modern begg – / orthodontic courses by indian dental academy

Modern Begg – Beddtiot & CAT

Techniques. INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

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.

www.indiandentalacademy.co

m

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

andfeatures of Begg and Edgewise mechanisms – specific situations – most advantageous.

Primary GoalFacility to treat each patient’s 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

thanapical bone.Crestal region – force sufficient – rapid

toothmovement.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”.www.indiandentalacademy.co

m

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 torquewww.indiandentalacademy.co

m

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 slotUprighting springs Turned 90° - miniature buccal tube.


Uprighting springs.

Original RecentOriginal. Helix farther from archwire.Hook arm – no extra offset

reqd.

RecentMore hygienic. irritation on gingiva.Appearance –less conspicuouswww.indiandentalacademy.co

m

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.www.indiandentalacademy.co

m

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.0.0190.0200.0210.022

0.020 x

0.016”

0.021 x

0.016”

0.022 x

0.016”


Newer non steel alloy archwires –Extremely resilient – gentle forcesApprop. size – precise bracket engagement.Esthetic & Hygienic. ( eliminate – aux.)

Torqued brackets build trt. into the appl.Facial root torque – lower incisors – augmentanchorage.

0.022 x 0.016” , 5° torque.

Limit tipping of upper incisors - palatal torque.


Important adv. - BEDDTIOT –

Facility for both 3 dimensional control & simple

bracketLimited tipping – light forces

Facilitate application of the best modality in every

situation.www.indiandentalacademy.co

m

Combined Anchorage TechniqueVariable 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 & UnitekBeneficial 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.www.indiandentalacademy.co

m

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.FinishingSelf 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 anchorageIt 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 densityExtrusive forces

Growth

Rot. Forces Habits www.indiandentalacademy.co

m

Static Anchorage.Increasing the forces – within the appl. Lesseffect 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.www.indiandentalacademy.co

m

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.www.indiandentalacademy.co

m

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 2nd molars – receive

attachment – as soon as practical: increase force control.

Mandibular 1st 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 1st 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.www.indiandentalacademy.co

m

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.www.indiandentalacademy.co

m

Stage I.Archwires:Initiated – 0.016 round wires – Begg slot.Cl II elastic force – lingual rolling – lower molar.Mild exp. – ¼ ” – 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.

www.indiandentalacademy.co

m

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.www.indiandentalacademy.co

m

Stage III.Crown & root coordination/ torquing &

parallelingstage.

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. www.indiandentalacademy.co

m

Mandibular:0.018 or 0.020 dia.Exp. ¼ ” 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 pos’n.

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. www.indiandentalacademy.co

m

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 .www.indiandentalacademy.co

m

Final Detailing.Adjustments / modifications – archwires -Discrepancies – size, symmetry, fn. of teeth.Repositioning br. / 1st order or 2nd order

bends.Settling – 0.014 wire + vertical elastics.

Finishing & Retention:Bonded canine to canine – lower.Hawleys Appliance – Upper.www.indiandentalacademy.co

m

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

For more details please visit www.indiandentalacademy.com


modern begg – / orthodontic courses by indian dental academy

Documents