Modern Begg

Modern Begg
Beddtiot & CAT Techniques.

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

Introduction
Conventional Begg empirical and cook book
trt.
Begg operators
limitations
- need to diverge from orthodox trt.
Contemporary trt. goals & strategies incorporated
into Begg practice.
Modern Begg.
Refined Begg.

Modern Begg.
Follows Begg principles large extent.
Brackets modified ( other than Ribbon arch
type used in conventional Begg)
BEDDTIOT.
(Begg Edgewise Diagnosis Determined
Totally Individualised Orthodontic
Technique.)
Offers capacity to employ selected principles and
features of Begg and Edgewise mechanisms
specific situations most advantageous.
Primary Goal
Facility to treat each patients needs most
efficient for that individual.
Strong points in Begg Technique:
Proficiency in bite opening.( with elastics )
Differential response to force.
pitting limited tipping x translation.
optimal ant. movement, anchorage conservation.
Edgewise appl.
Precise control.
Facilitates anch. Expenditure.

Foundations:
Light wire.
Gentle, long range force systems
Min. bracket size max. interbracket span.
Light undersized wires.

Differential response to force.
Simple horizontal force Tooth tip.
Crestal bone exp. 3x times more force than
apical bone.
Crestal region force sufficient rapid tooth
movement.
Apical region insufficient force.

Less bone around the neck of the tooth
than apex.

strain near the alveolar crest.
Stress
in apical region.
Above factors
multiply each other.
powerful adv. very light simple tipping forces.
Retraction tipping + uprighting
Adv. anchorage conserved.
Effective translatory retraction greater
force greater anchorage loss.
Repositioning roots after tipping reaction
strain insufficient for anchor loss

Modern orthodontic system concerned:
Interdental relationships.
Facial str. & appearance.
Orientation of the dentition in the face.
Oral function.
Best approach determined by diagnosis.
Appliance versatile.

Brackets.
Dimensions:
Narrow, single width edgewise br.
( 0.050 inch or 1.3 mm).
Horizontal slot 0.022 ( height ) x 0.028
(faciolingual depth).
Vertical slot 0.020 x 0.020.
Archwire slots torqued.
.

Torque values - 0, 5, 10, 15, 20.
All brackets identical - except for torque.
Torque indicator groove - gingival lingual root torque.
- occlusal lingual crown torque
Brackets:
bonding preferred.
Prewelded flat/curved universal bonding pads.
Advantages:
Facially facing archwire slots engagement of
archwire easy.
Small dimensions
. lip & cheek irritation.
occlusal interference.
bonding enamel surface.
problems with gingival proximity & oral hygiene.

Interbracket long resilient span
- archwire.
Wire less distortion.
Less elastic range requd. force.
Considerable ( limited ) tipping .
0.016 wires - 10 distal crown tipping.
0.018 wires - 5 mesial crown tipping
(uprighting)
braking not required.
Vertical slot
Uprighting springs
Turned 90 - miniature buccal tube.
Uprighting springs.

Original Recent
Original.
Helix farther from archwire.
Hook arm no extra offset reqd.
Recent
More hygienic.
irritation on gingiva.
Appearance less conspicuous
Buccal Tubes:
Dimensions:
4.5 mm long, 0.022 x 0.028 edgewise.

lingual crown torque, 25 lower.
10 - Upper.
Distal end of max. tube - 10 outward angulation.
( toe- in).
Headgear tube 0.051 occlusal & buccal.
In cases with deep bite/ moderate
- severe anchorage req
Addnl. Rect. Tube diagonally across
buccal surface of basic tube
mesial end pointing gingivally.
Dimensions.
4.5mm long, 0.022 x 0.028.
Outer tube ( Addnl. Tube ) - 15
angulation to inner tube.

Bite Opening:
Outer tubes main arch wire bite opening &
retraction phases.
Gingival angulation effective built in anchor
bends.( actual bend - - 25 ).
Inner tubes Rect. sectional wires lock PM &
Molar.
single large tooth C.R mesial than - C.R of Molar
Bite opening more potent check elastics.
Intrusive force - -
less tendency to tip
anchor units distally.
Rotations:
Early belief rotation control difficult.
Offset bracket side of tooth disp. lingually.
Overcorrection thickwalled elastomeric lig.-
placed on wire before insertion.
Bayonet bends.
Torque control:
Disadv. Of larger slot 0.022 x 0.028 large wires
used precise control Rigid.
Overcome resilient rect. Wires ribbon mode.
Sizes used:

Square wires.
0.019
0.020
0.021
0.022
0.020 x 0.016
0.021 x 0.016
0.022 x 0.016

Newer non steel alloy archwires
Extremely resilient gentle forces
Approp. size precise bracket engagement.
Esthetic & Hygienic. ( eliminate aux.)
Torqued brackets build trt. into the appl.
Facial root torque lower incisors augment
anchorage.
0.022 x 0.016 , 5 torque.
Limit tipping of upper incisors - palatal torque.

Important adv. - BEDDTIOT
Facility for both 3 dimensional control
& simple bracket
Limited tipping light forces

Facilitate application of the best modality in every
situation.
Combined Anchorage Technique
Variable Anchorage systems.
Design of the attachment
provides optimum light wire & straight wire trt.
capabilities.
Four stage light wire appliance successful
collaboration b/w Begg practitioners & Unitek
Beneficial design features adv. of Begg & St. wire.

Advantages & Disadv. of the two tech.
Begg light wire appl.
Advantages:
Light optimum force ( 60 90 g )
Continuous force.
Min. friction.
Rapid alignment, leveling , rotation of ant. teeth.
Rapid overbite correction.
Simultaneous crown tipping.
Continuous paralleling of roots at extn. sites.
Continuous torquing.
Extra oral force unnecessary.
Disadvantages.
Diff. co-ordinating max. & mand. arch
Diff. bilateral symmetry.
Premolar & molar torque control diff.
Diff. in stabilizing teeth final artistic
positioning.
Straight wire appliance.
Advantages:
Precise control PM & M torque.
Bilateral symmetry BL inclinations readily
attained.
Bilateral symetry of arch form.
bends in archwires.
Finishing
Self limitation of movmt. & stabilization of
teeth- final detailing.

Disadvantages.
force levels wider bracket, interbracket
span.
Rapid ant. alignment diff.
Overbite correction diff.
Addnl. anchorage necessary- friction.
Extra oral force reqd.
Alignment incisors & canines in sequence.

Dynamic & Static anchorage.
Dynamic anchorage
It comprises physical
forces generated by the
appl. in a complex
interrelationship equally
effective forces biologic
environment.

Light wire
force sys.
Biologic
force sys.
Unipoint
contacts
Muscle action
Anchor bend Tooth morph &
mass.
Archwire Cuspal interlock.
Aux. wire Freeway & fnl.
Paths.
Tipping force Occl. Force &
migr.
Intr forces Bone density
Extrusive forces Growth
Rot. Forces Habits
Static Anchorage.
Increasing the forces within the appl. Less
effect of the biologic force sys.
CAT dynamic & static anchorage resistance dev.
- applied certain stages trt. program.
Stage I & II Dynamic.
Stage III Dynamic / Static.
Stage IV Static.

Four Stage Light wire Appliance:
Appl. vehicle transmitting force
teeth &indirectly bone & soft tissue.
Design of appl. Elements, positioning, adjustments
& manipulations imp. max. trt. efforts.
Caution:
Prudent to use conventional approach each trt.
stage as long as progress is good.

Brackets.
Gingival or Ribbon arch slot free
tipping, no binding.
Edgewise slot precise final detailing.
Three bracket types optimal rotations,
tipping & torque.

Base beveled friction or binding with
archwire.
Torque, tip, in out sp. vary for each
tooth.

Molar tube:
0.036 round tube gingivally.( Begg )
0.018 x 0.025 or 0.022 x 0.028.
Tubes - 7 offset addnl. molar control Stage II.
0.018 x 0.025 slot recommended.
Conventional tubes preferred to convertible tubes.

Placement of brackets & tubes:
All teeth except 2
nd
molars receive attachment
as soon as practical: increase force control.
Mandibular 1
st
molar tubes placed first.
0.036 tube gingival margin.
rect. Tube middle third of crown.
edgewise tube 3.5 mm tip of buccal cusp of 1
st
molar.
3.5 mm std. for all brackets,
EXCEPT, Canines & upper LI br.
canine br. 0.5 mm gingivally,
LI br - 0.5 mm incisally.

Treatment technique:
Trt. divided into 4 stages.
Stage I - Organization.
Overbite correction.
Cl. II or Cl. III correction.
Alignment, levelling, elimination of rotations-
incisors.
Correction of crossbite & archwidth problems.
Overcorrection

Stage II. Consolidation.
Closure of remaining spaces.
Retraction of incisors.
Maintenance of overbite, rotations, antero-post.
corrections.
Overcorrection.
Stage III. Correction of crown & root inclination.
Uprighting & paralleling of roots.
Torquing of ant. teeth.
Maintenance of corrections.
Stage IV. Final detailing.
Attainment ideal arch form & co-ordination of
archwidth.
Attainment desired torque.
Precise intercuspation & fnl. harmony.
Optimal facial & dental esthetics.
Commencement of retention.
Stage I.
Archwires:
Initiated 0.016 round wires Begg slot.
Cl II elastic force lingual rolling lower molar.
Mild exp. reqd.
45 anchor bend 1-2 mm mesial molar tube.
In severe crowding
Multiloop deep bite/ max. anchorage cases.
Niti shallow bites / min. anchorage req.

Anchor bends-
Intrusive + labial movement.
Extrudes & tips molars distally.
Class II elastic force:
Combination of intrusive + retractive forces
Center of rotn.- more apical max. lingual
crown tipping.
Elastics:
Very light elastic forces.
2 -3 oz. 24 hrs a day.

Stage II.
End of stage I occl. organized appearance.
St. II begins consolidation of the dentition.
Goals in Stage I not reduced.
Elastics:
Intrarch elastics max. ant. retrcn. &
gen. space consolidation. 2-3 oz.
Six elastics used.
Elastics eliminated space closed.
Arch wire bent distal to molar tube.

Archwire:
0.018 round wire.
25 anchorage bend, 5 toe in bend.
Toe in bend counter act rotational moment
inter arch elastics.
Stage III.
Crown & root coordination/ torquing & paralleling
stage.
All spaces closed.
Crown tipping may be considerable.
All corrections maintained.
Molars & canine Class I reln.
post. occlsn. inter locked min. anchor loss-
subsequent torquing & uprighting.
Pre stage III reqd. occasionally.
Reevaluation of br. ht & posn. recommended.

Archwires:
Maxillary:
0.020 dia.
Constr. To Omega shape.
Anchor bend 0 - 5.
Inset bend into molar tube.
Vertical bend premolar slot.
V bend distal to canines.
Cinched .
Overcorrected.
Mandibular:
0.018 or 0.020 dia.
Exp. bilaterally.
Inset bend molar tube.
Vertical bend into premolar.
V bend distal to canines.
Anchor bend of 5 - 10.
Cinched.
Overcorrected.

Auxiliaries:
Uprighting springs.
Two forms.
Safety ligature hold tooth archwire.
Safety lock spring safety extension holds
wire in gingival slot.
Wire size used 0.014 or 0.016.
Torquing Aux.
0.016 wire four spur/ two spur.
Stage III complicated.
Constant monitoring reqd.
In CAT absolute determination final uprighting,
B-L placement, torque not reqd.
Straight wire slot final artistic finishing - teeth.

Stage IV.
Trt. done in edgewise slot.
Preangulated,pretorqued, in out
features
precise crown & root posn.
Stage IV not a substitute Stage III
Begg.
Excellent bite opening.
Enmasse retrcn. of incisors Stage I
& II.
Rapid uprighting canine & PM roots.
Torque of incisors Stage III.
All these adv. to be used to greatest extent
Begg mech.
Stage IV:
Primarily to increase effectiveness & precision- final
detailing.
hygiene problems auxiliary springs.
Lingual crown torque of post. teeth.
Establish bilateral symmetry uprighting.
Achieve proper paralleling & torque.
Coordinate arch form & width.
Second molars:
More optimal occlusal reln.
To obtain best arch form.
Coordinate crown & root torque of post. teeth.
To get levelling - two preliminary round wires
0.016 or 0.018 Nitinol wire.
Edge wise slot mech. alignment adequate.
Wires used.
0.017 x 0.025 NiTi.
0.016 x 0.022 , 0,018 x 0.025 SS.
Max. torque benefit 0.018 x 0.025 ss.
Post. teeth good axial incl.
reduce force levels 0.018 round .
Final Detailing.
Adjustments / modifications archwires -
Discrepancies size, symmetry, fn. of teeth.
Repositioning br. / 1
st
order or 2
nd
order bends.
Settling 0.014 wire + vertical elastics.
Finishing & Retention:
Bonded canine to canine lower.
Hawleys Appliance Upper.

Advantages of CAT.
Enhances trt. potentials.
Accumulates trt. advantages.
Reduces response time.
Enhances muscular effects.
Simplifies co-operation.
Variable anchorage effects.
Reduced energy losses.
Diversity of three slots.
Controlled tipping & translation.
Goal oriented trt.
Establishes positive profile control
Conclusion.
CAT system is a biomechanical approach to
treatment which enables the clinician to vary the
treatment technique, vary the type of movements
and vary the resistance anchorage to simplify
co-operation and to definitely expand the
opportunity to overcome problems and enhance
success of trt.

Thank you

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