Refined Begg – Modifications And Their Rationale

hyalinised areas – eliminated.

❖Treatment objectives.
❖ Theory of Attritional
Occlusion’ & Differential force 1. Static occlusion – Andrew’s six keys
concept. goal of Refined Begg.
1. Challenged overemphasis of Functional occlusion – Roth.
extractions. ▪Synchronization of CO & CR.
▪Elimination of hanging palatal
2. Anterior teeth remain stationary
cusps – upper posterior Teeth.
under heavy forces – only till
▪Cuspid protected occlusion.
▪Incisor guidance
❖ Diagnosis: ❖Treatment Planning. 4’s/5’s/upper 4’s,lower 5’s/
Conventional Cookbook approach – single arch
discarded. Overempahsised extractions/single LI.
Begg few criteria need to extract ❖Biomechanics.
1. ī to A – Pog line – previously Controlled tipping – 1st
2. ANB & FMA. ➢ Mixed dentition two stages.
considered ➢Growth Mollenhauer – root control
Present broad modulation – before or from 1st stage -MAA.
based diagnosis. during fixed appl. phase. Advantages:
➢ Molar distalization –
Skeletal, dental & ➢ Uncontrolled tipping
selected cases. ➢Avoid
soft tissue analysis. prevented.
extractions when
Growth estimation. possible. ➢Extraction ➢ Third stage shorter.
options – as dictated by ➢ Lingual root torque –
VTO. canine roots abutting
diagnosis – all
 against labial cortical plate.
❖Archform. ❑Built in adjustments – torque
Formerly – no due importance. ( Kameda ) & anti –rotation
( Mollenhauer) ❑Distal offset in molar
Present – tubes.
Maintenance – lower archform. ❑Archwires.
Higher grade Australian
Maintaining or improving upper
wires – Premium,Premium
archform.
+, supreme. Multistranded (
co-ax ) NiTi.
Alpha Ti.
Changes in the hardware. Tandem wires.
❑Elastics.
❑Attachments
 Ultra light ( “Roadrunner” of
Ormco) Light elastics ( ‘yellow’ ).
❑Other components.
Bypass hooks.
power pins.
TPA & Jasper Jumper – when indicated.
❖Stage I. Brakes
Multilooped archwires avoided. ❖Stage III.
Base wire – 0.020 premium.
MAA. Uprightning springs & torquing aux. – finer higher
grades.
Incisor intrusion –imp. in bite opening.
Second molar banding.
Bypass wires & distalizing archwires. Head gear when necessary.
❖Finishing stage.
Base wire → 0.018 as soon as
Rectangular wires.
possible.
Later – different. elastic configration. with lighter
Open bite cases – 0.014 wire initially. round wires tight buccal occlusion.
❖Stage II. Pre – finishing ceph.
❖Retention
MAA.
Base wire – 0.020.
 Conventional Begg – no emphasis – relapse tendency due to – growth or third molars
lower retention. Now – retention – till ruled out.

Refinements Refinements in Hardware.

Refinements in: ❖Attachments on teeth.

Diagnosis Brackets. –
Treatment approach. Retained original dimensions.

Hardware. ❖Built in adjustments Mechanics. Incisor brackets :

Finishing. Antirotational adjustments.
Retention. correctionMesial or distal edge raised – ML/DL

Built in torque.
Raising gingival or incisal edge of bracket
base away from tooth surface. (Kameda ).
❑Placement of attachments. U/L PM bracket – more occlusally.
Upper and lower canine brackets – Molar tubes – Upper →
more incisally placed. occlusally.
Lower incisor bracket – more Lower → more occl.
gingivally. than conventional gingival position.
Mesiodistal location. Bonding surface – polycarbonate
Usually kept in the M-D center of base. Enable easy debonding
crowns. If rotated 1mm closer to the To avoid enamel fracture.
proximal surface rotated towards the Properties:
lingual. High resistance to torsional forces.
➢New Material.- Ceramic Begg bracket. Friction.
Polycrystalline alumina → Debonding characteristics. No
Injection molding. special adhesives / special
instruments for debonding.
Pins used – SS/ brass and nylon pins.

♪ Other attachments. Archwires.

♪ Hooks:
Buccal hook ( centre of MB cusp. ) Newer grades Size.
Palatal cusp ( Centre of distolingual
cusp )
♪ Lingual buttons, cleats or - 0.020.
eyelets. Premium
Placed slightly off center – Premium + 0.010, 0.011, 0.014, 0.016,
over correcting rotations. ♪ 0.018.
Additional round tubes. Supreme 0.008, 0.010, 0.011.
For engaging lip bumpers,
head gears, distal ends of U
loops of EVAA appl.
❑Other materials.
Unravelling crowded teeth – early Polymeric materials:
treatment Goals. To match esthetics of ceramic
Several wires – brackets. Alpha Ti – finishing
1st gen.- Nitinol. stage. Sizes – 0.016x0.022’’,
0.018x0.022’’
Tma,
Niobium Ti
Chinese niti, superelastic
japanese niti.
Recent – Cu niti.
Maximum Superelastic range.
Low hysteresis.
Low modulus.
Rough surface ( ion implantation)
 Objectives – remained same – some added ➢Alignment – correction of
& elaborated. labolingual
Priorities in Stage I: displacements/rotations.
➢Upper incisor inclination - +
✓ Overbite before overjet.
10° of normal.
✓ Alignment of teeth
➢Rotations / BL positions of
✓ Proclination to be reduced before upper molars corrected. ➢PM
applying higher intrusive force. rotations.
Objectives – Described under two ➢Upper arch broadened in
substages. canine – PM area – to permit
❖Substage I – A. ➢Create mand. advancement.
space for correcting crowded teeth / Substage I – B.
close spacing if already present.
❖Bite opening- incisor intrusion, molar ❖Displaced & rotation of P.M’s
extrusion. corrected – if bonded.
❖Retraction of upper anteriors to eliminate the Archwires in Stage I.
overjet with control over the root position. Preferred archwire – 0.018’’ P
Mechanism of controlled tipping of upper or P+. Initially – 0.016’’ or
incisors. 0.014’’ often in combination
Preventing uncontrolled tipping of lower with other flexible wires.
incisor – during bite opening. Space created – distal
Root control – extreme lingual or labial tipping of canine. Excess
position of some ant. teeth. tipping of canines –
❖Mandibular plane angle – controlled. controlled by light
❖Correction of midline. uprighting springs
❖Interarch relation corrected to Class I.
 anchor bends upright
mesially
angulated upper molar teeth.

Ant. openbite casesupper archwire

– 0.014’’ SS.
Substage I B
❖Bite opening.
Preference – incisor intrusion & avoiding molar extrusion.
• Intrusive force – bite opening bends - acts labially - labially
placed brackets.
➢Labial crown/lingual root tipping.
 Resisted by elastics.
Magnitude & direction of net resultant force →intrusive elastic.
• Excess proclination or retroclination corrected in 1st substage.

Excess proclination or retroclination corrected in 1st substage.

Then intrusive and class II elastic force varied.
- orientation of resultant kept close to Centre of
Resistence.
Steps.
Intrusive force applied 45g, CLASS II force 60g.
Inclination improves. Intrusive force - 60g, Cl II - 30g.
Incisors upright – elastic application.- oblique ( ant.
pointing downward direction ).
• Alternative – ‘POWER ARMS’
Long been used in preadjusted edgewise appliance.
Trivandrum Intrusion Technique – Developed By Dr. K. Jyothindra Kumar.
For selective max. intrusion in the Begg technique.
Present technique:
Problem eliminated – elastics - Molar power arm →I/M circle anteriorly.
Made of 0.017x0.025’’ or larger size wire.
Optimal length – 5-7 mm, follows contour of the alveolus.

Soldered to bands – above molar tubes.

2.0 oz elastic, 0.016’’ archwire - 40° anchor bend

 Bite opening curve ( anchor & gable bends).

Modification – Dr. Jayade.

➢Mild gingival curve – midpoint 3mm over the brackets.
➢Vertical step up bend – 4 – 5 mm ht., 2 – 3 mm mesial to the molar tube.

➢Anchor bend – upper end of the step.

• Development of MAA In 1984, on request of Mollenhauer , A. J. Wilcock
made 0.009” supreme wire

• Later boxed aux. named

“ An Aligning auxiliary for ribbon arch bracket”.
• Requirements of MAA

• When reciprocal torque is required with the adjacent rectangle must not diverge
by more than 450

• Base wire should be able to resist vertical and transverse reactive forces from
MAA

ADVANTAGES OF MAA
• Of rapid bodily alignment of anterior teeth with gentle forces

• Reciprocablility of torquing forces on instanding laterals or palatally placed canines.

 root torque
Fixed functional appliance – CHURRO JUMPER –
used after lower anterior alignment

EVAA (Dutch)-experimental fixed appliance activator- used after alignment for 5-6
months
Additional objectives apart from conventional beggs
• Controlled tipping – space closure – anterior retraction.
• Prevent excess tipping – efficient brakes – space closure by protracting post.
• 1st pm extraction Cases – rotations & crossbites of 2nd pm corrected. Archwires in Stage
II of Refined Begg
In extn. & non extn. cases – 0.018” P or P+, or 0.020’’ P wires.
If stage corrections involved – extreme deep bite, badly distorted arch forms or
severe rotations – 0.020’’ archwires effective. Controlled tipping of the incisors.
MAA – lingual root torque – controlled lingual tipping – incisors during retraction.
Braking mechanics.
Second PM extn. Cases – excess space closed by post.
protraction.
Good profile at start of trt.
‘Brakes’ – reverse anchorage site – posterior → ant.
Commonly used:
Braking springs: passive uprighting springs – 0.018’’ wire.
Angulated T pins: prevent further tipping

Combination wires: either of SS or Alpha Ti alloy.

Ant segment. – 0.022 x 0.018’’ (ribbon mode).
Post. segment – 0.018’’ round
SS 0.022 x 0.018’’ sectionals – torqued in ribbon mode – piggy back over 0.018’’ base wire.

Need → PM’s – different vertical level.

Horizontal offset reqd. – engagement in PM bracket &
molar tube.
Archwire:
✓0.016’’ wire – one visit – arch wire engagement in
PM ✓Offset b/w PM & Molar.
✓Upper wire – gable bend.
✓Lower wire – mild anchor & gable bend.
 Torquing auxiliaries.
Torquing auxiliary with Spurs.
Addtional Objectives( Refined Begg ): Refinements –
✓Monitor sagittal & vertical anchorage. ✓ 0.012’’ P+ wire (PS). ✓ 0.014’’ or
✓Monitor & correct inclinations of post. 0.016’’ special + - used previously.
teeth ✓Correct – 2nd molars – when required. ✓ Inter spur span is curved – not
angulated or kept straight.
✓Monitor trt. for undesirable sequels – root
Modifications:
resorption, parafunctional habits
❑Reverse labial torque – one or both
laterals.
❑Torquing boxes – canines for lingual root
torque.
 Reciprocal torquing Aux.( ‘SPEC’ ) .
o Two adjacent teeth – torque in opp. Direction.
o 0.009’’ or 0.011’’ wires – Stage I. o 0.012”
– Stage III.
Uprighting springs.
▪ Earlier springs – 0.016’’ & 0.014’’ ▪
Mini springs – Mollenhauer – ( 0.009” dia ) ▪
Supreme grade wire.
Interarch objectives.

➢Normal overjet and overbite. ➢

Cl I canine & Molar reln.
➢Tight interdigitation of all the
cusps of post. Teeth. Functional
requirements.
✓ Matching CO – CR.
✓ No cuspal interference during
function.
✓ Cuspid & incisor guidance.
Control of etiologic factors.
Soft tissue factors
 Frenectomy , CSF etc.
• Round wires. ▪ Alpha Ti – 0.022 x 0.018’’ ribbon wires.
• 0.020’’ stage II wires used. ▪ Precise torque – build in ant. segment.
▪ Soft – easy to bend. Harder in mouth.
• Archwires given – ideal shape & coordinated. 0.022’’ vertical dimension – enough
▪
• First order & Second order adjustments made.
• Round & Rectangular Finishing wires used. Rectangular finishing wires.
First order. - Lower canine ‘tucked in’.
• Labio lingual position of upper • Second order adjustments.
laterals. • U 2 , shorter in relation to U1 and U3.
• Upper canine prominence. - Molar • Mesial angulation of U6.
offset .
• U3’s slightly more mesially angulated.
- Toe in for U6 – proper Class I .
 • L3 & L2 – levels to be adjusted. ❖ Over correction not required
clearence – 0.040’’ vertical slot –
vertical settling of the teeth.

Check list on finish.

❖ Establish all Andrews six keys.
❖ Check the midline.
❖ Check the occlusion – Centric
position.
❖ Occlusion in functional movements.
❖ Excellent interdigitation.
 MODERN BEGGS

Dynamic & Static anchorage. interrelationship – equally effective

Dynamic anchorage It comprises – forces – biologic environment.
physical forces generated by the Static Anchorage.
appliance– in a complex Increasing the forces – within the appl.
 Less effect of the biologic force
sys. CAT – dynamic & static
anchorage resistance device
Applied – certain stages – treatment
program.
Stage I & II → Dynamic.
Stage III → Dynamic / Static.
Stage IV → Static.
 Treatment technique is divided into 4 stages : 5. Late organization- AW placed in edgewise slot
Stage 1: Organization Stage 3: Correction of crown root inclination
1. Overbite correction 1. Torqueing of anterior teeth 2.
2. Correction of class II n III relation Uprighting and paralleling of roots.
3. Alignment, levelling and elimination of 3.Continued Maintenance of overbite, rotation n
rotations anteroposterior correction 4. Maintenance of
4. X-bite & archwidth problem over correction overcorrection tandem wires are used to open bite
& align teeth.
of anterior bracket Stage 4 : Final detailing
Stage 2 : Consolidation n 1. Attainment of ideal arch form & attainment of arch
1. Closure of remaining spaces width
2. Precise intercuspation & functional harmony in all
2.Retraction of incisors
mandibular excursions. Attainment of desired torque
3.Maintenance of overbite, rotation 3. NITI wires ranging from 0.016×0.022’’ to
anteroposterior correction.
 4. 0.018×0.025 placed. Reverse curve of spee used in
mandibular archwire. Optical & facial esthetics
Commencement of retention
4.Continuation of overcorrections. 5.
Dual flex arch wire used. 6.
BEDDTIOT.
(Begg Edgewise Diagnosis Determined Totally
Individualised Orthodontic Technique.)
Offers capacity to employ selected principles and • Facility to treat each patient’s needs –
features of Begg and Edgewise mechanisms – most efficient for that individual.
specific situations – most advantageous.
• Strong points in Begg Technique:
Primary Goal
 • 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.

 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.
Uprighting springs:Buccal tube : In cases with deep bite/

moderate - severe anchorage req Addnl. Rect. Tube –

diagonally across –
Original-buccal surface of basic tube –
mesial end pointing gingivally.
Helix farther from archwire.Dimensions.
Hook arm – no extra offset reqd. 4.5mm long, 0.022 x 0.028”.
Outer tube ( Addnl. Tube ) - 15°
angulation to inner tube.
RecentMore hygienic.
Less irritation on gingiva.
Appearance –less conspicuous
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. Esthetic & Hygienic. ( eliminate – aux.)
0.022 x 0.016” , 5° torque.
Newer non steel alloy archwires – Extremely Limit tipping of upper incisors - palatal
resilient – gentle forces Approp. size – torque.
precise bracket engagement.
Important adv. - BEDDTIOT –
✓ Facility for both 3 dimensional control &
simple bracket
✓ Limited tipping – light forces
✓ Facilitate application of the best modality in
every situation.
Development of ribbon arch type buccal
tubes for anchor molars
Stage 3 burden lessened ,
transferred to stage 2. Uprightning
done in stage 3
Securing archwires : double back O loops for ligation
 Steel ligature & pins
Stage 2 – space closure.
High hat pins acts as
hooks on cuspid
brackets. Both buccal
and linhual elastics are
used
Stage 1 bracket placement with bracket slots directed
inciassly to receive archwires with vertical loops .
Horizontal circle distal to cuspid brackets.
Stage 3 – brackets with vertical slots directed
gingivally. Torquing springs for inciasors and
uprighing
springs for bicuspids are used
 archwire chamber – Round wire float freely
in chamber, permit adequate tipping of
Bracket head
archwire
constricted in portion permits
snapping in and retention of wire.

Rest in grooved wing of Overall

receptacalefor stability length

Fits into vertical slot holds

inserted bracket in position
when bent at right angle
Closed by using hoe plier Stage 1: Tipping
If malocclusion is with deep
overbite – include bite plane.

Bracket
opened by
using an insert
spreader and
removed using Multilooped archwire (for uncrowding) changed to
scaler which plain 2 looped archwire as soon as possible, while
act as crowbar. continuing class II mechanics until class I molar &
canine relations are achieved
 Stage 2 : 0.012” or 0.014” highly Space closing
tempered round SS can be used for severly helical loop
irregular tooth positions.
Leveling & space closing appliance :
made of 0.014 or 0.016” round SS wire.
Imparts flexibility, uprightens teeth
adjacent to extraction spaces.

anchorage reinforcement.
Applianceis bend back
Used for additional behind the tubes, cinching
slightly creating fixed/removable resistance device.
 Optional use of receptacle as a Low
profile receptale created to regular
edgewise bracket offer less bulk in height
& width
Finishing movements by 0.016 Modified combination technique
or
0.018” dual helical spring AW
features: ✓ No special ties
✓ Minimum unwanted tooth movements
✓ No unpredictable reaction to torque
✓ Lesser no of auxillary springs in 3rd stage
✓ No heavy base wire required for special tooth
movements.

Torquing appliance for central

incisor
Brackets: Interbracket – long resilient span
bonding preferred. - archwire.
Prewelded – flat/curved – universal bonding Wire – less distortion.
pads. Less elastic range requd.→ force.
Advantages: Considerable ( limited ) tipping .
• Facially facing archwire slots – 0.016 wires - 10° distal crown tipping.
engagement of archwire easy. 0.018 wires - 5° mesial crown tipping
• Small dimensions – (uprighting)
• Less Lip & cheek irritation. “braking” – not required.
• Less Occlusal interference. Vertical slot
• Less Bonding enamel surface. Uprighting springs
Turned 90° - miniature buccal tube.
• Less Problems with gingival proximity &
oral hygiene.
Wire combination used in each stage

1. Anterior wire : canine to canine

2. Posterior wires
3. Anterior k type wires with A K hooks
• Alignment of posterior teeth begin after
alignment of anteriors.
• Type 2 wire used
• 0.016’’ anterior k type extra special plus grade
• Posterior plain NITI 0.016’’
canines- rotation t pins or high hat
ligature
Intermaxillary elastic usage in stage 2
Method of closing extraction spaces – pulling through
elastomeris module
Stage 3 : Begin with use of type 2 wire

Molar offset incorporated Conclusion

No bracket system is perfect. All systems have
advantages and dis advantages. Its upto the
clinician to use his/her skills to overcome
deficiencies. This was a brief of the creator of
these appliances that the best aspects of beggs
and edgewise appliances is incorporated in the
which is efficient, easy to use and consistently
good results.