Conventional begg's stage 3 in orthodontics /certified fixed orthodontic courses by Indian dental academy

The Begg Appliance
and Technique
Stage III
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INDIAN DENTAL ACADEMY
Leader in continuing dental education


Outline
► Introduction

► Tooth Relationships at start of Stage III

► Bending of Main Arch Wires for Stage III
► Auxiliaries used during Stage III

- Uprighting Springs
- Torqueing Auxiliaries
► Application of third stage arch wires and auxiliaries
to teeth
► Additions and modifications in stage III mechanics

Introduction
► The third stage of treatment should be

commenced only after the completion of all the
objectives of preceding stages.
► Objectives of stage III
1.Maintaining all the corrections achieved
during first and second stages.
2.Achieve desired axial inclinations of all
the teeth.


Tooth Relationships at start of
Stage III
► The teeth of a four

bicuspid extraction
case should appear
as shown in the fig.
► Bicuspids in good
occlusion and the
anterior teeth slightly
apart.
► Anterior teeth lingually inclined, and
bicuspids and cuspids need root paralleling.

Bending of main arch wires for Stage
III

► To maintain proper dental

arch form and bite-opening
achieved during treatment,
new heavier arch wires are
used.
► Maxillary arch wire bent from
0.020 inch round arch wire
material and slightly
constricted in its distal bends
to counteract the widening
effects of the maxillary
torqueing auxiliary.


Proper arch form of stage III
0.020 arch wire.

► The upper arch wire is

passive (vertically) in
the molar tubes.
► It has a slight gingival
bend distal to the
cuspid bracket area to
counteract the occlusal
vectors of force
created by all anterior
lingual root torqueing
auxiliaries.

Maxillary 0.020 inch arch wire as viewed
from the buccal.
Anterior portion is offset gingivally to
counteract the incisal force generated by
most torqueing auxiliaries.


► The mandibular arch

wire used is 0.020 inch
round wire.
► Expansion
incorporated (slight).
► Anchor bend
continued, but it is not
as pronounced as that
present during stage II.

Proper mandibular arch form for
stage III made from 0.020 inch
wire.


► A mild bend placed

distal to the
mandibular cuspid
bracket area to reduce
any tendency for
recurrence of an
anterior overbite during
stage III.
► A slight vertical step in
the anchor bend area.

Buccal view of stage III arch wire. Note
the slight anchor bend and a bend to
depress the anterior teeth.


Auxiliaries used during stage III
► The two

main auxiliaries :
► Individual Root Springs or Mesio distal uprighting
Springs.
► Torqueing auxiliaries.


Uprighting Springs
►
1.
2.
►
1.
2.

Original Spring.
Smaller & fewer coils.
A longer lever arm.
Refinement of
original spring.
Larger more resilient
coils.
Short lever arm.

►
1.
2.

Advantages of
Short Springs:
They are Selfretaining.
Being short they do
not interfere with
springs on
adjacent teeth.


Spring - Pin
► A problem inherent in all uprighting springs is

that, when engaged and under tension, the coil
presses against the gingival edge of the
beacket.
► If arch wire is not safely tied into the slot of the
bracket, this force from the coils can cause the
bracket to move away from the arch wire, with a
subsequent elongation of the tooth.


► As a solution to this

problem authors have
invented, Spring
Pin.
► A Combination of a
Lock Pin and an
Uprighting Spring.
► The leg of the pin
portion passes lingual
to the arch wire and
the tail fits labial to it
in the space in the
bracket that normaly
accepts the lock pin.


► The arch wire is so held securely( yet loose) in

the bracket slot, and the tooth is free to upright
mesiodistally with no danger of its being
elongated.


Torqueing Auxiliaries
► To torque roots of the maxillary anterior teeth

lingually.
► Torqueing is nearly always necessary
(especially with upper incisors) in mild
discrepancy cases that require extraction of the
four first premolars i,e in cases having only a
mild excess of tooth substance relative to jaw
size.
► This is because crowns of the incisors tipped
back a long way lingually to close the extraction
spaces.

► It is usually unnecessary to torque incisor roots

lingually in four first premolar extraction cases that
have considerable excess of tooth substance
relative to the jaw size.
► The extraction spaces are more prone to close
quickly than in mild discrepancy cases.
► Therefore, the extraction spaces close before the
crowns of the incisors are able to tip very far back.


► It is always necessary to torque the incisor roots

lingually, usually both the upper and the lower
incisor roots, in severest discrepancy cases.
► This is because it is necessary to extract eight
teeth in these most severe discrepancy cases i,e
4 first PM’s & 4 first permanent M’s.
► The extraction of these eight teeth leaves a
large amount of space that needs to be closed
by the tipping of the incisors and in the process
they would have moved a long way lingually.

► It is sometimes necessary to torque the roots

lingually in non extraction cases also, especially
in those that have an excess of jaw substance
relative to tooth size.
► In most of the patients, by the end of the second
stage of treatment (and sometimes before this
time), it becomes quite obvious that whether it is
necessary to torque incisor roots lingually or not.


► Originally spurs, to rest against the labial

surfaces of the upper centrals and the laterals,
were bent into the main maxillary arch wire i,e
0.016 inch arch wire material.
► The torque force was transmitted in a spiral
manner along the main arch wire to the anchor
molars.
► Effect was to move the molars buccally and
rotate them distobuccaly.
► By employing a heavier main upper arch wire in
conjunction with the torqueing auxiliaries bent
from lighter material( 0.014 to 0.016 inch), it is
possible to prevent undesired movement of the
maxillary anchor molars.

► At present, there are

many different designs
for anterior root
torqueing auxiliaries.
► Probably the most
popular is the original
four- spur type.

Four spur torqeing auxiliary. Applied
gingival to the main arch wire. Left in place
until the upper anterior teeth are overtorqued.


Bending the four-spur auxiliary
► Root torqueing spurs,

when used to move to
roots of anterior teeth,
are formed in such
positions that they will
exert force as close to
the centers of labial
surfaces of the tooth
crowns as possible.

► Bend the auxiliary

using 0.014 or 0.016
inch diameter arch
wire material, working
from left to right.
► The novices can cut
the wire and straight a
6 inch length of wire.
► Place the
straightened wire in
the central incisor
brackets, centered by
eye, and the ends
pulled incisally.


► This automatically begins

the bends for the mesial
legs of both central
incisor spurs.
► These spurs are
completed, bending them
so that they lean slightly
towards the midline.
► The wire is then returned
to the mouth and
grasped by light wire
pliers.

► After being removed

from the mouth, the
mesial leg of the left
lateral incisor spur is
formed by bending
the wire around the
pliers.
► The spur is
completed, bending it
with the same mesial
inclination as given to
the central incisor
spur.

► The wire is returned to the mouth, placed in the

brackets and the right lateral incisor spur is bent
following the same procedure as was done for
the left one.
► The auxiliary which now has four torqueing
spurs, is placed again in the mouth and the distal
ends are cut off midway between the cuspid and
the second bicuspid brackets.
► Ends are curled back on themselves, as a
protective measure.


Activating the four spur auxiliary
► Using the light wire pliers, the auxiliary is formed

into an arc smaller than that of the anterior
portion of the patient’s dental arch, with the
spurs in a nearly horizontal position.
► This constricted arch form of the auxiliary
counteracts the reciprocal forces applied to the
arch wire when the auxiliary is engaged, which
tend to widen the dental arch.
It also guarantees that the
maximum amount of torque
force is derived from each
auxiliary.

► If it is found that the auxiliary needs to be formed

into a smaller arc, the original bends at the base
of the distal legs of each spur can be increased.
► Another method is to place a slight “V” bend
midway between the spurs.
► Both measures will cause the distal ends of the
auxiliary to move together.


► The final modification in the torqueing auxiliary is

the bending of the “Cuspid-Curve” in the
distal arms.
► In the passive state this curve will cause the
arms to appear to drop below the level of the
main arch wire.
► When the torqueing auxiliary is applied, these
distal arms will be rotated by the spurs striking
the labial surfaces of the anterior teeth.
► This curve will then follow that of the main arch
below.


Pre-Wound Torqueing Auxiliary
► This Pre-Wound (Rat-Trap type) auxiliary was

originally devised by one of the author (P. R.
Begg) in the early 1950’s.
► Graduated sizes are available to fit varying
mesiodistal widths of the teeth.
► It is simpler to apply and is capable of delivering a
greater force through a greater range of
movement than other type of auxiliaries –
regardless of the size of wire used in its
construction.

► 0.014/0.016 inch round wire.
► A small incisal offset or “V”

bend, in the midline of the
main arch wire acts as a
reciprocating stop for the
auxiliary.
► Since this type of auxiliary is
activated by meeting the
resistance of the stop in the
midline of the arch wire, it is
more effective in torqueing
when only central incisors
require torqueing.


► When the maxillary lateral

incisors need their roots to be
brought labially, as is usually the
case if these teeth were
displaced lingually, prior to
treatment, the pre-wound
auxiliary can be modified.
► The lateral torque bars are
overwound so that they fall in a
plane approximately 90 to the
plane of the central incisors
torque bars.

Application of the third stage arch
wires and the auxiliaries to the teeth
► Place the upper and lower

arch wires in the mouth.
The lower arch wire is
pinned in place.
► Place the proper springpins in the brackets of all
the mandibular teeth
requiring mesiodistal
uprighting and in the
maxillary second premolar
brackets.


► The proportion of the uprighting force delivered

to each tooth is related to its proximity to the
point of engagement of the arm of the spring and
to the flexibility of the arch wire.
► The use of heavier arch wires has reduced any
ill effects from the reciprocal forces delivered by
the uprighting springs or torqueing auxiliaries.
► Normally, in a case requiring pretreatment
extraction of first premolars, the lower canines
require the greatest amount of mesiodistal
uprighting.

►
1.
2.
3.
4.
5.
6.

The order of descending need of the remaining
teeth to be uprighted:
Lower canines
Upper canines
Lower second premolars
Upper second premolars
Upper lateral incisors
The lower lateral incisors ( requiring the least
amount of force)

►

►

1.
2.
3.
4.

The forces on the teeth can be varied by using
springs fashioned from different sizes of wires
and having either two or three coils.
The following types of springs, or spring-pins,
deliver the amounts of forces that are required
in a four first premolar extraction case during
stage III.
Upper and Lower Canines- 0.016/0.018 inch &
2-coils
Upper and Lower Second Premolars- 0.016
inch & 2-coils
Upper Lateral incisors-0.014 inch & 2-coils
Lower Lateral incisors-0.014 inch & 3-coils.

► Pin the upper torqueing

auxiliary in one of the
maxillary central incisors
brackets. The distal
ends of the auxiliary
wire then pinned into the
canine brackets gingival
to the main arch wire
with spring-pins.


► Spring –pins are then placed on the upper lateral

incisors, which usually require their roots to be
torqued distally, and on the upper second
premolars.
► Normally the centrals do not require mesiodistal
uprighting and are pinned to the arch wire with
stage III lock pins.


► In order to prevent the creation of the spaces in the

dental arches due to pressures on the teeth from
the anterior root torqueing auxiliaries and individual
uprighting springs, the ends of the arch wires are
bent around the distal of the molar tubes.
► The upper arch wire can be bent so that it rests
against the molar band occlusally to the molar tube.


► This gives an increased axial inclination control in

the bucco-lingual direction, and also helps prevent
maxillary molar flaring during stage III.
► When bending the end of the arch wire, care
should taken to prevent the beaks of the pliers
from resting against the distal surfaces of the
tubes.
► This can set up a Camming Action that results
in the arch wire being drawn distally through the
molar tube with such force during bending that the
arch wire can be permanently distorted in the
maxillary hook area.


Additions and modifications in stage
III Mechanics
► If the maxillary or

mandibular anchor molars
show signs of rotating
distobuccaly, tie with 0.012
inch diameter ligature wire
from the lingual of the
molar to the lingual button
on the cuspid.
► This tie helps to control the
rotations of the molars.

► Some times it is not desirable to torque the roots

of all four maxillary anterior teeth lingually.
► If it is felt that only the central incisors are to be
torqued, an auxiliary with two spurs is used.
► Maxillary laterals often displaced bodily to the
lingual prior to treatment. During stage I & II, the
crowns of these teeth are tipped labially, leaving
their roots too far lingual.
► Assuming that the central incisors require the
usual lingual torque, an auxiliary shown below
(on right side) can be used.


► Another lingual root

torqueing auxiliary that can
be easily applied and
removed has been invented
by Dr. Jhon Kichton.
► It can be made to include
both the centrals and
laterals, or shortened to
torque centrals only.

• This type of auxiliary is capable of exerting a
great amount force, especially when fashoined
from 0.016 inch wire and used in conjuction
with 0.020 main arch wire.

► The use of a torqueing auxiliary (0.016 inch)

in
conjunction with a heavy base arch wire (0.020
inch) with a vertical spur in the midline.
► Vertical spur in the midline bent into the main
arch wire, acts as a point of resistance against
center section of auxiliary.


► Maxillary arch wire with a gingivally directed stop

bent in the midline being used in conjunction with
a 0.014 or 0.016 inch auxiliary to torque the roots
of the lateral incisors labially.


Reverse Torqueing auxiliary
► In a properly treated four first bicuspid extraction

case, the anchor molars( entire dental arches)
are brought farther forward during the third stage
than during previous stages.
► In the severe tooth mass discrepancy cases, the
mandibular dental arch may assume its desired
mesiodistal positioning on basal bone before
stage III is compelted.
► In order to retard further anterior movement of
the lower dental arch and to upright the
mandibular incisors, which usually becoming
labially inclined, A Reverse Torqueing Auxiliary
is applied.

► The vertical spurs exert

labial pressure against
the lingual surface of the
main arch wire, while the
horizontal sections press
lingually against the
labial surface of the four
incisors.
► This causes the roots of
these teeth to move
labially and their crowns
to attempt to move
lingually.

► Since there are no spaces left

between the crowns of the
teeth in the third stage, lingual
movement of the crowns is not
possible.
► The force is passed on distally
through the contact points
between the teeth to the
mandibular molars.
► This reverse torqueing thus
becomes an excellent source
of intraoral anchorage duing
stage III.

The Begg
Appliance and
Technique Stage
III

Outline
► Objectives of stage III
► How Objectives are achieved
► Problems and their remedies of stage III
► Causes of loss of anchorage in stage III
► Positions of teeth at the end of stage Three
► Stage III models
► Conclusion

Objectives of Stage III
Maintaining all the corrections achieved
during first and second stages.
2. Achieve desired axial inclinations of all
the teeth.
1.


How Objectives are achieved
1. Maintaining all the corrections achieved
during stages I & II.




Mesiodistal molar relationship maintained
through the wearing of class II or class III
elastics as required.
Original spaces between anterior teeth are
prevented from recurring by tying
intermaxillry circles to the cuspid brackets
with steel ligature wire.






Over corrections of cuspids are maintained by
engaging the brackets which have been offset on
the teeth.
Over corrections of bicuspids are held by replacing
elastic threads with steel ligature ties.
Over corrections of central and lateral incisors are
maintained through the continued use of bayonet
bends in the arch wires.










Opening of a deep anterior overbite is
maintained through the continued use of biteopening bends and class II or class III elastics.
The correction of posterior crossbites is
maintained by modifying the archwire or by
wearing of cross elastics as necessary.
Posterior spaces kept closed by bending the
distal ends of the arch wire around the buccal
tubes.
Arch form and overbite correction maintained by
using heavier (0.018 to 0.025) main archwire.


2. Achieve desired axial inclinations of the
teeth.




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 of
torqueing auxilaries.


Problems that may be encountered during
the third stage and their remedies
1. Maxilary molar widening:
Cause

Remedy

A. Anchor bends

A.

present in
maxillary wire.

Remove the maxillary arch wire
and eliminate or reduce the
anchor bends so that arch wire
does not exert excessive gingival
force on the maxillary molars.


1. Maxilary molar widening:
Cause

Remedy

B. Too much bite

A.

Remove the arch wire and
lessen the degree of bend.

A.

Construct a new arch wire
from hard 0.020 inch round
wire.

opening bend
between cuspid and
bicuspid.
C. Maxillary arch wire
too flexible ; i,e too
small in diameter.


1. Maxillary molar widening:
Cause

Remedy

D. Maxillary arch wire too

A.

Remove and modify the
arch wire.

A.

Remove auxiliary and
modify – narrow in posterior
or shorten so that it ends
between cuspid and
bicuspids.

wide .
E. Torqueing auxiliary
not constricted
adequately or
extended too far
distally.


2. Mandibular molars narrowing:
Cause

Remedy

A. Lower arch wire not wide
enough.

A.

B. Class II elastics

A.

exerting too much force.

Remove and widen distal
ends of arch wire.
Use lighter elastics
( 2 to 2 1/2 ounces ).


Cause:

Remedy:

A. Presence of steel
ligature tie from the
lingual of the
mandibular cuspid
to the lingual of the
mandibular molar.

A.

Remove the lingual tie.
Hold the spaces closed
by bending the arch wire
around the distal of the
buccal tube.



Cause:

Remedy:

A. Lack of support

A.

through the occlusal
contact with the
maxillary molars.

Use posterior cross
elastics and check
symmetry of both arch
wires.


3. Anterior bite opening:
Cause:

Remedy:

A. Too much power in

A.

the torqueing
auxiliary.

Less activation in
auxiliary, or make
auxiliary from smaller
size wire.


3. Anterior bite opening:
Cause:

Remedy:

B. Maxillary arch wire too

A.

thin.

Use heavier main third
stage arch wire.

C. Patient not wearing

A.

Educate patient.

A.

Remove all torqueing
mechanisms ; return to
stage I.

class II elastics.
D. Bite not open at
beginning of stage 3.


4. Teeth not uprighting mesiodistally:
Cause:

Remedy:

A.

A.

Springs not active.

Arch wire caught on
the edge of the
bracket.

Remove and activate
spring.

B.

A.

Use spring with more
reseliency.

A.Tighten spring-pin to draw

arch wire in bracket.


4. Teeth not uprighting mesiodistally:
Cause:

Remedy:

A. Springs placed in
backwards.

A.

Remove and replace properly.

B. Occlusal

A.

Remove band and move
bracket incisally to cause
leveling of teeth.

interferences
caused by an
elevated tooth.


5.Maxillary anterior teeth not torqueing
palatally.
Cause:

Remedy:

A. Not enough force

A.

Remove and reactivate.

from maxillary
torqueing
auxiliary.
B. Maxillary incisal

B.

Make a new auxiliary from
heavier wire.

A.

Open the bite by arch wire
modification or by placing
anterior brackets farthe to
the incisal.

edges caught
lingual to lower
anterior teeth.


6. Lower anterior teeth labially inclined:
Cause:

Remedy:

A. Normal mesial

A.

If near the end of stage III, do
nothing.

B.

If in the middle of stage III,
place reverse torqueing
auxiliary to upright lower
anterior teeth.

migration of teeth
during third stage.


7. Rotation of teeth other than molars
Cause:

Remedy:

A. Lack of complete

A.

Seat arch wire completely in
the bracket slot, using a
spring pin or steel ligature.

A.

Recement band with bracket
in proper location.

bracket
engagement.
B. Bracket off center
of labial surface of
teeth.


Causes of loss anchorage
► If class II elastics are not worn during the

third stage, the upper dental arch as a
whole will move too forward while the roots
of the teeth of both dental arches are being
uprighted.
► Use of rectangular arch wires during third
stage to torque tooth roots instead of using
root torqueing spurs formed from light round
arch wires.

Positions of teeth at the end of
stage III

End of Stage III with perfect parallelism
of canine and premolar roots.


Stage III Models
1. Basically for teaching purposes
2. To check the arch width and the contour
3. Self-discipline to complete the third stage
4. To check the inclination of the upper and
lower anterior teeth – the impression
should be deep to appreciate
5. To see as to how anchorage was
maintained in treatment
6. It is certainly a visual aid for the patient and
parents

Conclusion
The Begg Stage III treatment phase is more
complex than for the previous once, involving
the application of many auxiliaries.
The careful understanding and practicing of
Begg Technique helps us to provide an optimum
treatment to the patient.
The good beginning brings the good end &
the good end should always depict what it meant
to be at the beginning….

Leader in continuing dental education


Conventional begg's stage 3 in orthodontics /certified fixed orthodontic courses by Indian dental academy

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