Beggs Philosophy Ortho / Orthodontic Courses by Indian Dental Academy

SYMPOSIUM
ON

THE BEGG TECHNIQUE
CONVENTIONAL & CONTEMPORARY

PART I BEGG PHILOSOPHY
www.indiandentalacademy.com
INTRODUCTION

ANATOMICALLY CORRECT ATTRITIONAL
OCCLUSION

DIFFERENTIAL FORCE

SEVEN COMPONENTS OF BEGG,S TECHNIQUE

ADVANTAGES OF BEGG,S TECHNIQUE

DISADVANTAGES OF BEGG,S TECHNIQUE

CONVENTIONAL vs. REFINED BEGG,S

INTRODUCTION
The general objective of orthodontic treatment with
any technique is to obtain a result that simulates normal
occlusion in so far as practicable with the malocclusion
at hand and the appliance employed for its correction.

With the Begg technique, although all individual and
group tooth movements toward this over-all objective
are carried out simultaneously and as promptly as
possible, the treatment is divided into three stages,
each of which has its own integrant objectives and
movements.

The objective of orthodontic treatment is to correct malocclusion
of the teeth and those deformities of the jaws and face associated
with it.

"Normal" occlusion has come to imply not only correct occlusion of
the teeth but also that all of the structures of the dental
apparatus are anatomically and functionally correct and in harmony
with the correctly occluding teeth.

He devised a concept about optimal force levels and efficient
force distribution, using his wire for arches as well as auxiliaries
with a modification of Angle's ribbon arch bracket, and called it
"the light wire differential force technique."

ANATOMICALLY CORRECT

ATTRITIONAL OCCLUSION
Begg discarded the concept of textbook normal occlusion as a
fallacy and therefore as a hindrance to progress in orthodontics
and dentistry generally.

He adopted stone age man attritional occlusion as the basis of
orthodontics, because it is the anatomically and functionally
correct occlusion.

He said that the production and maintenance of correct, well-
functioning, healthy and esthetically acceptable occlusion must
be the aim not only of orthodontists but of all dental
practitioners.
Correct occlusion is not the static condition that it is held to be in
the concept of textbook normal occlusion.

In correct occlusion the positional relationships of individual teeth
to each other in the same dental arch, the occlusal relationships of
the teeth of one dental arch to those of the opposite arch and the
relationships of the teeth to the jaws change continually throughout
life.

Therefore the only constant in correct occlusion is continually
changing occlusion.

Correct occlusion is not a fixed or particular anatomic state, but a
changing functional process undergoing continual modification and
adjustment during the whole life of both deciduous and secondary
dentitions.
The study of Stone Age dentitions was carried out on skulls of
Australian aboriginals who died before the white man came to
Australia.

Australian aboriginal skulls were used for this study not because
the development of attritional occlusion of their teeth differed
from the development of attritional occlusion of Stone Age mans
teeth in other parts of the world, but because such skulls were
more readily available than the skulls of other Stone Age people.

By studying Stone Age dentitions, not only the development of
correct occlusion is revealed but also the etiology of many of
civilized mans malocclusions.
Anatomically correct occlusion can develop only when there is
sufficient attrition of the teeth for them to assume correct
occlusal relationships.

Stone age man's teeth have occlusal and proximal attrition. Often
this is so marked that dentin is exposed occlusally, incisally and
proximally.

Textbook Normal occlusion in civilized man is anatomically
incorrect, because his food is too soft and concentrated to cause
tooth attrition.

The incisal occlusal, proximal and axial relations of civilized mans
teeth remain almost static throughout life, because the unworn
cusps are firmly locked in what are erroneously but almost
universally regarded as anatomically correct occlusal relations.

Also, the almost static positions, especially the mesiodistal, of
civilized mans teeth in relation to his jaws are not anatomically
correct.
Civilized mans jaws are prevented by unworn teeth from
assuming correct relations to each other in all directions,
especially the vertical.

With reference to the vertical direction, civilized mans
upper and lower jaws are forced farther and farther
apart as his teeth continually erupt without being
continually reduced in vertical length by occlusal and
incisal attrition.
High unworn tooth cusps are wrongly considered to
have evolved in man to maintain stability of occlusion
throughout life.

The only true advantage of high cusps is that they
help to guide the teeth into their occlusal
relationships when the teeth are erupting, and then to
hold them in these relations for only a short time
after their eruption. Thereafter, unworn tooth cusps
prevent the development of continually changing
anatomically correct occlusal relations.

Two factors in anatomically
correct occlusion
Tooth migration

Changing anatomy of teeth

Tooth migration

A physiologically basic factor which is indispensable for bringing
about the continually changing positions of the teeth in the jaw
bones.

Teeth continually move throughout life in two directions
simultaneously - horizontal (mesial migration) and vertical (continual
eruption).

In the available orthodontic literature mesial migration
of human teeth is regarded not as being essential to
the maintenance of proper occlusion but as an
aberration, a perversion which arises from the so-
called anterior component of forces.

It is considered to play no role other than to produce
malocclusion.

On the contrary mesial migration is undoubtedly a quite
normal and vitally necessary physiologic process,
related to and part of the process of continual tooth
migration.

Changing anatomy of teeth

The anatomic forms of the teeth begin to change soon
after eruption because of wear or attrition.

This tooth wear chiefly takes place occlusally, incisally
and proximally.

Absence of attrition in man causes malocclusion of
dentitions which would be free of malocclusion and
irregularity of the teeth in the presence of the amount of
attrition that occurs in stone age man.
Causes Of Stone Age Mans Tooth Attrition

The food of Stone Age man was hard, coarse, fibrous and gritty.

He did not know how to refine his food and reduce it to a soft, pappy
consistency before eating it.

His food contained much more indigestible bulk and roughage than
civilized mans food.

He had to eat larger quantity of food than we do in order to sustain
himself.

The nature of his food required him to spend more time eating and to
expend more force in mastication.

Therefore extensive and rapid occlusal and proximal attrition
developed throughout the life of his deciduous and permanent
dentitions.
ATTRITIONAL OCCLUSION

IN

THE DECIDUOUS

DENTITION
When stone age man's deciduous incisors first erupt, an
incisor overbite develops, just as it does at this stage in
civilized man.

As stone age mans deciduous teeth erupt and occlude,
attrition immediately commences the process of
reduction in the size of each tooth, occlusally, incisally
and proximally.

As the occlusal surfaces of the deciduous molar crowns
are worn flat, the restriction or movement caused by the
original cuspal locking disappears. The upper and lower
deciduous dental arches are thereby unrestricted in their
masticatory movements.
As attrition progress, all of stone age mans lower deciduous teeth
move forward en mass in their occlusal relations with the upper
deciduous teeth.

With this change in occlusal relations, the original deciduous incisor
overbite gradually disappears.

Incisors assume a complete edge to -edge bite soon after all of the
deciduous teeth have erupted.
This forward movement of the occlusal relations of
stone age mans lower deciduous dental arch, relative to
the upper causes the distal surfaces of the lower
second deciduous molars to assume positions farther
mesially than the distal surfaces of the upper second
deciduous molars.
Absence of attrition of civilized mans deciduous teeth prevents the
forward movement of the lower deciduous teeth and hence the
forward movement of the whole of the lower deciduous dental arch,
relative to the upper.

Thus, the overbite of the deciduous incisors persists until they are
shed.

This absence of attritional forward movement of occlusal relations
of civilized man's lower deciduous dental arch, relative to the upper
frequently prevents the lower first permanent molar from erupting
far enough mesially.

When stone age mans upper and lower first permanent molars erupt,
they can more easily assume their well-known occlusally correct
relation because of the change in occlusal relation of the deciduous
teeth.

Occlusal attrition causes the occluso-cervical heights of all stone age
mans deciduous teeth to be reduced, so that the distance between
the upper and lower jaws is less than it is at this stage in civilized
mans non attritional occlusion.

Therefore, stone age mans upper and lower first permanent molars
have less distance to erupt before occluding with each other than do
civilized mans.
Because of extensive proximal attrition of the deciduous
teeth and their proximal contact being maintained by the
process of continual mesial migration, the overall
mesiodistal lengths of the upper and lower deciduous
dental arches are considerably reduced.

Civilized mans first permanent molars are forced to
erupt too far distally in the jaws, and after eruption are
still held too far back by absence of proximal attrition of
the deciduous teeth.

Shallow glenoid fossa and
flat head of mandibular condyle
During the period of development of stone age man's deciduous
dentition the glenoid fossa is shallow and the head of the condyle is
relatively flat. Therefore, lateral mandibular movements during
mastication are extensive and wide.

On the other hand civilized mans glenoid fossa at this stage of
development is smaller and deeper and condylar head is also smaller
and more rounded and fits up farther into the glenoid fossa. So that
the range of mandibular excursions is more restricted.
When stone age mans permanent incisors first erupt there is an
overbite, just as there is throughout life in civilized man.

However, mastication of hard, coarse, fibrous and gritty food soon
causes stone age mans permanent incisors to wear incisally at first
at an oblique angle.

The obliquity of the plane of
attrition of the incisal edges
at first points downward and
forward.

This obliquity is gradually reduced as more attrition takes place, the
crowns of the lower incisors inclining more labially.

Ultimately the plane of attrition of the upper and lower incisors
becomes horizontal and an edge to- edge occlusal relationship of
stone age man's upper and lower permanent incisors is established
in just the same manner as the relations of his deciduous incisors
change from the initial overbite to the edge-to-edge bite.
Therefore, stone age mans curve of spee
is not nearly so curved as in textbook normal
occlusion. It is usually almost a flat plane
mesiodistally. Campbell (1925) first showed
that stone age mans overbite of the
permanent incisors changes during adolescence
to the edge-to-edge bite.
The cutting or incisal edges of stone age mans upper and lower
permanent incisors are changed by attrition into flat occlusal surfaces.

The elimination of the incisor overbite freely permits stone age mans
lower permanent incisors to tip labially to their anatomically correct
position.

On the other hand the persistence of the incisor overbite throughout
life in civilized man causes the lower permanent incisors to be held in
anatomically and functionally incorrect upright positions.
Also, the persistence of the incisor overbite
in civilized man forces his upper permanent
incisors to remain in anatomically and
functionally abnormal labial position, whereas
the elimination of the incisor overbite in stone
age man permits the upper permanent incisors
to assume more vertically upright axial
inclinations.
During the transitional change from stone age mans incisor overbite
of adolescence to the adult edge to-edge bite, the premolars,
canines and second permanent molars erupt, and occlusal and
proximal attrition of these teeth immediately commences.

As all of stone age mans teeth wear proximally, they maintain
contact by mesial migration.

Thus, instead of there being proximal point contact of teeth as
there is in civilized man, large surfaces of neighboring teeth that
are continually increasing in area are in contact with each other.

Therefore the amount of space required in each jaw to accommodate
the teeth gradually becomes less as proximal and occlusal attrition
proceeds.
Before stone age mans permanent canines erupt, proximal attrition
and the maintenance of proximal contact of the teeth bring about a
mesiodistal reduction of the total width of the four permanent
incisors and also of the first and second premolars.

There is slightly less space for eruption of canines if the second
deciduous molars have not been shed before the permanent canines
erupt.
Therefore, the permanent canines have much more
space in which to erupt than if attritional mesiodistal
dental arch reduction had not occurred.

Also, the distal surface of the first permanent molars
and the mesial surfaces of the second permanent molars
commence to wear as soon as these teeth erupt.

Early attritional reduction in the overall lengths of the dental arches
prevents the development of crowding, overlapping, rotation and
bimaxillary protrusion of the six upper and lower permanent anterior
teeth as well as irregularity and crowding of the premolars, all of
which would inevitably occur in the absence of attrition.

This attritional reduction in the length of the dental arches leaves
more spaces at the distal ends of the dental arches for the eruption
of the third permanent molar.

In this process of attritional mesial migration, the central incisors
migrate least of all but the second permanent molars migrate over a
longer distance than any teeth that have erupted up to this stage,
a distance equal to the sum of the attrition of all the teeth mesial
to them.
The eruption and coming into occlusion of civilized man's third
permanent molars are often prevented or so retarded or made so
difficult by the absence of tooth attrition and by the subsequent
inability of all of the teeth mesial to the third permanent molars to
migrate mesially.

This abnormal holding back of civilized man's third permanent molars
too far distally in his jaws is a main cause of the high incidence of
his third molar impactions.

It is also responsible for the apices of the roots of civilized mans
third permanent molars being closed and their roots being fully
formed before eruption.
In stone age man with anatomically correct attritional occlusion,
the third permanent molars usually erupt within a year or two
after the eruption of all other teeth of the second set.

Two phenomena that support the contention that attritional
occlusion is the natural and proper occlusion for man:

The third molars are the only teeth that have their root
formation completed before eruption in civilized man's non
attritional dentition.

The third molars conform to the behavior of all other human
teeth by erupting before complete root formation in the
attritional dentition of stone age man.

The amount of reduction in length by tooth attrition of the lower
dental arch prior to the eruption of the lower third permanent
molars taken in 1930 on the large collection of Australian aboriginal
skulls and teeth at the south Australian museum.
Averages of mesiodistal width
measurements of lower unworn
permanent teeth of Australian
aboriginals
Averages of mesiodistal width
measurements of permanent
teeth having inter proximal
attrition
The difference between the two sets of measurements is 5.28 mm.

This measurement represents the reduction on only one side of the
mandible at this stage.

Therefore, even before the eruption of the third permanent molars
the average reduction of the length of the whole dental arch from
the distal surface of the second permanent molar on one side to the
other side is 10.56 mm.

The amount of attritional reduction in the length of the upper dental
arch at this stage is only about 1 mm less than in the lower dental
arch.
Murphy (1964) has studied attrition in older Australian
aboriginals. He worked on 90 Australian aboriginals
skulls in Britain and has produced valuable evidence that
attrition occlusion is the correct pattern for the human
dentition.

His work has confirmed that measurements on the
mandibles of young Australian aboriginals are conclusive
in their implications concerning the part played by
proximal attrition and associated mesial migration in
the development of the human dentition.
For descriptive purposes Broca has divided occlusal
and incisal attrition into four stages:

First stage- enamel worn without cusp obliteration or
exposure of dentin.

Second stage- cusps worn down and dentin exposed.

Third stage a further stage in which quite an
appreciable amount of the crown of the tooth is worn
away.

Fourth stage an extreme stage in which most of the
crown has disappeared and the wear has extended to the
neck of the tooth.
Occlusal and incisal attrition of the teeth also plays an important
part in this reduction.

The greatest mesiodistal diameters of the crowns of unworn
teeth are at their contact points.

The contact points of posterior teeth are closer to their occlusal
surfaces than to their neck.

The points of contact of the lower incisors with each other are
at of close to their incisal edges.

Occlusal and incisal attrition

After occlusal attrition has extended farther gingivally than the
original points of contact of the unworn teeth, the greatest
reduction in dental arch length is not due to proximal attrition, it
is due to occlusal and incisal attrition, because unworn teeth
become mesiodistally narrower toward their necks.

Forward shift of lower permanent dental arch in relation to upper
As the cusps of the permanent teeth are wearing
away and the edge-to-edge incisor bite is becoming
established all the lower teeth move forward relative
to the upper teeth so that the molars, premolars and
canines eventually assume typical Angle Class III
occlusal relations.

This attritional occlusion despite its Class III occlusal
relations of the teeth is the only anatomically correct
occlusion.
Occlusal attrition and vertical dimension of the face
As occlusal attrition becomes more pronounced, the vertical distance
separating the alveolar bone of the upper jaw from that of the lower
jaw does not usually become less in stone age man, because the upper
and lower teeth are continually erupting thus compensating for
attritional occlusion.

In contrast to this, the distance separating the tooth bearing part of
civilized man's lower jaw from that of his upper jaw becomes greater
as he grows older because he does not have occlusal attrition.

However, he retains the process of continual tooth eruption which he
inherits from his stone age ancestors.
Whether there is an optimum orthodontic force that
will give best results , move the teeth at most favorable
rate and with least tissue damage and pain?

Whether tooth moving force should be applied
continuously or intermittently?

Storey and smith concluded that there is an optimum
range of force values that produces a maximum rate of
distal movement of canines, and this optimum force did
not produce any deleterious movement of the molar
anchor unit.
Differential is defined as the difference of two or
more motions or pressures.

Tooth movement = force x time
resistance

The amount of force required to move teeth is in
positive ratio to the surface area of the tooth root
attached to the bone by the periodontal membrane.

The ratio of area of contact of tooth roots with bone
in the canine and molar is approximately 3:8.
THE ROLE OF FORCE,
RESISTANCE, AND TIME IN
DIFFERENTIAL TOOTH
MOVEMENT AND THEIR
BIOMECHANICAL
PRINCIPLES.

In an interdental force system (one that uses no
auxiliaries, such as headgear and bite plates) the only
appliance forces are those exerted between one or
more teeth and one or more other teeth.

In keeping with Newton's third law, these forces can
only be equal and opposite. They are differential only in
that they are exerted in opposite directions.

When these forces are exerted, they encounter tissue
resistance, and it is tissue resistance that exhibits
the differential response to equal and opposite forces
which results in differential tooth movement.

Simple crown tipping, for example, encounters little
resistance and responds rapidly, but root tipping or
bodily movement meets with high resistance and
responds slowly.

In the first two stages of treatment, Begg uses the
principle of differential resistance when he opposes crown
tipping and other low-resistance, rapid-response
movements of the anterior teeth against bodily or high-
resistance, slow-response movement of the anchor molars.

This manipulates force and time to conserve anchorage
because (a) the light force (about 2 to 2 ounces) is
adequate to overcome the low resistance of the anterior
teeth but is less effective against the high resistance of
the molars and (b) within this time period (about 10 to 12
months) more of the rapidly responding anterior tooth
movements will occur than the slowly responding
movements of the anchor molars.

In the third stage, Begg uses equivalent resistance when
he opposes the high-resistance, slow-response
movements of anterior torquing and paralleling against
the high-resistance, slow-response movements of the
second premolars and molars.

However, although the resistances and responses are
equivalent in type, they are seldom equal in magnitude,
and it is in this third stage that most anchorage loss
occurs.
When Begg adopted the principle of differential resistance
for tooth movement in the first two stages, he took
advantage of the significant difference between the types
of resistance used and the amounts of force required to
overcome them.

For example, Begg noted that Storey and Smith used 150
to 200 grams (5.3 to 7.1 ounces) of space-closing force on
each canine to retract it bodily.

In 1961, however, he stated that only 60 to 70 grams
(2.1 to 2.5 ounces) was required on each side to tip all
six anterior teeth posteriorly. Thus, by employing
differential resistance instead of equivalent
resistance in the first two stages, he tips all six
anterior teeth backward with only 37 per cent of the
force Storey and Smith needed to retract the two
canines bodily.

Furthermore, 60 to 70 grams is only about 20 to 23
per cent of the 300 grams of force reported by them
as the minimal required for mesial molar movements.

To sum up, in an interdental force system where forces
are exerted only between one or more teeth and one or
more other teeth, in keeping with Newton's third law,
these forces can only be equal and opposite.

Differential force has acquired a broader meaning which
may be stated as follows: Differential tooth movement
is brought about by the use of differential resistance
to equal and opposite forces; equivalent movement is
brought about by equivalent resistance to these
reciprocal forces. To enhance beneficial movements
and to conserve anchorage, differential resistance is
used in preference to equivalent resistance as long as
practicable during treatment.

A diagnosis that acknowledges that the
primitive process of mesial migration and
vertical eruption of the teeth can persist in
civilized man combined with treatment
objectives that include the overcorrection of
all mal-relationships.

These considerations above all are the key
stone of successful treatment.
Simultaneous movement of each tooth toward its
final position in dental arch including rapid
elimination of incisal and cuspal interferences.

The maintenance of the new relationships
throughout the treatment promotes post
treatment stability.
The total separation of root moving forces from
arch wires is carried out during 3rd stage of
treatment.

Torquing auxiliaries are utilized for buccolingual
root movement and individual uprighting springs
are used for mesiodistal root positioning.

The arch wires are relatively large in cross
section to maintain previous vertical and
horizontal corrections and to withstand
reciprocal forces from the root moving
auxiliaries.
Application of the proper elastic forces to create
the desired differential movement of teeth.

The amount of force needed to move teeth along
their paths of least resistance toward their
normal positions in the jaws is so light that it can
be generated and controlled intraorally.

Intermaxillary forces can vary from 2 to 3 oz and
intramaxillary forces can vary from 2 to 10 oz
depending on whether large rooted or small
rooted teeth are to be moved.
Use of the light round continuous arch wires bent
from the hardest wire possible.

Not only must the wire have the highest degree
of resilience it also must relax under stress.

The arch wires also must have the proper form
including bite opening bends or curves to control
vertical dimension.
Use of molar attachments that prevent free
mesio distal tipping and yet permit the arch
wires to slide freely.

This combination permits the rapid retraction
of the anterior teeth as the arch wires slide
distally and if desired, facilitates the mesial
movement of posterior teeth without pushing
the anterior teeth.
Use of auxiliaries on all teeth except

the anchor molars.
Light forces are used, physiologically more acceptable
and comfortable.

Efficient anchorage control using intra oral source.

Deep overbites can be opened quickly and effectively.

Quick alignment of teeth can be obtained.

Early resolution of the malocclusion.

Root can be efficiently uprighted and torqued.

Low cost.

Round wire-ribbon bracket relationship was unable to
give the precise control required for a fine finishing.
Posterior root control was very difficult.
Rotational control was poor with the use of undersize
wire.
True intrusion of upper incisors was minimal.
Overuse of class II elastics caused:
Lack of upper incisors intrusion
Undesirable proclination of lower incisors
Unfavorable tipping of mand and occlusal plane
Uncontrolled tipping.
Excess uncontrolled tipping in first two stages
necessitated a long third stage.

CONVENTIONAL

vs.

REFINED BEGG,S
Changes in the concepts

Improvements in the hardware

Modification in the mechanics
Attritional Occlusion
Corrucini questioned some of the
observations in Begg's study.

Many operators have challenged
overemphasis on extractions in
anticipation of crowding.

Begg's appliance is now totally
bifurcated from theory of attritional
occlusion
More understanding of biology of
tooth movement
Differential forces
Diagnosis
Broad based
Treatment objectives
For Static occlusion:

Andrews six keys to normal occlusion form the goal.

For functional occlusion:

Synchronization of CO and CR.
Elimination of hanging palatal cusps of upper
posterior teeth.
Cuspid protected occlusion.
Incisor guidance.
Treatment planning
Use of orthopedic appliances.
Distalization of upper molars.
Asymmetric extractions.

Biomechanics
Controlled tipping from first stage.
Leader in continuing dental education

Beggs Philosophy Ortho / Orthodontic Courses by Indian Dental Academy

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