www.indiandentalacademy.com

Anchor bends.
Reduced or removed?
Archwire should just touch the mesial
opening of the buccal tubes at 6 o’ clock
position without exerting tipping action.

Molar horizontal offset.
-Because of difference in the buccolingual
dimensions of the molars and premolars.
-To place the central developmental
grooves of the teeth in alignment.
Placed 1-2mm mesial to the molar tubes.

Occlusal blend (vertical step-up bend).
-Mesial to the molar tube.
- To obtain bicuspid bracket engagement
-Maintain correct vertical molar-premolar
relation.
Change in the marginal ridge height thatChange in the marginal ridge height that
will accompany uprighting of a mesiallywill accompany uprighting of a mesially
tipped premolar should be taken intotipped premolar should be taken into
consideration.consideration.

‘V’ bend ( Gingival bend, Accessory bite
opening bend)
Slight (about 15 degrees) ‘V’ bend distal
to canines in the base archwire which will
bow the incisal section of archwire
gingivally.
Extent should be sufficient to bring the
anterior section of archwire to the level of
gingival margin of the central incisors
when the archwire is seated in the molar
tubes and premolar brackets.

Reciprocal actions of canine and
premolar uprighting springs?
Resultant openbite in the canine premolar
area. www.indiandentalacademy.com

Reciprocal action of incisal torquing
auxillary?
Resultant deepening of overbite in central
incisor area. www.indiandentalacademy.com

‘V’ bend will produce an intrusive force on
central incisors and and a slight extrusive
force on canines and premolars, thus
compensating distorting forces.
Maintain the bite-opening achieved in
earlier stages.

The posterior section of the base archwire
is constricted.
Molar portion of the base archwire should
lie on the tips of lingual cusps of molars
when the archwire is held over the
occlusal aspect of dental arch to
determine arch form.
Care about expansion or constriction of
canines? www.indiandentalacademy.com

To counteract the widening effect of
incisor torquing auxillary i.e to counteract
the untoward moments resulting from
activation of incisor torquing auxillary
which tips the molars buccally.

If molar intrusion occurs it can be
controlled by the use of vertical elastics
between the maxillary and mandibular
molars.

Bending archwires around tubes.
Distal tips should be annealed to the level
of distal of molar buccal tube.
Wire is cut off 2mm distal to molar buccal
tube and free end is bent so that it rests
against the molar band occlusally to the
molar tube.
-Serves to maintain space closure.

Care to be taken to prevent the beaks of
pliers from resting against the distal
surface of the tube.
-Can set up a camming action that results
in the archwire being drawn distally
through the molar tube with such force
during bending that the archwire can be
permanently distorted in the inter-maxillary
hook area. This can destroy the desired
archform and permit the anchor molars to
move buccally. www.indiandentalacademy.com

The bend should be barely snug against
the distal end of tube.
Cinching back the ends of archwire tightly
cause molar expansion and disto-buccal
molar rotation.

Lingual ligatures.Lingual ligatures.
Described by Dr. Raleigh Williams.
Made of 0.012-inch ligature wire.
Tied to molar and pulled anteriorly
through the cervical embrasure between
lateral incisor and cuspids and is twisted
around the archwire.

Should be used to maintain space closure
and hold corrected molar rotation.
Should be snug but never tight.

Excessive tightening of this ligature tends
to distort archform by flattening the
archwire in the area of circle hook and
may cause proximal binding which may
interfere with uprighting.

Mandibular base archwire.
0.020-inch round stainless steel
Australian heat-treated arch wire is used.

Intermaxillary hooks.
Intermaxillary hooks are located 0.5mm mesial
to each canine bracket.
Formed with first step of Tweed’s loop-forming
pliers. (1mm diameter)
Small rings occupy less archwire space between
the canine and lateral incisor brackets thereby
providing more space for the horizontal arms of
the lateral incisor uprighting springs.
Ligation of hooks to canine brackets.

Slight (about 10 degrees) ‘V’ bend distal
to canines in the base archwire which will
bow the incisal section of archwire
gingivally.
As heavier base archwire is used, anchor
bend reduced than in earlier stages to
prevent distal tipping of molars.
Molar horizontal offset and vertical step.

Expanded at its end to combat the
continued tendency for the mandibular
anchor molars to tip lingually from the
wearing of class II elastics.

Mesio-distal Uprighting spring (Individual
root-spring)
Original uprighting spring with long lever
arm and tail.

Refinement of the original spring.
-Shorter lever arm.
-Larger, more resilient coils.
-As efficient as original spring.
-The angulation of the active arm
 and retentive arm is 135 degree.
Advantages: self retaining and being short they
do not interfere with springs on adjacent teeth.

Self retaining uprighting spring with 3 full
coils to provide gentle, continuous force
necessary to upright teeth without
requiring reactivation.

Placed in the pin channels of the
brackets.
Helix should wind in the lingual direction
i.e towards the tooth surface and lie on the
gingival aspect of the archwire at the
opening of the bracket slot.

Length of the hook is made slightly
greater than the diameter of the helix to
keep arm of spring parallel to the archwire
in the vertical plane.
To avoid the rotating force on the tooth,
the arm of the spring is offset buccally to
make it parallel to the archwire in the
horizontal plane.www.indiandentalacademy.com

Direction of Hooks?Direction of Hooks?

Action of short arm uprighting spring.

Long-arm uprighting springs.Long-arm uprighting springs.
-Used when mesiodistal diameters of canine and
premolars are small where it is not possible to
place the short-arm type of uprighting springs
without the hooks contacting each other.

Inherent Problem?
When the uprighting springs are engaged
and under tension, the coils press against
the gingival edge of the bracket. If the
archwire is not safely tied into the slot in
the bracket, this force from the coil can
cause the bracket to move away from the
archwire, with a subsequent elongation of
the tooth.

Solution?
Spring-pin.Spring-pin.
 - combination of lock-pin and and an uprighting
spring.
The leg of the pin portion passes lingual to the archwire,
and the tail of the spring fits labial to the archwire in the
space in the space in the bracket slot, and the tooth is
free to upright mesiodistally with no danger of it being
elongated.
Eliminates the need for ligating the arch wire to the
bracket www.indiandentalacademy.com

Spring-pin is inserted in bracket with the
pin portion passing lingual to the archwire.

Annealed end of spring is bent around the
incisal end of bracket, securely locking the
spring-pin and archwire in place.

Arm of spring is hooked over the archwire,
activating the coils and creating the
necessary force to upright the tooth
mesiodistally.

The horizontal arms of the uprighting springs
may need to be shortened as uprighting occurs
to prevent space opening, tooth rotation, and
impairment of the uprighting action which may
result from contact of the hooks with the
adjacent brackets or bands.

 The degree of activation of the uprighting
spring depends on
1) Size of wire.
2) Diameter of the helix.
3) Number of turns in the helix.
4) Length of the arm of the spring, and
5) Size of the root of the tooth being
uprighted.

In a first premolar extraction case:
Order for need of teeth to be uprighted:
Lower canines
Upper canines
Lower second premolars
Upper second premolars
Upper lateral incisors
Lower lateral incisors

Upper and lower canines-0.016-inch or
0.018inch, 2- coils
Upper and lower second premolars- 0.016
inch , 2- coils
Upper lateral incisors – 0.014 inch,2- coils
Lower lateral incisors – 0,014 inch ,3-
coils

 Most resilient available wire should be
used (Australian heat-treated
stainless steel) because:
1) Makes possible the engagement of the arm of
the spring about the archwire, with little chance
of deformation.
2) Insures full activation of the springs during a
greater range of uprighting.
3) There is less need to reactivate the arms of
springs to insure continuous uprighting of teeth.

Arch wire ligation prior to placement
of uprighting spring

MildMild discrepancy cases i.e in firstdiscrepancy cases i.e in first
premolar extraction cases havingpremolar extraction cases having
only aonly a mild excess of toothmild excess of tooth
substance relative to jaw sizesubstance relative to jaw size??

ModerateModerate discrepancy cases i.e indiscrepancy cases i.e in
first premolar extraction casesfirst premolar extraction cases
havinghaving considerable excess ofconsiderable excess of
tooth substance relative to jawtooth substance relative to jaw
sizesize??

SevereSevere discrepancy cases i.e indiscrepancy cases i.e in
which it is necessary to extractwhich it is necessary to extract
eight teeth (4 first premolars and 4eight teeth (4 first premolars and 4
first permanent molars)?first permanent molars)?

Non-extractionNon-extraction cases, especiallycases, especially
those cases that have anthose cases that have an excess ofexcess of
jaw substance relative to toothjaw substance relative to tooth
sizesize??

Originally spurs to rest against the labial
surfaces of upper central and lateral
incisors were bent into the main maxillary
archwire made from 0.016-inch archwire
material.
The effect was to move the molars
buccally and also to rotate them disto-
buccally.

By employing a heavier main base
archwire in conjunction with a torquing
auxiliary bent from lighter material (0.014
to 0.016-inch), it was possible to prevent
undesired movement of the maxillary
anchor molars.

Four-Spur torquing auxiliary.Four-Spur torquing auxiliary.
Employed to torque upper and lower incisor
roots palatally.
Made with 0.016 or 0.014-inch archwire.

Factors which alter the forceFactors which alter the force
values of an auxiliary:values of an auxiliary:
1) Type of wire
2) Diameter of the wire
3) Size of the circle
4) Angle the spur makes with the plane
of the auxiliary
5) Axial inclination of the teeth
6) Length of the spur?

The amount of torque force is related to the
extent that the spurs are tipped back, the
torque force being derived from the amount of
torque in main line of auxiliary archwire.
The spurs play a passive role- they act
only as means of delivery of torque force
from the main line of archwire.www.indiandentalacademy.com

Procedure for bending four-spur torquing
auxiliary:

Auxiliary is formed into an arc smaller
than that of the anterior portion of the
patients dental arch, with the spurs in a
nearly horizontal position.

Torquing auxillary with spurTorquing auxillary with spurB
E
G
G
When spread along the wider curvature
Lingual torquing
Vertical plane in which
the aux orients when fitted
into the incisor is changed
to the horizontal plane of
the arch wire when tied to
it
The larger arc of
the anterior portion
of the wire roll
inwards
The tip of spur to press in aThe tip of spur to press in a
lingual direction against thelingual direction against the
gingival portion of thegingival portion of the
crowncrown
Inter spur span – lift in a
labial direction
Bracket slot
Base arch wire
Counter act

Pre-Wound Torquing Auxiliary.Pre-Wound Torquing Auxiliary.
Not in common use.
- Precise nature of wire-bending required.
-Complex.
Produced commercially- using special
bending fixtures.
Graduated sizes- Varying mesiodistal
widths of teeth. www.indiandentalacademy.com

Simpler to apply.
Capable of delivering greater amount of
force through a greater range of
movement than other types of incisor
torquing auxiliaries.
Wound either from 0.016 or 0.014-inch
wire.

Activated by meeting the resistance of the
stop on the midline of the archwire.
Possible to remove torque bars from the
lateral incisors as these teeth become
adequately torqued.
Can be modified to produce labial root
movement.

Procedure for assembling a Stage III
mechanism:
1} Place the upper and lower main base
archwires in the mouth.
2} Lower archwire is pinned in place,
using Stage III lock-pins on teeth that do
not require mesiodistal uprighting.
3} Place proper spring pins in all
remaining mandibular teeth and maxillary
second premolar brackets.

4} Pin the upper torquing auxiliary in one
of the maxillary central incisor brackets.
5} Distal ends of auxiliary are then pinned
into canine brackets gingival to main
archwire with spring-pins.
6} Bend the distal ends of the archwire as
described earlier.www.indiandentalacademy.com

Additional considerations:Additional considerations:
If the maxillary or mandibular anchor molars
show signs of rotating distobuccally, tie with
0.012-inch diameter ligature wire lingually from
lingual hook on molar to lingual button on
cuspid.
The end of archwire should not be bent tightly
around the distal surface of molar tube here, as
molar tube must be free to slide distally to allow
the molars to rotate distolingually.

TWO SPUR TORQUING AUXILIARYTWO SPUR TORQUING AUXILIARY
( von der Heydt auxiliary )( von der Heydt auxiliary )
When only central incisors reguire the
torque, auxillary with two spurs is used.

Maxillary lateral incisors are often displaced
bodily to the lingual prior to the treatment.
During stages I and III, their crowns are tipped
labially, leaving their roots far to the lingual.
Unless their roots are torqued labially during
stage III, their crowns will tend to relapse
lingually .
RECIPROCAL TORQUING AUXILIARYRECIPROCAL TORQUING AUXILIARY
( SAIN Auxiliary)( SAIN Auxiliary)

Dr John Kitchton’s lingual rootDr John Kitchton’s lingual root
torquing auxiliary.torquing auxiliary.
Can be easily applied and removed.
Can be used for torquing central and
lateral incisors or only central incisor roots.
Capable of exerting a great amount of
force, especially when fashioned from
0.016-inch archwire material.

Passive state.
Activation is increased by bending lever
arms further gingivally before placing.

Auxiliary can be placed with coils
straddling archwire.

Auxiliary bent from 0.016-inch archwire to
torque the roots of the maxillary central
and lateral incisors palatally. Vertical spur
bent into heavy main archwire acts as a
point of resistance against centre section
of auxiliary. www.indiandentalacademy.com

Auxiliary modified to apply labial root
torque to maxillary lateral incisors only.
The resistance spur on main archwire is
lingual to centre section of auxiliary.

Mandibular Reverse TorquingMandibular Reverse Torquing
AuxiliaryAuxiliary.
 Indicated if lower
anterior teeth are
becoming too
proclined.
 Acts as a source of
intra oral mandibular
anchorage to inhibit
forward movement of
mandibular dental
arch. www.indiandentalacademy.com

ONE TO ONE TORQUEING AUXILIARYONE TO ONE TORQUEING AUXILIARY
Indicated when two
adjacent teeth require
root torque in opposite
directions.
Tends to deliver
excessive force therefore
degree of activation
between lever arms
should be low

Auxiliary to correct buccolingualAuxiliary to correct buccolingual
axial inclination of premolar.axial inclination of premolar.

Use of Class II Elastics.
Prevent the force exerted by vertical root
torquing spurs in the upper auxillary
archwire from moving whole of upper
dental arch anteriorly.
Prevent the dental arches from reverting
to their original class II occlusal relations
and keep the incisors in end to end bite.

PROBLEMS ENCOUNTERED DURING STAGE IIIPROBLEMS ENCOUNTERED DURING STAGE III
Maxillary Molars Widening?Maxillary Molars Widening?
Mandibular molars narrowing?Mandibular molars narrowing?
Anterior bite deepening?Anterior bite deepening?
Teeth not uprighting mesiodistally?Teeth not uprighting mesiodistally?
Maxillary anterior teeth not torqueingMaxillary anterior teeth not torqueing
palatally?palatally?
Lower anterior teeth labially inclined?Lower anterior teeth labially inclined?
Rotation of teeth other than molars?Rotation of teeth other than molars?

Causes of loss of anchorage in the third
stage of treatment.
Class II elastics not worn.
Use of rectangular archwires to torque
tooth roots instead of using root-torquing
spurs formed from light round archwire.

Conclusion.Conclusion.
-One needs a lot of perseverance to reach
proficiency in this technique.
-Various refinements and modifications in
the Begg technique have given the
orthodontists innumerable ways of
achieving the objectives of the procedure.
-We as Orthodontists should go ahead
and put them to judicious and profitable
use. www.indiandentalacademy.com

Sequence of insertion of Archwires
and Auxiliaries
The base arch wires are inserted
unpinned but fitting well upto the Begg slot
Arch wires are cinched distal to the
molars to prevent the spaces from
opening up
Depending on the need for torquing the
torquing auxiliary is fabricated

In the lower arch only uprighting
springs are inserted unless labial/lingual
torque is needed
direct the lower arms towards the root
movement intended
insert the vertical leg into the pin slot
pull it occlusally so the spring lock
holds the archwire firmly
bend this vertical leg towards the root
movement intended
to activate hook the lever arm to the
main archwire.www.indiandentalacademy.com

After the root tipping movements of the
third stage are completed remove the
torquing and paralleling auxiliaries and
make adjustments in the base archwire
to complete the treatment.
To flatten the occlusal plane make
localized vertical offset bends to level
individual teeth
To obtain bilateral symmetry make
definite localized horizontal offset bends
to expand or contract individual teeth
and make the arch symmetrical

INDIVIDUAL TORQUEING AUXILIARYINDIVIDUAL TORQUEING AUXILIARY
 Used for selected upper or lower teeth
 Auxiliary should extend at least one tooth pass
tooth being torqued, and around curve of arch, for
maximum activation.
 If placed gingivally, torque the root of the lateral
lingually.

ASYMMETRICAL TORQUING AUXILIARYASYMMETRICAL TORQUING AUXILIARY
 Auxiliary used to produce palatal root torque of the maxillary
right central and lateral incisors.
 The ends of the auxiliary are terminated distal to the canine
brackets.
 As the central incisor loop is formed mesial to the bracket
and the lateral incisor loop is formed distal to the bracket
mesodistal movement of the auxiliary is prevented.

Barrer in 1963 suggested the
acuteness of the angle between the
torquing spur and the horizontal plane

Chourie in 1965 in his thesis sugested thatChourie in 1965 in his thesis sugested that
length of the torque spur loop exerts anlength of the torque spur loop exerts an
affect upon the amount of force deliveredaffect upon the amount of force delivered
to the root tip.to the root tip.
Newmann in 1963 presented aNewmann in 1963 presented a
formula for calculating the force atformula for calculating the force at
the apex of the incisorsthe apex of the incisors
..

F=ØG¶r4
2Ld
Ø is the angle in radians
G is the average modulus of
rigidity of stainless steel
¶ is a constant
L is length of the wire
d is the distance from root apex to
bracket area
r is the radius of the wirewww.indiandentalacademy.com

The lingual torquing effect is on account of two
factors:
1. Vertical plane changes to horizontal.
2. Smaller circle opens to large.
Both these effects force the tips of the
spurs to press in a lingual direction against the
gingival portion of the crown. Reciprocally, the inter –
spur spans of the auxiliary tend to lift away in a labial
direction. Thus a force couple is created. The labial
forces are resisted by the bracket slots and the base
archwire to which auxiliary is tied this accentuates the
action of root lingual moving force.

Thank you
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Stage iii of begg’s technique changed /certified fixed orthodontic courses by Indian dental academy

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