Ref

WHY BEGG?
 Nature of malocclusions encountered in an average indian
practice-eg.Bimaxillary protrusion,crowding,pronounced
overjet
 Limited scope for growth modulation (or) orthognathic
surgery-Tooth moving abilities of begg appliance make it
ideal choice for camouflage treatment
 General level of awareness
 Cost of the treatment
2/28/2017 2

WHY BEGG LOST POPULARITY IN OTHER
COUNTRIES
WRONG PROJECTION
 Simple technique that was capable of producing miracles
with minimum efforts
 Easy technique requiring a simplistic diagnosis &
stereotype treatment for all malocclusions
 Dogmatic approach of Dr.Begg & some of his followers
who refused to accept modern trends like mixed dentition
treament & growth modulation using headgear or
functional appliances
 Overemphasis on extractions, based on “theory of
attritional occlusion”
2/28/2017 3

VESTED COMMERICIAL INTERESTS FURTHER HASTENED THE
DOWNFALL OF BEGG APPLIANCE
 Manufacturers sensing a tremendous profit potential in
PEA aggressively promoted them, creating an impression
that begg appliance was mechanically inferior.
 An increasing number of orthodontists started joining
hands with maxillo-facial surgeons to treat moderate (or
even mild) skeletal problems using surgical orthodontics.
2/28/2017 4

ADVANTAGES
 Light forces- physiologically more acceptable by patient
 Anchorage control-intraoral anchorage used
 Quick correction of deep bite and alignmment
 Efficient uprighting or torquing of single or group of
teeth
 Less demands on patient cooperation
 Low cost
However, with time it was realized that the same bracket
wire combination was responsible for some of the
serious drawbacks of the appliance.
CONVENTIONAL BEGG
2/28/2017 5

DISADVANTAGES
 No precise control-Round wire-ribbon arch bracket
 Posterior root torque is difficult
 True intrusion is less likely
 Poor rotational control-use of undersized wire in stage 1
and stage 2
 Over use of class II elastics caused
a.Lack of upper incisor intrusion
b.undesirable proclination of lower incisors
c.unfavourable tipping of mand. and occlusal planes
2/28/2017 6

 Uncontrolled tipping ,associated with root resorption
 Heavy torque requirement in third stage because of
excess uncontrolled tipping in first 2 stages
 Over emphasis on extractions
 No fail safe mechanism to check tipping or torquing
movements ,because bracket permitted excess
mesiodistal and labiolingual movements
2/28/2017 7

The whole spectrum of differences between the
conventional and refined begg can be studied under 3
headings;
 CONCEPTUAL CHANGES
 HARDWARE ADVANCEMENTS
 MODIFICATION OF MECHANICS
2/28/2017 8

CONCEPTUAL CHANGES
1. Theoretical foundation
2. Treatment objectives
3. Diagnosis
4. Treatment planning
5. Biomechanics
6. Arch-forms
2/28/2017 9

1.THEORETICAL FOUNDATION
Theoretical foundation of conventional begg rest on “Theory of
attritional occlusion” & “Differential force concept”.
 It is accepted at present that the lack of attrition may
contribute to development of malocclusion in modern man,
 Many operators have challenged the justification, based on
this theory, of overemphasis on extractions in anticipation
of development of crowding in future ( in other words make
up for the lack of attrition in the modern man’s dentition)
2/28/2017 10

CONCEPT OF DIFFERENTIAL FORCES:
 It was thought that light intra or inter arch forces would
retract the anteriors, whereas heavier forces would make
anterior teeth as an anchor unit & protract only posteriors.
 The anterior teeth will remain stationary only till
hyalinised areas in their periodontium are eliminated &
then they would suddenly move posteriorly.
 Sole dependence on heavy forces for protracting the
posterior teeth in conventional begg often result in dished
in profile
 This is now prevented by using efficient brakes along with
application of heavy (differential) forces.
2/28/2017 11

2.TREATMENT OBJECTIVE
 For a static occlusion: Andrew’s 6 keys to normal occlusion
form goal of refined beg
 For functional occlusion: following aspects are checked at the
end of treatment.
1. Synchronization of CO & CR
2. Elimination of hanging palatal cusps of upper posterior
teeth, which may cause functional interference & lead to
parafunctional habits
3. cuspid protected occlusion
4. incisor guidance(specially in open bite cases)
2/28/2017 12

3.DIAGNOSIS
 Diagnostic approach was a simplistic one in conventional
begg.
- Dental positions & skeletal relations were analyzed using few
criteria like lower incisor to a- pog line, angles ANB & FMA
- Considerations of facial profile ,pattern and growth potential
were not given importance much
 Present day diagnosis on the other hand is broad based
involving patient’s skeletal,dental & soft tissues analyses
,growth estimation & vto
2/28/2017 13

4.TREATMENT PLANNING
 Treatment during mixed dentition is not considered
unnecessary as in the past,due to benefits of mixed dentition
treatment in controlling & directing the growth,converting
borderline case into non-extraction
 Previously, the need to extract teeth was over emphasized.
 Present tendency is to avoid extractions as much as possible. In
doubtful situation non-extraction treatment is tried first.
 Interproximal reduction is also a viable option in many cases
2/28/2017 14

5.BIOMECHANICS
 Treatment mechanics still consists of crown tipping followed
by root uprighting,but is now directed at achieving
controlling tipping in first 2 stages ( eg: by use of MAA- root
control right from 1st stage by applying ultra-light torquing
and uprighting force on anterior teeth)
6. ARCH FORM
 Present day begg practice acknowledges benefits of
maintaining lower arch form & maintaining or improving the
upper arch form.
 Proper arch form & co-ordination of upper and lower arch
wires is checked at every stage.
2/28/2017 15

HARDWARE ADVANCEMENTS
 ATTACHMENTS
 ARCH WIRES
 ELASTICS
 ACCESSORIES
2/28/2017 16

ATTACHMENTS
 Basic design of begg bracket has not changed. Built-
in torque (kameda) & anti-rotation (mollenhauer)
are available
.020”
.045”
.015”
2/28/2017 17

a.ANTIROTATIONAL ADJUSTMENTS
 The rotational control in the begg bracket during the initial
stages is poor due to excessive play when .014” or .016” wire is
used in .020” slot
 The mesial or distal edge of bracket is raised away from
tooth surface for mesio-lingual or disto -lingual correction
respectively.
 Such brackets are ready made available or be prepared by
welding a piece of .010” ligature wire on mesial or distal edge
of bracket base mesh.(Mollenhauer)
2/28/2017 18

Anti-Rotation Adjustment
0.008” ligature wire is
Welded on bracket base
2/28/2017 19

Anti-Rotation Bracket
This modifiaction greatly increases the rotational control
thus eliminates the need for archwire offsets,which are
required for holding the corrected rotations throughout
the treatment
2/28/2017 20

b.Built –in- torque
 kameda recommends such adjustment into the brackets,by
raising the incisal/gingival edge of the bracket base away from
tooth surface.
 Brackets have a thin metal wedge interposed between
bracket base & mesh
2/28/2017 21

MOLAR TUBES
UPPER MOLAR TUBES
 Fixed perpendicular to the mesial
aspect of upper molar bands –
results 10 degree disto lingual
rotation offset (suggested by
swain)
2/28/2017 22

LOWER MOLAR TUBES
A lesser offset of
approximately 5 degrees
disto lingual rotation
given
2/28/2017 23

0.036”
0.072”
0.024”
5 mm
6 mm
ROUND MOLAR TUBE
RECTANGULAR
MOLAR TUBE
2/28/2017 24

Placement of the attachments
A) HEIGHT FROM INCISAL OR OCCLUSAL EDGES
Maxillary teeth 7 6 5 4 3 2 1
Height (mm) 3 3.5 3.5 3.5 4 3.5 4
Height (mm) 3 3.5 3.5 3.5 4 4 4
Mandibular teeth 7 6 5 4 3 2 1
2/28/2017 25

ALTERATION OF BRACKET PLACEMENT
1. Crown height:
 For bigger or smaller teeth , all the brackets and tubes are placed
0.5 mm gingivally or occlusally respectively, for every 1 mm
increase or decrease in crown height.
2. Overbite considerations:
a. For deep bite cases,recommended anterior bracket placement
chart
b. For openbite cases, brackets on all the anteriors are placed more
gingivally by 0.5mm
Maxillary Anteriors 3 2 1
Height (mm) 3.5 3 4
Height (mm) 3.5 3.5 4
Mandibular Anteriors 3 2 1
2/28/2017 26

3.Mandibular plane considerdations
If MP angle is to be altered in a growing child ,
opening of mp angle: increase the height of
attachments by 0.5mm & viceversa.
4.Lower incisor inclination:
 Brackets on lower incisors are placed relatively, more
incisally in class III cases, which will require a
lingual root torquing auxuliary during 3rd stage
2/28/2017 27

B) MESIO DISTAL LOCATION
Brackets
 Incisor brackets are kept at the mesio distal center of the
crown
 In a rotated canine or premolar
brackets are kept slightly off centre so
that they are 1 mm closer to the proximal
surface that is rotated towards the lingual
Molar tubes
 Mesial of the tube in line with mesio-buccal cusp tip
 Parallel to line joining the tips of buccal cusps
2/28/2017 28

PALATAL BRACKETS
Brackets are placed on palatal surface of
upper incisors when palatal elastics
from a tpa are used for upper
incisor intrusion.
OTHER ATTACHMENTS:
1.HOOKS: Buccal hook attaches at the center of m-b cusp, while
palatal/lingual hooks are placed close to center of disto-lingual cusps .
2. LINGUAL BUTTONS, CLEATS, OR EYELETS :
 placed on lingual surface of any teeth
requiring additional points of attachment
for rotational control.
 Placed slightly offcenter for over correcting rotations.
2/28/2017 29

3. ADDITIONAL ROUND TUBES : Required in some cases for
engaging lip bumpers, inner bow of headgears or distal ends
of ‘u’ loop wires of EVAA appliance
 Tubes placed gingival to main tube, except in case of EVAA
appliance where they are placed occlusally.
4. LINGUAL & PALATAL SHEATHS :are placed on molar
bands when TPA or lingual arches need to be used.
2/28/2017 30
LIP BUMPER-.040” OR .044”
HEADGEAR-.044” OR .048”
EVAA APPLIANCE-.036”

ARCH WIRES
 INITIAL ALIGNING PHASE – For unraveling
crowding,thin premium plus or supreme
wires,multistranded (co-ax) or NiTi are freely used
 FINISHING STAGE – Rectangular S.S wires or alpha
titanium wires can be used
Combinations of rectangular and round cross sections in
the anterior and posterior areas (tandem wires) are used
as braking mechanism
2/28/2017 31

GENERAL CONSIDERATIONS IN BENDING
THE ARCHWIRES
1.ARCH FORM CONSIDERATIONS:
 In general, archwire expansion or contraction required in refined
begg is less compared to conventional begg because of the use of
higher grade wires & heavier wires are started earlier in
treatment.
2. CUSPID CIRCLES:
a. size: should be made with inner diameter of 1 to 1.5mm
b. location: is varied depending on initial malocclusion in
anterior segment.
 In initially crowded cases, circles are kept tightly abutting cuspid
brackets after teeth are decrowded & aligned
2/28/2017 32

 In cases, where anteriors are spaced to begin with, circles are
kept 1mm mesial to cuspid brackets after the spaces close.
 If teeth teeth are normally aligned at beginning, circles are
kept 0.5mm mesial to cuspid bracket
c.plane of cuspid circle,-must be kept parallel to plane of
arch wire.This helps in detecting a rolling of molar section of
arch wire in the molar tube,as the cuspid circles also change
the plane
2/28/2017 33

d. occluso-gingival location of anterior & posterior
segments at cuspid circles needs to be varied to help in
controlling the bite, or to prevent undesired extrusion of
some of teeth.
 In normal bite or moderate deep bite
cases,the anterior segment is kept gingival
to posterior segment for intruding incisors
 During 3rd stage anterior segment is occlusal & posterior
segment gingival ,where archwires have gable bends, which
helps in reducing extrusion of cuspids.
2/28/2017 34

3.MOLAR STOPS:
Usually needed in lower archwire when a forward movement of
the lower molars is to be avoided under the effect of cl II or lower
cl I elastics.
Upper molar stops(distalizing loops) are required when upper
molars are to be distalized
2/28/2017 35

4. ANCHOR BENDS:
a) Location: located about 3mm in front of mesial end of molar
tube
b) Degree of bend during bite opening:
 Amount of bend in .016” upper arch wire is 30-50 degrees &
somewhat less in lower archwire
 Heavier .018” wires require a correspondingly lesser degree of
bend.
2/28/2017 36

12 O'clock 6 O'clock
EXIT ENTRY
2/28/2017 37

5. Anchor curves instead of anchor bends
 In non extraction cases that do not involve significant incisor
intrusion, archwire can be formed with anchor curves, instead
of anchor bends.
 Here, archwire is engaged into
premolar brackets
 Bite opening is primarily by extrusion
of premolars & are poor in active incisor intrusion.
6. Arch wire ends:
 In 1st & 2nd stages, lower wire ends are lightly bent at the
distal of lower molar tube to help in minimizing flaring of
lower incisors
 Upper wire ends are usually not bent, to permit freedom for
distal uprighting of molars
 Only during the 3rd stage wire ends are tightly cinched after
annealing them.
2/28/2017 38

7.cuspid ties
 Cuspid circles are tied to the cuspid brackets during initial
stages to prevent distal drifting of the canines and resultant
spacing between anteriors
 Elastomeric modules are also used instead of ligature wires
 Modules are effective, in closing minor anterior spacing by
providing a longer lasting force, unlike ligature wires whose
force drops rapidly when spaces start closing
2/28/2017 39

PINS USED IN REFINED BEGG
FIRST STAGE PINS- Have shoulder that keeps head of the pin
outside slot
THIRD STAGE PINS- Pinhead enters the slot
HIGH HAT PINS- Permit freedom of sliding and tipping
HOOK PINS- Used when more than one wire is to be engaged
in slot
‘T’ PINS- Used as brakes in second stage ,or in finishing stage
2/28/2017 40

STAGE I
 Objectives of conventional Begg
 Alignment of teeth
 Elimination of cross bites
 Over bite correction
 Over jet correction
 Correction of arch form
 Matching the midlines
 Attaining class I molar and canine relation
2/28/2017 42

STAGE I OF REFINED BEGG
 Priorities
 Overbite reduction to precede overjet reduction
 Crowding to be relieved so as to engage 0.016 or 0.018 base
wires into all the bracket slots for applying intrusive force to
all teeth evenly.
 If canines are to be moved distally to relieve crowding or if
they are badly rotated they receive priority over everything
else initially.
 Severely proclined or retroclined incisors are to be brought
to proper inclination before applying higher intrusive forces
2/28/2017 43

Sub stage I-A
 Create space for decrowding or close existing spaces.
 Alignment of teeth
 Labio-ligual movements
 Correction of rotations
 Correction of anterior cross bite
 Improve upper incisor inclination to +/- 10o of normal.
 Molar rotations and posterior cross bites to be corrected with TPA.
 Premolar rotations to be corrected using only palatal or lingual
attachments.
 Upper arch form in the canine area is broadened, if narrow ,to
facilitate mandibular advancement for class II correction.
2/28/2017 44

 On completion of substage 1-A all the anteriors are in
good contact, which facilitates full engagement of a
plain (non looped & non offsetted)archwire of
required thickness (initially .016” then .018”) into all
bracket slots
 This is essential in order to apply higher intrusive force
to all teeth in the later substage 1-B
2/28/2017 45

Sub stage I-B
 Maximize incisor intrusion and minimize molar extrusion during
bite opening.
 To achieve controlled tipping of upper incisors during retraction.
 Prevent uncontrolled tipping of lower incisors during bite
opening.
 Apply root control for correction of extreme labio-lingual
movements such as blocked in lateral incisors.
 Control the mandibular plane angle.
 Match skeletal and dental midlines.
 Correct inter arch relationship to Class I.
 Premolar displacements and rotations are corrected if they are
bonded.2/28/2017 46

SUB-STAGE I-A
I.ALGNMENT OF CROWDED ANTERIOR TEETH:
Stiff wires,ie.wires having a relatively high load deflection rate
,are required for resisting the undesired effects of class II
elastics
The alignment is best carried out by using flexible wires with a
low load deflection rate. The arch wire also permits sliding of
teeth in order to open adequate space to relieve their crowding
2/28/2017 47

DECLINE IN USE OF MULTILOOPED WIRE
DISADVANTAGE:
a)uneven bite opening
b)labial flaring of the incisors
c)loss of control over the molar positions
d)loss of anchorage
e)difficult in maintaining hygiene
2/28/2017 48

ALIGNMENT OF TEETH WITHOUT USING
MULTILOOPED WIRES IN REFINED BEGG
 0.016 or 0.014 round S.S as base arch wire
 Niti and multi stranded wires (singly or in combination)
0.016” ROUND NiTi ALONG WITH 0.014” ROUND S.S FOR DECROWDING
2/28/2017 49

1.There are 2 situations in which full-length NiTi
may be used without support from S.S wire
a) when maxillary canines are highly placed & also need to be
distalized for releving anterior crowding, a full niti wire
engages all upper teeth
b) In an openbite situation with lack of upper incisor
exposure,an upper full length flexible wire along with cl-II
elastics can be used till upper crowding gets relieved.
2/28/2017 50

2. AMOUNT OF CANINE DISTALIZATION NEEDED TO
CREATE SPACE FOR RELIEVING CROWDING
 If anteriors are very minimally crowded needing upto 0.5
mm of additional space,.016” s.s. archwire is formed with
cuspid circles tightly pressing against canine brackets
 For creating space upto 1 mm by bilateral canine
distalization in a slightly more crowded case, .014” s.s wire,
with cuspid circles formed 0.5mm mesial to canine brackets
can be used.
 In all other cases with more amount of crowding than above,
space for unravelling crowding is provided by sliding canines
distally along s.s. base wire ( .016” 0r .014”) and the cuspid
circles in the wire are omitted against the canine to be
distalized ,and elastics are hooked to canine brackets
2/28/2017 51

3. AMOUNT OF WIRE DEFLECTION: REQUIRED
TO ENGAGE ARCHWIRE IN BRACKETS ON
CROWDED & MALALIGNED TEETH
a) If there is minimal crowding of 1-2mm, S.S archwires
themselves in .016” 0r ..014” can be used for correcting
malalignment by modifying wires with offset bends or ‘v’
bends
b) If crowding is more than 2mm, a more flexible wire such as
.016” or .014” Niti, .0165” co-ax or .009” supreme wire will be
required for moving teeth over greater distances, without
subjecting them to excessive forces.
2/28/2017 52

4. AMOUNT OF ROTATIONAL CORRECTION
REQUIRED
 Arch wire should fill bracket slot as much as possible for
rotational corrections
 Supreme wires can be used for labio-lingual displacements that
are to be corrected & if rotations are also to be corrected, NiTi
or co-ax wires should be considered.
 Niti,co-ax or supreme wires for correcting incisor irregulaties
are usually used as sectionals from canine to canine, in
combination with steel base wire (.016 “ or .014”)
2/28/2017 53

5. INDICATION FOR USING A SINGLE LOOP
 When one incisor ( usually lateral ) is crowded out of arch while
all remaining incisors & the other side canine are well aligned
but angulated towards crowded incisor, a single loop can be used
for reciprocal movement of teeth.
 Loop made in .014” or .o16” wire at crowded incisor
If canine is well placed & does not need distal movement, its cuspid circle
is omitted, & loop is made at the mesial of molar tube on same side
2/28/2017 54

6. ANTERIOR OPEN BITE
 Upper archwire is made of .014”ss wire, when extrusion of
upper incisors is desired for elimination of open bite. Lower
archwire is made of .016” size.
 In cl II cases, anchor bends in upper arch wires help in
uprightring mesially angulated upper molar teeth.
 Hence, mild to moderate anchor bends are given in upper
archwire are balanced by suitable cl II elastics.These wires
continue only until the openbite closes
2/28/2017 55

7. OVER CORRECTION OF ROTATIONS:
 As one proceeds to stiffer wires forcing the wire into anti
rotation brackets may lead to bond failure
 Hence, rotated teeth should be corrected at each visit on
the lesser dimension wires by using rotation modules, so
that bigger size wires can be easily engaged in the
subsequent visits.
2/28/2017 56

OTHER CORRECTIONS OF SUB-STAGE I-A
II. CLOSING ANTERIOR SPACING:
A) For retracting proclined but otherwise well aligned
anteriors, .016” s.s. archwire is used
 Cuspid circles are kept 2mm mesial to canine brackets&
elastic cuspid ties are given.
 cl II or lower cl I elastics are used for retracting upper or
lower incisors respectively
2/28/2017 57

b) When spacing is to be closed without retracting
anteriors , for example in case of macrognathia or
microdontia, cuspid circles are kept sufficiently
mesially & spaces closed by tying the anterior teeth
with a figure of 8 elastomeric tie
 In this cases,consideration to be given ,to how the
mesial movement of concerned canine is going to
affect its relationship with corresponding canine
in opposite arch
2/28/2017 58

c) If incisors are spaced,proclined & also malaligned,
malalignment is corrected first followed by space closure
d) In some cases , canines need not be moved mesially
because available spacing is just sufficient to correct
malplaced incisors eg. case of midline diastema and
palatally displaced lateral incisors, the cuspid circles are
kept touching the canine brackets and diastema is closed
by tying the central incisor bracket with an elastomeric
thread
e) Active space closure should not be attempted till
intrusion is accomplished since intrusion of incisor takes
up some amount of space.
2/28/2017 59

III. IMPROVING INCLINATION OF UPPER INCISORS
 a) Excessively proclined upper incisors are retracted to
some extent by using cl-II elastics
 b) Retroclined incisors are allowed to upright ,cl-II elastics
are avoided & if need to be proclined ,loops against molar
tubes can be used
IV MOLAR POSITION CORRECTION
 a) Rotated molars are corrected with appropriate toe-in or
toe-out bends in .016s.s. archwirwe
 b)Mild bucco- lingual displacements of molars can be
corrected with required expansion or contraction in s.s.
archwire itself.
2/28/2017 60

V. SOME TYPES OF PREMOLAR DEROTATIONS
 Are effected by tying only palatal or lingual
attachments
 Rotational springs are to be used in only sub-stage Ib,
because they would hinder free sliding of arch wire.
VI . ARCH FORM CORRECTION.
 Unless when upper arch form is excessively narrow, arch
form in most cl-II cases can be broadened in canine –
premolar area by shaping archwire suitably
 Lower arch form is altered only when badly distorted
2/28/2017 61

SUB-STAGE IB
 Forms major part of stage 1
 Arch wires used are standard .018” p+ or p wires
 Elastics employed are mostly cl II light or ultra light
2/28/2017 62

1.Bite opening
 True intrusion of incisors and avoiding molar
extrusion are of prime importance
 The interplay of intrusive and elastic forces determines
the magnitude and direction of the net resultant force
 The site for placing bite opening bends is yet another
important consideration
2/28/2017 63

Strategies for bite opening
 Initially when incisors are severely proclined
 Intrusive force=45gms
 Class II force=60gms
 As inclination improves
 Intrusive force=60gms
 Class II force=30gms
 Applying class I force from
power arms soldered gingival
to the molar tube is yet another option
2/28/2017 64

Control of force vector
GRADUAL INCREASE IN INTRUSIVE FORCE AND REDUCTION IN
CLASS II FORCE CHANGES THE DIRECTION OF RESULTANT FORCE TO
KEEP IT CLOSE TO Cres
2/28/2017 65
Reduces proclination but less
intrusion-SUBSTAGE 1 As incisors become upright,elastic
force become oblique,and bring about
active intrusion

1. CONVENTIONAL BITE OPENING BENDS, Placed 3mm mesial to
molar tube, tend to cause more intrusion of upper canines &
progressively less intrusion of lateral & central incisors-due to
bowing of archwire in canine area
2. GABLE BENDS Placed distal to canines, tend to cause a relative
extrusion of canines, while there is progressively more intrusion
of lateral & central incisors
2/28/2017 66

3. WITH HOCEVAR’S MODIFICATION, (bend on either side of canine)The
central incisors are subjected to intrusion while canine & lateral
incisor are both extruded with respect to central incisors
4. USING A BITE –OPENING CURVE (Or simultaneous anchor
and gable bends as in kameda’s design) the canines
( & premolars,. If engaged) are extruded, while laterals &
centrals experience progressively more intrusive effect.
2/28/2017 67

ARCHWIRE MODFICATION FOR UNIFORM INTRUSION OF 6 UPPER ANTERIORS
IN THOSE CASES, THAT REQUIRE SIGNIFICANT AMOUNT OF INCISOR INTRUSION
a) A mild gingival curve is incorporated in anterior section starting from
mesial of one cuspid circle to corresponding point on other side
b) Intrusive action of gingival curve can be further augmented, by
incorporating a vertical step-up bend 4-5mm in height & placed 2-3mm
mesial to molar tube on both sides.Anchor bend of required degree is
placed at upper end of step
2/28/2017 68

II ELIMINATION OF OVERJET BY MAINTAINING CONTROL OVER
ROOT POSITIONS OF ANTERIOR TEETH
A) CONTROLLED TIPPING OF UPPER INCISORS DURING RETRACTION
With combination of higher intrusive forces & light or ultra
light elastic forces , that is used for incisor intrusion,
chances of obtaining a proper m/f ratio for controlled
tipping are much better.
The ratio of counter moment to retractive component of cl II
elastic force lies in range of recommended ratio of
controlled tipping of incisors (between 5:1 & 8:1)
B) PREVENTING UNCONTROLLED TIPPING OF LOWER INCISORS
 Lower incisor brackets are bonded as far gingivally as
possible. Anchor bends are of lesser degree compared to
upper arch
2/28/2017 69

 MAA with labial root torque is used on lower incisors during stage I
 The ends of lower arch wire are bent distal to molar tubes, as
recommended by Hocevar.This helps in minimizing the tipping of lower
incisors
C. ROOT CONTROL DURING CORRECTION OF EXTREME LINGUAL OR
LABIAL POSITIONS OF ANTERIORS
1.Labial root movement of instanding incisors or canines is initiated during
sub-stage 1 B by using MAA
2. If adjacent lateral incisor & canine need reciprocal
torque, a ‘spec’ auxiliary is used.
2/28/2017 70

III. CONTROLLING MANDIBULAR PLANE ANGLE
 MP angle can open during treatment due to molar extrusion, causing
worsening of cl II profile
 Minimal anchor bends in high angle cases, TPA or high pull head gear
on upper molars can be used to avoid extrusion of molars.
IV CORRECTING MIDLINE DISCREPANCY
 Upper midline correction is done by using slightly uneven Class II
elastic force on two sides till it gets corrected
 If both midlines are deviated, to opposite directions a midline diagonal
elastic(upper left cuspid to lower right –as required) is used along with
cl II elastics
 If lower midline is deviated, it is corrected by using unilateral lower cl I
elastic.
2/28/2017 71

V. CORRECTING INTER - ARCH RELATIONSHIPS TO CL- I
 In a growing child, correction of molar & canine relation from cl II to cl I
is mostly achieved by encouraging mandibular growth
 In few patients, unlocking of occlusion during bite opening coupled with
cl II elastics has a functional appliance like effect
 In other cases, a functional appliance such as EVAA, is required along
with fixed mechano-therapy.
 Mesial movement of lower posterior dental segment with respect to
upper, brought by action of cl II elastics, plays a major role while treating
adults
 In selected cases, cl II molar relation is corrected by distalizing upper
molars.
2/28/2017 72

OBJECTIVES
1. To maintain all corrections achieved during stage-I
2. To close all extraction spaces
In addition
 1. Controlled tipping of incisors, when space closure is to be
mainly achieved by anterior retraction
 2.Preventing excess tipping of anteriors, when space closure
is mainly achieved by protracting the anteriors
 3.If molar relation is not fully corrected at end of stg-I, this
correction is also done during stg II
 In the first premolar extraction cases, crossbites & rotations
of 2nd premolars are corrected during this stage.
2/28/2017 74

Archwires in stage II of refined begg
 In premolar extraction & non-extraction cases, archwires
can be made either of .018”p or p+, .020”p wires, depending
on severity of initial malocclusion
 If stg I corrections involved extreme deepbite, badly
distorted arch forms or severe rotations, archwires are made
in .020” size . Otherwise, .018” wires of stg- 1 can be
continued during stg-11
2/28/2017 75

CONTROLLD TIPPING OF INCISORS
 MAA for lingual root torque is a must during stg II for
controlled lingual tipping of incisors during their retraction.
 COMB’N OF STIFF BASE ARCH WIRE, .018” P+
& ULTRA LIGHT ROOT MOVING FORCES FROM
MAA MADE FROM .009” SUPREME WIRE
 If canines appear to tip distally excessively, fitting .010”
uprighting springs, minimizes their uncontrolled tipping.
2/28/2017 76

BRAKING MECHANICS FOR PROTRACTING POSTERIORS
 Brakes, reverse the anchorage site from posterior to
anterior segment by permitting only the bodily
movement of anterior teeth
 This conversion of tipping to bodily movement is
either in a mesio-distal direction for canines&
lateral incisors,or in a labio-lingual direction for
incisors.
 The former is achieved by using braking springs or
‘t’ pins, while latter is achieved by using some
torquing component on incisor teeth.
2/28/2017 77

COMMONLY USED BRAKES ARE:
 1. BRAKING SPRINGS: These are passive uprighting springs
made in .018” wire
2/28/2017 78

2. ANGULATED “T” PINS
 These pins maintain the tipping
already brought about, but
prevent further tipping
3. COMBINATION WIRES:
 These are made either of stainless steel or of alpha –titanium
alloy
 Anterior segment is .022” x .018” (ribbon mode) & posterior
segment is in .018” round cross- section
 Depending on protraction needs, wire is shaped such that
anterior segment fits in brackets passively or with a small
amount of lingual root torque
 Thus anterior segment remains stationary,thus preventing
the flattening of profile
2/28/2017 79

ELASTICS
 Different configurations are employed during this stage as
per patient ‘s needs.
1) Upper & lower class I elastics are required in most cases
2) when molar relation is not fully corrected during stg I, cl
II elastics along with lower cl I elastics are used at the
beginning of stg II till molar relation gets
corrected.Thereafter, upper & lower cl 1 elastics are
continued.
2/28/2017 80

3)Cl II elastics may be added to hold corrected
molar relation, thus making a “z”
configuration.However, cl II elastics are to be used
sparingly as possible because of bite deepening
effect.
2/28/2017 81

4)If upper & lower anterior teeth do
not retract at same rate, only cl II
elastics are given when the overjet
increases
5) Only lower cl I elastics are given
when upper anteriors tend to go in
a crossbite relation ,when such
abnormal relations are corrected,
elastic pattern is reverted back for
retracting both upper & lower
anteriors together.
2/28/2017 82

STRENGTH OF ELASTICS IS ALSO VARIED ACCODRING TO
CLINICAL REQUIREMENT
 Light (yellow) cl I or cl II elastics are used for
anterior retraction
 For posterior protraction, stronger (green) cl I
elastics are used.
 Very heavy – blue or red elastics are seldom
required, only when green elastics are found
ineffective ( as,for eg: in low mandibular plane
angle case)
 Rotational effect on molars from cl I elastics
increases with their strength
2/28/2017 83

PRE STAGE III
 Most of cases require pre-stg-III
adjustments before going from stg II
to stg III. This is because the
premolars are usually not engaged in
archwire till extraction spaces are
completely or almost compleletely
closed
 Also engagement of archwire in
premolar bracket & molar tube
requires a horizontal offset between
the two, to compensate for greater
buccal bulge due to bigger
dimension of molar.
2/28/2017 85

 The upper archwire is given a gable bend distal to canine,
while anchor bend in arch wire is eliminated. This helps in
holding deepbite correction & simultaneously uprighting
molars, which had tipped distally during earlier stages
 The lower wire is given both a mild anchor bend as well as
a mild gable bend.
 The positions of anterior & posterior segments of wires are
inverted to avoid excessive extrusive effect of canines on
account of gable bends
2/28/2017 86

 Pre-stg III adjustments are usually completed within one
month.
 If discrepancy between premolar & molar positions is
excessive, it may require 2 months to go from .016’ archwire
through .018” intermediate archwire to .020” stg-III archwire
 New impressions are taken at pre-stg 111. A lateral ceph &
panoramic radiograph are also taken, which help in assessing
degree of root movement needed during 3rd stage.
2/28/2017 87

STAGE III
 Correction of labio/bucco-lingual & mesio-distal root
positions of all teeth that is achieved during stg III is
mandatory for achieving optimum esthetics, function &
stability of treated occlusion.
OBJECTIVES:
1. To maintain corrections achieved during first two stages
2. To achieve desired root positions
2/28/2017 88

ADDITIONAL OBJECTIVES FOR REFINED BEGG
1. To carefully monitor the saggital & vertical anchorage.
augment anchorage if necessary
2. To monitor & correct the inclinations of posterior teeth,
specially molars
3. To correct positions of 2nd molars, whenever necessary
4. To monitor treatment for undesirable squeals, like root
resorption & para-functional habits due to cuspal
interference
2/28/2017 89

MECHANICS OF STG-III
 Torquing auxiliary for labio-lingual root movements &
uprighting springs for mesio-distal root movements generate
reciprocal reactions in all 3 planes of space which when not
properly controlled, result in complications
A)The lingual root torquing auxiliary, also tends to cause labial
crown movements, extrusion of anteriors & intrusion of
posteriors,and buccal crown movement of posteriors
.
2/28/2017 90

 B) The uprighting springs for distal root movement also have
similar effects as lingual torquing auxilary in all 3 dimensions.
The vertical & sagittal reactions are easily appreciated
 The reciprocal mesial crown moving forces are commonly
resisted by cinching the distal ends of archwires & cl II elastics
 When the mesial drag on lower arch, on account of uprighting
springs & cl II elastics, is more than can be resisted by cinching
wire ends or by occlusion, a reverse (labial) root torquing
auxiliary should be used to counteract it.
2/28/2017 91

PROBLEMS ENCOUNTERED IN STG-III
1) UNDESIRABLE SAGGITAL MOVEMENTS
A) In treatment of cl II malocclusion, inter arch relation reverts
back ( partially or fully) from corrected cl I to cl II, when
upper arch moves mesially.
B) Mesial movement of both arches causes a reversal of
bimaxillary protusion correction
C) Individual crown movements in a mesial direction can crowd
incisors & affect rotational correction
d) Mesial & distal crown moving tendencies in teeth adjacent to
extraction sites can open extraction spacing, closed earlier at
end of 2nd stage
2/28/2017 92

2) Undesired vertical movements cause anterior deepbite to
return partially or fully.In 2nd premolar & first molar
extraction cases, an open bite may develop in molar area.
3) Undesired transverse movements cause the molars
(especially uppers) to roll out buccally & rotate. This can
lead to serious functional disturbances.
4) Root resorption possibilities are substantial during 3rd
stage
2/28/2017 93

HOW THE 3RD STAGE PROBLEMS ARE OVERCOME
1) HOW TO MINIMISE ROOT MOVEMENTS IN 3rd STAGE
A) By diagnosing case correctly & by carefully planning
extraction decision, over retraction of incisors is avoided.
B) By using efficient brakes ,the molars can be protracted in
those cases where extractions were dictated by such factors
as caries, trauma or periodontal conditions rather than space
requirement considerations.
C) By using improved mechanics in first 2 stages, incisors are
tipped in a controlled manner
2/28/2017 94

2) USE OF HEAVY BASE WIRES
 Base wires now used are .020” premium grade, which are
almost 3 times stiffer than previous .020” special plus wires
 These are very effective in resisting vertical & transverse
reactions of auxiliaries & springs
3) LIGHTER AUXILIARIES & UPRIGHTING SPRINGS
 Because of reduced need to torque incisor roots, torquing
auxiliary often used is a 2 spur auxiliary.
 The spur design auxiliaries having two, four or six spurs are
made in .012” wire
 Uprighting springs are also made in very light wires
 On account of their low load deflection rate, they tax
anchorage in all 3 directions much less, & are also less likely
to cause root resorption
2/28/2017 95

4) LIGHT CLASS II ELASTICS
 Because of lighter reciprocal actions generated,only
light cl II elastics are required in most cases, thus
eliminating problems associated with use of heavy cl II
elastics
5) REINFORCEMENT OF ANCHORAGE
 Most of cases benefit by using a reverse torquing auxiliary
on lower incisors for augmenting anchorage in saggital
direction
 A headgear or TPA may be used to upper molars , lip
bumper to lower molars
 Molar uprighting springs reinforce anchorage in sggital &
vertical directions in 2nd premolar or first molar extraction
cases.
2/28/2017 96

 Base wire made in .020” premium grade are
generally adequate for transverse anchorage,
provided enough contraction & toe-in is built in
wires.
 many of corrections , achieved in first 2 stages, is
always lost during 3rd stage. hence it is better to
overdo them by about 15% at end of 2nd stage, in
order to compensate for loss during stg III
2/28/2017 97

ARCHWIRES IN STAGE-III
 Archwires are made with cuspid circles tightly touching cuspid
brackets as suggested by Raleigh williams
 Posterior segments of arch wires are kept gingivally in relation to
anterior segments,this helps in avoiding excess extrusion of the canine
on the account of gable bends in the arch wire
 The amount of contraction in upper archwire (as also toe-in) or
expansion in lower archwire is much less using .020” premium wires
than previous .020” special plus wires.
2/28/2017 98

 In lower archwire 2-4mm expansion is adequate.
 Other factors like patient’s facial type, extraction patterns,
& density of alveolar bone must be considered for judging
correct amount of contraction & expansion.
 The amount of gable bend in upper wire & anchor bend &
gable bends in the lower wire are decided according to
degree of overbite in original malocclusion
 Wire bends are tightly
annealed & tightly cinched
 Upper & lower arch wires
must be properly co-ordinated.
2/28/2017 99

ELASTICS IN STAGE-III
 In majority of cases, very light cl II elastics such as yellow
are adequate for maintaining inter arch relationship
 Blue or red elastics in distal vertical or box configuration
may be used to prevent tipping of upper & lower molars
 Heavier inter arch elastics, green or blue may be used
when extraction spaces tend to open
2/28/2017 100

VARIOUS TORQUING AUXILIARIES &UPRIGHTING SPRINGS
TORQUING AUXILIARY WITH SPURS
Lingual torquing effect is on account of 2 factors
1) The vertical plane in which torquing auxiliary orients when
fitted on two central incisors is changed to horizontal plane
of archwire when fully tied to it.
2/28/2017 101

2) When torquing auxiliary is opened to larger arc of
anterior portion of arch wire, it rolls inwards
Both of these effects force the tips of the spurs to press in a lingual
direction against the gingival portion of the crowns
 Reciprocally, Inter-spur spans of auxiliary tend to lift in a labial
direction.Thus a couple is created.
 Labial forces are resisted by bracket slots & base wire to which
auxiliary is tied,thus accentuating action of lingual root moving
forces.
 Auxiliary is made from .012” premium plus unlike .014” or .016”
special plus wire previously used.
2/28/2017 102

OTHER TORQUING AUXILIARY DESIGNS
1. SINGLE-ROOT TORQUING AUXILIARY – PROPOSED BY KESLING
 Particularly indicated in upper
premolars requiring buccal root
torque to eliminate cuspal
interfernce of hanging palatal cusp
 Long arm of the auxillary is
piggybacked over the main arch wire
,need not be united,but it could lie
occlusal to the base wires in the slot
as well
 Auxillary with convexity facing
upward have buccal root torquing
effect on upper premolars
Lingual root torque
auxillary
2/28/2017 103

2.RECIPROCAL TORQUING AUXILIARY ( ‘SPEC’ ) DESIGN
 Employed when two adjacent teeth
Require root torque in opposite
Directions
 Made in .009” 0r .010” wires, used
for controlling root movements in stg-1
and stage 2,Made in .012” wire ,in stg III
 Box on tooth requiring labial root torque is placed incisal to
main wire while box on other tooth requiring lingual root
torque sits piggyback on main wire.
 Hence a cross-over bend is required between two adjacent
teeth ,because arch wire has to cross over main wire
2/28/2017 104

3. REVERSE TORQUING AUXILIARY FOR CONTROLLING ROOTS
OF CANINES & PREMOLARS
 Described by Franciskus Tan, for labial
root movement of palatally impacted
maxillary canine, whose crown has been
aligned but root is still placed palatally &
needs labial root torque, however if
required for lingual root torque it is
simply inverted.
 Made from .012wire ”p+ wire fitted in
conjunction with .018” or .020” base wire
 It is inserted in molar tube from distal
end
 An offset is placed in auxiliary to bypass
main wire
 In order to resist palatal root torque on
molar , they are stabilised by TPA
Inserted from distal side of molar tube
and resting passively on canine
Activated auxillary pressing against
incisal portion of canine ,tied in
canine bracket2/28/2017 105

4. BUCCAL ROOT TORQUE ON MOLARS
 When upper molar crown roll buccally because of lack of
control during third stage ,their root must be torqued
buccally to lift palatal hanging cusps
 Made in .014” size wire fitted in molar tubes along with
main archwire
 It has boot design occlusal extension on molars
 Boot portion is twisted lingually & given a toe-in, & whole
auxiliary is suitably contracted.
 It can be ligated to main wire at 2-3 places on either side.2/28/2017 106

UPRIGHTING SPRINGS IN NEW AUSTRALIAN WIRE
 MOLLENHAUER, INTRODUCED MINI SPRINGS MADE IN .009”
SUPREME GRADE WIRE
DIFFERENCES WITH OLDER SPRINGS
 1. The coil of springs is only twice as the size of wire,in contrast to size of
former springs that was 4 times the wire diameter
 2. The stem of spring run tangenttial to coil, unlike previous springs in
which stem was radial to coil
 Activation is 100%, stem & active arm make an angle of 180 deg compared
to earlier 135 deg angulation
 New springs are ‘mini’ because inner diameter of coil is only twice size of
wire diameter
2/28/2017 107

FINISHING & DETAILING IN REFINED BEGG
 Rectangular wire finishing has added advantage of being
able to apply torque to any or all posterior teeth
 Requirements for first, second, & third order corrections of
every tooth as can be meticuously planned from study
models & radiographs
Round finishing archwires
 Normally, .020” stg III are used for finishing movements
unless when large vertical displacements of individual
teeth are required for settling of teeth
2/28/2017 108

FIRST-ORDER ADJUSTMENTS
1. Proper labio-lingual position of uper lateral incisors- u-2
are slightly tucked lingually with horizontal offsets to
compensate for difference in labio-lingual thickness 0f u-1
& u-2
2.Upper canine prominence. – On account of labio-lingual
thickness between u-2 & u-3 an offset may req’d in archwire
b/w’n them.
3. An offset made in 3rd stage wires between premolars &
molars to compensate for buccal contours is continued in
finishing
2/28/2017 109

4. A toe-in required for u-6& (u-7, when necessary) for disto-
lingual rotation in order to obtain a good cl-I molar relationship
5. The curvature between u-3 & u -6 is flattened if upper
premolars are expanded & more than required
6. Lower canines are “ tucked in’
7.In treatment of severely crowded incisors ,an inset between l-
2 & l-3 ,and offset between l-3 & adjacent premolar are made
to actively tuck in canine2/28/2017 110

SECOND ORDER ADJUSTMENTS
 1. The u-2 in relation to u-1 & u-3, should be slightly shorter
 2.A slight mesial angulation of u-6 for seating its disto-
buccal cusp against m-b cusp of corresponding l-7 is
required according to Andrew’s recommendation
2/28/2017 111

 3. u-3s are slightly more mesially angulated to make
their cusp tips occlude with distal half of labial
surface of l-3,& not in l-3& l-4. This is recommended
for cuspid protected occlusion
 4,levels of l-3 & l-2 are to be adjusted, if necessary by
a step in archwire between them
2/28/2017 112

RECTANGULAR FINISHING WIRES
 Rectangular ribbon molar tubes are provided from
beginning by using comb’n tubes or round molar tubes
are replaced with rectagular tubes at time of starting
finishing stage
 Alpha-titanium.022” x .018” ribbon wires are used for
finishing
2/28/2017 113

 Upper & lower archwires are shaped as in ideal form
after incorporating ,required 1st & 2nd order bends,
expansion or contraction & bite opening curves are
also bent.
 Tip corrections , if adequate are maintained with ‘t’
pins
 If more tip correction is required appropriate
uprighting springs are continued along with
rectangular base wire.
2/28/2017 114

Conclusion
The refined begg appliance satisfies all the criteria for an
efficient appliance design like
 preciseM/F ratio for controlled tipping
 Light and fairly constant force
 Physiologically acceptable by patient
 Patient cooperation needed only to a minimum extent
Thus the refined begg should be considered as an
appliance on par with any other modern appliance
2/28/2017 115

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