The Begg philosophy and fundamental

principles
MILTON R. S I M S ~ B . D . S . , M.Sc.D. ¢
Boston, Mass.

T. H . HUXLEY once made the penetrating observation that " I t is the cus-
t o m a r y fate of new truths to begin as Heresies and to end as Superstitions."
Surely no qualities have been more characteristic of our branch of medical
science than the regimentation of thought in appliance t h e r a p y and the con-
flicting viewpoints that exist in m a n y quarters. This, indeed, has been a constant
threat to orthodontic progress, particularly when the pretense of open-minded-
ness has involved nothing more than a rearrangement of original prejudices.
However, it is necessary to relate that we now have on our hands an additional
orthodontic dilemma in the form of light-wire misuse. Therefore, some forth-
right orthodontic appraisal is necessary if we are to preserve and maintain our
professional responsibilities toward our young patients, m a n y of whom have
been subjected to misguided mechanothcrapy with light wires in the name of
Dr. Begg.
The use of light wires is by no means a new concept. Much of the pioneering
development in the application of resilient arches was carried out right here
in New York by Dr. E. M. Griffin more than 30 years ago. Moreover, the John-
son " t w i n a r c h " appliance, introduced in 1931, utilizes the properties of light
resilient r o u n d wires.
Dr. Begg, after more than 20 years of intensive development, has offered
an appliance technique which he assesses in the following terms:
Correctly applied, the light arch wire technique can produce universal tooth
movement with light optimum forces, least discomfort to the patients, minimum

Presented before the Northeastern Society of Orthodontists~ New York, b;. Y.,
March 11 to 13, 1962.
CVisiting Assistant Professor of Orthodontics, Boston University School of Medieine~
1961-1962; Visiting Australian Fulbright Scholar, 1960-1962. Present address:
Dental Hospital, Frome Road~ Adelaide, South Australia.
.!5
16 Sims A , , J. Orthodontics
J a n u a r y 19 6 4

loosening of teeth, and least injury to the tooth investing tissues. These same light
forces will move the teeth most rapidly and are said to be the most easily controlled
forces.

Such claims might be considered quite extravagant had they not been rou-
tinely proved in practice for many years. There are also the additional virtues
in the elimination of the need for headgear and bite plates, together with a
reduction in the required chair time and number of arch wires necessary to
correct a malocclusion. Undoubtedly, this is a formidable list of improvements
over established techniques.
In an endeavor to orientate light wire thinking correctly, I wish to explain
precisely the salient features of Dr. Begg's orthodontic philosophy, the clinical
application of differential forces, and the fabrication of light resilient arch
wires. Only with perfect understanding can we hope to appreciate the basic
fundamental principles involved, develop a treatment plan on the basis of correct
treatment objectives, and put aside ideas of bracket and gadget improvization
which have arisen as a result of fallacious concepts and mistaken therapy.
There can be no denying that during the last 8 years the influence of Dr.
Begg1-3 has been profound in stimulating orthodontists within the United States
to reappraise the physiologic virtues of the application of light forces and light
resilient arch wires in the treatment of malocclusions. Thus, at long last, the
investigations of such great men as Sandstedt, Oppenheim, Gottlieb, Schwarz,
Orban, and Reitan, to name but a few, are beginning to receive the attention
they deserve.

NORMAL OCCLUSION

I would like briefly to direct your attention to some particular phases of

Begg's investigations relating to his concept of nominal occlusion and a biologic
rationale for extraction in orthodontic treatment.
The diverse meanings implied by the term n o r m a l occlusion are numerous.
Angle, Hellman, LeRoy Johnson, Calvin Case, Simon, Tweed, and Strang are
but a few who have offered definitions of their concepts of normal occlusion.
Begg 1 has proposed a concept of normal occlusion defined as "anatomically
correct occlusion" based on Stone Age man's dentition as exemplified in the
Australian aborigine. This theory is certainly a radical departure from, and at
variance with, previous orthodontic considerations. Yet it provides a basis of
explanation for certain factors affecting the etiology of malocclusion and a
biologic rationale supporting extraction in orthodontic procedures.
The two major factors to be considered in producing anatomically correct
occlusion in the aborigine are tooth migration and attritional tooth wear. Begg
contends that attritional occlusion with wearing away of tooth cusps, reduction
in arch length, and establishment of an edge-to-edge incisor bite together with
an Angle Class I I I occlusal relationship results in the only anatomically correct
occlusion and has the constant quality that it is continually changing throughout
life. On the other hand, he states that so-called textbook normal occlusion, with
the teeth almost unworn throughout life, both occlusally and interproximally,
and with high interlocking cusps and inci~r overbite, is anatomically abnormal.
~o~um~ 5o
Number 1
Begg philosophy! and. fundamental principles 17

The teeth are prevented by these high cusps from altering their occlusal relations
as they should and are kept from migrating mesially in the proper manner i~
the jaws.
Hunt's 4 findings support the importance cf such anthropolo~c considera-
tions. Campbell 5 has also demonstrated additional features of Stone Age man'~
dentition, namely, continual changes in the oeclusal plane and variations i~
arch width.

A BIOIJOGIC R A T I O N A L E FOR EXTRACTION IN ORTHODONTIC T R E A T M E N T

Since, in our treatment of orthodontic patients, we are dealing with the

occlusion of civilized man and not the dentition of Stone Age man, it is obvious
that certain compromises must be made. There is no longer a harmonious s(.-
quenee of events producing arch reduction and anatomically correct occlusion.
We nlust also take into account the evolutionary reduction in jaw size which
has particularly affected the alveolar portion of the maxilla and nlandible. '~
Such a deficiency of bone is most obvious in the mandibular incisal area when
emphasized by the presence of so-called good pogonion development. This is a
complicatin~ factor in addition to that of attritional lack.
In the incisal region of the arches we must therefore adopt a different
method of approach to treatment of our cases. Any attempt to move the denti-
tion further forward off alveolar bone, in conformity with our consideration of
mesial migration as applied to the buecal segments, can only lead to instabilit:~"
in orthodontic treatment. Compromise is therefore forced upon us in treatment
aims and objectives, so we use the tried and proven method of aligning and
moving the incisal teeth back on basal bone, the standard, incidentally, being
rather personal and dependent upon each operator's individual concepts. For-
tunately for us and our patients, nature seems to be quite tolerant of such
distal positioning of the incisal teeth. It is just this t)~pe of compromise which
produces the most stable, functional, and esthetic orthodontic results for our
patients.
For the following reasons, therefore, tooth extraction where necessary, is not
an empirical expediency but a rational procedure which h~s a sound etiologie~t]
basis :
:l. It simulates to some degree the natural loss of tooth substance which
should take place by attrition.
2. It balances discrepancies between tooth size and evolutionary Mveolar
bone reduction.
3. It affords a means of masking severe anteroposterior jaw malrelatioii-
ships.
However, you will readily appreciate that extraction does not entirely paral-
lel attrition. It differs in bringing about dental arch reduction suddenly and
at fixed intermittent points in the jaws.
When extraction is confined to either the premolar or first molar regions,
it enables us to harness the naturally occurring anterior force component, mesial
migration, and move the most distal segment forward in the direction of naturally
18 Sims Am. J. Orthodontics
January 1 9 6 4

occurring migration and thus position these teeth in a more anatomically cor-
rect mesial relationship within the jaws. Furthermore, the tMrd molars are
therefore given the opportunity to erupt mesially into funciional occlusion.
Such a logical procedure contrasts with techniques that require the distal move-
ment of buccal segments. This not only attempts to put mesial migration into
reverse, but it also increases the tendency to relapse and frequently produces
a third molar impaction, necessitating eventual extraction at the distal extremi-
ties of the arch.
The theme of the first part of this discussion has centered around the extrac-
tion rationale. Let me briefly continue this development to its logical conclusion
and present the following points for your consideration.
The orthodontic nonextraetionist is constantly having to refer treated pa-
tients to the oral surgeon for the subsequent removal of third molars that have
become impacted as a result of orthodontic treatment. Again, how often does
the orthodontist have four premolars removed as an adjunct to treatment, only
to find at a later stage that the four third molars are impacted and require
removalS. In other words, eight teeth have been removed because of orthodontic
treatment. Yet Bcgg has been erroneously spoken of as a radical extractionist
merely because, in selected malocclusion cases, he has had the foresight to com-
plete all of the necessary eight extractions prior to commencing orthodontic
treatment.

DIFFERENTIAL ~ORCES
Since the clinical application of differential forces, as conceived and prac-
ticed by Begg, is at variance with established concepts of tooth movement and
intraoral anchorage, a full understanding necessitates a complete re-evaluation
of certain hitherto accepted principles of orthodontic doctrine.
Storey and Smith 7 using an edgewise mechanism, moved cuspids distally,
with the first molar and the second premolar serving as the anchor unit. Their
results showed that a light optimum force of 200 grams moved only the cuspid;
a heavy force of 500 grams moved only the molar-premolar segment (with the
cuspid therefore acting as an anchor), while a medium force of 350 grams
simultaneously moved both cuspid and molar segments.
With the use of the Begg appliance in clinical practice, the force values ad-
vocated by Storey and Smith are much higher than the ideal required to move
cuspids distally. For example, Class II intermaxillary elastics, each delivering
no more than 60 grams of tractive force, are quite sufficient for the simultaneous
retraction of six maxillary anterior teeth when the first permanent molar is
used as the source of anchorage. Even more difficult for clinicians to appreciate
is the fact that, with four first permanent molars extracted, second molars can
provide all the anchorage required for the distal movement of the anterior maxil-
lary segment of ten teeth, from second premolar to second premolar, when
light Class II elastics are used. This correction is obtained without loss of
anchorage, production of a bimaxillary protrusion, or incorporation of any
supplementary anchorage aids.
Prevailing doubts of anchorage stability, as expressed by Kanter s and Ren-
vommehO
Number 1
Begg philosophy and fundamental principles 19

froe,9 may indicate the feeling of insecurity underlying the current trend toward
the use of greater extraoral anchorage reinforcement in some other orthodontic
techniques.
Begg has offered a far simpler means of obtaining adequate intraoral anchor-
age than hitherto appreciated or believed possible. This is accomplished through
the medium of differential force application.

A DISCUSSION OF ELASTICS AND THEIR APPLICATION IN THE L I G H T - ~ ' I R E

TECHNIQUE

Differential forces give greater control of movements and high standards

of results, even in difficult cases. There is a considerable reduction in treatment
time and simplification of treatment procedures. This is because the various
groups of tooth movements are carried out simultaneously, each group movement
reciprocally assisting all other groups and producing a balanced flow of cor-
rectional movements.
Any discussion of differential forces obviously bears an iutimate relationship
to the biology of human tissue reaction to orthodontic appliances. However, due
recognition has yet to be accorded this all-important area of the investing tooth
structures.
Today, even though we are well aware of the great progress being made in
the histologic aspects of our diverse techniques, we have yet to determine how
best to apply the recommendations of our research investigators to present
clinical procedures. Furthermore, as might be expected in dealing with the
unpredictable complexity of living tissue response, great diversity of opinion
should exist among research workers. For example, Sehwarz ~° stated: "Most
favorable treatment is that which works with forces not greater than the pres-
sure in the blood capillaries (i.e. 25 grams per sq. ram.), moving a tooth less
than I ram. distance." But Goldman ~1 considers that bone response to orthodontic
stimuli is produced by fluid displacement within the marrow spaces of lhe
alveolar bone. This effect is inactive unless slightly in excess of normal capillary
blood pressure.
At the opposite end of the spectrum we have the investigations of Halderson,
Johns, and Moyers, ~2 who found that the forces being applied by certain rec-
tangular arch appliances exceeded 900 grams or 32 ounces. They stated: " T h e
edgewise mechanism operates, more than any other appliance, in the realm
of controlled pathology. It would be of little practical clinical use if this were
not true; yet this fact is often neglected."
We are, therefore, faced with the dilemma of a diversity of orthodontic
opinion in treatment values that are 30 ounces apart, and the difference is as
obvious as it is painful and traumatic to the patients.
There are additional factors that must be taken into account. Lura ~:~ con-
siders that forces within the limits of tolerance for tooth-investing structures
are determined by hereditary and functional factors. Nor must we overlook
such important effects as the duration of force and the unresolved issue regard.
ing the desirability of intermittent or continuous force application. Moreover,
the clinical significance of intrusive forces also requires further investigation.
20 Sims A ~ I . J. Orthodo~tties
Janua~'y 1964

In giving our attention to applied force values, we must always be cognizant

of the fact that the term applied force has little meaning unless it is also quali-
fied by indicating the direction of force application.
When four first permanent molars are removed in the treatment of a severe
malocclusion with the Begg light-wire technique, light Class II elastics, each
delivering no more than 60 grams of tension, will effectively retract ~ maxillary
anterior segment of ten teeth from the left second premolar to the right second
premolar. This means that a total of 120 grams is more than adequate for
effectively moving ten teeth distally, without loss of anchorage, to obtain the
desired maximum orthodontic correction. From the arithmetic (though not
precise biologic) point of view, a mere 12 grams of tension is applied to each
anterior tooth.
The prevailing diversity of opinion and experience in the use of force may
at first seem to suggest a lack of agreement in orthodontic appraisal. We are
progressing rapidly, however, and a more realistic sense of clinical force appli-
cation is fast becoming apparent within our ranks. Researchers and clinicians
are now in more common accord regarding the use of light forces. However,
clinical use of differential force application, as described by Begg, awaits greater
understanding.
The scholarly words of Frederick B. Noyes 14 merit great consideration: " I t
is very difficult for the orthodontist to understand that force does not move
teeth, but rather should be only of sufficient magnitude to stimulate the pro-
duction of cellular elements, which are responsible for tooth movements."

A RESUM,I~ OF THE BEGG APPLIANCE

The use of differential orthodontic forces makes it possible to carry out
simultaneously, and with maximum efficiency, various groups of tooth move-
ments, such as aligning crowded teeth, opening up deep overbites, and correcting
anteroposterior tooth relationships. Differential forces are also used to the
same advantages in nonextraction cases.
Most important, it is unnecessary to carry out the accepted edgewise prac-
tice of anchorage preparation in Class I and Class II cases by placing treatment
in reverse with Class I I I elastics fortified with extraoral anchorage.
Round resilient, heat-treated, cold-drawn material 0.016 inch or less in
diameter is used to form the arch wires. All auxiliaries, such as vertical expan-
sion loops, auxiliary arches with vertical torquing spurs, intermaxillary hooks,
and stops are bent into the arch form during fabrication.
The bracket attachments used on the stainless steel band material are modi-
fied ribbon arch brackets which must permit application of the principles of
single point attachment to allow simple tipping of the teeth without any binding
or friction whatsoever between arch wire and bracket. Any binding action will
produce bodily tooth movement and loss of anchorage control. Bands with ribbon
arch brackets are placed on the six anterior teeth in each arch. The four first
molars are banded, and round buccal tubes are attached with their long axes
parallel to the occlusal surface. When first molars are extracted, the second
molars are banded with an oval-shaped tube to permit the use of ~ doubled-back
vozume ~o Begg philosophy and fundamental principles "2:1
Number I

arch. All arch wires are fabricated at the chair, from the left buccal tube to the
right bueca[ tube, the intermaxillary hooks being positioned just mesial to the
cuspid brackets.
In the preparation of arch wires, one outstanding difference betweell the
edgewise technique and the Begg light-wire technique is that edgewise areJ~
wires are shaped to the ideal form and the teeth arc then nloved out to the arch
wires, whereas the arches for the light-wire technique are initially shape(] s,
that they will tend to overmove the teeth and, as a result, the teeth are brought
into correct alignment as arch wire resiliency is exhausted. The Tweed and
Begg philosophies are extraordinarily similar in their final treatment objectives.
The fundamental differences lie in the approach to treatment planning, th(~
sequence of treatment stages, and the utilization of the principle of overtrea(
ment ~'~before cases are placed in retention (Fig. 1).

Fig. 1. A, Models made 2 years after retention was concluded. The only retention was with a
Hawley retainer in the maxillary arch. B, Models made en the day t h a t bands were r~,~
moved, illustrating overeorrection of the incisor relationship.

A. B.
J
Fig. 2. Same case as in Fig. 1, showing models s t the completion of retention (A), together
with the mutilated malocclusion when the patient, first presented for treatment (B).
22 Sims Am. J. Orthodontics
J a n u a r y 19 6 4

LIGHT-WIRE APPLIANCES AND THE THREE STAGES OF TREATMENT IN" THE BEGG
TECHNIQUE
I t is essential to obey the following order of procedures in applying the
Begg technique. Notice that a balanced flow of tooth movements is accomplished,
all teeth moving by the most direct paths to their final positions.
A.

B.

Fig. 3. A, The incisor relationship on the day that appliances were removed. B, Two years
later, after discontinuance of retention with a maxillary Hawley retainer.

Stage I involves the simultaneous alignment of all u p p e r and lower anterior

teeth, elimination of overbite, correction of rotated teeth, elimination of cross-
bites, and production of a slight Class I I I relationship in the bueeal segments.
This first stage of treatment is essentially the simple tipping of maxillary an-
terior teeth. The lower molars must always remain controlled in an upright
position.
Stage I I involves the closing of all remaining extraction spaces with horizon-
tal elastics. This is achieved by the controlled application of differential forces.
Volume ~o Begg philosophy and fundamental principles 23
Number i

Light elastic forces close spaces by moving the incisal segment distally, while
increased elastic forces can be utilized to move the buccal segments forward.
Throughout this stage, tile use of Class II elastics is continued. In some instances
of treatment, this can be a rather startling phase of progress because of the
manner in which the crowns of the maxillary incisors are tipped back.
Stage III involves the final positioning of all tootll roots in their correct
axial relationships by means of auxiliary attachments. The roots of the cuspids
and premolars are orientated by the use of uprighting springs. Correct axial
inclinations of the incisors are obtained by means of an auxiliary torquing arch.
As an aid to understanding Begg light-wire procedures, the following facts
should t)e appreciated:
1. This is not a loop appliance, as many have been led to believe and
encouraged to use.
2. Mesial tipping of molar teeth is always a positive indication of exces-
sive force application through the medium of intermaxillary elastics.
3. A fundamental aspect of successful and stable treatment is over-
correction of all tooth relations (Fig. 1).
4. This is a simplified technique which will prove disastrous when inno-
vations and improvization are attempted.
5. Anchorage principles are utilized, although there is no separate stage
of anchorage preparation.
6. The Begg light-wire appliance does not require more extractions than
other techniques.
CONCLUSION

G. H. Terwilliger 16 once made the following interesting statement: " i n

speaking of mechanics, it is often said of Dr. Angle that he would never have been
satisfied with what he called the 'Latest and Best.' No doubt that is true. I be-
lieve, however, that he would have directed his efforts toward answering the
physiological requirements, for his method of appraising appliances was: first,
physiology; second, mechanics; and, third, a r t . " This surely suggests that,
to progress, we must develop a flexibility of mind and not allow ourselves to
be conditioned by orthodontic propaganda. Our problems are not superficial,
and the solutions will not be simple.
As a scientist, the orthodontist must continually re-examine his concepts in
the realization that new knowledge is constantly forthcoming. For our specialty
to continue to practice by tradition indicates that we ]ack a sense of purpose
and the necessary foresight to progress along with other branches of the medical
sciences. Surely this is not true. Conflicting viewpoints in orthodontics nmst be
set aside for the benefit of both our patients and ourselves, so that an approach
to the therapy of malocclusion shall be made with more common accord. After
all, the purpose of orthodontics is not to make an issue of who is right and who
is wrong but to establish what is right and what is wrong for the patient.
In our continual efforts to obtain a system of treatment that will giw~ us
ready-made answers, we overlook the inevitable fact that thought, reason, and
skill are still attributes of the orthodontist and not the arch wire. Yet, even at
24 Sims A,~. J. Orthodontics
J a n u a r y 1964

this late date, we are still trying to tailor our patients to stereotyped arch forms.
Intelligent reasoning demands that an appliance should be tailored to the pa-
tient, not the patient to the appliance. So it is that the Begg light-wire technique
is the thinking man's method, where treatment progress alone determines ap-
pliance modification.
If you are at all inclined to transgress prevailing orthodontic concepts and
aspire to a different type of orthodontics, then I would urge you sincerely to
attempt this subtle technique. Should your enthusiasm be lukewarm, however,
leave light wire alone.
The last word in orthodontics has yet to be said. Certainly light wire is not
the final answer to all our orthodontic problems. Neither is any other existing
appliance. Heaven forbid that 40 years from now orthodontics will not be
practiced quite differently from any systems in current use. However, the Begg
technique is a great advancement toward the ultimate development.
There is a new baby in the orthodontic nursery. Handle it roughly or abuse
it, and you will have a delinquent on your hands in a very short space of time.
Treat the newcomer with care, nurture it, and you will have a fine addition to
the family from the outset.
Since malocclusions develop without pain, let us dedicate our professional
efforts to correcting them without pain.
REFERENCES
1. Begg, P. R.: Stone Age Man's Dentition, AM. J. ORTHODONTICS 40: 298-312, 373-383,
462-475, 517-531, 1954.
2. Begg, P. R.: Differential Force in Orthodontic Treatment, AM. J. ORTHODONTICS 42:
481-510, 1956.
3. Begg, P. R. : Light Arch Wire Technique, AM. J. Ot~THODON~ICS47: 30-48, 1961.
4. tttmt, E. E.: Malocclusion and Civilization, AM. J. ORTHODONTICS 47: 406-422, 1961.
5. Campbell, T. D.: The Dentition and Palate of the Australian Aboriginal, Adelaide,
Australia, 1925, tIasse]l Press.
6. Brash, J. C.: The Etiology of Irregularity and Malocclusion of the Teeth, ed. 2, London,
1956, Dental Board of the United Kingdom.
7. Storey, E., and Smith, R.: FOrce in Orthodontics and Its Relation to Tooth Movement,
Australian J. Dent. 56: 13, ][952.
8. Kanter, F.: Man~bular Anchorage and Extraoral Force, AM. J. ORTHODONTICS 42:
194-208, 1956.
9. Renfroe, E. W.: The Factor of Stabilization in Anchorage, AM. J. ORTHODONTICS 42:
883-896, 1956.
10. Schwarz, A. M.: Tissue Changes Incident to Tooth Movement, INT. J. ORTHODONTIA18:
331, 1932.
11. Goldman, It. M. : Graduate Orthodontic Lectures, Boston University School of Medicine,
1962.
12. ttalderson~ I~., Johns, E. E., and Moyers, R.: The Selection of Forces for Tooth Move-
ment, AM. J. ORTHODONTICS39: 25-35, 1953.
13. Lura, I-L E.: Tissue Reactions of Bone Upon Mechanical Stresses, AM. J. ORTHODONTICS
38: 453-459, 1952.
14. Mathews, J. Rodney: Clinical Management and Supportive Rationale in Early Ortho-
dontic Therapy, Angle Orthodontist 31: 35-52, 196].
15. Waldron, R.: Reviewing the Problem of Retention, A~. J. ORTHODO~TICS& OaAL SUNG.
28: 770-791, 1942.
16. Terwilliger, G. It. : The Development of the Edgewise Arch Mechanism and Its Place in
Contemporary Orthodontics, AM. J. ORTHODONTICS37: 670-678, 1951.