Traditional begg philosophy /certified fixed orthodontic courses by Indian dental academy

TRADITIONAL BEGG
PHILOSOPHY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


EVOLUTION OF THE BEGG’S APPLIANCE.
Begg: After graduating from the Melbourne university in
1923, he went to study with Dr.Angle in California.
In 1924,coincidentally with Dr.Begg’s arrival in
California,Dr.Angle was developing the edgewise
mechanism.
Dr.Angle took ribbon archwire which was normally inserted
vertically from the incisal and turned it on it’s
edge-”edgewise” to insert it horizontally.
In november 1925,Dr.Begg sailed back to Australia and
started practicing orthodontics in Adelaide in 1926.
{edgewise mechanism-non-extraction principle}.
For 2 years, Dr.Begg faithfully followed Dr.Angle’s teaching
of retaining the full complement of teeth.However in many
of his patients,he was not satisfied with post treatment profile
and faced with serious relapses of the treatment results.

In february 1928 he began to routinely remove teeth and reduce the
mesiodistal width by proximal stripping.
He knew from experience and his appreciation of the role,attrition
is meant to play in the development of man’s dentition that seeks
reduction was often necessary to permit the proper repositioning of
the teeth to enhance FUNCTION,STABILITY AND
ESTHETICS.

Dr.Begg realised that edgewise mechanism was not designed to
rapidlyclose extraction spaces and for quickly reducing deep
overbites.
To facilitate such changes,he began using .020inch round platinised
gold rather than rectangular archwire in 1929.

In 1931/32 he started using .018inch round stainless steel
wire bending the vertical loops,intermaxillary
circles right into the archwire.however he soon
realises that if round archwires were engaged in
edgewise brackets,indiscriminate and
often undesired root moving forces could be created.
This prolonged the anterior biteopening and taxed loss of anchorage.
In 1933,about 2 years after switching over to round wire,he began
treating some cases with ribbon arch bracket.he realised that these
relatively narrow brackets with vertically facing slots allowed the
teeth to move under very light forces.


Dr.Begg described a treatment approach based
on the following hypotheses which were backed
to some extent by his own researches.
They were:
1.Theory of attritional occlusion
2.Theory of differential forces
3.The employment of a modified form of ribbon
arch bracket and light gauge round archwire.

THE THEORY OF ATTRITIONAL OCCLUSION
Dr.Begg founded the concept of correct occlusion based on his studies on the
skulls of australian aboriginals..
.He found that the dentitions displayed a considerable amount of attrition ,both
occlusally and interproximally.
.The dento-alveolar height was maintained by continuous eruption and
proximal contact by mesial tooth migration.,facilitated by cuspal wear.
.The incisor relationship became edge to edge thereby reducing the chance of
lower incisor imbrication through overbite obstruction…
The total reduction in arch length resulting from attrition amounted
approximately to one bicuspid width either side of both dental arches by the
time the aboriginal was 20 years of age…
These findings accord with the studies of miss Corisande smyth with her study
of anglo-saxon skulls…
According to sir Arthur keith,in bronze-age Britain,skulls showerd edge-toedge incisor relationship waswww.indiandentalacademy.com
common..

Normal occlusion in young adult of
present day

Normal occlusion in
primitive times.


But in the present age,due to the refined and pre-cooked food,less dental
attrition was observed.The absence of attrition along with the presence of
mesial tooth migration does not relieve the dental overcrowding ,particularly
in the lower incisor region where the modern overbite prevents their escape
into edge-to-edge relationship with the uppers.
Dr.Begg used the findings from his study of australian aboriginal occlusions
as a justification to extraction.He argues that if in this present era tooth
material is not lost through attrition ,it would be rweasonable to cause a
commensurate reduction artificially.through extraction.
However,care should be taken to restrict the employment of extraction
within logical limits..
Thus the extraction approach in orthodontic treatment came into existence .
Surely,there will be exceptions to the extraction approach just as there were
to the non-extraction approach.


Theory of differential forces.
The theory of differential forces in it’s original form was described by
dr.Begg in an article AJO{1956} his observation was based to a large extent
on the work of Storey and Smith.
The range of light pressures which would cause the teeth to move at an
optimum rate with minimal disturbance of the supporting tissues.
Pressures below this range would produce a slow rate of response while
those above incurred a reaction within the bone support,referred as
“undermining resorption”.
Applying these principles to the begg technique,the force of the
intermaxillary elastics used inn stage I of treatment ,was kept light so that the
upper labial segment was retracted while the lower anchor molars has
negligible mesial movement.later,if it was required that the residual
extraction spaces should be closed largely by the mesial movement of the
posterior teeth, the elastic forces are increased so that the anterior segment
with their relatively small root area received an excess of force sufficient to
delay their movement,while the posteriors moved forward.

a.A force of less than 150 grams causes no distal bodily movement of canine.
b.A force of 150 -200 grams is optimum to move canine distally.
c.A force of 300-500 grams causes the molars to move easily.this high force is resisted
by the tissues investing the canine root,thus affording anchorage for mesial movement
of molars.


Concept of undermining resorption
According to the concept of undermining resorption,excessive orthodontic
forces ,when exerted on teeth cause the periodontal membrane and toothinvesting bone to be compressed.this causes the occlusion of bloodvessels
and the blood supply is cut off in these areas.This inadequate blood supply
causes necrosis of the compressed parts of the periodontal membrane and
bone..This leads to no tooth movement until phagocytic action removes the
necrosed tissues and until new living tissues form.this excessive force also
causes pain and loosens teeth.
The effect of this process is that teeth do not move continually but
intermitently and much slower than when lighter orthodontic force is used.
On the other hand,if lighter and appropriate orthodontic force is applied
,the periodontal blood vessels are not occluded so that the bone on the side
of pressure is continually and rapidly resorbed and new bone is
simultaneously formed on the side of negative pressure without any
discomfort and loosening of teeth.
heavy force – internmittent movement.
light force - continual www.indiandentalacademy.com tooth movement.
flow of uninterrupted

THE MEANING OF DIFFERENTIAL
ORTHODONTIC FORCE.
In physics and mechanics ,differential is defined as the difference
of two or more motions or pressures.the orthodontic force
values used in this technique cause:
1. Minimum discomfort
2. Minimum loosening of teeth.
3. Minimum damage to tooth investing tissues.
4. Rapid tooth movement
5. Easily controllable forces.

The meaning of optimum
orthodontic force
The optimum orthodontic force means that force which moves teeth the most
rapidly with least discomfort to the patient ,and with least damage to the teeth
and other investing tissues.
The forces that are most favourable for tooth movement on the standpoint of
rapidity and tissue tolerance are according to storey and smith much lower than
that exerted by edge wise archwire.
According to Halderson,Johns and Moyers ,the force exerted by edgewise
archwire is of very high value of over 2 pounds or 900 grams which causes a
pathogenic tissue response.
hence, they advocated the use of light round wires as
1.It takes as much advantage of tipping movements as is possible.
2.It utilises forces much lighter than are possible with a standard edgewise wire.

Materials ,appliances necessary for the
begg technique.
The spring quality of the firstmade steel was a great improvement
compared to the rectangular gold platinum wire.however,it was either
too soft or too brittle.

In 1940’s dr.Begg met Arthur.J.Wilcock who was directing
metallurgical research in the university of Melbourne.after many years
of research,Mr.Wilcock finally produced a cold drawn heattreated
wire that combined the balance between resilience and hardness with
the unique property of zero stress relaxation that dr.begg was
seeking.this unusualwire permitted dr.begg to open deep anterior
overbite while controlling archform and providing molar stability.

however dr.begg had the same problem
controlling the mesiodistalinclination of teeth
with ribbon arch brackets that dr.begg had
experienced 30 years back.

Dr.Begg attempted to modify the ribbon-arch bracket
by soldering horizontal band spurs to the labial and
buccal surfaces of the bands.when the tooth required
mesiodistal tipping,the archwire was permitted to
contact the horizontal band spur.the archwire was then
deflected towards the bracket with a lockpin or steel
ligature.the resultant flexing of the archwire provided a
degree of mesiodistal axial control or movement.

LOCKPINS

1.One-point safety lockpin:

 first stage of treatment with .016 inch archwire.
Shoulder on labial surface of the head strikes bracket to
prevent impingement of pin and the archwire.
Beveled undersurface of head leaves adequate space for
tipping.
2.Second stage lockpin:
Safety shoulder prevents binding on archwires .
The bodyof the pinis dimensioned to open 256-500 bracket
slot to 0.020 inch to accept larger archwires during stageII.
3.Hook lockpin:
Used on all teeth that do not require mesiodistal uprighting
during stage III.

ADJUNCTS TO LIGHT WIRE TECHNIQUE
ELASTICS:{LATEX OR RUBBER}: Which will exert a force
equal to between 60 and 70 grams when they are new and first
placed.
ELASTIC TIE MATERIAL: To provide force to rotate or erupt
teeth.The elastomeric materialis more esthetic howeverwhen
extremely light pressure is desired ,the elastic thread is generally
used.
STAINLESS STEEL LIGATURE WIRES OF VARIOUS
DIMENSIONS.
ELASTOMERIC RINGS {1.5 TO 2mm} are used to connect the
cuspid brackets to intermaxillary hooks to keep the six upper and
lower anterior teeth in contact.


LINGUAL BUTTONS: used as points of engagement for the
following:rubber elastics,ligature wires,specially shaped
sections of archwire material and orthodontic elastic thread
MOLAR HOOKS WITH BALL ENDS:makes the placing of
elastics simple for the patient.
KESLING TOOTH SPACING SPRINGS


BRACKET PLACEMENT
Brackets are centred mesiodistally on the
labial and buccal surfaces of the teeth with
the base of the archwire slots 4 mm from
the incisal edges or cusp tips.
For lateral incisors,the brackets are set
close to the incisal edge,{3.5 mm},to
provide the desired esthetic shortening of
these teeth in relation to their neighbours.
The lingual buttons should be positioned
directly opposite the areas of archwire
engagement on the opposite side of the
teeth.This is necessary to permit free
mesiodistal tipping and uprighting of the
teeth.

BUCCAL TUBE PLACEMENT

Molar buccal tubes are oriented parallel to a line bisecting the
crown mesiodistallyas viewed from the occlusal and parallel to
the occlusal surface as viewed from the buccal.
Mandibular molar tubes are attached as far gingivally as possible
to keep the archwire away from the occlusal plane.


THREE STAGES OF
TREATMENT.
Begg’s technique is divided into 3 separate and distinct stages that
must not be allowed to overlap.it is chiefly with the object of
preventing anchorage failure that the technique is divided into 3
distinct stages of tooth movement,

1.STAGE I
2.STAGE II
3.STAGE III

OBJECTIVES OF STAGE I:
1.crowding and irregularity of all teeth are corrected.
2.spaces between anterior teeth are closed.
3.rotations of all teeth are overcorrected to rotations that are the reverse
of but less than the original rotations.
4.open the anterior overbite.
5. Anteroposterior occlusal relations of all teeth are overcorrected in
class I and class II malocclusions until the posterior teeth reach almost
classIII occlusal relations.
6.the contours of both the dental arches are brought to good
proportions.
7.the upper and lower extraction spaces becomes more smaller.
8.correct posterior crossbites.

9.the axial relations of the anchor molars are corrected in this stage.

STAGE I
In order to reduce deep overbite of anterior teeth,anchorage bends are
made in the upper and lower 0.016 inch diameter round archwires
mesial to the molar tubes so that the anterior parts of the archwires
lie gingivally to the anterior teeth.

When rectangular edgewise archwires are used for
bitreopening,aconsiderable amount of bite opening is obtained by
tipping back of the upper and lower molar anchor teeth with
elevation of their mesial marginal ridges due to heavy forces.

After completion of treatment,the elevated mesial marginal ridge
settle back in their sockets resulting in relapse of anterior overbite..

However ,in contrast, with the use of round arch wires,due to the light
forces employed, only rapid movements of the upper and lower anterior
teeth ocuurs gingivally ..
There is no movement of the molars.Hence the deep overbite is
eliminated and the results are stable..

STAGE I
THE ARCH FORM OF THE ARCH-WIRE IN STAGE I IS GENERALLY EXPANDED OVER IT’S
ENTIRE WIDTH TO COUNTERACT THE LINGUAL MOVEMENT OF THE ANCHOR MOLARS
ANCHOR MOLARS ,ESPECIALLY THOSE IN THE MANDIBLE TEND TO TIP LINGUSALLY AS
A RESULT OF VERTICAL COMPONENT OF FORCE FOUND IN CLASS ii INTERMAXILLARY
ELASTICS.
IN THIS TECHNIQUE,NO TEETH SHOULD BE HELD FIRM..SO THAT THEY CAN RESPOND
TO GENTLE TOOTH –MOVING FORCES..
ELIMINATION OF ANTERIOR CROWDING:
VERTICAL LOOPS BETWEEN CROWDED ANTERIOR TEETH ARE USED WITH
BRACKET AREAS MODIFIED FOR DESIRED OVERCORRECTIONS.
ARCH LENGTH DESIGNED SAO THAT INTERMAXILLARY CIRCLES REST AGAINST
MESIAL SURFACE OF CUSPID BRACKETS.


CLOSURE OF ANTERIOR SPACES:
PLAIN ARCHWIRE WITH ELASTIC FROM CUSPID PIN TAIL TO
CUSPID PIN TAIL.
CORRECTION OF ROTATION:
1.OVERCORRECTION OF BRACKET AREAS BETWEEN ANTERIOR VERTICAL
LOOPS.
2.USE OF ELASTIC THREAD .
3.USE OF ROTATING SPRINGS.
CORRECTION OF POSTERIOR CROSSBITES:
1.MODIFY ARCHWIDTH OF ONE OR MORE ARCHWIRES.
2.WEARING OF CROSS ELASTICS.-USUALLY BILATERALLY.
3.RAPID MAXILLARY OVER EXPANSION PRIOR TO THE BEGINNING OF STAGE 1


STAGE II

OBJECTIVES OF THE SECOND STAGE:
1.maintain all corrections achieved during first stage.
2.close any remaining posterior spaces.
all tooth movements that should be performed in the second
stage of treatment are carried out simultaneously and must be
completed in both dental arches before proceeding to stage III.

STAGE II
ARCH WIRE:
THE FUNCTION OF ARCHWIRES IN STAGE II IS TO MAINTAIN THE CORRECTIONS
ALREADY ACHIEVED AND TO STABILISE THE TEETH AGAINBST ANY ADVERSE
RECIPROCAL FORCES.
TO ACHIEVE THIS HEAVIER {0.020 INCH} UPPER AND LOWER ARCHWIRES ARE USED..
THE ANCHOR BENDS PLACED IN THE HEAVIER ARCHWIRE MUST BE LESS THAN THAT
OF THE LIGHTER WIRES.

WEARING OF ELASTICS DURING STAGE II:
THE WEARING OF HORIZONTAL ELASTICS CREATES A ROTATIONAL FORCE
ON THE MOLARS .TO PREVENT THIS,THE DISTAL ENDS
OF THE ARCHWIRES CAN BE
GIVEN A SLIGHT AMOUNT OF TOE-IN.


TOOTH RELATIONSHIPS AT THE START OF STAGE III
SINCE SOME % OF MANY CORRECTION ACHIEVED IN THE FIRST 2 STAGES IS
LOST IN STAGE III ,IT IS BETTER TO OVERDO ALL OF THEM BY 15%
1.EDGE-EDGE INCISORS –ALL UPPER AND LOWER ANTERIORS
RETROCLINED.2.CANINES DISTALLY TIPPED AND SECOND PREMOLAR
MESIALLY TIPPED.
3.MOLARS UPRIGHT.
4.IN ANTERIOR OVERBITE: POSITIVE OVERBITE.
5.ALL SPACES CLOSED ,ROTATIONS AND MIDLINE DEVIATIONS
OVERCORRECTED.
ALL THE TEETH SHOULD BE WELL-ALKIGNED AND OCCLUDING IN SLIGHT
MESIO-OCCLUSION.


OBJECTIVES OF THIRD STAGE:
1.MAINTAIN ALL CORRECTIONS ACHIEVED FIRST
AND SECOND STAGES.
Posterior spaces kept closed by bending the distal ends of the
archwires around the buccal tubes.
Archform and overbite correction maintained by using heavier
{0.018 to 0.025 inch} main arch wires.
2.ACHIEVE DESIRED AXIAL INCLINATIONS OF ALL
TEETH.
Changes in the mesiodistalinclination of teeth by the use of
individual root-tipping springs.
Lingual or labial root torque is applied to the anterior teeth
through the application of torqueing auxillaries.

ARCHFORMS
ALL THE FORCES OF STAGE III AUXILIARIES ARE EXPRESSED THROUGH BASE
ARCHWIRE HENCE IT CALLS FOR A STIFFER ARCHWIRE {0.020 INCH} IN STAGEIII
TO RESIST DISTORTING FORCES FROM AUXILLIARIES.
THE MAXILLARY BASE ARCHWIRE INCORPORATES THE FOLLOWING:
1.INTERMAXILLARY CIRCLE
2.ANCHOR BENDS
3.MOLAR VERTICAL OFFSET
4.HORIZONTAL MOLAR OFFSET
5.V-BEND
6.CONSTRICTION: TO COUNTERACT THE WIDENING EFFECT OF THE MAXILLARY
TORQUEING AUXILIARY.
7.TOE-IN
8.CINCHIN/LINGUAL LIGATION..


MANDIBULAR ARCHFORMS
THE MANDIBULAR ARCHWIRE INCORPORATES THE FOLLOWING:
1.IDEAL ARCHFORM WITH PROPER ANTERIOR CURVATURE
2.GOOD CANINE CONTOURING
3.REDUCED ANCHOR BENDS
4.GABLE BEND DISTAL TO CANINE.
5.2-4MM EXPANSION IN POSTERIOR SEGMENT TO COUNTERACT LINGUAL
TIPPING BY CLASSII ELASTIC USE.
6.MILD VERTICAL &HORIZONTAL MOLAR OFFSET..


AUXILIARIES USED IN STAGE III
1.UPRIGHTING SPRING
2.TORQUEING AUXILIARY

UPRIGHTING SPRING:
IT WAS FIRST DEVELOPED BY DR.BEGG.IIN 1961.
IT HAS 3 PARTS:
1.ACTIVE ARM WITH TERMINAL PART AS HOOK.
2.HELIX CAN BE 2-3 FULL HELIX ,0.5-1MM INTERNAL
DIAMETER.
3.STEM/LEG-RETENTIVE ARM.
SELF-RETAINING UPRIGHTING SPRING WITH 3 FULL COILS TO PROIVIDE
GENTLE,CONTINUOUS FORCE NECESSARY TO UPRIGHT TEETH WITHOUT
REQUIRING REACTIVATION.


TORQUEING AUXILIARY
BY THE END OF STAGE II ,IT BECOMES QUITE OBVIOUS
WHETHERINCISOR ROOT TORQUEING IS NECESSARY OR
NOT.DR.BEGG HAD SEPARATED ROOT MOVING FORCES FROM
CROWN MOVING FORCES AND FOR THIS HE HAD DESIGNED SPUR
TORQUING AUXILIARY .
IT CAN BE 2,,4,6 SPUR AND USED FOR LABIAL OR PALATAL ROOT
TORQUE.WHEN FORMED IT HAS THE FOLLOWING FEATURES.:
1.VERTICAL LOOPS
2.INTER SPUR SPAN
3.CUSPID CONTOURING
4TERMINAL HOOK.
MATERIAL USED: 0.014 SPECIAL + WIRE ..
DESIGN:
4 SPUR OCTAGON WITH ONE SIDE MISSING AND SIZE OF A 50
PAISE COIN.
THE LENGTH OF THE SPUR IS 5MM ON AN AVERAGE.
THE ANGLE BETWEEN THE SPUR AND THE HORIZONTAL LEG IS 2530 DEGREES.

THE MESIAL LEG OF EACH TORQUING SPUR IS MADE 0.5MM -1MM

IS IT NECESSARY TO USE EXTRAORAL
ANCHORAGE?
With the Begg technique,the dental arches are as a
result of applying differential arch wire and rubber
ligature force values ,taken so far back in the jaws
that ample allowance is made for that inevitable
forward movement of the dental arches which occurs
when the axial inclinations of the teeth are being
corrected in the latter part of treatment.
Therefore,extraoral anchorage never has to be used
with the light round archwire technique.

THE CORRECTION OF MIDLINE DISCREPANCY
THE CORRECTION OF MIDLINE DISCREPANCY USING THE EDGEWISE TECHNIQUE
WITH THE ANTERIOR INTERMAXILLARY CROSS ELASTICS IS DIFFICULT AND
TIME-CONSUMING..
HOWEVER WITH THE BEGG TECHNIQUE,MOST CENTER LINE DISCREPANCIES
AUTOMATICALLY DISAPPEAR BY THE TIME THE SECOND STAGE HAS BEEN
COMPLETED.AND THE REST ARE CORRECTED DURING THE MESIODISTAL TOOTH
UPRIGHTING DURING STAGE III.
IT IS THE FORCES FROM THE HORIZONTAL SPACE-CLOSING ELASTICS THAT ARE
CHIEFLY RESPONSIBLE FOR THE EASE WITH WHICH MOST CENTER LINE
DISCREPANCIES CAN BE CORRECTED.
DURING THE USE OF HORIZONTAL ELASTICS AIDED BY CLASS II ELASTICS,THE
EXTRACTION SPACE WILL BE CLOSED ON ONE SIDE SOONER THAN ON THE OTHER
SIDE.HENCE ,THE MIDLINE WILL BE SITUATED FARTHER AROUND TO THAT
SIDE.THEN,THE SPACE –CLOSING ELASTIC ON THE SIDE WHERE THE EXTRACTION
SPACE IS NOT YET CLOSED GRADUALLY PULLS THE CENTER AROUND TOWARD
THIS STILL UNCLOSED SIDE.


STAGE MODELS.
THE IMPORTANCE OF STAGE MODELS AS TOLD BY DR.A ROCKE,:
1.TO CHECK THE ARCH CONTOUR AND WIDTH.
2.TO CHECK THE INCLINATION OF UPPER AND LOWER ANTERIOR
TEETH.
3.SELF-DISCIPLINE TO TO COMPLETE EACH STAGE BEFORE
PROCEEDING TO THE NEXT.
4.TO DETERMINE THE TEETH MOVEMENT.
5.TO GAIN INSIGHT INTO ANCHORAGE MAINTAINED IN THE
TREATMENT.
6.VISUAL AID FOR PATIENTS AND PARENTS.
7.VISUAL AID FOR REFERRING DENTISTS THE POSSIBILITY OF
ANTERIOR TORQUING..

BEGG TECHNIQUE-TIME SAVING PROCEDURE.
THE LIGHT ROUND ARCHWIRE DIFFERENTIAL FORCE
TREATMENT TECHNIQUE:
1.GIVES SUPERIOR FINAL TREATMENT RESULTS
2.GIVES LESS PATIENT DISCOMFORT
3.THE OVERALL TREATMENT TIME IS MATERIALLY
SHORTENED
4.FEWER INTERIM APPLIANCE ADJUSTMENTS ARE REQUIRED
5.CHAIRSIDE TIME IS GREATLY RTEDUCED.

Most other methods involve 25 or more adjustments of appliances
which must be worn from 2 to 4 years with patient visits spaced at 2 to 3
week intervals.In cioontrast,begg technique normally requires an appliance
to be worn for 10-20 months ,with far fewer adjustments and with patient
visits spaced at 6 week intervals..

CONCLUSION

The development of dr.Begg’s different way of orthodontic
therapy was not the resulkt of a single discovery but
rather ,the product of a long tedious ,well-organised trial
and error process.
When correctly applied,his light archwire technique can
produce universal tooth movement with light optimum
forces,least discomfort to patients ,minimum loosening of
teeth and least injury to tooth investing tissues.
Dr.Begg’s theory does not depend upon cephalometrics to
establish angulations nor does it require complicated
engineering formulae for moving teeth.
Because the begg technique,requires shorter time,it does not
mean that it is a “snap” method requiring less orthodontic
skill or ingenuity. www.indiandentalacademy.com
.

CONCLUSION
Inspite of the fact that dr.Begg was born to an industrial
executive,and that he could have very well made a
fortune in business,he chose to bring smiles in people’s
lives around the world.
The successful use of a given appliance will be based on an
understanding of the underlying principles.These can be
taught; but the exact practical application requires a
measure of the art of the craftsman,or craft of the artist
which are qualities of the individual and cannot be taught.

REFERENCES
1.BEGG ORTHODONTIC THEORY AND TECHNIQUE :
BEGG AND KESLING.
2.BEGG:APPLIANCE AND TECHNIQUE
G.G.T.FLETCHER..


Traditional begg philosophy /certified fixed orthodontic courses by Indian dental academy

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (20)

Similaire à Traditional begg philosophy /certified fixed orthodontic courses by Indian dental academy

Similaire à Traditional begg philosophy /certified fixed orthodontic courses by Indian dental academy (20)

Plus de Indian dental academy

Plus de Indian dental academy (20)

Dernier

Dernier (20)

Traditional begg philosophy /certified fixed orthodontic courses by Indian dental academy