Problem shooting stg ii /certified fixed orthodontic courses by Indian dental academy

PROBLEM SHOOTING
IN STAGE II & ITS
MANAGEMENT
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Problems Encountered During Begg Trt.
Problems can occur in any stage or can either
be
 Poor tissue response
 Lack of patient cooperation
 Poor mechanics
Identification of problem is imp. for
producing successful results.

1.Ant. bite closing
 Lack of bite opening bends
 Remove AW, place proper bite-opening bends

 Bitten out bite opening bends, arch wire
distorted
 Pt. edu. for proper diet
 Remove, correct & replace archwire

 Anchor molar out of occlusion
 Discontinue Class II or Class III elastics
 Horizontal elastics from molar to intermaxilary
hook to move the molars towards one another.

 Vertical elastics from U-m to L-m

 Patient not wearing I.M elastics properly
 Educate patient

2. Ant. teeth assuming class III relationship
Excessive wearing of class II elastics
 Discontinue Class II elastics till teeth are in edge
to edge relation
 place class III elastics.
Discontinue class III elastics when ant. teeth are
edge to edge

3. Spaces dev. between ant. teeth.
 Failure to give cuspid tie
 Intermax. circles formed too far apart
 Roll one or both circles mesially, tie with steel lig.
 if space is too large, close space with hor. elastic
from 3-3

4. Anchor molars rotating distobuccally
 Toe-out on arch wire
 Remove arch wire & place toe in bend

 Too much force from horizontal elastics
 Use lighter hor. Elastics
 Tie elastic thread from canine lingual button to
lingual hook on molar.

 Elastics pulling on distal of molar tube
 Place the hook properly
 Edu. pt. to place elastic on hook rather than
around tube.

5. Canine roots bulging on labial plate of
alv. bone
 Normal distal tipping of canine crown
causes mesial movement of apices,since
canine is located at the curve of arch which
causes bulging of plate.This will disappear
during stage III as apices moves distally.
 Do nothing

 Poor arch form
 Poor bracket placement
 if bracket is to far gingival tooth will supra
erupt. Inclined plane relationship with opposing
teeth  rotate mand. cuspid crowns lingually
 roots labially


6. Posterior space not closing
 Poor elastic cooperation.
 Educate the patient
 Make sure that pt. can hook the elastics

 AW not free to slide distally through tube
 Remove source of resistance
 End of wire striking 2nd molar
 Anchor bend in molar tube
 Arch wire short & caught on burr inside tube

 A W pinned or caught in PM bracket slot
 Unpin archwire, remove from slot
 Place bypass clamp

 Pt. placing tongue or pencil in space
 Educate patient

 Occlusal interference
 ↑ Anchor bend to open bite
 Check bracket level

 Ant. teeth not free to tip distally
 Use proper brackets
 Make sure AW is not pinned too tightly
 Make sure AW is seated in bracket slot, not
caught on flange of bracket
 If tongue habit, place spurs on lingual
surface of teeth, refer to speech and
swallowing therapy spec.

7. Mesial tipping of 2nd PM
 Slight, expected mesial movement of
anchor molar
 proceed with stage II, conti. to guard anchorage

 Abnormal loss of anchorage
 Remove AW, ↑ Anchor bend.
 ↓ elastic force
 Check for loose molar band or tubes

8. Mand. ant. teeth achieving desired
lingual inclination before space closure
 Careful preservation of anchorage
 Apply braking mechanics
 Apply 6- 10 oz. horizontal elastics with braking
mechanics

 Excess space present at beginning of trt.
(Conginitally small or missing teeth or space
from trauma or caries)
 Clinical experience & education of patient

9. Relapse of crowding
 Intermax. circles not abutting to canines
 Pins dislodged from brackets
10. Too much retraction of U –incisors resulting
in gummy smile
 Uncontrolled tipping of incisors
 Use MAA

 Not attaining proper intrusion of U - incisors
 Use of Power arms or TPA for wearing class I
elastics

Anchorage loss
during stage II


 Lock pin binding the arch wire in bracket
(prevent free tipping of teeth)

 Use proper lock pins
 If possible, pin tails should be bend before head
strike the arch wire

 Cuspid forced out into buccal plate
(Improper arch wire form, Causes drag teeth
can not tip freely)

 Place the distal ends of arch wire in molar
tubes, see if wire lies so far labially in canine
region

 Too strong elastic force
 Use proper intermaxillary elastic force
 2-2½ ounce

 Wearing more than one elastic
 Pt. must be properly educated in
Function of elastics & danger of wearing more
elastics

 Arch wire accidentally engaged in the
slot of second premolar
(Increases friction)

 Use of bypass clamp
 Remove the premolar band for first 6 weeks


 Arch wire binding in buccal tube
(If arch wire too short to protrude through the
distal end of molar tube,
When cut to proper length, cause internal burring
(not removed by ordinary polishing)

 Make always slightly longer than necessary
 Do not cut the end of wire until all modifications
and bends

 End of arch wires striking the second
molar
(Retards and sometimes stops the distal sliding
of arch wire (usually in upper molar)

 Extend the arch wire farther distally
buccal to 2nd molar

 If impossible, cut it short enough to
allow it to slide freely until next visit

 End of arch wire penetrating gingival tissue
(Usually distal end of lower arch
Gingival tissue (bone) prevent free sliding)

 instruct pt. to visit orthodontist if they feel
discomfort or can not engage elastics

 Anchorage bends engaging buccal tube
(Once entered in molar tube free sliding is prevented
due to three point contact)
 Check the situation every visit
 If necessary remove the arch wire, st. it and, make
new AB mesially


 Ligating premolar too tightly to arch wire
Arch wire can not slide distally
 Ligate the arch wire lightly so that arch is free to
slide


  Improper toe in
  Results in loss of control of anchor teeth & failure to
reduce ant. deep bite.
• Proper amount of toe in or toe out  by placing the
AW in molar tubes & in ant. brackets
 The wire should pass st. forward & occlusally as it
leaves the mesial end of the tube from the action of
anchor bend.


 Starting stage II too soon
 If ant. teeth are not in genuine end to
end contact, not free to tip under the
forces of horizontal elastics


 Arch wire rolling in buccal tube
 Avoid too much anchorage bend
 and/or too much toe in bend


 Improper ligature tie at canine
 do not pass ligature ties on canines over the
incisal of brackets  prevents free tipping

 It should pass directly distally across the labial
surface of canine


Conclusion
A thorough knowledge of basic principles
involved in Begg mechanotherapy is
essential to avoid any form of problems
during treatment.
An awareness of all possible problems help
us in every stage of treatment, leading to
excellent treatment results.


Problem shooting stg ii /certified fixed orthodontic courses by Indian dental academy

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