Begg Technique ORTHO / Orthodontic Courses by Indian Dental Academy

INDIAN DENTAL
ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
CONTENTS
Introduction
Instruments used in Begg technique
Bracket and Buccal-tube placement
Case - selection
STAGE I :-
1. Stage-I arch wire formation
2. Objectives of stage-I
3. Biomechanics of stage-I
Conclusion (Picture at the end of stage I)
References
INTRODUCTION
Begg LIGHT WIRE DIFFERENTIAL
FORCE TECHNIQUE is a unique
technique of moving teeth using simple
tipping movements to bring about
correction of malocclusions

Based on the theories of -
1. Attritional occlusion
2.The theory of differential pressures
3. Light round wire forces
BEGG INSTRUMENTARIUM
THE LIGHT WIRE PLIER

1.The main plier in Begg
technique
2.Is a refined version of
an original plier designed
by E.H Angle for S.S
White company
3.Referred to as No. 139
or BIRD
BEAK PLIER
BIRD BEAK PLIER S.S WHITE No.-130

T.P-No.139

Dr. Begg found it necessary to reduce
the size of the beak in order to make
delicate bends eg. The boot hooks and
the vertical loops

Design
1.Has one round and one square beak
2.The beaks are tapering
3.A groove at to 1 mm

Uses
1.Arch wire bending (S.S White No.-
139)

2.Placing lock pins (Longer beak-T.P
No.130)
ARCH WIRE CONTOURING PLIER

1.No. 128 pliers

2.Used to develop
cuspid-curves

3.Improperly formed
arch wire results in
NARROWING of
the cuspids.

ARCH FORMING PLIERS/
RIBBON ARCH PLIERS
Originally designed to bend RIBBON
ARCH and EDGE-WISE arch wires

Beaks are ground to be parallel at
appox .020

Used to firmly grasp both wires when
wrapping the end of an arch wire when
completing the bending of a double
back end

PIN AND LIGATURE CUTTING
PLIERS

Originally designed by Dr. E.H Angle
USED TO
1. Cut and remove lock pins
2.To cut ligature wires

TWEED LOOP FORMING PLIER
Plier No. 442

Used to make
cuspid circles
and verticle
loops

The 2
nd
step of
the plier is
used (2mm )
2 mm
1
2step
3
Cuspid circle
BRACKET and MOLAR TUBE
PLACEMENT
BRACKET PLACEMENT
Is of utmost importance

Brackets can be
1.Weldable
2.Bonded

High flange bracket
preferred;possess wider
area of welding

Jigs- helps to place brackets in proper
position

Bracket positioning jig
Bracket placed at 4mm from the incisal edge
Bracket centered mesio-distally www.indiandentalacademy.com
Brackets are placed on all teeth except
the molars

Are - CENTERED MESIO-DISTALLY

Base of the bracket slots - 4 mm
from the incisal edges or the cusp tips

Only exception Maxillary lateral
incisor, placed at 3.5 mm (for desired
esthetic shortening), but if its lingually
placed bracket positioned 4mm

If the tooth is rotated originally the
bracket is placed
off-center
Off-centered brackets
1
2
BANDING THE 2nd BICUSPIDS ?
Banding the 2
nd
bicuspids - optional in first
stage

Disadvantage long length of unsupported
archwire , liable to get distorted

Unsupported arch wire
Banding the 2
nd
bicuspids , placing
brackets on them along with bypass
clamps provide protection and support
to the arch wire against buccal rolling
and gives firmer bodily control over the
anchor molars.

Bypass clamp guides the arch wire
Second bicuspid brackets should not be
placed , if they contact the distal of the
buccal cusps of the Mx molar in class II
relation , when class II traction is used

Second bicuspids should be banded before
the final act of space closure in order to -
1. Avoid the possibility of over closure
2. Possible exclusion of these teeth from
the dental arch

The lingual button placed directly
opposite to the areas of arch wire
engagement.
BUCCAL TUBE PLACEMENT
Lower molar tube positioned more gingival to avoid occlusal interference
Molar tube
At center of M-B
cusp
Molar tube to be
Molar tube to be parallel to the occlusal surface
Molar tube to be
Ball end hook
MOLAR OFF-SETS
As suggested by
SWAIN
1.Upper molar
tubes fixed
perpendicular to the
mesial aspect of the
Mx-molar bands ,
which results in
appox.10 degree disto-
lingual rotational off-
set
LOWER MOLAR
TUBES
1.Lesser off-set of
appox. 5 degrees disto-
lingual rotational off-
set

2.Off-sets are placed
to maintain the relation
of the M-B and the D-B
cusps
POSITION OF THE BRACKETS
AND THE TUBES
4 mm
3.5 mm
4 mm 4 mm 4 mm
4 mm 4 mm
4 mm 4 mm
3.5 mm
Molar tube off-set
Brackets centered mesio-distally
Off-centered brackets
on rotated teeth
Mx molar offset- 5-10
Md molar 5-7
BRACKET AND TUBE ARRANGEMENT
CASE SELECTION
Begg appliance offers a comprehensive
mechanical system suited for almost all
forms of mal-occlusions

Most effective in extraction cases which
provide a margin of excess of space

Can be successfully used in non-extraction
cases as well

1.Well suited in cases of Class I with
marked bi-dental
protrusion
2.Class II div. 1 and
div. 2 with deep bite
3.Cases with severe
crowding
4.Cases with pronounced
over-jet and excess
anterior spacing

Bi-max
Marked over-jet and bite
Bi-max protrusion
Incompetent lips

WHETHER TO EXTRACT OR NOT?
Depends on
1.Type and severity of mal-occlusion
2.Treatment goals
3.Ability and experience of the operator
4.Age of the patient
5.Condition of the teeth
6.Anticipated patient co-operation
7.Skeletal pattern
8.Patients preferences

REQUIREMENTS
Accurate diagnosis and treatment plan
Good study models
OPG and lateral cephalogram
Good set of facial photographs

RELATIONSHIP OF THE LOWER
INCISORS TO THE A-P LINE (A
Diagnostic aid) A.J.O , May 1969

Will alignment of the
lower teeth relocate the
incisal edges of the lower
incisors too far ahead of
the A-P line?
Will leveling of the curve
of spee in the in the
lower arch move the
incisal edges of the
lower incisors too far
ahead of the A-P line ?

Will correcting the molar
relation consume so much
anchorage that the incisal
edges of the lower incisors
are moved too far ahead
the A-P line?
Will remodeling of the point
A ,change the location of
theA-P line ,resulting in the
incisal edges of the lower
incisors being too far ahead
of the A-P line ?

Will the growth or
repositioning during
treatment, change the
location of the A-P line ,
and result in the incisal
edges of the lower incisors
being too far ahead of the
A-P line ?

If the answers to all the above is NO
- non-extraction

If 1 or more answers are YES
reduction of tooth mass is must

BEGG TECHNIQUE - STAGE I
OBJECTIVES
1.Open the anterior over-bite
2.Over-correct the mesio-distal relation-
ship of the buccal segments
3.Close any anterior spaces
4.Eliminate any anterior crowding
5.Over-rotate teeth requiring correction
6.Correct posterior cross-bite
APPLIANCE CONSTRUCTION
Arch wire with
vertical loops 0.016
1.used to unravel
crowded teeth and
rotate anterior teeth
2.One loop between
two teeth
3.Never placed distal
to the canines
4.Bracket area
CONSTRUCTION

For a lingual positioned
tooth
1 mm short
In inter-dental areas
The arch wire is modified
in the BRACKET AREA
to over-correct the
anterior teeth
FINISHED STAGE-I ARCH WIRE
WITH VERTICAL LOOPS
When anterior teeth are
spaced and irregular -
VERTICAL CONTRACTION
LOOPS ARE USED

Difference arch wire is
shifted to the left

Loops activated (opened)

Intermaxillary circles tied
distally against the cuspids

stops
Contraction loop
PLAIN ARCH WIRES TO CLOSE
ANTERIOR SPACES
Developed by- P.C
KESLING

1.Using plain arch wire
with elastics OR

2.Two small elastic
scan be used
rather than one
large elastic
ROTATING CUSPIDS AND
BICUSPIDS
Rotated using
elastic thread from
the lingual button to
the arch wire

Or using ROTATING
SPRINGS
If along with the
premolar the molar
also needs rotation,
an elastic tie can
be given between the
molar and the
premolar
ELASTIC - TIE
MOLAR ANCHORAGE BENDS
Bite-opening
bends/Tip-back
bends/Anchor-bend

Bend faces vertical
occlusally (if not ,
toe-in or toe-out is
placed )

Facing occlusally
LOCATION OF THE ANCHOR
BENDS
3 mm mesial to the
mesial end of the
molar tube

The wire enters at
6 oclock and exits at
12 oclock when the
anterior segment is
pulled incisally

ANCHOR BEND
3 mm
DEGREE OF BITE OPENING BEND

Amount of bend is 30-50 degrees

Correct amount of bend judged by
anterior segment deflection of the wire
in the vestibule

Upper arch wire should be- in vestibule
Lower - mid-way between the teeth and
vestibule
30-50 degrees
PRECISELY MEASURING THE
FORCE
Measured using a
DIAL-GUAGE ,
especially when the
intrusive force
requirement is
critical
A nearly 20 mm
displacement of the
upper arch wire will
result in 1.5 ounces of
depressive force (nearly
42.49grms)

14 mm of displacement
of the lower wire
produces 1.2 ounces of
depressive force
KESLING 1985
CHANGING TO AN ARCH WIRE
WITHOUT VERTICAL LOOPS
Its Desirable to discard the arch wire
with vertical loops as soon as possible

Reason Vertical loop increases the
flexibility of the arch wire in the
vertical plane and thus interferes with
the anterior biteopening (vertical
control)

Class II elastics and Dontrix
CLASS III ELASTIC IN PLACE
Plain arch wire with Bayonet bends ,
intermaxillary hooks ,anchor bends and
elastics

Bayonet bends hold the teeth in over-
corrected positions

Intermaxillary circles hold the inter-
cuspid arch length

Elastics to correct mesio-distal relation
Right buccal
Frontal
Left buccal
INTRA-ORAL PHOTOGRAPHS
End of stage I

AT THE END OF
STAGE I
Correction of over-bite to edge-to-edge
bite

Correction of over-jet to edge-to-edge

Correction of crowding

Over-corrections of rotations of
anteriors

Closure of anterior spaces

Corrections of cross-bites

Beginning of correction of pre-molar
rotations

Over-corrections of disto-occlusion
(mesio-distal molar relations )

Partial corrections of mid-line
discrepancies

Correction of axial inclinations of Md
incisors

Beginning correction of open - bite

MECHANICS OF TOOTH MOVEMENT
STAGE I
1.INTRUSION
In conventional Begg BITE-OPENING
occurred mainly due to molar extrusion
(Major weakness of conventional Begg)

Little is attributed to lower incisor
intrusion

In Begg treatment all the 6-anteriors
are intruded together (a unique feature)
Bite-opening force is derived from the
ANCHOR BEND

A moment generated by the anchor
bend in the molar tube , is automatically
balanced by the generation of an
intrusive force on the anteriors , and an
extrusive force on the molars in order
to establish equilibrium

Moments and
counter-moments
generated
Depending on the direction of intrusive
force The tooth under-goes varying
degree of intrusion as well as labial
crown-lingual root tipping (rotation-
UNDESIRABLE)

This is resisted in case of Mx-incisors
by CLASS II elastics in stage I.

Class II elastics, not only have a
HORIZONTAL FORCE component but
also have a VERTICAL FORCE
COMPONENT

The vertical force component, reduces
the magnitude of intrusive force of the
archwire

The horizontal force component , affects
the net resultant direction of force

CONSIDERATION OF MAGNITUDE
OF INTRUSIVE FORCE
Optimum force required for intrusion of
is appox. 15-30 grms/ incisor(slightly
higher values for canines)

Anchor bend exert force of appox. ;
1. 1.5 oz in Mx (intrusive) at mid-line
2. 1.2 oz in Md (intrusive) at mid-line

Class II elastics 1 oz (extrusive)

Thus , the net intrusive force in the Mx
incisors is 0.5 oz (at mid-line) or
appox. 14.16 gms for three teeth i.e
nearly 5 grms of force /tooth , which is
far below the optimal force suggested

For active intrusion the Mx incisors
should receive appox. 60-70 grms of net
force in the mid-line after negating the
extrusive component of the class II
elastics

PROBLEMS ENCOUNTERED
DURING STAGE I
BITE NOT OPENING
1.Patient not wearing elastics
a).Remedy-Educate the patient and
parents

2.Biting of the bite-opening bends
a).Remedy-Remove arch wires and
restore bite-opening bends

b). Check positions of the anchor
bends (if too far mesial ,move them
closer)

c). Check the level of Md molars (lower ,
if necessary)

d). Check eating habits

3.Failure to place proper bite opening
bends
Remedy Place proper amount of bite-
opening bends in the arch wires

4.Anchor molars out of occlusion (most
common in perm. 1
st
molar extractions)
a).Remedy- Placement of vertical
elastics from molar to molar
b).Place a horizontal elastic

EXCEPTION TO THE RULE
5.Loose molar bands
Remedy- re-cement the
band

6.Improper angulation of the buccal tube
or the entire molar band
Remedy-Tube should be parallel to the
occlusal and the buccal surfaces

MOLAR WIDTH NARROWING
(USUALLY MANDIBULAR )

1.Vertical component of class II elastic
force
Remedy-Form Md arch wider in the
posterior segment
b).Add wide auxilliary arch wire

2.Prolonged wearing of posterior cross -
elastics

3.Disto-lingually rotated canines
Remedy- Donot engage the arch wire in
the cuspid brackets until these teeth
have been ratated by elastic thread or
other means

4.Bicuspid rotational elastic tie on the
lingual from the bicuspid to the molar
Remedy Extend the main arch wire to
the buccal surface of the 2
nd
molar

b).Place toe-out on the distal-end
c).Re-tie elastic thread from the bicuspid
to the arch wire
d)All

5.Rolling of the distal ends of the arch
wire , causing the anchor bend to turn
into a rotational force on the molar
Remedy- Place toe-in or toe-out at the
anchor bend

ADVERSE TIPPING OF THE ANCHOR
MOLARS
1.No anchor bends (if tipped mesially)
Remedy- Remove archwire and place
proper anchor bends

2.Too much anchor bends (if tipped
distally)
Remedy-Remove the
arch wire and
reduce the amount
of anchor bends
3.Proper anchor bends , but placed for a
long time (anchor molar tips distally)
REMEDY-Having recognized the
problem, cont. OR if severe than band
the 2
nd
molar and it acts as the anchor
molar now and place an ordinary bracket
on the 1
st
molar

4.Loose molar bands (mesial tip)

5.Improper placement of the tube or/and
the band (may tip mesially or distally)

6.Excessive elastic force (molar tip
mesially)
7.Improper placement of elastics .
(If not placed in the ball-end hook and
placed elsewhere, elastic will not slip as
the tooth moves and the force is not
applied in the centre of resistance and
hence the tooth would tip (mesially)
REMEDY- Instruct the patient in
proper placement of elastics
NO APPRECIABLE CHANGES
1.Not wearing elastics
REMEDY-Educate the patient

2.Arch wire(s) bend out of shape
REMEDY- Rebend the arch wires
b).Check eating habits

c).Check the level of the Md molar
tube (lower them , if necessary)

d).Check the position of the anchor
bends (if far mesially , move them
closer to the tube)

3.Oral habits present that counteract the
forces of the appliances
REMEDY- Identification of the habit

4.Patient seen too soon
REMEDY- Dismiss the patient for
atleast 6-weeks

VERTICAL LOOPS BURIED IN THE
GINGIVA

1.Original, looped arch wire left in the
mouth for too long
REMEDY-Remove it and replace with plain
arch wire with bayonet bends

2.Misjudgement in placement of the
vertical loops in the proper direction
REMEDY-If anterior teeth are still
crowded and irregular , remove , modify
the direction of the loops and replace

ELASTICS WHICH BREAK OR
DONOT STAY
1.May be an excuse for not wearing
elastics

2.Elastic will not stay on the inter-
maxillary circle
REMEDY-Open the inter-maxillary
circle vertically
And distally engage into the ball-hook

LOCK PINS LOST
1.Occluso-incisal forces
REMEDY-Use steel pins , if brass used
earlier
b).Check anchor bends to facilitate
opening of the bite

2.If missing at random ,throughout the
mouth (patient must picking them )
b).Use ligature instead of pins
EXTREMELY MOBILE MOLARS
1.Clenching of the teeth
REMEDY- Educate the patient or
suggest to chew sugar free gum to
break the habit

2.Intermittent wearing of the elastics
REMEDY-Patient education

3.Pathology
REMEDY-Treatment of the pathology


4.Excessive force applied to the molars
REMEDY- Reduce arch wire size to
0.016
b).Reduce elastic force to 2 1/2 oz
c).Reduce degree of anchor bends

5.No apparent cause
REMEDY-Remove the arch wires and
elastics for 8-10 wks and obsreve ; the
molars should tighten
LOWER ANTERIOR TEETH TIPPED
LABIALLY
1.May be an optical illusion with roots
actually moving lingually

2.Binding of the arch wire in the bicuspid
brackets
REMEDY-Use by-pass clamps
b).Remove bicuspid band temporarily
3.Binding of the ends of the arch wire in
the distal end of the buccal tube
REMEDY-Remove the wires and correct

4.Poor diagnosis
REMEDY-Reconsider the necessity for
extraction
ANTERIOR OPEN-BITE NOT
CLOSING
1.Patient not wearing anterior vertical
elastics
REMEDY- Patient education

2.Persistent tongue-thrust or other
adverse habits
REMEDY- Educate the patient
b).Habit breaking appliance

c).Place lingually directed spurs on
lower anteriors

3.Too much anchor bend
REMEDY-Reduce the degree of the
anchor bends

TOOTH NOT ROTATING
1.Not enough space
REMEDY- Check diagnosis and the arch
wire design

2.Not enough activation in the bracket
area of the arch wire
REMEDY- Remove the arch wire and
activate the vertical loops
MID-LINE DISCREPANCY
1.Asymmetrical tipping of the anterior
teeth
REMEDY- Do nothing , but study the
situation carefully and the ultimate
uprighting of the teeth in the 3
rd
stage
will correct the mid-line
CONCLUSION
The Begg technique is divided into various
stages with the purpose of anchorage
preservation and every stage has some
specific objectives to attain.

And for the success of the technique is
mandatory to follow and attain all the
objectives in the specified stage ,
before entering into the next stage
Right buccal
Frontal
Left buccal
REFERENCES
1.Begg and Kesling Orthodontic theory
and technique -2
nd
edition
2.Fletcher
3.Vade maecum of Begg technique-Cadman
4.Molleanheaurs advanced manual
5.Refined Begg by V.PJayade

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Begg Technique ORTHO / Orthodontic Courses by Indian Dental Academy

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