General considerations of stage 2 in beggs technique

General considerations
of Stage II in Begg
Technique.
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Introduction
Objective of ortho trt is to correct
malocclusion of teeth and those
deformities of the jaws and face
associated with it .
1954 Dr. Begg published – “Stone Age
Man’s Dentition” – “Round wire
Technique”.
This later evolved into the light wire
technique.

Changes.
Finished cases with detail and precision.
3 distinct stages.
Root torquing auxiliaries
Mesiodistal uprighting springs.
Emphasised imp. Of free tipping.
Stage models.

Second Stage of Trt.
Complete closure of what still
remains of the extraction spaces –
carried out.
Space closure carried out - elastics

 Objectives Of Second Stage.
1. Maintain all corrections achieved during
first stage.
 M-D molar relationship maintained –
Cl II or Cl III elastics.
 Original spaces b/w ant. teeth prevented from
recurring – tying IM circles to cuspid brackets

Over rotations
 of cuspids maintained – engaging
brackets – offset on the teeth.
of bicuspids held – replacing elastic
threads with steel ligature ties.
 of Central and lateral incisors –
maintained – continued use of bayonet
bends in the archwires.

 Bite opening maintained – continued use
of bite opening bends & Cl II or Cl III
elastics.
 Correction of post. Crossbite maintained
– modifying archwire or cross elastics.
2. Close any remaining post. spaces.
 Wearing of horizontal elastics.

Malocclusion of 2nd
stage – not same as at
the beginning of trt.
Most malocclusions – similar appearance –
conclusion of first stage mechanics.
Edge to edge or mild open bite reln.
Spaces b/w cuspids & 2nd
bicuspids.
Class II  Class I or Class III.
Class III  mild Class II

Class II elastics –
relieved of correcting overjet.
used to attain or maintain overcorrected
positions of ant. & post. teeth.
Molars –
relieved of correcting overbite.
if necessary anchorage bend

Reasons for a second stage of treatment.
Prevent posterior teeth from being moved
too far mesially.
Insufficient space to move ant. teeth back
onto basal bone upper & lower dental
arches – too far anteriorly in the jaws
BMP.
Anchorage failure does not occur – 1st
stage
completed before 2nd
stage.

Commencement of stage II –
Lateral ceph & stage models.
Intraoral photographs.
Lateral Ceph. compared with that of original
M.O
 antero posterior tooth movements in ref
to each other & to face & cranium.
 anchorage maintained properly.
 inclination of the anterior teeth.

Importance of stage models.
Check arch contour and width.
Inclination of upper and lower anterior
teeth.
 Self discipline to complete each
stage before proceeding.

Following through to overcorrections
in trt. – rotations, overbite
corrections and mesio-distal relns.
Better insight how anchorage – maintained
in trt.
Better conception of how the technique
progresses.
Visual aid for the patient and parents.

Elastics
Used to effect changes in length, breadth and
depth of dental arches.
Elastic force should signify measured force for
the individual patient.
Elastic – exert only traction force.

Size of elastics – dist . stretched.
Large dia molar extn. cases.
Small Class II elastics Bicuspid extn.(small
teeth).
Smaller horizontal elastics  later 2nd
stage.

Reactivation cycles.
Natural rubber Begg elastics (1960’s) – 5 – 8Oz
force on insertion, in two days, constant at 2 Oz
– next 2 days –
 Elastic force reactivated in 4 days.
Latex elastics – lower force initially, less wear off
over 24 hr span,
 Elastic force reactivated daily

Space closing elastics – horizontal or
intramaxillary elastics.
Necessary to maintain anteroposterior relation of buccal
teeth & edge to edge to relation of incisors
- Cl II intermaxillary elastics.
Six elastics worn simultaneously.

Problems encountered with elastic
wear.
 Space closing elastic – irritating the
gingiva
Seat it occlusally to the PM bracket
b/w ligature wire & band.
Horizontal elastic from buccal
surface of molars – rotational force.
Distal ends – toe in ( more in
maxillary than mandibular.)
Horizontal elastics – engaged on lingual hooks rather
than on buccal.www.indiandentalacademy.com

Lingual elastics.
Used as a supplement or a counterbalancing
agent to buccal elastic force - efficiency of
force distribution.
Help in obtaining desired movements and
preventing or arresting undesired movements of
teeth – until needed archwire changes are made.
Can be used for retraction of ant. segment.
Half strength horizontal elastics – on both buccal
and lingual surfaces.

Advantages in using half strength elastics.
Better positional control over the anchor molar –
obviating the need for a mandatory
compensatory ‘toe in’.
Closure of extn spaces easier.
Improves anchorage potentialof molar – simpler
mechanics.
Additional adaptational demands on patient’s
tongue
Greater patient co-operation – elastic wear.

Archwires.
Initially 0.018 inch archwire used.
Trt. Proceeds smoothly – 0.020” arch wires
used.
Only function – to maintain the corrections –
achieved. ( bite opening, arch form & tooth
alignment.)
Stabilize the teeth against – adv. Reciprocal
forces – application of elastics or auxiliaries.

Anchorage bend.
 in comparison with that given – 0.018” wire.
Variation in location.
Stage of trt. – 2nd
stage.
Far enough forward – spaces close before anchorage
bends reaches molar tube.
Rate of progress & amount of space remaining.
If rapid – bends placed farther forwards
Little space – tooth contact before anchorage bend
reaches molar tube.

Inserting and activating archwires.
Insert and check.
Degree of anchorage bend –
adequate to resist forward pull of elastics.
rest passively – halfway b/w brackets &
mucolabial fold.
Distal ends of the archwires –
1 – 2 mm beyond the distal end of the tubes.
Anchorage bends sufficiently forward
- too far or too less.

Tooth movements carried out during the
second stage of trt.
Spaces in the buccal segment to be closed.
Extn. Space of four first premolars.
Congenital absence of 2nd
P.M.
Lost buccal teeth due to caries.
Spaces b/w teeth in Non-Extn cases.
Exception.
Extreme tooth spacing – small tooth size.

Closure of spaces by
 retracting upper and lower incisors
OR
 moving post. segments mesially to
lose anchorage.
Decision depends on
Torquing requirements anticipated in 3rd
stage,
apical base diff.
Profile requirements of the patient.

Large apical base diff. at start of trt. –
lingual root torque in third stage - SNA.
Upper and lower incisors tipped lingually
with horizontal elastics.
Profile good at start – small ANB diff. –
spaces closed moving post segments
mesially- to avoid flattening of profile.
Stronger elastics
One point contact bracket of cuspid  2 point
contact – passive uprighting spring.

Correction of midline discrepancies.
Usually corrected in stage I with Class II
elastics.
Horizontal elastics in Stage II – diff. in
amnt. of extn. space remaining –
corrected.
Severe discrepancies – anterior
intermaxillary cross elastics.

Corrective movements of bicuspids –
performed easily and quickly
tight intercuspation of bicuspids prior to trt.
Due to correction of overjet and overbite.
Note existing rotational status of molars &
cuspids
Horizontal elastic – buccal or lingual as
necessary.
No rotation – half strength horizontal elastics-
buccal & lingual.

Braking mechanics.
spaces to be closed by mesial
movement of the posteriors.
one point contact bracket of cuspids
2 point contact bracket.
 braking type paralleling auxiliary on
cuspids.
 Aux: - usually a passive spring – arm
and stem at an angle of 120°. ( 0.018
or 0.020” wire)
LIC &B.C passive

 Passive spring –
misconception – enough
force to hold – cuspid
upright.
 Pin incisors tightly –
intentional binding of
archwire – limit tipping.
 Extreme cases – torque
arch aux.
 Heavier elastic forces –
4-6 Oz. (113 – 170 gm).

Engaging bicuspid with caution.
Bracket too far gingivally – extrusion of this tooth
and intrusion of the anchor molar & cuspid.
Absence of bayonet bends – bicuspid
overexpansion and molar overcontraction.
Bicuspids – not to be pinned in until archwire
changes are made at the commencement of the
third stage.

Shortening of doubled back archwires.
Straight back archwires – cut distally.
For shortening doubled back archwire & to
reposition its anchor bend –
small vertical take up loops in the buccal
sections of the archwire.
1st
made distal to the cuspid bracket.
just mesial to the anchor bend

Teeth positions at the end of Stage II.
Extraction spaces – closed.
Anteroposterior occlusal relations –
maintained.
crowns of upper and lower ant. teeth –
tipped back or ‘dished in’
- most favorable state – in success of trt.
evidence- upper & lower dental arches –
not brought anteriorly.

Crowns of CI  tipped back
lingually.
Crowns of LI  tipped lingually &
distally, root apices
farther mesial than
crown.
Crowns of Caninetipped distally not
lingually

Summary
Started after achieving stage I objectives.
Maintain all corrections achieved –
A-P occlusal relations.
Overjet & overbite.
Major tooth movement – space closure in
post.buccal segments.
Achieved – elastics –
Intramaxillary – space closure.
Intermaxillary – maintanence.

Archwire – 0.020” base wire – maintain
corrections.
Closure of spaces –
Retraction of ant.
Mesial movement of molars.
End of stage II.
Completed closure of spaces.
Maintanence of corrections achieved in stage I

Conclusion
 Through the use of the optimum orthodontic
force ie, one that moves the teeth most rapidly,
with least discomfort to the patient and with least
damage to the teeth and their investing tissues,
effective space closure is achieved with
minimum taxation of anchorage.
 Teeth are left in the proper position to be
uprighted and put into good axial relation in the
third stage.

General considerations of stage 2 in beggs technique

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