REFINED BEGG

TECHNIQUE

1
CONTENTS

• EVOLUTION OF BEGG TECHNIQUE

• EVOLUTION OF REFINED BEGG

• APPLIANCE DESIGN

• STAGE -I

• STAGE -II AND PRE STAGE – III

• STAGE – III

• VARIOUS AUXILLARIES
2
• FINISHING AND DETAILING

• CONCLUSION

• REFERENCE

3
EVOLUTION OF BEG TECHNIQUE

• Dr. Begg initially used the edgewise appliance which he had

learnt from Dr. Angle during the development of edge wise
appliance.

• However, he started getting disappointed because of slow tooth

movements and realized the futility of following Dr. Angle’s non-
extraction dictum in every case.

• He then went on to experiment with the ribbon arch bracket-

round arch wire combination to create new approach.
4
 CLASSICAL BEGG CONCEPTS

• His studies on attritional occlusion convinced him that

extractions were essential in most patients to make up for
the lack of attrition in modern man.

• He also introduced the concept of differential forces to

move different segments of teeth based on storey and
smith’s work.

5
MATERIAL ADVANCEMENTS

• He kept close tabs with advancements in metallurgy and

his association with A.J. Wilcock lead to the development
of high tensile stainless steel light wires.

• In fact these wires were only a spin-off from the

metallurgical research equipment that was being
developed during the war time years.

6
 CLASSICAL BEGG
ADVANTAGES DISADVANTAGES
• Light forces • No precise control
• Posterior root torque is difficult
• Anchorage control
• True intrusion is less likely
• Quick correction
• Poor rotational control
• Efficient uprighting • Over use of class ii elastics
• Less demands on • Uncontrolled tipping and root
patient cooperation resorption
• Low cost • Heavy torque requirement
• Over emphasis on extractions
• No fail safe mechanism
7
• Begg operators gradually started noticing its limitations
and realizing that there was a need to diverge from
orthodox treatment in order to overcome them.

8
 EVOLUTION

REFINED BEGG MODIFIED BEGG

• Use the same Begg • Change in the shape of
bracket the bracket
• Use of newer high Ex: Tip – edge
tensile wires and BEDDTIOT
auxillaries to overcome
the drawbacks of the C.A.T and other
classic technique Combination brackets
9
REFINED BEGG

Refinements can be broadly classified under the following

headings:

• Conceptual changes

• Hardware advancements

• Modification of mechanics

10
CONCEPTUAL CHANGES

• Theory of ATTRITIONAL OCCLUSION Questioned by

Corrucini. Over emphasis on extraction in the anticipation
of crowding.

• Concept of DIFFERENTIAL FORCES It was thought that light

intra or inter arch forces would retract the anteriors,
whereas heavier forces would make the ant. teeth as
anchor teeth & protract only the post.

11
• It is now known that when heavy forces are used for
protracting the post. the ant. Teeth would remain
stationary until the hyalinised tissue is eliminated. Then
they would move posteriorly.

• This resulted in dish in the profile. Now prevented by using

sufficient BRAKES.

12
TREATMENT OBJECTIVES
• For static occlusion - Andrew’s 6 keys to normal occlusion form the
goal of refined beg.

• Functional occlusion – gnathologic objectives as outlined by ROTH

and others.

Like the following aspects

1. Synchronization of CO and CR.

2. Elimination of hanging palatal cusps of the upper posterior teeth.

3. Cuspid protected occlusion.

4. Incisor guidance(specially in open bite cases) 13

 DIAGNOSIS
• Skeletal, dental & soft tissue analysis.

• VTO

14
 TREATMENT PLANNING
• COOK BOOK APPROACH DISCARDED.

• Benefits of treatment during mixed dentition is recognized.

• Direct & modulate growth by using functional or orthopedic

appliances.

• Conversion of borderline cases in non extraction. ”When in

doubt, extract”discarded. Leeway space is used to resolve mild
crowding. Interproximal reduction.

• Upper molar distalization.

• Asymmetric extractions. 15
 BIOMECHANICS
• Controlled tipping in 1st two stages followed by root
uprighting.

• Mollenhauer: root control from the very 1st stage. MAA- aligns
teeth, exerts ultra light torquing & up righting forces on the
anterior teeth. Combines 1st & 3rd stage of begg.3rd stage is
shorter.

• Prevents undesirable uncontrolled tipping.

• Provides labial & lingual root torque.

16
 ARCH FORM

• Recognizes the benefits of maintaining the lower arch

form.

• Improving the upper arch form.

• Proper arch form & coordination of upper & lower arch

wires is checked at every stage.

17
CHANGES IN HARDWARE

Attachments

• Bracket - built in adjustments such as torque(kameda) and anti-

rotation(Mollenhauer) are available.

• Molar tube – Distal offset.

18
 ARCH WIRES

• Higher grade australian arch wires like: premium,

premium plus, supreme.

• Pulse straightened.

• Unraveling of crowding: thin premium plus or supreme

wires, multi-stranded (co-ax) or niti wires are used.

• For finishing: alpha titanium wires. Rectangular wires.

• Tandem wires :combination of rect.& Round cross sections

in the ant. & Post. Segment. Braking mechanism.
19
APPLIANCE CONSTRUCTION IN
REFINED BEGG

20
ATTACHMENTS ON THE TEETH 0.020”

Dimensions of components

• BRACKETS – the brackets used are

0.045”
TP 256-000, or any other having a
similar design and dimensions.

• Depth – 0.020”

• Height – 0.045”

• Dimensions of bracket base 3x3mm

0.015”
21
MOLAR TUBES

• Round molar tubes – 0.036” inner diameter and

6mm length.

• Oval tubes – 0.072x0.024” lumen size and 5mm

length – on second molar tubes in first molar
extraction cases.

• COMBINATION TUBES(TP Lab)

• These have round gingival diameter tube – 6.2mm

long

• Rectangular(ribbon) occlusal tube – 0.025x0.018”

and 5.5mm long

22
BUILT IN ADJUSTMENTS

INCISOR BRACKETS

• ANTI- ROTATIONAL ADJUSTMENTS – the

mesial or distal edge of the bracket is
raised away from the tooth surface for
mesiolingual or distolingual correction.

• They are ready made or can be

prepared(by mullenhauer) by welding a
piece of ligature wire(0.010”) on bracket
base mesh.
23
BUILT IN TORQUE

• Introduced by kameda

• Obtained by raising the incisal or

gingival edge of the bracket base
away from the tooth surface

• Brackets are commercially

available

24
MOLAR TUBES
Upper molar tubes - suggested by swain

• Fixed perpendicular to the mesial aspect of upper molar bands –

results 10 ◦ disto-lingual rotation offset.

Lower molar tubes - a lesser offset of 5◦ .

25
PLACEMENT OF ATTACHMENTS
A) HEIGHT

• Upper and lower canine brackets are placed more incisally.

• Lower incisor brackets placed more gingivally.

• Upper and lower premolar brackets are occlusally placed.

• Upper molar tubes placed slightly occlusally.

26
B) MESIO-DISTAL LOCATION

1) Brackets – incisor brackets are

DISTALLY OFF
kept at the mesio distal center CENTERED BRACKET
of the crown

2) In a rotated canine or premolar

brackets are kept slightly off
centre so thet they are 1 mm
OFFCENTERED
closer to the proximal surface
LINGUAL CLEAT

27
HOW MANY TEETH ARE TO BE BRACKETED
AT THE BEGINNING OF THE TREATMENT

• 1st premolar extraction cases – brackets are not placed on 2nd

premolars because they interfere with bite opening mechanism.

• 2nd premolar extraction cases – brackets are bonded on the

remaining premolars right from the beginning.

28
PALATAL BRACKETS

• Placed on the palatal surface of upper incisors when palatal

elastics from a TPA are used for upper incisor intrusion.

29
OTHER ATTACHMENTS

1)Hooks – buccal and lingual

• Buccal hook – attaches at the center of mesio-buccal cusp while

palatal or lingual hooks are placed close to disto-lingual cusp.

• Used for elastic engagement.

2) lingual buttons , cleats or eyelets

• Additional attachments for rotational control.

• Placed slightly off centered for over correcting the rotations

30
3)Additional round tubes

• Used for engaging lip bumper , head gears , EVAA appliance

• Placed gingivally to the main tube except in case of evaa where

it is placed occlusally

• Lip bumper tube 0.040” / 0.044” - head gear 0.044” / 0.048” –

EVAA 0.036”

31
4)lingual or palatal sheaths

• Placed on molar bands when trans palatal or lingual arches are

used.

ARCH WIRES

• Initial aligning phase – small diameter australian wires , niti or

braided S.S wires – used as sectional wires along with base arch
wire

• Finishing stage – rectangular S.S wires or alpha titanium wires –

can be used in second stage as combination wires for braking
mechanics 32
ARCH WIRE BENDING
• Arch form

• Cuspid circles

• Molar stops

• Anchor bends

• Anchor curves

• Arch wire ends

• Maximum stiffness

• Cuspid ties
33
MOLAR STOPS

• Usually placed in lower

arch wire
• Forward movement of
lower molars can be
avoided

34
ARCH WIRE ENDS

• First and second

stages lower wire
ends are lightly bent
at the distal of the
lower molar tube

35
CUSPID TIES

• ELASTOMERIC
MODULES ARE USED
INSTEAD OF LIGATURE
WIRE

36
PINS USED IN REFINED BEGG

• FIRST STAGE PINS

• THIRD STAGE PINS
• HIGH HAT PINS
• HOOK PINS
• ‘T’ PINS

37
STAGE-I

38
CLASSICAL BEGG OBJECTIVES

• Alignment

• Elimination of crossbites

• Correction of abnormal overbite

• Reduction of overjet(by lingual tipping of incisors)

• Correction of arch form

• Match of midlines

• Attaining class I molar and canine relation

39
IN REFINED BEGG STAGE I is divided into sub stages I-A and I-B.

SUB STAGE I-A

• Correction of crowding and spacing

• Alignment

• Upper incisor inclination

• Rotation correction of molars and premolars

• Arch form correction

• Duration – 1-6 months

40
SUB STAGE I-B
• Bite opening.

• Retraction of the upper anterior teeth to eliminate the overjet.

• Control of mandibular plane angle.

• Matching the upper and lower midlines

• Correcting the inter arch relationship to class I.

• Duration – 4-6 months

41
ARCH WIRE

Arch wires used earlier –

• Multi looped arch wire(0.016” round S.S) Multi looped arch wire

Disadvantage: by Sims

• Uneven Bite opening

• Labial Flaring of the incisors

• Loss OF Control over the molar

• Loss OF Anchorage

• Difficult in maintaining hygiene.

42
Present arch wires –

• In sub stage I-A correction 0.016” round S.S is used.(occasionally

0.014” followed by 0.016” S.S wire)

• Correction of malalignment - Niti and multi stranded wires are

used (sectionals or full wire)

• In sub stage I-B – it is changed to 0.018” wire.

• For deepbite cases – 0.018” P+ or P and class II elastics –which

cause true incisor intrusion.

• For openbite cases – upper 0.014” P+ or P wire, lower 0.016” P+

or P wire 43
0.016” ROUND NiTi ALONG WITH 0.014”
ROUND S.S FOR DE CROWDING

44
• Open bite situation upper full length of flexible archwire with class 2
elastics can be used till the upper crowding gets relieved, since bite
deepening effect is desirable.

45
 FLEXIBLE SECTIONALS

• Niti , co-ax or supreme wires in

combination with S.S. Base wires,
since weak to resist the adverse
effects of the elastics.

• Should be started only after the

canines have distalized sufficiently to
open adequate space to align incisors.

46
 FULL LENGTH NITI
ARCHWIRES
• Max. Canines are highly placed& also need to be distalized to relieve
crowding.
• Ultra light class2 elastics are hooked over the canine bracket to move
them distally.
• Anterior bite does not deepen, since the high position canine absorbs
the extrusive component of the class2 elastics.

47
• Crowding

• 1-2 mm – 0.016” or 0.014” S.S modified with V-bend / offset

bends.

• >2mm 0.016” or 0.014” NiTi, 0.0165” coaxial or 0.009” supreme

S.S.

V-bend 48
SINGLE LOOP ARCH WIRE

• Indication – when one incisor is

crowded out of arch

• Made up of 0.014” or 0.016 round

S.S arch wire at the crowded
incisor.

• Cuspid circles should touch the

canine bracket.

• Activated by opening the coil 2mm.

49
CLOSING ANTERIOR SPACES

• 0.016” round S.S used.

• Cuspid circles are kept 2mm

mesial to the canine bracket

• Elastic cuspid ties are used.

50
MOLAR POSITION CORRECTION

Rotated molars

• Toe in or toe out bends placed

in a 0.016 s.S wire

• Double back bends along with

oval tube applies a lingual or
buccal crown torque

51
PINS IN SUBSTAGE I (A)

• Stage I pins – well positioned incisors

• High hat pins – permit free sliding of the teeth , facilitate

engagement of elastics

• Hook pins – incase sectional wire along with base arch

wires

52
SUB STAGE I (B)

Arch wires used – 0.018 premium plus or premium wires

elastics – class II light or ultra light

53
 BITE OPENING IN CONVENTIONAL BEGG

• Resulting from molar extrusion and small amount of lower

incisor intrusion

54
REFINED BEGG

• Orientation of the
resultant is kept close to
the center of resistance of
upper incisors and more or
less parallel to the long
axis

55
POWER ARM METHOD

• Dr. Jyothindra kumar

• 0.018x0.025”are bent in the

form of hook&soldered.

• Elastics placed from power

arm-cuspid circle.

56
ANCHOR BENDS

GABLE BEND

57
HOCEVAR MODIFICATIONS

58
KAMEDA’S MODIFICATION

59
Vertical step up bends

4 – 5 mm height

2- 3 mm mesial to molar tube

60
PALATAL ELASTICS

61
OVERJET REDUCTION

• Conventional begg - edge to edge relation resulted from

Uncontrolled tipping of upper anteriors.

• Refined begg – controlled tipping.

62
UNCONTROLLED TIPPING OF LOWER
INCISORS

Prevented by –

• Brackets are bonded gingivally

• ‘MAA’with labial root torque is used – stage 1

• Lower arch wires are bent distal to molar

tubes(hocever)

63
ELASTICS IN STAGE 1

• Light/ultra light class 2 elastics

• Palatal &power arm elastics

• Lower class 1elastics – crowding

• Midline elastics

64
 CAUSE FOR ANCHORAGE LOSS

• Insufficient resistance from anchor bends

• Heavy elastic pull

• Increased resistance from the anterior teeth

65
ARCH WIRE DESIGN FOR MOLAR
DISTALIZATION
• 0.016”premium s.S wire used

• Incisor intrusion

-Bayonet bend b/w

Canines&1st premolars

• Cuspid circle should touch

canine bracket

• 45 degree anchor bend.

66
 MOLLENHAUER’S ALIGNING
AUXILLIARY(MAA)

• MOLLENHAUER – 1984

67
ACTIVATING MAA

68
REQUIREMENTS OF MAA

• Must generate very light forces(0.009” size)

• Must be able to resist deformation(supreme grade wire)

• Base wire should resist the vertical and transverse reactive

forces of maa

69
Advantages

• Intrusion and simultaneous retraction of anterior teeth

• Rapid bodily alignment of anterior teeth

• Short stage III due to controlled tipping

70
• Reciprocability of torquing forces on the instanding laterals
or palatally placed canine which help in periodontal
support

• Possibility of growing cortical bone at the a and b points

71
Various applications of maa

• Bodily alignment of crowded teeth

• Labial root torque on the lower incisors

• By bending more positive torque into maa it can be used

after stage i as braking mechanics

• For controlling mesio distal root position(maa tip)

72
 MODIFICATIONS OF MAA

DESIGN FOR LABIAL ROO TORQUE

ON ALL ANTERIOR TEETH

73
MAA DESIGN FOR LINGUAL ROOT TORQUE

BASE WIRE IS ENGAGED FIRST , THEN THE MAA IS ENGAGED

PIGGY BACK
74
RECIPROCAL ROOT TORQUE

BOX MEANT FOR LABIAL ROOT TORQUE RIDES OVER THE

MAIN WIRE(CROSS OVER BEND)
75
• RECTANGULAR BRAIDED NiTi INSTED OF MAA

0.017” x 0.025” BRAIDED RECTANGULAR NiTi (TURBO

FROM M/S ORMCO)

76
 OTHER BOXED AUXILLIARIES

Two boxes on the upper central incisors for lingual root

torque.

77
• Two boxes on the upper laterals for labial root torque.

78
‘JENNERS’ AUXILLARY

79
FIXED FUNCTIONAL ALONG WITH REFINED BEGG

Churro jumper

• Upper molar bands with

double round tubes

• Used after lower anterior

alignment

• 0.025 x 0.018” or 0.025 x

0.017” ribbon wire
80
 EVAA APPLIANCE

VAN DER SCHUEREN&DE SMIT(1994)

81
82
• One extra round tube is placed occlusal on the upper
molar bands

• Used after alignment

• Right&left occlusal blocks joined by lower plate

• Anchored in the occlusal tubes of upper molar

• 5-6 months full time

83
STAGE II

84
Objectives:
Similar to conventional begg –
1. To maintain all the corrections achieved during stage I
2. To close all the extraction spaces.

85
In addition, the stage II of the refined Begg aims at the following:
1. Controlled tipping of the incisors, when retracting anteriors.
2. Preventing excess tipping of the anteriors (by using efficient
brakes), when space closure is mainly achieved by protracting the
posteriors.
3. If the molar relation is not fully corrected at the end of stage I, this
correction is also achieved during the stage II.
4. In the 1st premolar extraction cases, crossbites and rotations of the
2nd premolars are corrected during this stage.

86
ARCHWIRES :
Premolar extraction cases – 0.018” P or P+, or, 0.020” P wires,
depending on the severity of initial malocclusion.
If the stage I corrections involved extreme deep bite, badly distorted
arch forms or severe rotations, new archwires are made for the 2nd
stage in 0.020” size. Otherwise, 0.018” wires of the stage I can be
continued during the stage II also.
Heavy 0.020” archwires are extremely effective in:
1. Maintaining the rotational overcorrection, deep bite correction and
arch form.
2. Resist disto-buccal rotational tendency of the molars due to class I
87
elastics used during the space closure.
• A reduction in the anchor bends is necessary, because a continued
use of high degree of anchor bends will lead to excessive tipping of
the molars, specially the upper ones.
• The premolars are bypassed till the spaces close, except when they
are in disto-buccal rotation. Such rotations require engagement of
the archwire in the slot either for rotational correction using
modules, or for holding the rotational correction using rotational
springs. This is done towards the end of stage II and anchor curves
are used instead of anchor bends.

88
CONTROLLED TIPPING OF THE INCISORS:
MAA for lingual root torque is a must during the stage II for controlled
lingual tipping of the incisors during their retraction

89
• If the canines appear to tip distally excessively, 0.010”
uprighting springs on them minimizes their uncontrolled
tipping.

90
Braking mechanics for protracting the posteriors:

• When space is to be closed mainly by protraction of the

posteriors – it can be done by using efficient braking
mechanics.

• The ‘brakes’ reverse the anchorage site from the posterior

to the anterior segment by permitting only the bodily
movement of the anterior teeth, instead of allowing them
the freedom of tipping.

91
• This conversion of tipping to bodily movement is either in a
mesio-distal direction for the canines and lateral incisors, or in a
labio-lingual direction for the incisors. The former is achieved by
using braking springs or ‘T’ pins, while latter is achieved by using
some torquing component on the incisor teeth.

92
The commonly used brakes are

as follows:

1. BRAKING SPRINGS –

These are passive uprighting

springs made in 0.018”

wire, which almost fill the bracket

channel.
93
2. ANGULATED ‘T’ PINS –

These pins maintain the tipping already brought about,

but prevent further tipping.

94
3. COMBINATION WIRES –

• These are made either of stainless steel or alpha- titanium alloy.

The anterior segment is 0.022”× 0.018” (ribbon mode) and the
posterior segment is in 0.018” round cross-section. The alpha-
titanium wires being softer are easier to engage in the anterior
bracket slots

95
• Torque in the anterior segment can
be precisely built to the required
degree, using a 0.022” torquing turret
in which the wire is positioned in a
ribbon mode. It must be remembered
that greater the torque built in the
anterior segment, more bite
deepening effect it will have; besides
the shearing force on the brackets,
which tends to open the slots or
dislodge the brackets. 96
 Since combination wires are expensive, rectangular stainless
0.022”× 0.018” sectionals, suitably torqued in the same ribbon
mode, can be used piggy back over a round 0.018” base wire,
both held together using hook pins.

4. TORQUING AUXILLARIES:
A two spur or four spur auxiliary,
which is activated to the desired
extent, or a MAA design in 0.010” or
0.011” size can be used as a braking
mechanism along with a strong base
wire (0.020” or atleast 0.018”) 97
DEROTATION OF PREMOLARS:

A. Non-extraction treatment cases-

1a. First premolar having MB

rotation and 5 and 6 normal.

1b. The first premolar and molar

are normal but second premolar
has a MB rotation

98
2. The 4 and 5 both have MB rotations.

3. The 4 has DB rotation and the 5 has MB rotation.

99
4. The 4 has DB rotation and the
5 has MB rotation.

5. The 4 or 5 has DB rotation but the other premolar is normal.

a. If mild – bracket placed off centered.
b. If severe – along with off centered bracket,
flexible sectional wire such as NiTi
c. If so severe that bracket cannot be placed off centered because of
extreme tooth displacement, it is placed in center of the tooth and
derotation carried by rotation springs 100
B. 1st Premolar extraction cases –

1. MB rotation of 5 can be corrected as described as for

nonextraction treatment. A bracket is placed on 5 towards the
end of stage II.

2. DB rotation of 5 can be corrected by placing a bracket towards

the end of stage II and then derotating with the help of rotational
module or a spring.

101
C. 2nd Premolar or 1st Molar extraction cases –

Brackets are placed from the beginning in these cases to avoid extrusion
of the premolars as the anteriors are retracted. However, they are
bypassed by the archwire and only ligated till the bite opens.

1. MB rotation of 4 is corrected
early from the palatal side

2. DB rotation can be corrected

as mentioned earlier in A5 102
ELASTICS:

Different configurations are employed during this stage as per

the patient’s needs –

1. Upper and lower class I elastics are required in most cases.

103
2. When the molar relation is not fully corrected during stage I,
class II elastics along with lower class I elastics are used at the
beginning of stage II till the molar relation is corrected.
Thereafter, upper and lower class I elastics are continued.

104
3. Class II elastics may be added to hold the corrected molar relation,
thus making a Z configuration. However, class II elastics should be
used as sparingly as possible because of their bite deepening effect.
In many cases, they are required only part time (for 8 hours during
sleep, or for 12 hours during night).

105
4. If the upper and lower teeth do not retract at the same rate,
only class II elastics are given when the overjet increases
(because the lower anteriors are retracting faster than the
upper)

106
On the other hand, only lower class I elastics are given when the
upper anteriors tend to go in a crossbite relation (because the
upper retraction is faster than lower). When such abnormal
relations are corrected, the elastic pattern is reverted back for
retracting both the upper and lower anteriors together.

107
• Strength of the elastics is also varied according to the clinical

requirement. Light (yellow) class I or class II elastics are

employed for anterior retraction. For posterior protraction,

stronger (green) class I elastics are employed.

• Very heavy- blue or red elastics are seldom required, only

when green elastics are found ineffective as, for example, in a

low mandibular plane angle case.

108
PINS USED IN STAGE II:
Hook pins are used when the anterior retraction is attempted
in a controlled manner using MAA along with a base wire. While
these pins permit full freedom of lingual tipping of incisors, they
limit the distal tipping of the canines. The rectangular sectional
along with the round base wire, or the rectangular component of
the combination wires for protracting the posteriors, are also
engaged using hook pins.

109
DURATION OF STAGE II:
• The durations of stage I and stage II have an inverse
relationship in the extraction cases. Longer the stage I, lesser will
be the need to close the space in stage II, hence shorter its
duration and vice versa.
• The 2 stages together take approximately 1 yr to complete in
most cases, and should not take more than 1 yr 3 months even in
very difficult cases.

110
Check list at the end of stage II:

1. All spaces are closed completely

2. All teeth are well aligned

3. The anteriors are in edge to edge bite

4. The incisors are either are upright or slightly retroclined

5. The canines and premolars are in mild to moderate

Mesio-distal angulations

6. The canine and molar relations are class I

111
Pre stage III :

most of the cases require the pre stage III adjustments before going
from stage II to stage III. This is so because the premolars are usually
not engaged in the archwire till the extraction spaces are completely or
almost completely closed. Hence the premolars are at a different
vertical level than the molars at the end of stage II.

112
Also, engagement of the archwire in premolar bracket and the
molar tube and the molar tube requires a horizontal offset
between the two, in order to compensate for the greater buccal
bulge due to bigger dimension of molars

113
Coordinated upper and lower prestage III wires

114
• If the vertical and /or horizontal discrepancy is such that the
0.018” wire of stage II cannot be engaged in the premolar
brackets at end of stage II, a slightly undersized 0.016” archwire
can be used for one visit in order to get the archwire
engagement in the premolar brackets. The horizontal offset
between the canines and the premolar brackets of the earlier
stage I and stage II is eliminated (unless required for holding the
overcorrected position of a canine that was initially buccally
placed or distobuccally rotated).

115
• The offset is now made between the premolar and the molar. A
vertical adjustment is also made at the same sight so as to engage
the premolar brackets. These adjustment should be semi passive
so that they bring about the required correction without creating
excessive forces. Then the heavier wires are employed for the
stage III.

116
 The upper arch wire is given a gable bend distal to the canine, while
the anchor bend in the archwire is eliminated. This helps in holding the
deep bite correction and simultaneous uprighting the molars, which
had tipped distally during earlier stages. The lower wire is given both
the a mild anchor bend as well as mild gable bend. The position of
anterior and posterior segments of the wires are inverted to avoid
excessive extrusive effects on the canines on account of the gable
bends.

117
• The archwires ends are bent to prevent opening of the
extraction spaces. Light class II elastics are used, as required,
for maintaining the corrected relationships of the anterior
and posterior teeth. Occasionally, class I elastics may be
required for holding the closure of extraction spaces.

• The pre stage iii adjustments are usually completed within

1 month. If the discrepancy between the premolar and molar
positions is excessive, it may require two months to go from
the 0.016” archwire through the 0.018” intermediate
archwire to the 0.020 third stage archwire.
118
New impressions are taken at the beginning of pre stage III. A lateral
cephalogram and a panoramic radiograph are also taken, which help in
assessing the degree of root movement needed during the stage III.

119
STAGE III

Objectives –

1. Maintain the corrections achieved upto stage I & II

2. To achieve desired root position

3. Monitor the saggital and vertical anchorage

4. To correct the positions of second molars when reuired

5. Monitor the inclinations of the posterior teeth specially

molars

120
PROBLEMS ENCOUNTERED IN STAGE III

• Undesired sagittal movements

• Undesired vertical movements (anterior deep bite)

• Undesired transverse movements(buccal rolling of

molars)

• Root resorption possibilities

121
HOW TO OVERCOME III STAGE PROBLEMS

A)Problem of root movements - Can be minimized by:

1. Carefully planning the extraction decision

2. By using efficient brakes

3. By using improved mechanics in first two stages

B) use of heavy wires(0.020” premium)

C) lighter auxilliaries and uprighting springs(0.012” wire)

D) light class ii elastics

E) reinforcement of anchorage
122
ARCH WIRES IN STAGE III

• 0.020” premium wires are used

• Cuspid circles tightly touching the cuspid bracket(raleigh

williams)

• The posterior segment are kept gingivally in relation to the

anterior

123
STAGE III ARCH WIRES

124
• A mild toe in in placed in the upper molar segment

• Degree of geble bend and anchor bend decided according to the

degree of over bite.

• Wire ends are annealed and tightly sinched

Elastics:

• Light class ii (tp yellow) – maintaining the inter arch relationship

• Blue or red elastics to prevent tipping of upper and lower molars

125
TORQUING AUXILLIARIES WITH SPURS

• 0.012” premium

plus(pulse straightened)

s.S wire used

126
FINISING AND DETAILING

Objectives:-

Intra arch objectives:

• Good inter dental contacts

• Rotations are over corrected

• Complete space closure

• Proper vertical levelling of all teeth

127
• Proper tip and torque of all teeth

• Proper arch form

• Maintain the lower inter canine dimension

Inter arch objectives:

• Normal over jet and over bite

• Class I molar and canine relation

• Tight inter digitation of all cusps of posterior teeth

128
ROUND FINISHING ARCH WIRES
• 0.020” S.S ROUND WIRE USED

129
FIRST ORDER ADJUSTMENTS

• Proper labiolingual position of the lateral

• Upper canine prominence

• Molar offset

• Toe in relation to upper molar for disto lingual rotation

• The curvature between upper canine and molar is flattened

130
 SECOND ORDER ADJUSTMENTS

• U 2 in relation to u 1 and u 3 should be slightly shorter

• Slight mesial angulation of u 6 for proper occlusion

• U 3 is slightly more mesially angulated for proper canine relation

131
2ND ORDER ADJUSTMENTS

132
Elastics:

• Light class II (TP yellow) – maintaining the inter arch relationship

• Blue or red elastics to prevent tipping of upper and lower molars

133
 RECTANGULAR FINISHING WIRE

3. Vertical 0.022” dimension gives enough clearance in the

0.040” begg vertical slot for vertical settling of teeth

134
CONCLUSION

• Every appliance system has its own benefits and drawbacks. A

wise thing to do is to make a system which integrates the best
of all.

• Finally in the end it looks like all these refinements are an

attempt to incorporate contemporary edge wise principles
into begg mechanotherapy so as to make the best of both
worlds
135
REFERENCE
• P jayade vijay mrs anuradha V jayade, refined begg for modern
times, first edition.

• Robert s. Corruccini, australian aboriginal tooth succession,

attrition, and begg's theory interproximal. Am j orthod dentofac
orthop 1990;97:349-57.

• Mollenhauer B: new approaches to the beg technique, aust

orthod J;10(2):67, 1987.

• Kameda A:KB Technique – its theory and practice, J Ind Orthod

soc; 23:51, 1992. 136
• Jayade VP, Indian beg practice and cross roads JIOS 1989
Vol:20.

137