American Journal of’ ORTHODONTICS

Founded in 1915 Volume 81, Number I January, 1982

Copyright 0 1982 be The C. V. MO& Compun~

ORIGINAL ARTICLES

Orthodontic force systems:

Technical refinements for
increased efficient y
Dr. Hocevar

Richard A. Hocevar, D.M.D.*

Gainrsville, Fla.

The efficiency of the Begg technique suffers because Class II elastics overwhelm anchor bends, which normally
do not yield enough force for vertical control of maxillary incisors. This can be improved by attention to detail and
modifications. Bite-opening bends in the arch wires distal to canines and lateral incisors, long (6.5 mm.)
mesiogingivally angulated molar tubes, and placement of intermaxillary elastics at the distal ends of the tubes are
all helpful. Intermaxillary “check elastics,” having one end over the posterior end of the maxillary arch wire, both
strands under the end of the mandibular arch wire, and the other end up to the maxillary anterior teeth, reinforce
anchor bends and extrude upper and lower molars while keeping them upright. They augment bite opening in
Stage I and counteract the adverse affects of the auxiliaries in Stage Ill.

Key words: Begg technique, biomechanics, incisor intrusion, check elastics, overbite reduction

A recent article’ reviewed the physical
principles governing tooth movement and gave some
consideration to ways in which biologic response might
differ from that which might be expected from superfi-
cial application of the laws of “pure physics. ” The
present article considers the clinical application of those
principles more closely and offers suggestions, based
on them, for more efficient use of fixed appliances,
giving particular attention to the Begg technique.
BEGG STAGES I AND II
The maxillary incisors
All aspects of any “light wire” treatment require
careful consideration of the anticipated directions of
tooth movement and delicate balancing of the forces
delivered by arch wires and elastics; this is especially
important for management of the upper incisors. Ten
*Associate Professor, Department of Orthodontics, College of Dentistry,
versity of Florida.
Hoeve, Mulie, and Brandt’ and Burstone” have exam-
ined this subject and suggest that treatment planning for
any patient should involve consideration of the desir-
ability and feasibility of maxillary incisor intrusion.
Sims4 implied that he believed incisor retraction should
be controlled in such a way as to limit retroclination,
but he did not explain how this was to be accomplished.
Ten Hoeve and Mulie criticized excessive retroclina-
tion and advocated intrusion of upper incisors early in
treatment. It is difficult to achieve this sort of control of
maxillary incisors with conventional Begg treatment.
The vertical extrusive force component of “Class
II” elastics on the upper incisors is counteracted by the
force in the opposite direction delivered by the anchor
bend in the arch wire mesial to the maxillary molar. If
the magnitudes of these two vertical forces are equal,
the upper incisor experiences only the horizontal com-
ponent of the elastic force. This horizontal force tips
the upper incisor crown lingually as shown in Fig. 1, A.
Uni-
Should the vertical component of the Class II elastic be
larger than that of the arch wire anchor bend, then the

0002.9416/82/010001+ I l$Ol. 10/O 0 1982 The C. V. Mosby Co. 1

2 Hocevur
e=f
a I a
d
D E
Fig. 1. Vector analysis of forces. a, Arch wire anchor
Class II elastic. d, Resultant of a and c. e, Horizontal
Vector lengths are proportional to force magnitudes.
incisor is affected by the resultant force of the horizon-
tal vector and the two vertical vectors, which has a
similar effect, that is, rotation of the incisor about an
axis at CR (Fig. 1, B). If the anchor bend produces a
larger intrusive force, the resultant, depending on the
inclination of the incisor, may pass through the root and
produce some translation as well as rotation (Fig. 1, C).
If the force system is maintained as the tooth retro-
clines, the moment arm increases; hence, the propor-
tion of rotation will increase in relation to the amount
of translation.’ Furthermore, as maxillary anterior teeth
are retracted and mandibular molars protracted, the di-
rection of pull of the Class II elastics becomes more
vertical; the resultant vector, f, falls farther away from
CR, and the relative amount of rotation increases still
more. If anchor bend and elastic were in such a balance
that their resultant force passed directly through its CR,
the upper incisor would move bodily along the line
from bracket to CR (Fig. 1, D). With the anchor bend
force much stronger, thus placing the resultant vector
anterior to CR but still within or very close to the root
area, the response would be flaring and some intrusion
:
d
bend. b, Class II elastic. c, Vertical component of
component of elastic. f, Total resultant force.
(See text for explanation of situations A-F.)
(Fig. 1, E). With anchor bend forces strong enough to
throw the resultant farther anterior to the root area, the
incisor would rotate about the CR, with the incisal edge
going anteriorly and the apex posteriorly (Fig. 1, F).
Unless some form of couple is employed, for any
given incisor position there is a unique line of pure
translation. Since pure translation occurs only with a
force vector through the CR, this unique line is defined
by the line traversing the bracket and CR (Fig. 1, D).’
Thus, a somewhat retroclined incisor may be translated
only in a relatively vertical direction and a proclined
incisor in a relatively more horizontal direction. As-
suming that the same Class II elastic force is used,
translation of a retroclined incisor requires a much
stronger force from the anchor bend than does transla-
tion of a proclined one. In fact, proclined incisors could
be “flared” inadvertently by excessive anchor bend
force (Figs. 1, E and F).
Fig. 2 depicts a typical Class II, Division 1 incisor
relation and the tooth movement that would be required
if it were to be corrected in such a way as to maintain
the edge of the upper incisor at its original level. The
Vdume 8 I
Number I
Fig. 2. Reducing this overjet without allowing
upper incisor to drop would require a balance
probably impracticable with conventional Begg technique.
posttreatment projection of the lower incisor is derived
by summation of estimates of lower incisor intrusion
and molar extrusion (that is, bite opening from all
sources except upper incisor intrusion). No anteropos-
terior movement of the lower incisor was desired. This
case is a Begg technique archetype, but it is, in fact, at
the very limit of the capabilities of the technique. The
upper incisor would have to be intruded and retracted
considerably beyond its projected final position in an-
ticipation of its response to Stage III uprighting, even
though the torque requirement would be minimal.
Maintaining a force system to produce the line of force
shown, keeping it in balance for the required time,
would be very difficult; in fact, it is quite unlikely that a
force sufficiently vertical to prevent the incisors’ drop-
ping could be sustained.’
Retroclined upper incisors, as in Class II, Division
2 cases, require forces directed more vertically early in
treatment. The conventional system which depends on
Class II elastics is unsatisfactory in these cases, as it
cannot produce a resultant force with a strong enough
upward component; thus, the incisors are retroclined
further and not elevated (Fig. 3).
Fig. 1, C shows that if the anchor bends are to make
even a minimal initial contribution toward translation,
the force they deliver must be roughly equal in mag-
nitude to that delivered by the Class II elastics; for
example, if the elastic pull is 60 grams per side, the
“intrusive” force of the upper arch wire at the midline
must be 120 grams. Sims’ listed forces produced by
anchor bends in various situations. As he did not spec-
Orthodontic ,force systems 3
b
a
the edge of the Fig. 3. Class II, Division 2 incisor relation. Force a, while its
of forces that is direction is even more vertical than that shown in Fig. 2, would
produce only further retroclination in this situation. Intrusion
would require that the total resultant force on the incisors act in
direction b. Following intrusion, a posteriorly directed force and
a couple to produce lingual root torque would be required to
achieve the desired final position indicated by the shaded
incisor.
ify the buccal tube length or angulation, length of arch
wire, or the distance the wires were deflected, his
figures can be taken as only rough indications but
should serve to alert us to a sobering realization. The
maximum force he listed was 70 grams, which required
either 45degree anchor bends in 0.5 mm. (0.020 inch)
or 80-degree anchor bends in 0.04 mm. (0.016 inch)
wire; a 0.04 mm. wire with 45degree anchor bends is
said to deliver only 35 grams! Swain7 cites comparable
figures, and I have found them to be clinically realistic.
Thornton and Nikolai8 recently studied the vertical
forces resulting from various combinations of arch
wires and elastics to determine the “intrusion poten-
tial” of the Begg applicance, but they overlooked the
most important factor in maxillary incisor movement-
the direction of the total resultant force and its relation
to CR. Their apparatus prevented posterior movement
of the arch wires and measured only the vertical force
component. Teeth are not affected by the magnitudes of
various components of force systems; they experience
only the total resultant force, as shown throughout Fig.
1. The fact that there may be a vertical component to
the force does not necessarily demonstrate that the
appliance has an “intrusion potential. ” Most Begg
practitioners are probably using anchor bends that con-
tribute little or nothing of significance to the upper
incisor retraction force system. On the other hand,

Fig. 4. Lateral open bite caused by arch wire
stronger anchor bends induce more distal tipping of the
molars.
The addition of more horizontal force in the form of
“Class I” elastics makes it even more difficult to
achieve anything more than pure tipping about CR’ in
Stage II. If Stage I has been managed well, there is
frequently little or no need for a maxillary Stage II (in
Class II cases) or, if some maxillary space does remain
after Stage I, the need for further Class II elastic wear
may be minimal, so the upper incisors will be affected
by the resultant force of anchor bends and Class I elas-
tic only. Even so, once the incisors have begun to ret-
recline, it is probably unrealistic to expect to achieve a
force balance that will yield any significant element of
translational movement with conventional Begg me-
chanics.
Improved arch wire design. Many cases treated
with the Begg technique display varying degrees of
open-bite in the canine-premolar area during treatment,
some of them developing it in Stage I and retaining it
until the appliances are removed (Fig. 4). This points
out a deficiency in standard arch wire design. In a typi-
cal case, as a conventional arch wire with anchor bends
is deflected so as to seat fully into the central incisor
brackets, it bows in such a way that it lies at, or just
gingival to, the entrance to lateral incisor brackets and
definitely gingival to the canine brackets (Fig. 5, A).
Pinning such a wire into all six anterior brackets has the
effect of a reciprocal relative intrusion of canines and
extrusion of central incisors (Fig. 5, B). Even if the
wire did not bow upon initial engagement and engaged
all of the canine and incisor brackets evenly, the
canines, being closer to the molars, would, by the
principle of the lever, experience more intrusive force
than the incisors and would experience it first. Thus,
they would be intruded, dissipating some of the force,
and the wire would bow slightly, leaving the incisors
behind.
The arch wire modification shown in Fig. 6 is rec-
ommended for use in all moderate to deep overbite
cases throughout all stages of treatment in both arches.
Bite-opening bends are placed opposite the distal sur-
faces of the canines and at the rings, so as to place the
wire slightly gingival to the incisor brackets when it is
seated fully in the canines. In cases having overerupted
incisors, such an arch wire will appear to exert an ex-
trusive force on the canines relative to the incisors ini-
tially, but, since the anchor bends are producing gingi-
vally directed force throughout the anterior portion of
the wire, this configuration, when properly adjusted,
will just ensure that intrusive force is delivered most
bowing.
effectively to the incisors. The idea is not to intrude
incisors at the expense of canine extrusion but to avoid
the opposite. The anchor bends should be adjusted so
the activated arch wire gives the desired level of verti-
cal force. This force is determined, not by the degree of
any of these bends alone, but by the vertical deflection
of the anterior portion of the wire to engage the
brackets.
Obviously, this arch wire configuration is con-
traindicated in open-bite cases. It may also be undesir-
able for a brief period in some Class II patients in
whom the canines may best be taken out of occlusion to
facilitate correction of their relationship (to avoid
“clashing” as the cusps pass each other in going from
Class II to Class I).
The mandibular incisors
The only mechanism acting directly on the lower
incisors in Stage I is the mandibular arch wire. The
effect of the anchor bends on any but the most retro-
clined lower incisors is simple tipping (that is, labial
flaring), which may give the appearance of some prog-
ress toward opening the bite as the incisal edges travel a
downward and forward arc. Alignment of crowded in-
cisors, whether accomplished by looped or plain arch
wires, has a reciprocal action between the canines and
incisors, tipping the former distally and the latter an-
teriorly, thus having the same effect as the anchor
bends on the incisors.
Mandibular incisal edges frequently contact either
the upper incisors or palatal gingiva and are thus pre-
vented from flaring; then the lower anchor bends can
produce true intrusion, perhaps even augmented by
contact with the maxillary anterior teeth as they are
retracted. Thus, there is good reason for using light
forces and aligning lower anterior teeth at a restrained
pace. In patients with anterior nonocclusion, flaring can
be minimized if ample time is allowed for distal move-
ment of the lower canines and for retraction of the
upper anterior teeth until they contact the lower anterior
 Orthodontic ,force systems 5

teeth. In patients whose upper and lower incisors con-

tact in occlusion, maxillary incisor retraction may be
impeded and anchorage may be lost if the lower in-
cisors are flared too forcefully against the upper in-
cisors .
Another important factor in preventing incisor flar-
ing, and thus accomplishing true intrusion, is cinching
the arch wire (that is, placing gingivally directed right-
angle bends in its annealed ends). These bends should
be snugly against the distal ends of the buccal tubes,
but the wire must not be pulled back forcefully in plac-
ing them or the anchor bends will be activated as high-
force closing springs, causing anchorage loss. Cinching
uses the molars as anchorage to prevent the incisor
brackets from moving anteriorly. It also prevents the
ends of the arch wire from being pulled forward and
either getting caught in or drawn completely out of the
Fig. 5. Typical Begg arch wire tends to intrude canines and
buccal tubes during mastication of foods which distort extrude incisors relative to each other.
the unsupported buccal spans of the wires. Cinching
keeps the arch wire ends clear of gingivae and second
molars and provides ideally situated hooks for inter-
maxillary elastics and a clear indication of the amount
of space closure.

Mandibular molars
Lower molars are controlled by a complex interac-
tion of arch wire and elastics. Class II elastics tend to
roll them lingually and tip them mesially, but theoreti-
cally should not by themselves cause significant extru-
sion, as their line of force passes outside the root.’ If a
molar is visualized from the distal aspect (Fig. 7, A) it
is clear that while the Class II elastic would tip it lin-
gually and the arch wire expansion would tip it buccally,
the resultant of the two should move it upward and
outward. The fact that expansion of lower molars is not
usually experienced may be due to the anatomy of bone
and/or muscle, or perhaps to the fact that the vertical
component of the elastic force is usually considerably
stronger than the arch wire expansion, resulting in a
tendency for the roots alone to move slightly buccally
as the tooth is extruded (Fig. 7, 8).
Efficient treatment demands that every detail of
appliances be set up to yield the utmost advantage. The
effects of the adaptations suggested in the next three
paragraphs are cumulative, each supporting and en-
hancing the others.
Elustic positioning. Intermaxillary elastics can rein-
force vertical anchorage for incisor intrusion by coun-
tering the distal tipping effect of an arch wire upon the
molars.’ The positioning of the elastic on the molar is
very important in this respect. As shown in Fig. 8, a
“Class II” elastic worn from the posterior end of the
arch wire may produce twice as great a moment tend-
Fig. 6. Slight bite-opening bends (at arrows) mesial and distal to
the canines help ensure efficient bite opening, level occlusal
planes, and even occlusion. The wire is shown almost fully
activated (engaged) to illustrate the effect.
ing to tip the molar mesially as an elastic worn from a
mesial hook. Posterior elastic positioning also produces
a slightly more horizontal and less vertical direction of
force to both the maxillary anterior teeth and the man-
dibular molars, as does the buccal tube angulation de-
scribed below. Buccal tubes should be constructed so
as to retain intermaxillary elastics at the posterior end
of the arch wire (Fig. 9, B) rather than toward the
center or anterior end of the tube (Fig. 9, A).
Gingival angulation of buccal tubes. Ten Hoeve,
Mulie, and Brandtl have advocated mesiogingival an-
gulation of maxillary molar tubes. There are definite
advantages to angulating the mesial ends of all buccal
tubes gingivally (Fig. 10). The degree of anchor bend
required is reduced, simplifying molar control and de-
creasing the risk of anchor bends rolling to toe in or toe
out. The facts that the tubes themselves direct the arch
wires gingivally and that the anchor bends are reduced
help to keep the critical unsupported buccal spans of the
arch wires as well out of the way of occlusion as possi-
ble, thus minimizing distortion (Fig. 11). The distal
6 Hocevar

b c
b c

A
Fig. 9. Incorrect (A) and correct (8) molar tube designs. The
mesial hook, optional, is for intramaxillary elastics only.

Length of buccal tubes. The length of the buccal

A 6 tubes is also a factor in appliance efficiency. Begg
tubes are commercially available in 4.5 and 6.5 mm.
Fig. 7. If the resultant (c) of the arch wire expansion force (a)
and the vertical component of the Class II elastic force (b) lengths. The shorter tubes offer somewhat less control;
passed directly through CR, the lower molar would be likely to anchor bends and toe-in or toe-out bends must be
move occlusally and buccally (A). Molar extrusion without buc- slightly greater (Fig. 11). Longer tubes make the most
cal movement (6) is probably accounted for by force b being efficient use of anchor bends and of the advantages of
considerably greater than a. Perhaps bone anatomy and mus-
wearing intermaxillary elastics from the distal ends of
cle are also involved.
arch wires (Fig. 8), holding the elastics further from
CR so as to create greater mesial tipping moments on
the molars.
Maxillary molars

In the first stage of traditional Begg treatment the

upper molars are affected by the upper arch wire and,
through it, by the Class II elastics, which reinforce the
effect upon the molar of the anchor bends. As the upper
anchor bends are not balanced by any other forces, they
must be limited to avoid excessive molar tipping. The
mechanics of the second and third stages do tend to tip
the molars mesially against the anchor bends, but with
negligible bite-opening efficiency. Furthermore, many
Class II and nonextraction treatments will have no
maxillary Stage II, and most overbite reduction is
Fig. 8. Forces on a lower molar produced by a Class II elastic achieved in the crucial first stage. While the maxillary
hooked on the distal end of the arch wire (a) and a mesial hook arch may well be part of the overbite problem, it is
(b). The moment arm, and hence the moment tending to tip the not normally part of the solution in traditional Begg
molar mesially, may be much greater with distal elastic attach-
technique.
ment. Using long buccal tubes and angulating them mesiogin-
givally, distoocclusally are other factors important in maximizing Molar rotations. Upper molars are frequently found
this moment. to be rotated mesiolingually, the buccal surface appear-
ing to have come forward as the tooth rotated about the
ends of the wires point away from the gingiva, so there palatal root.” Correction of this rotation can help cor-
is less chance of their halting treatment progress by rect molar distoclusion and gain space and is necessary
contacting the gingiva or second molars, and they are for an “ideal” occlusion.‘“The desired molar “toe-in”
more easily accessible to both operator and patient. The can be accomplished and maintained by having the
distal ends of the arch wires are slightly farther from molar segments of maxillary arch wires parallel or
CR when tubes are angulated, another factor in increas- slightly convergent throughout treatment, and is facili-
ing the moment created by Class II elastics (Fig. 8). tated by buccal tubes which are angulated in the hori-
 Fig. 10. Consistently correct mesiogingival angulation of molar
tubes is achieved easily by making a scratch mark on the band
parallel to the occlusal surface at the desired height and then
welding the tube diagonally across the scratch so that the
mesio-occlusal and distogingival points of the tube ends are on
Fig. 11. With short, horizontally oriented molar tubes (top),
the line. This method automatically determines the correct posi-
when arch wires are pinned into incisor brackets (broken lines),
tion for the tube, no matter what the inclination of the molar in
the anchor bends are so placed as to be very likely to be de-
the malocclusion may be.
formed by mastication. This is not the case with long,
mesiogingivally angulated tubes (bottom). In both illustrations
the arch wires are activated through the same range and thus
zontal plane, having the distal end of the tube set out deliver the same force to molars and incisors, but the degree of
from the buccal surface (Fig. 12). During the rotation anchor bend in the top illustration is twice as great as that in the
bottom one. The shortness of the tube in the top illustration is
correction, the palatal root seems to remain stationary
exaggerated to emphasize its effect. In a clinically realistic sit-
while the buccal surface moves distally. If the arch wire uation, most of the advantage portrayed in the lower illustration
is cinched, this contributes anchorage for the retraction is due to the mesiogingival tube angulation, but the effects of
of the anterior teeth; when the buccal surfaces of the tube length and angulation are additive.
molars move distally, they carry the arch wire, and
hence the anterior teeth, with them.

“CHECK” ELASTICS
In general, in conventional Begg treatment most
bite opening is attributable to lower molar extrusion
and sometimes to some lower incisor intrusion. Maxil-
lary teeth usually are not involved significantly in
overbite reduction.
The interaction of anchor bends and molars is recip-
rocal; that is, while the arch wire tends to tip the molars
distally, the molars direct the anterior portion of the
wire gingivally, providing “anchorage” in the vertical
plane. This vertical anchorage can be reinforced’ by the
simple expedient of a pattern of intermaxillary elastic
wear which I have dubbed “check elastics” (for the
\/ mark that the configuration resembles).” One end of Fig. 12. A maxillary molar tube having its distal end offset from
the elastic is hooked over the cinched distal end of the the buccal surface facilitates control of molar rotation.
upper arch wire, both strands are hooked under the
cinched distal end of the lower arch wire (no special
hooks are called for), and the other end is placed over Check elastics provide occlusally directed vertical
the upper elastic hook (“ring”) mesial to the canine force on the tail end of each arch wire which, in concert
(Fig. 13). This differs from a “triangular” elastic in with the anchor bends, causes extrusion of both upper
that it eliminates the undesirabie horizontal strand and lower molars; counteracts the anchor bends’ ten-
along the upper arch that would place a mesial force on dency to tip the molars distally; and, in tending to tip
upper molars and cause maxillary anchorage loss. the molars forward against the anchor bends, allows the

Fig, 13. A “check elastic” in place.
anterior portions of the arch wires to exert more api-
tally directed force on the incisors and canines. These
elastics can be used to upright distally tipped molars
without loss of control of bite opening; even with an-
chor bends reduced or eliminated, the elastics’ tipping
of the molars mesiogingivally against the arch wires
maintains some intrusive force on the incisors.
Vector diagrams in Fig. 14 illustrate a comparison
of the forces delivered by “Class II” and “check”
elastics pulling with equal jbrces at the upper canine
rings. (In the average case, check elastics delivering
forces of 50 to 60 grams at each ring with the teeth in
occlusion would be used in the early stages.) With the
check, the mesial horizontal component of force on the
lower molar is about one third greater; a distal horizon-
tal component equal to this increment affects the upper
molar. The vertical component on the lower molar is
between three and four times greater with the check
elastics, and there is a vertical component on the tail
end of the upper arch wire about three times as great as
that at the ring. Thus, whereas with Class II elastics
there is a downward force in the upper arch only at the
rings, with check elastics there is in addition a force
three times as great at the posterior end of the arch, so
the maxillary arch tends to rotate down at the back and
up in front, rather than vice versa, as with Class II
elastics.
Vertical molar-to-molar elastics, while they repre-
sent a step in the right direction, have several disadvan-
tages compared to check elastics. Because of their
necessarily small size, they have very limited range,
like short heavy sections of arch wire; the force they
produce is negligible when the mandible is in a position
of occlusion or rest, but it increases tremendously with
opening. The much greater length of check elastics,
much of which is oriented horizontally, provides in-
creased elastic range and a more constant gentle force
throughout the range of mandibular positions; it also
allows patients to apply checks more easily than verti-
Cal elastics. If vertical elastics were used alone, they
would tend to produce incisor flaring rather than intxu-
sion, whereas check elastics produce a horizontal force
component that yields incisor retraction. Class II elas-
tics may be worn in conjunction with vertical elastics
for the same effect, but check elastics still have the
advantages cited above. Class II elastics may, of
course, be worn in combination with checks where it is
desirable to increase the retracting force without in-
creasing the vertical force on the molars.
Check elastics do have some minor disadvantages.
They tend to “roll” upper as well as lower molars
lingually, they frequently produce molar mobility, and
they are somewhat more difficult for patients to learn to
place than are Class II elastics. The “rolling” is pre-
vented easily by expanding the arch wires; both upper
and lower wires need more expansion to compensate
for checks than the lower would need for Class 11 elas-
tics. The molar mobility does not seem to be a real
problem; periapical radiographs have shown no patho-
sis, even in adults whose molars have exhibited ex-
treme mobility. It serves as a highly reliable indication
of elastic-wearing cooperation; if the elastics are worn
faithfully, the molars will be mobile unless either a bite
plane is in use or all teeth are engaged on the arch
wires, as in Stage III. Mobility may be most marked in
patients who clench or brux, but anterior bite planes
used in conjunction with check elastics in these patients
prevent mobility while facilitating rapid molar extru-
sion. Patients lacking dexterity can usually learn to
place check elastics quite readily if they have been
allowed to wear ordinary Class II elastics for the first
appointment interval.
Molar extrusion
I do not wish to enter the long-standing and continu-
ing controversy’~ x Tr.i2~i6 over the relative merits of
molar extrusion and incisor intrusion for overbite re-
duction; nor do I wish to review the arguments here.
My opinion is that the treatment plan should be dictated
by the diagnosis, that the mechanics employed in a case
should be designed to reduce and not accentuate the
features of the patient that deviate from the norm.
Thus, molar extrusion would be contraindicated in pa-
tients with open-bites, steep mandibular planes, or
disproportionately long anterior lower face heights;
when such patients require bite opening it should be
sought, insofar as possible, by incisor intrusion.
Moderate molar extrusion can be beneficial in pa-
tients with average or flat mandibular planes and aver-
age or short anterior lower face heights. Reduction of
severely deep overbites by attack on all four fronts (that
is, intrusion of maxillary and mandibular incisors and
extrusion of maxillary and mandibular molars) requires
the least tooth movement in each area. I have not noted
detrimental “hinging open” of the mandible in these
cases (Fig. 15).
Volumr RI
Nurnbrr I Orthodontic force systems 9

Fig. 14. Vector diagrams. Vector length is proportional to force magnitude, A, Forces produced by a
Class II elastic. a, Force on upper anterior teeth; b and c horizontal and vertical components of a; d,
force on lower molar; e and f vertical and horizontal components of d. B, Forces on lower molars and
upper anterior teeth produced by a check elastic. g, Force of the intermolar segment of the elastic on
the lower molars; h, force of the molar-to-ring segment of the elastic on the lower molar; i, total force on
the lower molar, the resultant of g and h; j, vertical component of i; k, horizontal component of i; I, force
on upper anterior teeth; m and n, horizontal and vertical components, respectively, of I. C, Force of
check elastic on upper molar (0) and its horizontal (p) and vertical (q) components.

BEGG STAGE III
Ten Hoeve, Mulie, and Brandt’, s have discussed
some of the undesirable aspects of third-stage tooth
movement. They have ascribed most of the blame for
these problems to palatal anatomy and injudicious
movement of the maxillary incisors in the first two
stages and have suggested modifications in the con-
ventional Begg approach. In light of their work, and
that of Edwards,‘? it is clear that anatomy of the jaws
must be given due consideration in planning the course
of treatment and that the objectives of the first half of
treatment should be revised to include increased con-
cern for controlled movements of incisors with intru-
sion and retraction with limited tipping.
However, regarding Stage III, the problem is not
solely one of anatomy, and the solution should not be
sought solely in the earlier stages. A “pure Begg”
Stage III appliance tends to deepen the overbite and
rotate the occlusal plane, and especially the maxillary
arch, down in front and up in back; all mechanisms for
moving the apices of the upper incisor roots palatally
have the side effect of delivering downward force on
the anterior teeth and reciprocal upward force on the
posterior teeth.’ Uprighting springs tend to bow the
arch wires so as to cause relative extrusion of incisors.
“V bends”iX or bite-opening curves in the arch wires
are used to compensate for the effect of the uprighting
springs but can actually have an effect opposite to that
 ble, a high-pull headgear hooking onto the base arch
wire mesial to the upper central or lateral incisors may
be indicated, with no Class 11 elastics. It will hold the
maxillary anterior teeth up, maintaining bite opening
without contributing to mandibular opening and face
lengthening, The case with a flat mandibular plane and
short anterior lower face (Class II, Division 2 type). ifit
t-quit-es extra unchorage it1 dw horizontal pltttw ~ may
be treated best by the addition in Stage III of a cervical
headgear which, besides providing itori:onttrl anchor-
age, will hold the posterior portion of the maxillary
arch down and, if possible, open the mandible. For
most other cases, check elastics are ideal. As explained
C.D.. 0 J.F.. 9.
above, they provide vertical anchorage at the distal
born 11 - 9 - 66 born 12 - 13 - 63 ends of both arch wires and place greater extrusive

0A .- . .. 56 _-24-,a- 80
79 0 B -
---- 12
S-24-76
- ,3- 76
force at the back of the upper arch than at the front, thus
reversing the usual tendency for the maxillary arch to
Fig. 15. Cases showing typical mandibular responses to “check rotate down anteriorly and up posteriorly; they ensure
elastics.” Patient C. D., with a severe Class II, Division 1 that the back ends (molars) of the “rockers” rock to-
malocclusion, showed only 2 mm. total AP skull growth in the ward each other and the front ends (incisors) away from
13-month interval between her pretreatment and progress each other; and they enhance the effect of the arch wire
cephalograms; nasion-maxillary incisal edge increased only 1
configuration recommended in the section on anterior
mm. while nasion-menton increased 5.5 mm. Patient J. F., with
a severe Class II, Division 2 malocclusion, also showed 2 mm. teeth in maintaining overbite reduction throughout
total anteroposterior skull growth in the 27 months between the treatment. Their routine use in Stage III in deep-bite
pre- and posttreatment cephalograms; the height, nasion- cases dependably prevents the undesirable conse-
maxillary incisal edge increased 2 mm., while nasion-menton quences of the conventional third stage if patients are
increased 9 mm.; that is, anterior lower face height increased 7
given elastics that will deliver 110 to 140 Gm. of force
mm. These increases in anterior lower face height were not
effected at the expense of undesirable backward rotations of at the maxillary rings and are instructed to wear them
the mandibles but were associated with considerable growth of just as much as is necessary to maintain an edge-to-
the rami. While the mandibular plane angles did increase edge incisor relationship.
slightly, the mandibles maintained their anteroposterior posi-
tions in the faces. SUMMARY
The balancing of forces of arch wires and elastics
desired. Like the rockers of a rocking chair, these arch for control of molars and incisors and reduction of
wires can rock either way; since the maxillary ante- overbite has been studied. Technical refinements for
rior teeth are under the influence of extrusive force the improvement of fixed appliance efficiency have
from both the torquing auxiliary and Class II elastics, been suggested. The article has considered the Begg
they rock downward and the molars rock upward. technique specifically, but many of the points discussed
McDowell’” suggested that there are limits to molar are of equal relevance to other systems.
extrusion which are reached relatively early in treat- I. Retraction of maxillary incisors deserves careful
ment. Class II elastics probably tend to deepen the force system analysis and application, particularly in
overbite in Stage III; they certainly contribute toward the many cases in which intrusion is desirable.
upper incisor extrusion and can extrude lower molars 2. Anchor bends, as commonly used in the con-
only as much as growth and upper molar intrusion al- ventional Begg technique, are not likely to have a sig-
low. I have known practitioners to employ heavier and nificant effect on maxillary incisor movement.
heavier Class II elastics in attempt to reverse progres- 3. Slight bite-opening bends mesial and distal to
sive overbite increase in Stage III, only to find that the the canines in all arch wires can help ensure that intru-
bite continued to deepen. sive force is delivered primarily to incisors, and main-
There are a number of solutions to this problem; the tain level arches.
characteristics of each individual patient determine 4. Vertical intrusive force on mandibular incisors
which is most suitable for that case. For the patient with may cause proclination unless accompanied by some
marked anterior lower face height and a steep mandi- distal force.
Volume 8 I Orthodontic f&e systems 11
Numhrr 1

5. There are many reasons for routinely cinching 4. Sims, M. R.: Anchorage, a continuing crisis. In Cook, J. T.
almost all arch wires at the distal ends of the buccal (editor): Transactions of the Third International Orthodontic
Congress, London, 1975, Crosby Lockwood Staples, vol. 2, pp.
tubes throughout treatment.
410-419.
6. Positioning intermaxillary elastics at the poste- 5. Ten Hoeve, A., and Mulie, R. M.: The effect of anteroposterior
rior ends of arch wires, using long buccal tubes, and incisor repositioning on the palatal cortex as studied with
angulating all tubes mesiogingivally are important fac- laminagraphy, J. Clin. Orthod. 10: 804-822, 1976.
tors in efficient reduction of overbite. 6. Sims. M. R.: Conceptual orthodontics, AM. J. ORTHOD. 71:
431-439, 1977.
7. The use of maxillary molar tubes whose distal
7. Swain, B. F.: Begg differential light forces technique. In
ends are set out from the buccal surface and arch wires Graber, T. M., and Swain, B. F. (editors): Current orthodontic
with “toe-in” throughout treatment aids correction and concepts and techniques, ed. 2, Philadelphia, 1975, W. B.
control of maxillary molar rotations. Saunders Company, vol. 2.
8. ‘Check elastics” can provide a potent mecha- 8. Thornton. C. B., and Nikolai, R. J.: Maxillary anterior intrusive
forces generated by Begg Stage I appliances, AM. J. ORTHOD.
nism for overbite reduction, causing extrusion of maxil-
79: 610-624, 1981.
lary and mandibular molars and counteracting the ten- 9. Dewel, B. F.: Clinical observations on axial inclinations of
dency of the anchor bends to tip the molars distally, teeth, AM. J. ORTHOD. 35: 98-115, 1949.
thus aiding incisor intrusion. 10. Andrews, L. F.: The six keys to normal occlusion, AM. .I.
9. A conventional Begg Stage III appliance tends ORTHOD. 62: 296.309, 1972.
1 I. Hocevar. R. A.: Force balance and control with the Begg tech-
to rotate the occlusal plane, and especially the maxil-
nique, N. 2. Orthod. Sot. Newsletter 6: 4-8, 1977.
lary arch, down in front and up in back and to deepen 12. Mulie, R. M., and Ten Hoeve, A.: The limitations of tooth
the overbite. movement within the symphysis studied with laminagraphy and
10. The above tendency can be counteracted by standardised occlusal films, J. Clin. Orthod. 10: 882-899, 1976.
routine use of check elastics in most cases. Cervical 13. Watson, W. G.: A computerized appraisal of the high-pull
face-bow. AM. J. ORTHOD. 62: 561-579, 1972.
headgear to maxillary molars or anterior high-pull
14. Schudy, F. F.: Sound biologic concepts in orthodontics, AM. J.
headgear may be preferable in a few cases of specific ORTHOD. 63: 376-397, 1973.
types. 15. Williams, R.: Begg treatment of high-angle cases. AM. J.
ORTHOD. 57: 573.589, 1970.
16. Williams, R.: The cant of the occlusal and mandibular planes
REFERENCES with and without pure Begg treatment, J. Pratt. Orthod. 11:
1. Hocevar. R. A.: Understanding, planning, and managing tooth 496-505. 1968.
movement: Orthodontic force system theory, AM. J. ORTHOD. 17. Edwards. J. G.: A study of the anterior portion of the palate as it
80: 457.477, 1981. relates to orthodontic therapy, AM. J. ORTHOD. 69: 249.273,
2. Ten Hoeve. A., Mulie, R. M., and Brandt, S.: Technique mod- 1976.
ifications to achieve intrusion of the maxillary anterior segment. 18. Cadman, G. R.: A vade mecum for the Begg technique, AM. J.
J. Clin. Orthod. 11: 174-198, 1977. ORTHOD. 67: 477.512, 601-624, 1975.
3. Burstone. C. R.: Deep overbite correction by intrusion, AM. J. 19. McDowell, C. S.: The hidden force, Angle Orthod. 37: 109.
ORTHOD. 72: 1-22. 1977. 131, 1967.