4.
Dr P.R Begg was born in
1898 in a small, gold
mining town Coolgardie,
west Australia.
Grew up in south
Australia.As a boy he saw
the sketch of Australia
aborginal and noticed
their teeth were worn flat,
no one thought to tell him
why or how it happened.
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5.
In his early twenties he worked as a Jackaroo at
Boonoke- a sheep and cattle station in New south
Australia, looking after both cattle and sheep.
He noticed many people with crooked teeth and saw
many feeble attempts at correction of these problems
with many treatment failures and few successes.
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6. .
As he wanted to help such people he enrolled in the
dental course at the University of Melbourne instead of
taking the medical course, as he originally intended.
At the commencement of third year of training, Dr Begg
decided to practice orthodontics after graduating in
dentistry.
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7.
Dr Stanley Wilkinson, a former student of E.H Angle was
the lecturer in Orhodontics and used the seventh edition
of “Malocclusion of the teeth” as the text book. Dr Begg
graduated in 1923 with B.D.Sc Degree the L.D.S
Diploma.
His introduction to Dr. Angle‟s work led him to travel to
Pasadena, California in 1924 to study with Dr. Angle.
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8. -
DR. Begg was with Dr.
Angle from
February,1924 to
November,1925.
- At that time Dr. Angle
was teaching his
followers the Ribbon arch
appliance which he
introduced in 1916.
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9. -
Coincidentally with Begg‟s arrival in California Dr. Angle
was developing he Edgwise arch mechanisms, Which he
felt was a vast improvement over the Ribbon arch
Appliance
-
Angle instructed Dr. Begg and Fred Ishii of Japan in the
use of the Edgewise mechanism, before it was revealed
to the profession. Since Dr. Angle was ill, it was they
who first treated patients with Edge wise Appliance
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11.
The relation between Dr,Begg and Dr.Angle was warm
and mutually rewarding. Dr.Begg helped Dr.Angle to cut
Edgewise brackets on a lathe from milled strips of
platinized gold provided by S.S. white dental company.
At that time Dr.Spenser Atkison demonstrated to the
students that it was normal for the upper first permanent
molars to move continuously mesially throughout life. Dr.
angle referred to this as the anterior component of force.
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12.
During Dr. Begg‟s stay Dr.Angle wrote, and read for the
first time, his paper entitled. “ The latest and Best in
orthodontic Mechanism” ( published in Dent. Cosmos
1928 and 1929 ). It disclosed the use of edge wise
Mechanism.
In November, 1925 Dr. Begg sailed back to Australia. In
December of the same year he began practicing
Orthodonics in Adelaide, south Australia.
Married Nellie Hamilton in 1928.
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13.
Begg the only orhodontist in Adelaide in 1926 practiced Edgewise
non extraction, technique.
He was appointed Lecturer in Orthodontics at the university of
Adelaide, a position he held until the university‟s retirement age. (
Retirement in 1964).
For two years, Dr. Begg faithfully followed Dr. Angle‟s
teaching of retaining the full compliment of teeth.
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14.
However in many of his patients he was‟nt satisfied with
post treatment profiles and there was the serious
problem of relapses.
In February of 1928 he began to routinely remove teeth
or reduce tooth widths by mesio - distal stripping in
patients with excess tooth substance.
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15. .
He learnt from experience and his ever – growing appreciation of the
role of attritional occlusion in the development of man‟s dentition,
that such reduction was often necessary to permit the proper
repositioning of the teeth to enhance function, stability and esthetics.
Initially he faced opposition from dentist of his patients. It was only
after his superior treatment results were seen to stand the test of
time that the criticism relented. He retreated many patients who had
relapse due to retention of excessive tooth material.
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16. CHANGING THE MECHANICS
-
Dr. Begg began to realize the Edgewise mechanism was not
designed to rapidly close extraction space or quickly reduce deep
overbites.
-
To facilitate such changes he began using 0.20‟‟ round platinized
gold, rather than rectangular, arch wire in 1929. In 1931 he started
using .018‟‟ round stainless steel wire, bending the now popular
vertical loops and intermaxillary hooks right into the arch wires.
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17. -
He soon realized that if round arch wire were engaged in edgewise
brackets, indiscriminate and often undesired root moving forces could be
created this prolongs the anterior bite opening and taxed intraoral
anchorage.
-
In 1933, about 3 years after switching from rectangular to round arch wire
material, he began treating some cases using S.S. White ribbon arch
brackets, to which he had been exposed during his stay with Dr.Angle.
-
Dr. Begg faced the openings of the brackets slots of the ribbon arch
brackets gingivally, instead of incisally as advocated by Dr. Angle. He
realized that these relatively narrow brackets with vertically facing slots
allowed the teeth to move under much lighter forces.
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18.
To improve rotation tooth control with the use of smaller round wires
in the Ribbon Arch Brackets, Dr. Begg filed their bases before
soldering them to the bands. This reduced the widths of the arch
wire slots.
In 1935 Dr. Begg was awarded the title of D.D.Sc. For his thesis
entitled, “Some aspects of the etiology of irregularity and
malocclusion of teeth‟‟. This was the illumination of his study of
attritional occlusion that began with the casual observation in the
aborginal prior to World War I, and included studying the skulls of
American Indian at the southern Museum in California.
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19. A NEW WIRE
In the early 1940‟s Dr. Begg met Arthur J.Wilcock, director of
metallurgical research projects at the University of Melbourne.
After many years of research Wilcock produced a cold drawn heat
treated wire that combined the balance between hardness and
resilience with the unique property of zero stress relaxation that
Dr.Begg was seeking.
This unusual wire permitted to open anterior over bites, while
controlling arch form and providing molar stability.
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21.
He also produced the modified Ribbon arch brackets,
lock pins and special buccal tubes to meet Dr.Begg‟s
ever-changing requirements in these experimental years
In 1952 Dr Begg began to use 0.16‟‟ round stainless
steel wires instead of 0.18‟‟ permitting to open anterior
overbites quickly.
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22.
In 1939 DR.Begg wrote his doctoral thesis “ The Evolutionary
Reduction and degenaration of Man‟s Jaws and teeth‟‟ in 1939. It
relates attrition or more often lack of it, to the etiology of
malocclusion and other dental problems in modern man.
In 1954 Dr.Begg published paper entitled, “Stone Age Man‟s
dentition” and as the title suggests, it also dealt with attritional
occlusion, and explained why it is the anatomically correct
occlusion.
At the end of his article he disclosed a new technique which he
referred to as the “round wire technique”, advocating at that time the
use of 0.18” (0.46mm) diameter stainless steel arch wires in
modified Ribbon Arch brackets.
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23.
The technique describe in this 1954 article was much
different from what it is today, and the treatment results
shown did not include detailed finishing. Even so, it drew
relatively large response including correspondance from
three prominent orthodontist who expressed an interest
in the treatment method disclosed – his found from the
Angle school, Dr. Spencer Atkinson; Dr. Robert strang
and Dr. CharlesTweed.
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24.
In 1956 (Am Jr) Dr. Begg had another article published entitled,
differential Force in orthodontic Treatment.
While he did not specifically define differential force in so many words,
its operation was explained.
This demonstrated that this techniques and theories of
treatment were able to produce acceptable results in unbelievable
short treatment times for all types of malocclusion- from the simplest
to the most extreme discrepancies of both teeth and jaws.
.
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25.
As a result of reading this article several orthodontists
visited Dr.Begg in Adelaide, South Australia.
In 1957 Dr.H.D. Kesling and Dr. George Dissham came
from the United states. They spent several weeks in
Dr.Begg‟s office and home, attempting to learn the
technique, which was extremely difficult as there was no
organization to it.
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26. INTRODUCTION OF BEGG TECHNIQUE IN THE
UNITED STATES
Upon Kesling‟s return from Adelaide,he had plans to implement
his new technique in his practice along with Dr.R. A. Rocke not just
to selected patients, but every patient.
In 1959 the Kesling and Rocke Orthodontic group invited over
150 orthodontist from across the united states, to assess the results
of their results of their 100 consecutively – treated cases by Begg
technique.
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27.
Dr .H.D. Kesling, first
orthodontist in the United
States to practice the
Begg Technique, and the
one most responsible for
popularizing its use
through showings and
courses
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28.
While the results were not of the quality of the results achieved
today, they demonstrated the ability of the Begg technique to quickly
open deep anterior open bites. Treatment times were relatively
short, and the number of adjustments few. As a result there arose a
demand for training in this new technique.
First course in Begg Technique had 31 students, was held in the
new orthodontic center in Westville, Indiana on june 1959 (1week
course). The brackets used were the new Double - Tab type.
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29. However, the use of the double tab bracket proved difficult, as arch
wires were unnecessarily complicated to permit desired tooth
movement. Also, it lacked the ability to overcorrect the teeth which is
so necessary to reduce the tendency for relapse.
Dr Begg realized that inorder to make his technique acceptable to
leading orthodontist in the united states, most of whom were using
Edgewise mechanism at that time, he had to finish his cases with
more precision.
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30.
Prior to their visit, Dr. Begg was mainly concerned with repositioning
the teeth instable positions over basal bone. The final settling of
teeth he left to the forces of occlusion, guided when necessary by an
upper retainer with circumferential wire.
Also he realized the growing demand for training in his new
technique required that the treatment be organised in some manner
to facilitate both teaching and learning.
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31.
The result was that in April of 1960, as Dr. Begg began
unpacking his models (which he had brought as part of
his presentation before the American Association of
Orthodontist), members of the kesling and Rocke group
were stunned by his quality of treatment . Hours after
seeing the quality of results achieved by Dr.Begg with
modified Ribbon Arch brackets, Dr.Kesling made the
decision to scrap his double- tab brackets.
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32. In the years between Dr.Kesling‟s first visit in 1957 and his trip to the United
states in the spring of 1960, Dr.Begg did the following:
1.Finished his cases with such detail and precision that they could not be
discerned from similar cases treated with Edgewise mechanism.
2. Seperated the technique into three distinct stages and established objectives
for each stage.
3.Developed root torqueing auxiliaries separate from the main arch wire.
4.Introduced mesiodistal uprighting spring.
5. Emphasized the importance of free tipping of tooth crowns in the early
stages of treatment.
6. Suggested taking stage models to discipline the orthodontist.
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34.
The Begg differential force technique is a unique approach to
orthodontic treatment. The philosophy behind it, including diagnosis,
method and direction of tooth movement , is keyed to attritional
occlusion.
Dr.Begg‟s studies of stone age Man‟s dentition indicate that man‟s
occlusion is not static, but an ever changing one.The teeth
continoully migrate mesially and vertically and compensate for the
attrition of their proximal and occluso – incisal surfaces. The
absence of attrition caused by civilized man‟s soft diet does not
eliminate the migration of teeth.
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35. DIFFERENTIAL FORCE
In 1956 Dr Begg introduced the concept of
Differential force.
His observations was based on the work of Storey
and Smith and their experiments on tooth
movement response to different pressure
applications.
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36.
IT IS DEFINED AS A FORCE THAT RESULTS IN A
DIFFERENT RATE OR TOOTH MOVEMENT AT ONE
END THAN THE OTHER.
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37.
A range of light pressures which would
cause teeth to move at an optimum rate and with
minimal disturbance of the supportive tissues optimum orthodontic force.
Pressures below this produce a slow rate of
response, while above incurred a reaction within
the bone support (undermining resorption), which
also had an effect of retarding tooth movement.
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38.
When a relatively light force is applied reciprocally
between small – rooted anterior teeth and larger –
rooted posterior teeth, the anterior teeth move
relatively rapidly, whereas the larger – rooted
posterior teeth remain almost stationary.
Conversely, if a relatively heavy force is applied in
the same situation, the posterior teeth tend to
migrate mesially while the anterior teeth resist
movement.
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39.
Here given elastic force is relatively constant, It is
the rate of movement of the teeth on either end of
the force that varies.
Accordingly, it would perhaps be more appropriate
to refer to “ differential reactions” rather than
differential forces.
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40.
A. Mechanics at each end of the force permites the force to
differentiate as desired.
B. If the mechanics are the same at both ends of the force,
the initial reaction will be for the molar, which has a smaller
root surface area, to move forward and the anterior teeth
remain stationary.
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41.
The significance of this concept is enhanced by the
ability to choose mechanics that promote free tipping
where the greatest movement is desired and prevent
free tipping where stability or anchorage is indicated.
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42.
A goal of Begg‟s treatment is over correction of the teeth to allow for
the natural tendency for relapse that occurs when orthodontic
appliance removed.
The differential force technique is designed to permit teeth to move
towards their anatomically correct positions in the jaw under the
influence of very light forces – as would occur naturally in the
presence of attrition.
.
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43.
The light intra oral forces of Begg Technique do not
place undue strain on the anchor molars.
The appliance is designed to permit the teeth to move
independently of one another – whether tipping freely in
the early stages or during detailed root positioning in the
final stage.
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44.
Another feature is that the movement of all the teeth towards and
beyond their desired final positions is initiated at the start of
treatment ie. The movement of the teeth is not segmented into
groups with one group waiting for another.
Both archwires and intermaxillary elastics are applied at the bonding
appointment causing immediate reduction of deep overbite and
overjets. The discomfort caused by the initiation of tooth movement
produces a change in eating and biting habits that lessens the
chance for appliance damage.
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45.
The movement of all teeth is due to the synergistic effect
of the forces and appliances working together in the
presence of proper diagnosis.
The begg synergistic arch graphically demonstrates and
emphasizes the importance of the combination of
avrious components comprising the Begg theory and
technique.
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46. SEVEN SYNERGISTIC COMPO NENTS
1. A diagnosis and treatment plan that recognizes the persistence of
hereditary forces of mesial migration and vertical eruption of teeth and has
its objectives the over correction of malrelationships of both teeth and jaws.
2. The simultaneous movement of all teeth. From the beginning of
treatment each tooth is directed towards its final position in the dental arch.
3. The total separation of root moving forces from arch wire forces during
the final third stage of treatment.
4. The application of proper elastic forces to create the desired differential
movement of the teeth.
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47.
5. The use of light round continuos arch wires bent from the hardest
wire possible – Not only must the wire be of highest quality, but the
aech wire have proper form, including bite opening bends, to control
the vertical dimension.
6. The use of molar attachments that prevent free mesiodistal
tipping and yet permit the arch wire to slide freely mesio distally.
This permits the rapid retraction of the anterior teeth.
7. The use of attachments on all teth, except anchor molars, that
control rotations yet permit free tipping in the desired direction and
free sliding along arch wires.
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49. ATTRITIONAL OCCLUSION
There is nothing more important for a dental or
orthodontic student to learn than the normal attritional
development of mans dentition. Only then can he or she
understand the true cases of most dental and
orhtodontic problems, and take appropriate remedial
action.
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50.
Dr. Begg noticed that the teeth of Aborigines had not only extensive
occlusal and interproximal wear, but also exhibited total lack of
caries, periodontal disease and tooth crowding. He recognized
along with several others,that such examples of stone age man‟s
attritional occlusion represented the true occlusion for man – not a
pathological condition. This occlusion was far more efficient and
healthy than “textbook normal occlusion”. Civilized Man‟s unworn
dentition with all its related problems is abnormal.
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52.
Teeth continually erupt vertically, migrate mesially, and
usually are collectively too large to be accommodated in
the jaws without a reduction of tooth mass. This
reduction, which occurs naturally in primitive man from
attrition, can be replaced in civilized man by planned
mesiodistal stripping and / or tooth extractions.
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53. Attrition causes continual
changes in the shapes
and sizes of the teeth.
Mesial migration
and vertical eruption in
the presence of attrition
result in their moving
occlusomesially in the
jaws
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54.
It is only recently that man has developed the ability to adapt the
elements of the environment to fit his demands. One of the first
elements altered was food. Civilized man has refined his food;
eliminated the grit and excess fiber, resulting in foods that are soft,
pasty, ultra – refined and high in carbohydrates – causing caries.
Dr. Begg feels the present concept of textbook-normal occlusion
with its static tooth relationships shapes and sizes, is incorrect. Such
an occlusion, and diet that permits it, are actually the causes of the
majority of dental problems existing today.
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55.
In civilized man the persistence of an anterior overbite
locks the lower incisors in an anatomically and
functionally incorrect position. This restraint the natural
tendency for the lower incisor to become more
procumbent,also encourages further crowding of these
teeth. Persistence of anterior overbite also locks the
maxillary incisors in an anatomically and functionally
abnormal labial location.
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56.
Hard, coarse and gritty
food quickly causes
incisal and occlusal wear.
Initially the incisal wear is
oblique, but becomes
horizontal as wear
progress. The lower
incisors tip labially, while
the upper incisors
become more upright
until they assume an
edge to edge relationship.
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57. Gingival Recession And Vertical Eruption
The physiologic process of continual tooth eruption has
evolved to compensate for occlusal attrition. It persists in
modern man, even in the absence of attrition. As a result
of this, there is often continual increase in the vertical
dimension between maxilla and mandible. Consequently
civilized Man‟s face grows „‟longer‟‟ with age.
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58.
This eruption is often clinically misinterpreted as gingival
recession, when in fact it is the teeth that are erupting,
and the gingival margin that is remaining relatively
stationary. The rate of eruption and varies among
individuals.
The course and gritty diet that causes attrition also
controls caries and help prevent periodontal problems.Pit
and fissures are quickly reduced by occlusal
wear,thereby eliminating the focus of most caries in
civilized man.
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59.
In primitive man the
excessive occlusal forces
of mastication retard this
eruption to a rate
harmonious with the
progression of attritional
wear.If an individual lived
long enough, continoual
eruption and attritional
occlusion would result in
the shedding of the apical
portion of the root.
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60.
The course and gritty diet that causes attrition also
controls caries and help prevent periodontal
problems.Pits and fissures are quickly reduced by
occlusal wear,thereby eliminating the focus of most
caries in civilized man.
The diet itself is of low in carbohydrates and its
coarseness plus high volume prevents the accumulation
of dental plaque, without which there can be no dental
decay.
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61.
Gingival embrassure
areas (black triangles) in
civilized Man become
larger with age, due to
lack of proximal wear.
In primitive man the
interdental space remains
small,since the teeth
move together as the
proximal surfaces are
worn flat –creating large
broad contact areas.
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62. ERUPTION OF FIRST PERMANENT MOLARS
The edge to edge anterior tooth
relationship results in the lower
teeth being further forward in
relation to the upper teeth and
therefore, the mandibular second
deciduous molars are mesial to
the maxillary decidous second
molars. The lower first permanent
molar is then able to erupt in a
more mesial position and proper
initial relationship with the
maxillary first permanent molar is
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achieved.
63. ANATOMY OF TMJ
Attritional occlusion
can also affect anatomy
of the temporomandibular
joint.Primitive man
exhibits a shallow glenoid
fossa and flattened
condylar head, not the
deep fossa and round
head found in modearn
man.
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64. Eruption of succedaneous teeth.
Attrition brings about
enough reduction in
mesiodistal dimensions of
teeth to allow adequate
space for the erupting
permanent canines.
In the absence of
attrition there is often not
enough space for the
canine
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65. PROXIMAL WEAR
In attritional occlusion decidous teeth are worn away
quickly, both proximally an occlusally. The proximal wear
can result in increased space for later erupting canine
such as the canines.
In civilized man due to lack of proximal
attrition ,the permanent canines frequently lack adequate
space for eruption.
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66. ERUPTION OF THIRD MOLARS
In civilized man as no
proximal wear occurs
causes inadequate room
distal to the second
molars for normal
eruption of third molars
which leads to delayed
eruption and complete
impaction.
At the age of
12 to 13 years the third
molar begin to erupt in
attritional occlusion.
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67. CHANGE IN CURVE OF WILSON
As the permanent molars erupt
the bucco – lingual plane is
oblique. As wear progress, the
plane becomees horizontal, then
begins to slant downwards and
cusp of carabelli serves to
increase overall occlusal surface
area.
In civilized man the buccolingual
plane is oblique throughout life.
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68. SECONDARY DENTINE AND PULPAL PAIN
Value of pulpal pain is not to
warn of caries, but to warn of
atttrition approaching the pulp
faster than secondary dentin
can be laid down. This causes
automatic shift of bolus of food
and therefore attrition to other
teeth until secondary can
overtake the attrition.
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69. INCIDENCE OF CROWDING
Since attrition especially interproximallly causes a
continoual reduction in mesiodistal tooth widths, the
incidence of tooth crowding is relatively low in primitive
man.
The persistence of large teeth and the processes of
mesial migration in civilized Man explain the currrent
relatively high incidence of tooth crowding.
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70. CONCLUSION
As can be seen from the preceding examples, Man‟s
dentition is far healthier and efficient in an attritional
environment. However, this does not mean that
orthodontist or Dentist must prescribe abrasive diets or
begin eliminating cusps from their patients teeth. Rather,
it provides the reason for most of the problems seen in
the mouth of both dental and orthodontic patients.
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72.
An orthodontic technique may defined as a
systematic sequence of definite procedure to achieve the
correction of malocclusion with a specific type of
appliance or with a combination of appliances.
The Begg method is a system that demands
stringent interdependence of technique and appearance;
this technique requires specific bracket design, arch wire
size and configurations, molar tube size and molar tube
placement as well as specific system of procedure.
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73.
The method consist essentially of tipping movements of
the teeth. Two successive tipping movements are
required to achieve bodily movement. The first to
position the tooth crowns and second to position the
tooth roots. As a result of these tipping movements,
complemented by intrusion, extrusion and rotation of
teeth whenever required, optimal occlusion, axial
positioning and alignment of the teeth are secured.
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74. COMPONENTS OF BEGG APPLIANCE
ARCH WIRE MATERIAL
Round austenitic stainless
steel wire of 0.016 inch diameter,
which has been heat treated and
cold drawn down to its proper
diameter, in order to give it the
required properties of resiliency,
toughness and tensile strength. –
without which this technique could
not have been devleloped and
cannot be employed.
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75. PRECAUTION TAKEN WHILE BENDING THE WIRE
When the wire is bent around
the round beak of the pliers,
the stress on the crystalline
structure is confined to a small
area, which may cause the
wire to break.
When bending the wire
around the square beak the
points of stressare offset,
providing more area for
crystalline adjustment and
there fore less chance fracture.
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76. MODIFIED RIBBON ARCH BRACKET ( TP -256500)
By changing the lock pins,
the size of the arch wire
slot can be changed to
accept properly either a
0.016 inch or a 0.020 inch
arch wire
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77. Requirements for a light wire brackets
Ease of arch wire engagement
A means to guide both the tail and head of lock pin
during locking
Positive retention of arch wire in all 3 stages
Free tipping and sliding on arch wire
Ability to effect and hold rotation
Ability to prevent accidental tipping in stage III.
These brackets are fabricated from stainless
steel strips, hence it is economical.
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78. TYPES
A.
B.
c.
d.
1. Full flange
2.Half flange
1. Bondable
2. Weldable
1.Flat
2. Curved
Full flange brackets will have more friction with
arch wire and hence hindrance to smooth tipping
movement of anteriors.
in half flange brackets, contact of the flange
with arch wire is minimal , thus friction is also minimal.
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79. AUSTRALIAN ARCHWIRES
In 1952 Dr Begg in collaboration with an Australian
Metallurgist Mr. A.J Wilcock, developed a high tensile S.S wire
that is heat treated and cold drawn to yield its now familiar and
excellent clinical properties.
It was made thin enough, to distribute force at an optimal level
for tooth movement over a considerable period of time, over
long distance and with minimal loss of force intensity while
doing so.
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80. SIX TYPES OF AUSTRALIAN WIRE
1. REGULAR GRADE:
- Lowest grade – easy to bend
- Used for practice bending and forming auxillaries.
2. REGULAR PLUS:
- Easy to form, more resilient than regular grade
- Used for auxiliaries and arch wires when more
pressure and resistance to deformation as desired.
3. SPECIAL GRADE:
- Highly resilient yet can be formed into shape.
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81.
SPECIAL PLUS GRADE:
- Hardness and resiliency of 0.016” wire, is
excellent for supporting anchorage, and reducing
deep overbites.
- Must be bent with care.
EXTRA SP ECIAL PLUS GRADE :
- Also called premium plus
- This grade is unequalled in resiliency and
hardness.
- More difficult to bend and more subjected to
fracture.
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82.
SUPREME GRADE:
- It is ultra light tensile fine round stainless steel
wire.
- It was initially introduce in 0.010” diameter and
then further reduced to 0.009 diameter.
-It is primarily used in the early treatment for
rotation. Alignment and leveling.
- Although supreme exceeds the yield strength of
E.S.P, it is intended for use in either short section or
full arches where sharp bends are not required.
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83. BAND MATERIAL
These bands made of stainless steel strips of different
size and thickness are recommended for different teeth.
These available on 8 feet rolls or cut of 2 inches to 2.5
inches.
1. For incisors - 0.125 x 0.003 inch
2. For canines, premolars – 0.150 x 0.004 inch
3. For molars - 0.150 x 0.005 or 0.180 x 0.006 inch
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84. LOCK PINS
Second stage safety lock pin: Shoulder on head ensures free
mesiodistal tipping. Labiolingual width of tail dimension is reduced to
fit properly into TP – 256 – 500 bracket in conjunction with inch arch
wire.
One point safety lock pin : Used in stage I and II. The pin has a
shoulder that keeps the head of the pin outside the bracket slot and
prevents the impingement of pin on arch wire. The beveled
undersurface of head permits free mesiodistal tipping. Thickness of
pin is 0.019 length 0.200‟‟ x 0.220”
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85.
Hook lock pins : Used during III
stage. Since there is no safety
shoulder, they hold the arch wire
firmly against the base of the arch
wire slot. Thickness – 0.014” to
0.018” , length – 0.220 to 0.293
High hat safety lock pins:
They have a gingival extension on
head which provides a positive
point for engagement of vertical or
cross elastics.
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86. BUCCAL TUBES
Round molar tubes with
0.036 internal diameter
and 0.250 length are
routinely used.
Flat oval molar tubes and
doubled back wires are
used when second
permanent molars are the
anchor teeth and also
used in mandibular dental
arch when second
premolar is absent.
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87. AUXILLARY ATTACHMENTS
In addition to the
foregoing parts, the light
round arch wire technique
requires the following
adjustments .
LINGUAL BUTTONS:
The name clearly
indicates the side of the
teeth where it is to be
welded. Used for
correction of premolar
and molar rotation.
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89. EYELETS:
Are made from thin
stainless steel stiff wires.
They are very useful in
tying the ligature wire on
anterior teeth for purpose
of rotation.
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90. CLEAT LUG
-
-
-
Are made from heavier
metal.
Welded in the centre of
lingual surfaces and
gingival 1/3 of the band.
Facilitate proper pushing
of bands to its proper
place on the tooth.
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91. SEATING LUG - HOOK
Flat or contoured bases
designed for the use on lingual
surface of all teeth.
Uses:
- for placement of
elastics
- easy insertion and
removal of band.
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92. BALL END HOOKS:
They are attached to
buccal or lingual of molar
bands. Positioned as far
gingivally and near the
mesiodistal centre of the
tooth. Make the placing of
elastic simple for patient.
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93. Bypass clamp
Pinning of the arch wire in
the premolar brackets
can cause hinderence to
free tipping.
So in stage I and stage
II Bypass clamps are
used on the premolar
brackets.
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94. Ligature wires
These are very thin (0.007 to 0.009) stainless steel soft
wires.
- They are very useful in tying of the span of looped arch
wire, which are far away from its ideal position, thus
porgressive increase In force and also avoiding plastic
deformation of the arch wire.
- Also used as extra holding devices. When one wants to
feel secure about arch wire not getting disengaged from
the bracket slot by slipping out
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95. ELASTICS
Elastics are made of synthetic latex and of uniform sizes
and applying uniform forces when stretched to required
length. These elastics come in different sizes of internal
diameter and different thickness of their wall. Thinner
walled elastics are called “light elastics” and thick
walled elastics are called “Heavy elastics”
These elastics will exert a force equal to between 60 and
70 gms when they are new and first placed.
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96. Strength of the elastics varied according to the
clinical requirement.
- LIGHT( yellow) class I or class II used for
anterior retraction.
-STRONGER ( green) class I are used for
posterior protraction.
- BLUE OR RED used only when green elastics are
ineffective.
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97. USES OF ELASTICS
Anterior retraction
Posterior protraction
Correction of deep bite
Correction of class II or class III occlusion
Closure of extraction spaces
Correction of cross bite
Correction of rotation
Anterior open bite (box elastics )
Correction of midline.
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100. EFFECTS OF CLASS II ELASTIC
In lower molar region one
vector
taking
posteriors
mesially and other vector
extruding force on molar.
On
upper
anteriors
horizontal vector will tipp
and retract anteriors distally
and
vertical
counteract
vector
the
will
intrusive
effect of upper arch wire on
anteriors.
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105. STAGES OF THE BEGG TECHNIQUE
STAGE I – OBJECTIVES
1. Open the anterior overbite
2. Overcorrect the mesiodistal relationship of the
buccal segment as necessary.
3. Close any anterior space.
4. Eliminate any anterior crowding.
5. Overrotate all teeth that require rotating.
6.Correct posterior crossbites.
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106. HOW TO ACHIEVE THE OBJECTIVES
1.Open the anterior over bite
- use 0.016 inch hard Australian wire.
- Proper amount of anchor bends at proper
locations.
-Continual wearing of class II or Class III elastics.
2. Overcorrect the mesiodistal relationship of the buccal segments as
necessary.
- Continoual wearing of class II or class III elastics
as required.
- Proper anchorage or bite – opening bends in both upper and
lower arch wires.
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107. 3. Close any anterior space:
Plain arch wire with elastic from cuspid pin tail to
cuspid pin tail.
4.Eliminate any anterior crowding:
- Vertical loops between crowded anterior teeth, with
bracket areas modified for desired overcorrections.
- Arch length designed so that intermaxillary circles
rest against mesial surfaces of cuspid brackets.
5.Overrotate all teeth that require rotating
- Overcorrection of bracket areas between anterior
vertical loops.
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108. - Use of elastic thread from buttons or brackets to
rotate cuspids and bicuspids.
- Use of rotating springs
6. Correct posterior crossbites:
- Modify arch width of one or both arch wires
-wearing cross elastics
- Rapid maxillary overexpansion, folloed by aperiod
of stabilization prior to the placement of complete
appliances and the beginning of stage I.
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109. PRIORITIES IN THE STAGE I
1. It is generally agree that reduction of overbite must
precede reduction of overjet.
2. While treating cases with anterior crowding,
alignment of teeth becomes an important consideration.
3. when the upper incisors are very much proclined they
should be subjected to a light intrusive force and a
normal retractive class II elastic force till their
proclination reduces.
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110.
Stage I arch wire :
- Made from 0.016
heat treated high tensile
stainless steel wire.
- incorporate
anchor bends, intermaxillary
hooks,toe- in, toe – out bends,
vertical loop.
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116. TOE - IN BENDS:
Incorporated in the arch wire as anti – rotational
bends. The toe in bends should never exceed more than
5 degree.
TOE – OUT BENDS
To correct the disto – buccal molar rotation.
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117. ELASTICS
To open the bite
To correct the mesiodistal relationship of buccal
segments
To close the anterior spacing
Corection of rotation
Posterior crossbite corection
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120. PROBLEMS ARISING IN STAGE I
BITE NOT OPENING:
A. Patient not wearing elastics:
- educate the patient
-do not give enough elastics
- make it impossible to hook elastics and
see if problem is reported
B. Patient biting out bite opening bends.
- Remove the arch wire : restore bite
opening bends
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121. - Check the level of mandibular molar tubes, lower thm, if
necessary.
-
Check position of anchor bends, if too far mesially, move
them closer to molar tube.
-
Failure to place proper amount of bite opening bends
when arches were placed.
-
Loose molar band
-
Improper angulations of buccal tube or entire molar
bend.
MOLAR WIDTH NARROWING:
A. Verticl component of classs II elastic force
- Form mandibular arch wire wider in posterior
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segment
122. B. Prolonged wearing of posterior cross elastics to widen
opposing molars
- discontinue cross elastics and correct cross bite by
others means.
C. Disto – lingually rotated cuspids
1. Do not engage the arch wire in the cuspid brackets
until these teeth have been rotated by elastic thread or
other means.
3. ADVERSE TIPPING OF ANCHOR MOLARS
- If tipped mesially : there is no anchor bends. If tipped
distaly too much anchor bends.
- Improper placement of molar band or tube
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123. - Excessive elastic force
- Improper placement of elastics
- Oversize arch wire – molar tipped distally.
4. NO APPRECIABLE CHANGE
- Patient not wearing elastics
- Arch wire bend out of shape
- patient seen too soon
5. VERTICALLOOPS BURIED IN THE GINGIVA
a. Original, looped arch wire left in the mouth too
long
- replace it with plain arch wire with bayonet bends
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124. b. Misjudgment in the proper direction of vertical loops
when the arch wire was plced
- remove and modify the direction of the loops and
replace.
6. ELASTICS WHICH BREAK OR DO NOT STAY ON:
a. may just be an excuse for not wearing elastics
b. elastic will not stay on the intermaxillary circle.
7.LOCK PINS LOST;
a. occluso incisal force
-use steel pin
- Chek anchor bends to facilitate opening the bite
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125. 8. EXTREMELY MOBILE MOLARS:
A. clenching of the teeth
b. intermittent wearing of elastics
c. pathology
d. excessive force applied to molar
- Reduce arch wire size to 0.016 inch
- Reduce elastic force to 2 ½ ounces
- Reduce degree of anchor bends
9. LOWER ANTERIOR TEETH TIPPING LABIALLY:
A. May be an optical illusion with roots actually moving
lingually.
b. Binding of the arch wire in bicuspid brackets
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126.
Binding of ends of the arch wire inside distal ends of
buccal tube.
10. ANTERIOR OPEN BITE NOT CLOSING:
A. patient not wearing anterior vertical elastics
B. Persistent tongue thrust or other adverse habits
c. Too much anchor bend.
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127. STAGE II
OBJECTIVES:
1. Maintain all corrections achieved during
first stage.
2. Close any remaining posterior space.
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128.
Mesiodistal molar relationship maintained
through the wearing of clasII or ClassIII elastics
as required.
Spaces between the anterior teeth are prevented
by tying intermaxillary circles to the cuspid
brackets.
Overrotations of central and lateral incisors are
maintained through the continued use of
bayonet bends in the arch wires.
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129.
Mesiodistal molar relationship maintained
through the wearing of clasII or ClassIII elastics
as required.
Spaces between the anterior teeth are prevented
by tying intermaxillary circles to the cuspid
brackets.
Overrotations of central and lateral incisors are
maintained through the continued use of
bayonet bends in the arch wires.
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130.
Overrotations of bicuspids are held by
replacing elastic threads with steel ligature
tie.
Opening of deep anterior overbite is
maintained through the continued use of
bite opening bends and class II or class III
elastics.
Closing of extraction space by wearing of
horizontal elastics.
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131. ARCH WIRE ( 0.020 SS)
- To maintain the corrections already
achieved.
- To stabilize the teeth against any adverse
reciprocal forces may occur as a result of the application of
elastics or auxiliaries.
ANCHOR BEND:
- Less compared to stage I
PREMOLAR OFFSET BEND
LOCK PIN:
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- “Stage 2” safety lock pins.
132. ELASTIC
Horizontal intra-maxillary space closing elastics
with class 2 elastics to maintain to maintain the
edge to edge.
creates rotational tendency on molar
(distobuccal).
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133.
1.
Horizontal
elastic
is
engaged on the lingual of
the molar instead on the
buccal.
2. Elastic thread tie on the
lingual, from the canine to
molar.
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134. AUXILIARIES USED IN STAGE II
Passive uprighting springs on mandibular
canine.
It establish two point contact between the
teeth and arch wire to prevent further free
tipping.
The strength of horizontal elastics
increased from 21/2 ounces to 8 ounces.
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is
135. CORRECTION OF MIDLINE
Class II intermaxillary elastics on one side and class three on
other side.
Elastic from intermaxillary hook mesial to upper canine to
intermaxillary hook mesial of the lower canine on opposite
side
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136.
Ligature wire or by – pass clamps are used on
second premolars in order to avoid overclosure of
extraction space and pushing of II premolar
lingually.
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138. PROBLEM ENCOUNTERED DURING
SECOND STAGE
Anterior bite closing:
a. Not enough anchor bend
b. Bite – opening bends bitten out
- Educate patient , correct the archwire
c. Patient not wearing the classII elastics
d. Anchor molars out of occlusion
- Discontinue class II or class III elastics.
Use horizontal elastics to get molars in occlusion.
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139.
Anterior teeth assuming class III relation
a. Excessive wearing of class II elastics
Spaces Developing Between The Anterior
teeth:
a. Failure to give cuspid tie
b. Intermaxillary circles formed too far apart.
Anchor molar rotating distobucally
a. Toe – out on arch wire
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140. Anchor molars rotating distobuccally
a. Too much force from horizontal elastics
- Use lighter horizontal elastics
- Elastic thread from cuspid lingual
buttons to the lingual hooks on the molars.
Posterior spaces not closing:
a. Patient not wearing elastics.
b.Arch wire not free to slide distally through
buccal tube.
c. Arch wire pinned or caught in bicuspid
bracket slot.
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141. d. Anterior teeth or tooth not free to tip distally:
- Use proper brackets that allow free
mesiodistal tipping.
- use safety lock pins
Second bicuspids tipping mesially in first
bicuspid:
-
Slight, expected mesial movement of anchor molar
-
Abnormal loss of anchorage, if second bicuspids
are tipping excessively.
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142. STAGE III
OBJECTIVES:
1. Maintain all corrections achieved
during first and second stages.
2. Achieve desired axial inclinations of
all teeth.
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143. - Posterior spaces kept closed by bending the distal ends of
the arch wires around the buccal tubes.
-
Arch form and overbite corrections maintained by using
heavier (0.018 to 0.025) main arch wires.
- Changes in the mesiodistal inclinations of teeth are
accomplished by the use of individual root – tipping springs.
- Lingual or labial root torque is applied to anterior teeth
through the application www.indiandentalacademy.comauxiliaries.
of torqueing
144. STAGE THREE UPPER ARCH WIRE
Made by 0.20 s.s
Constricted in distal ends.
Gingival bend distal to cuspid
bracket.
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145. STAGE III LOWER ARCH WIRE
Made by 0.20 round s.s.
Expansion in distal ends.
Molar offset bend
Mild anchor bend distal to
canine.
Slight vertical step in the
anchor bend area.
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146. AUXILIARIES USED IN STAGE III
UPRIGHTING SPRING:
Used to correct the axial angulation of
teeth in mesio – distal direction.
Made by 0.014” round S.S
for canine and premolars,
0.012 for laterals.
Helix of spring face towards tooth
surface and lie on the gingival aspect of
arch wire.
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147.
The degree of activation of spring depends on
1. The size of wire from which spring is made
2. The diameter of the helix
3. The number of turns in helix
4. The length of the arms of spring
5. The size of the root of the tooth being
uprighted
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148.
Arch wire ligation prior to
placement of uprighting
spring
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149. TYPES OF UPRIGHTING SPRING
A combination safety lock
pin and uprighting spring
that eliminates the need
for ligating the arch wire
to the bracket. Locked in
place by bending the tail
of the spring around the
body of bracket.
Available as two coil and
three coil from .014
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150. PLAIN UPRIGHTING SPRING
Made of 0.014 for uprighting
canine and premolars, 0.012 for
incisors.
The angulation of the active arm
and retentive arm is 135 degree.
The helix with retentive arm
should face the tooth surface.
The base arch wire is ligated,
otherwise the action of uprighting
spring will extrude the tooth .
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151. -The
length of hook is made greater than the diameter
of the helix to keep the arm of the spring parallel to the
arch wire in the vertical plane.
--
To avoid a rotating force on the tooth, the arm of the
spring is offset buccally to make it parallel to the arch
wire in the horizontal plane.
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152. The degree of activation of the uprighting springs depends
on:
1. The size of wire
2. Diameter of helix
3. Number of turns in the helix
4. Length of the arm of the spring
5. The size of the root being uprighted.
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153. MINISPRING
Made of thinner diameter
(0.009) high resilient supreme
grade wire.
The coil of springs is only twice
the size of the wire.
The activation is 100%, the
stem and active arm are in one
line.
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154.
The hooks of short –
arm uprighting springs
will slide along the arch
wire and approach each
other as teeth upright.
If long arm uprighting
springs are used, the
arms of premolar and
canine cross each
other.
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155.
The rotational
component of the
tooth displacement,
caused by a single
force application, is
generally unfavorable.
Hence it is resisted by
applying a counter
moment as by
uprighting sping
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157. TYPES OF TORQUEING AUXILIARY
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
TWO SPUR TORQUEING
AUXILIARY
FOUR SPUR
SIX SPUR
RECIPROCAL
SHORT FOUR SPUR
INDIVIDUAL
ONE TO ONE
RECIPROCAL
LOWER REVERSE
RAT - TRAP
ASYMMETRICAL
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158. FOUR SPUR TORQUEING AUXILLARY
Used for torqueing the upper
anterior teeth palataly
Preformed from .016” wire
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159. TWO SPUR TORQUEING AUXILLARY
Used when lateral incisors do
not require palatal root torque ,
as in extraction cases when
upper laterals were displaced
slightly palataly.
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161. RECIPROCAL TORQUEING AUXILIARY
-
Indicated when the upper
lateral incisors were blocked
out palatally before treatment.
Their root apices must be
torqued labially to reduce the
tendency for the crowns to
relapse lingually.
-
Lever arms on laterals pass
incisaly for labial root torque.
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162. SHORT FOUR – SPUR TORQUEING AUXILIARY
Indicated for torqueing of
upper anterios.
Does not engage cuspid
bracket
Easy to fabricate.
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163. INDIVIDUAL TORQUEING AUXILIARY
Used for selected upper or
lower teeth
Auxiliary should extend at least
one tooth pass tooth being
torqued, and around curve of
arch, for maximum activation.
If placed gingivally, torque the
root of the lateral lingually.
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164. REVERSE TORQUEING AUXILIARY
Indicated if lower anterior
teeth are becoming too
proclined.
Acts as a source of intra
oral mandibular
anchorage to inhibit
forward movement of
mandibular dental arch.
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165. ONE TO ONE TORQUEING AUXILIARY
Indicated when two
adjacent teeth require
root torque in opposite
directions.
Tends to deliver
excessive force therefore
degree of activation
between lever arms
should be low
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166. RAT - TRAP TORQUEING AUXILIARY
Main arch wire is formed
from 0.020 inch round
wire.
The auxiliary is wound
from either 0.014 or
0.016 inch highly resilient
round wire.
The torqueing “bars” do
not extend to the gingiva.
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167. ASYMMETRICAL TORQUING
AUXILIARY
Auxiliary used to produce palatal root torque of
the maxillary right central and lateral incisors.
The ends of the auxiliary are terminated distal to
the canine brackets.
As the central incisor loop is formed mesial to the
bracket and the lateral incisor loop is formed distal
to the bracket mesodistal movement of the auxiliary
is prevented.
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168. 1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Two spur arch
Four spur arch
Modified four spur
Art four – spur
Modified Kitchon 2 – spurs
Kitchon two finger spur
F and J two spur arch
Von der heydt two – spur
arch
Modified reverse torque
arch
Sain reverse torque arch
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169. The lingual torquing effect is on account of two
factors:
1. Vertical plane changes to horizontal.
2. Smaller circle opens to large.
Both these effects force the tips of the
spurs to press in a lingual direction against the
gingival portion of the crown. Reciprocally, the
inter – spur spans of the auxiliary tend to lift away
in a labial direction. Thus a force couple is
created. The labial forces are resisted by the
bracket slots and the base archwire to which
auxiliary is tied this accentuates the action of root
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lingual moving force.
170. PROBLEMS ENCOUNTERED DURING
STAGE III
Maxillary Molars Widening:
A. Anchor bends present in maxillary arch wire.
b.Too much bite – opening bend between cuspid
and bicuspid
c. maxillary arch wire too small in diameter.
d. Maxillary arch wire too wide.
e. Torqueing auxillary not constricted adequately.
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171.
Mandibular molars narrowing
a. Lower arch wire not wide enough
b. class II elastics exerting too much force
c presence of steel ligature tie from the lingual of
the mandibular cuspid to the lingual of the
mandibular molar
Anterior bite deepening:
a. Too much power in the torqueing auxillary
b. Maxillary arch wire too thin.
c. Patient not wearing class II elastic
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172.
Teeth not uprighting mesiodistally:
A. springs not active
B. Arch wire caught on the edge of the bracket
- Tighten spring – pin to draw arch wire in
bracket
- Draw arch wire into bracket with a steel
ligature tie
C. Occlusal interference caused by an elevated
tooth.
D. Springs placed in backwards
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173.
Teeth not uprighting mesiodistally:
A. springs not active
B. Arch wire caught on the edge of the bracket
- Tighten spring – pin to draw arch wire in
bracket
- Draw arch wire into bracket with a steel
ligature tie
C. Occlusal interference caused by an elevated
tooth.
D. Springs placed in backwards
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174.
1.
2.
Maxillary anterior teeth not torqueing palatally
Not enough force from maxillary torqueing auxiliary
Maxillary incisal edges caught lingual to lower
anterior teeth
Lower anterior teeth labially inclined
Normal mesial migration of teeth during third
stage
Rotation of teeth other than molars
Lack of complete bracket engagement
Arch wire slot too large.
1.
2.
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175. It was partly through studying Stone age man’s attrition that
light tooth moving forces were found to make higher standards of
orthodontic treatment possible.
Furthermore, the light wire technique is unique in that the tooth
moving forces it exerts are so appropriate that extra – oral forces are
never required neither to enhance nor to combat the force values exerted
by it.
The advent of this technique provides common ground for
agreement between the school of thought advocating movement of tooth
roots to their correct relations and the school advocating light forces.
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