American Journal of ORTHODONTICS

Volume 67, Nuvlber 6, June, 1975

ORIGINAL ARTICLES

A vade mecurn for the Begg technique:

Treatment procedures
George R. Cadman, D.M.D.
Boston, Mass.
(Continued from the Hay issue)

T
he principles of the Begg technique, its advantages and disadvantages,
and the construction of the appliances used to achieve the objectives of the three
stages of treatment have been discussed in the first part of this article. This
second part describes appliance adjustments, including finishing procedures,
and presents a discussion of problems frequently encountered during treatment.
Treatment procedures

Relatively few adjustments should be needed during treatment, provided that

(1) the respective arch wires and, in Stage III, the auxiliaries have been made
correctly and (2) the patient has been cooperative in wearing the intermaxillary
elastics as directed and has refrained from distorting the arch wires.
The following adjustments will be found to be most common during the three
stages of treatment :
Stage I.
1. When anterior crowding and rotations have been corrected sufficiently
(usually after 1 or 2 months), the initial loop arch wires are replaced with 0.016
inch plain arch wires. The rings are formed 0.5 mm. mesial to the canine brackets
and ligated lightly to the brackets to prevent the occurrence of anterior spacing.
2. As the maxillary anterior teeth are retracted, the decreasing distance from
the mandibular molar hook to the maxillary elastic hook or ring results in a de-
crease in the amount of intermaxillary elastic force. The size of elastics is there-
fore changed from time to time as needed to maintain a force at about 2 ounces.
The patient should be instructed to replace elastics daily. They must be worn at
all times except while the teeth are being brushed.
601
602 Cadman Am. J. Orthod.
Jwne 1975

3. Horizontal bayonet bends should be made, usually one or two appointments

after the loop arch wires have been replaced by plain arch wires, to achieve slight
overcorrection of any original anterior rotations. It is generally agreed that
maintaining slight overcorrection of anterior rotations throughout treatment
by means of such bayonet bends decreases the tendency of the rotations to reap-
pear after treatment.
4. The arch wires should be inspected at each appointement to determine that
the anchorage bends are sufficient. If there should be any doubt, one should
remove the arch wires and replace or increase the anchorage bends. In general,
the bends should be made to such a degree that the anterior section of the arch
wire rests in the depth of the labial mucobuccal fold when the ends of the arch
wire are placed in the molar tubes.
The amount of anchorage bend will depend somewhat on the amount of bite
opening desired; that is, less anchorage bend will be used for a shallow overbite
than for a deep overbite. However, even in the presence of an open-bite, sufficient
anchorage bends are incorporated in the arch wires to prevent mesial tipping of
the molars, particularly the mandibular molars, which are subject to the mesial
component of Class II elastic traction.
5. As the arch wires move distally, the anchorage bends will approach the
mesial openings of the buccal tubes. Displacement of an anchorage bend into
the lumen causes binding of the wire in the tube which, in turn, results in cessa-
tion of anterior retraction, loss of molar control, and loss of overbite control. The
arch wire should be removed as often as necessary, and the location of the
anchorage bend should be moved mesially as required.
6. Probably the most frequently needed adjustment will be the correction of
arch wire distortion resulting from forces of mastication, particularly in the
buccal sections of the mandibular arch wire. The arch wires should be inspected
carefully at each appointment for such distortion and, if present, the arch wires
should be removed to make correcting adjustments.
7. At each appointment the patient should be examined carefully for the
establishment and maintenance of correlated maxillary and mandibular arch
forms which are judged to be normal for the individual.
Stage ZZ. During Stage II, horizontal as well as Class II intermaxillary
elastics are used as described in the section on arch wire formation. Treatment
procedures consist mainly of those enumerated for Stage I, with particular
attention to the need for any adjustment of the slight “toe-in” bends to prevent
mesiolingual rotation and/or mesial tipping of the molars (Fig. 24).
Because the arch wires are moving distally through the molar tubes, the distal
ends should be cut off and bent in to avoid tissue irritation as frequently as indi-
cated.
As each extraction space closes, the horizontal elastic in that quadrant is dis-
continued to avoid molar rotation, the molar toe-in bend is removed, and the
molar is ligated to the premolar and canine with 0.011 or 0.012 inch steel ligatures
connecting the respective lingual buttons or cleats.
In anticipation of the mesial movement of the crowns of all teeth during
Stage III resulting from the action of root-uprighting and torquing auxiliaries,
Volume
Nuntbn’
67
6
Vade ntecum for Begg technique 603

fig. 24. Insufficient distolingual molar bend in the arch wire has resulted in mesiolingual
rotation of the maxillary left first molar by the traction of the horizontal elastic during
Stage II.

incisors are intentionally tipped farther lingually and canines farther distally
than their desired final positions. However, there are instances (borderline ex-
traction cases, patients with flat profiles, large noses or chins, etc.) in which it is
desirable to close the extraction spaces by more than the usual amount of mesial
molar movement. In these circumstances “brakes” are employed, usually in the
mandibular arch, to stop the dista1 tipping of the anterior teeth. Uprighting
springs on canines and/or lateral incisors or a torquing auxiliary on the incisors
will provide this “braking” action. In order to minimize the tendency of the
braking auxiliaries to distort the arch wire and thereby increase the overbite,
they are activated very lightly to provide an almost passive resistance to further
distal tipping of t,he anterior teeth.
The use of brakes in Stage II effectively establishes an anterior anchorage,
the resistance to mesial bodily movement of the molars being opposed by resis-
tance to bodily retraction of the anterior teeth in the completion of space closure.
The result of the use of braking auxiliaries, therefore, will be (1) distal and lin-
gual bodily movement of the canines and incisors, (2) mesial bodily movement of
the molars, and (3) mesial tipping of the second premolars. Because of the in-
creased resistance of the anterior teeth, 2 to 4 ounces of horizontal elastic force
and 2 to 3 ounces of Class II elastic force may be used.
As in Stage I, correlated maxillary and mandibular arch forms should be
maintained. It should be emphasized that the arch form for each patient is in-
dividualized whenever required.
Stage III. Although the appliance is relatively complex, Stage III should
require the fewest adjustment procedures of the three stages if the base arch
wires and auxiliaries are made correctly. Treatment consists mainly of super-
vising the cooperation of the patient and the actions of the uprighting springs
and torquing auxiliary.
At each appointment the appliances and occlusion should be examined care-
fully for the beginning of any of the conditions enumerated in the section on
604 Cadman An,. J. O&hod.
June 1975

Fig. 25. Linguocclusion of the maxillary central incisors caused by excessive use of Class
II elastic traction during Stage III. The resulting occlusal forces will cause labial tipping
of the mandibular incisors and will impede palatal root torque of the maxillary central
incisors.
Fig. 26. An anterior diagonal elastic worn 12 to 14 hours per day to correct a midline
discrepancy. The lock pin of the maxillary left lateral incisor has been bent distally
to serve as a hook for the elastic. The opposite end of the elastic is hooked over the
ring mesial to the mandibular right canine. To permit engagement of the elastic, the
ligature tying the ring to the canine bracket has been removed.

“Problems Encountered in Treatment” and corrective measures should be taken.

1. TORQUING AUXILIARY. This adjunct to the main arch wire Usually requires
no adjustment. At each appointment, however, its action should be tested with an
explorer by lifting each loop out of contact with the labial surface of the incisor.
The roots of the incisors should be palpated from the labial to ascertain their
respective positions relative to the labial alveolar plate. If necessary, the auxiliary
should be removed, adjusted as indicated, and replaced.
During Stage III it is imperative that the maxillary incisors do not occlude
lingual to the mandibular incisors (Fig. 25), because lingual root torque of the
maxillary incisors will thereby be prevented and, instead, labial tipping of the
mandibular incisors will occur.
2. UPRIGHTING SPRINGS. As explained in the section on formation of the Stage
III appliance, the hooks of the respective uprighting springs will approach each
 Vade mecum for Begg technique 605

other as the premolars and canines upright. If they approximate each other with
less than 1 mm. separation, one or both should be replaced with springs having
shorter arms, or springs with longer arms should be constructed in such a manner
that the arms cross each other without binding (Fig. 21, B) .
Uprighting springs and the torquing auxiliary should be allowed to remain
active until overcorrection of the axial inclinations of the respective teeth has
been attained. The auxiliaries are then made passive and left in place to maintain
the roots and prevent relapse in the direction of the original root positions.
It will be observed that the action of an uprighting spring on only one side
of the arch will cause a shift of the midline. For example, an uprighting spring
placed to tip the root of the left lateral incisor distally will cause a shift of the
midline toward the right. Therefore, uprighting springs are usually used sym-
metrically to avoid a midline shift.
To upright teeth on only one side of the dental arch without shifting the
midline, it may be necessary to use a compensating asymmetrical elastic force,
such as:
A. A unilateral Class II elastic.
B. A strong Class II elastic force on one side and a weaker Class II
elastic force on the opposite side.
C. An anterior diagonal elastic, hooked over the mandibular elastic
ring on one side and a distally bent lock pin in the maxillary lateral in-
cisor bracket on the opposite side (Fig. 26). Because the wearing of this
anterior diagonal elastic is awkward, it is used only 12 hours a day, which
is usually sufficient. The ligature tying the lower elastic ring to the canine
bracket is removed on the appropriate side to allow the diagonal elastic
to be worn without slipping off the ring.
3. CORRECTION OF MIDLINE DEVIATIONS. It was stated earlier that the correction
of midline deviations usually occurs during Stage I and Stage II when the ex-
traction spaces close. Midline deviations generally result from tipping of the
incisor crowns, while the apices of the incisor roots are in their correct position.
The Begg bracket with single-point arch wire cont,act is well suited for correction
of midline deviations by tipping of the incisor crowns as the canines are tipped
distally, without producing the concomitant displacement of the incisor root
apices which occurs when edgewise brackets are employed. (A wide bracket with
a horizontal slot introduces simultaneous movement of crown and apex in op-
posite directions as soon as arch wire engagement is obtained.) Uprighting springs
can be used after the crowns of the incisors are tipped to their correct positions
if the root apices were displaced from the midline also.
The presence of a midline deviation at the end of Stage II may be the result
of one or more of the following conditions :
A. A skeletal asymmetry to a degree which precludes orthodontic cor-
rection of midline deviation.
B. A discrepancy between the mesiodistal crown diameters of the teeth
on the left side of the arch and those of the teeth on the right side, a con-
dition most frequently exhibited by the maxillary lateral incisors. Unless
the widths of the offending teeth can be equalized, preferably by stripping
606 Cadmwt Am. J. Orthod.
Julze 1975

the wider tooth and otherwise by placing a jacket crown on the narrower
tooth, the midline deviation cannot be corrected permanently. in the case
of a narrow maxillary lateral incisor the midline may be maintained in its
correct position, the lateral incisor held in contact with the central incisor,
and the residual space kept distal to the lateral incisor by means of a
retainer. The retention period for this esthetic compromise may be in-
definite.
C. An asymmetrical arrangement of the entire dentition in one jaw
in which all the teeth are positioned to the left or to the right of their
normal locations relative to the midline of the jaw. The optimum correc-
tion of such a condition demands careful treatment, which may involve
extraction of unlike teeth, the judicious utilization of response differentials
involved in the employment of braking auxiliaries, and both intermaxil-
lary and intramaxillary elastic forces.
D. Unilateral anchorage loss during Stage I or Stage II, usually
caused by cusp interference or binding of the arch wire.
The brackets used in the Begg technique, with their provision for tipping of
individual teeth with minimum resistance, lend themselves well to the usually
difficult and time-consuming process of midline correction. Frequently, a midline
discrepancy can be corrected in 1 or 2 months by the use of an anterior diagonal
elastic which is attached to the pin of the maxillary lateral incisor or canine on
one side and the intermaxillary elastic ring on the opposite side of the mandibular
arch. The maxillary lateral incisor or canine lock pin is bent horizontally toward
the distal aspect to serve as an attachment for the elastic (Fig. 26). The ligature
from the ring to the mandibular canine bracket on the opposite side must be re-
moved to permit engagement of the elastic.
It has been found that the use of such an elastic providing 11/2 to 2 ounces
of force for 12 to 14 hours each day will suffice for midline correction. Appro-
priate intermaxillary elastics are used concurrently to maintain the overcorrected
overbite and overjet and to provide asymmetrical forces as indicated to aid in
the midline correction.
The midline should be overcorrected before uprighting springs are placed in
the brackets of the anterior teeth which have been tipped in the process. To com-
pensate for the reciprocal action of the uprighting springs, which tends to cause
a return of the midline discrepancy, the anterior diagonal elastic and the ad-
ditional intermaxillary elastics used to effect the midline correction are continued
as needed until all root movements are complete.
Second molar adjustment

Second molars are not banded routinely in the Begg technique because these
teeth are not used for anchorage and because the second molars generally assume
and maintain correct positions in the dental arch throughout treatment. How-
ever, second molar adjustment is occasionally required as a result of their ectopic
eruption, rotation, or incorrect axial inclination.
Although the crown of a buccally erupting maxillary second molar often will
move spontaneously into correct position, this process may be impeded by in-
Volun~ 67
Number 6

sufficient available space or by the distal uprighting of the maxillary first molar
during the first stage of treatment. Provided sufficient space exists and the buccal
displacement is not excessive, such a malposed second molar can be tipped pala-
tally into the desired position by the extended distal end of the maxillary arch
wire. The arch wire is made sufficiently long to extend through the buccal tube of
the first molar and the extended distal portion is adjusted to exert a slight palatal
force against the buccal surface of the second molar. The molar area of the arch
wire should be constricted to compensate for the reciprocal buccal force against
the first molar.
Banding and use of cross elastics is required for the correction of a second
molar in such marked buccoversion that extension of the arch wire to its buccal
surface is not possible. If sufficient space does not exist for correct positioning of
the maxillary second molar, consideration should be given to extraction of the
unerupted third molar or to extraction of the second molar if radiographs indi-
cate the presence of a well-formed and favorably positioned unerupted third
molar. In evaluating the need for such extraction, the amount of expected tube-
rosity growth and the anticipated mesial movement of the first molar during the
second and third stages of treatment should be considered.
A lingually tipped mandibular second molar can be uprighted by banding
and by the use of cross elastics if the maxillary second molar is in buccoversion.
If the maxillary second molar is unerupted, or if it is in normal buccolingual
position, a lingually tipped mandibular second molar may be uprighted by means
of a finger spring attached to the lingual surface of the mandibular first molar
band. The posterior portion of the mandibular arch wire should be expanded to
compensate for the reciprocal lingual tipping force against the mandibular first
molar.
Second molars in cross-bite occlusion occasionally may be corrected by means
of a distal extension of the arch mire against the buccal surface of one second
molar and by a finger spring against the lingual surface of the opposing second
molar, as described above. This possibility is enhanced when rapid bite opening
accompanied by considerable extrusion of the mandibular molars occurs during
Stage I, resulting in a temporary lack of occlusion of the second molars. How-
ever, second molars in cross-bite, particularly in the presence of considerable
vertical overbite of these teeth, generally require banding and the use of cross-
elastics for correction. A bite plate to take the second molars out of occlusion is
seldom required ; in fact, the use of a bite plate during Begg treatment would
prevent or impede the simultaneous tooth movements desired in the correction of
the malocclusion.
Rotated or mesially tipped second molars should be banded with conventional
buccal tube attachments. If the rotation or tipping is not excessive, a 0.014 or
0.016 inch arch wire of appropriate length may be passed through the first molar
tube and then threaded through the tube of the second molar. Alignment of the
molars will frequently be achieved in 4 to 8 weeks.
If the degree of second molar rotation or tipping does not permit threading
the arch wire through both molar tubes, partial correction may be achieved by
passing the arch wire through the first molar tube and approximating the distal
 extension to the second molar 1ubcl by means of a cloubled ligat,urc threaded
through the tube. The correction can bc completed by threading the arch wire
through both molar tubes at a subsequent appointment.
The frictional binding of the arcah wires in the nonaligned molar tubes, or the
binding of arc411wire ligation to the scc*ond molar tubes, may impede the pro-
ccsses of bite opening and anterior tooth retraction if this procedure is instituted
in Stage I. For these reasons, the procedures tlesc*ribcd for second molar atl-
justments in which the main or auxiliary arch wires arc threaded through OI
ligated to the second molar tubes arc’ not grncrally undcrt,aken unt,il the end of
Stage II or the end of Stage III.
Occasionally, a considerable discrepancy in the occlusal lcrels of the mandibu-
lar first and second molars is ohservcd to appear (luring treatment, particularly
in Stage I, if rapid bite opening occurs. This c~ondition is caused bp extrusion of
the mandibular first molars from the vertical force wmponent of Class IT in-
termaxil1ar.v elastic treaction occurring more rapidly than t.he eruption of the
second molars. This marginal ridge discrepancy is generally transitory and
disappears with further eruption of the second molars.
Orcasionally, the mcsial marginal ridges of the maxillary or mandibular
second molars are observed to be at an occlusal level higher than the distal mar-
ginal ridges of the first molars. In the maxillary arch, this condition is usually the
result of a prolonged first stage of treatment, in which the anchorage bends have
caused excessive distal tipping of the maxillary molars. It may also he seen in
Stage III as a result of prolonged incisor toryuing which causes depression and
distal tipping of the maxillary molars. 1n the mandibular arch, distal tipping of
the first molars is almost invariabl,v the result of the inc+onsistent use of Class IT
intermaxillary elastics in the prlrscnrc of active anchorage bends.
Although undesirable, inasmuch as tlistal tipping of maxillary or mandibular
crowns often is accompanied 1)~ UlCSiill tipping of the respective root apices and
thus constitutes net anchorage loss, the c.ontlition, if mild in degree, is generally
self-correcting upon removal of tlic appliances and subsequent spontaneous oc-
clusal adjustment. In general, banding of second molars to correct distally tipped
first molars is necessary only if the first molars are tipped to a degree that causes
the distal contact points of the first molars to be locatctl gingival to the mesial
contact points of the second molars. This condition represents a loss of arch
length. Although correct.ion frequently (*an bc ac~hievccl 1)~ the placement of a
separating wire or a separating spring around the contact points, banding of
the second molars may be reqnirctl for molar alignment hp means of an arch
wire, as has been described.

Finishing procedures

The uprighting and torquin g auxiliaries are not removed until the axial in-
clinations of the respective teeth arr overcorrected. The inclinations of the
canines and premolars should be verified by means of periapical or panoramic
radiographs and the degree of incisor root torque by means of a lateral cephalo-
metric radiograph.
 Vade mecum for Begg technique 609

Overcorrection is necessary for t,wo reasons :

1. When the force of an auxiliary is removed, a certain amount of
“rebound” usually occurs as a result of the tendency of the root to return
slightly in the direction of its original position.
2. The closure of spaces following later band removal results in slight
lingual tipping of the incisor crowns, distal tipping of the canine and
lateral incisor crowns, and mesial tipping of the premolar crowns, all of
which are movements opposite those achieved by the auxiliaries during
Stage III.
The final corrections required for detailed finishing following Stage III
should be minimal if careful attention has been paid to each step through-
out the three stages of treatment, including accurate bracket placement in
the initial banding of the teeth.
Among the most frequently encountered conditions requiring attention at
this time are the following:
1. Undesired tooth rotations. Any incorrectly positioned brackets
should have been replaced early in treatment. However, even a correctly
placed bracket will permit rotation of the tooth if the bracket slot has
been forced open as a result of the following:
A. Distortion of the bracket in the process of welding the flanges to
the band. This condition is most frequently encountered in canines or
premolars, with marked curvature of the labial surfaces which requires
careful adaptation of the bracket flanges to the bands for efficient welding.
B. Excessive pressure on the bracket from the improper use of a band
seater or band driver during fitting and cementation.
C. Occlusal forces on the bracket from an opposing tooth. It may occur
prior to bite opening, or during slow or inadequate bite opening as a result
of faulty technique or poor cooperation from the patient in the use of in-
termaxillary elastics.
D. Occlusal forces on the bracket when the patient has been biting on
hard objects.
E. A blow directed gingivally, usually against the maxillary incisors.
F. The improper use of pliers producing excessive force when engaging
an arch wire in the bracket slot.
Although a rotation can be corrected by the formation of bayonet
bends in the arch wire, replacement of an incorrectly placed bracket is
often more efficient and less difficult and has the advantage of maintaining
an ideal, undistorted arch wire. If the bracket on a rotated tooth is cor-
rectly located but its slot has been enlarged by flange adaptation in the
welding process, the rotation can be corrected efficiently by the use of
elastic thread ligature.
Rotations which are the result of overcorrection of an original condi-
tion should be reduced so that no loss of arch length from overlapping
contact points will occur.
2. Introgenic open-bite. The desirability of achieving and maintaining
Fig. 27. Labial arch wire used to close spaces following band removal, prior to the
construction of a retainer. This arch wire permits occlusal settling” of the teeth while
restraining any tendency toward a return of maxillary incisor rotations, spacing, or ab-
normal overjet.

an edge-to-edge relation of the incisors throughout treatment has been

emphasized. If the original malorclusion exhibited excessive overbite, a
shallow overbite is established l)y appropriate arch wire adjustments,
such as decreasing the V bends and discontinuing t,he use of Class II
elastics. If continued Class II elastic force is needed to maintain neutroc-
elusion, the use of “triangular” elastics is preferable. This traction is simi-
lar to that from conventional Class II elastics, but one leg of the elastic
is engaged in the mandibular canine ring to provide a vertical force in
the incisor area. Occasionally, vertical 01 “box” elastics may bc required
in conjunction with arch wire adjustments to obtain closure of the anterior
open-bite.
3. I~zpropcr urch form. A large mirror (for instance, one employed in
making occlusal intraoral photographs) is a valuable aid for examining
the maxillary arch for symmetry and form. Maxillary and mandibular
arch wires must be correlated for arch form, and any apparent discrepan-
cies should be corrected. Appropriate cross elastics and vertical elastics
may be used to supplement the arch wire adjustments for improvement of
molar position and occlusion.
Some clinicians utilize vertical elastics to Ol)tihl masinial occlusal
intercuspation, while others rely on the natural settling of the teeth into
optimal occlusion after band removal. A tooth positioner can aici in tic-
tailed finishing.
One way to permit spontaneous occlusal settling, while preventing the re-
turn of abnormal overjet and maxillary incisor rotations, is through the use of
a labial arch wire following the removal of all bands except those on the maxil-
larv molars (Fig. 27).
This labial holding or finishing arch wire is made of 0.036 incah nichromc or
stainless steel wire. It is carefully fashioned with offset bends for the lateral
incisors and canines as dictated by the form ant1 size of individual teeth. If
rotations and malpositions of anterior teeth were present in the original mal-
occlusion, the arch wire should contact the respective teeth in such a manner that
any relapse is minimized during the time required for band space closure and
occlusal settling. As with all arch wires used, attention should be directed to the
arch form judged normal for the individual patient.
Small hooks are soldered on the gingival aspect of the labial arch wire 2 to 3
mm. mesial to the molar tubes to allow distal movement of the arch wire through
the tubes as band spaces are closed. The soldered hooks on the arch wire are tied
back snugly with 0.009 inch steel ligatures to the molar tubes to close band spaces.
Occasionally, these spaces will be large enough to require the use of elastic
thread rather than steel ligatures for efficient closure without excessive force.
Elastic thread ligatures for final space closure should be used with caution. If
the hooks are soldered on the labial arch wire too far mesial to the molar tubes
and the patient is not observed carefully, the spaces may close completely, often
in a matter of hours or days, with a recurrence of crowding and rotations.
The labial arch wire is inspected and adjusted as needed at weekly intervals
until space closure and occlusal settling have occurred. The time required will
vary among individual patients, but usually 1 to 3 weeks will suffice. If marked
rotations of anterior teeth were present originally, the labial arch wire should be
employed for a minimal time to accomplish its objectives.
Impressions are then made for the construction of the retaining appliance or
appliances judged to be most effective for the patient.
Pretreatment and posttreatment dental casts, together with superimposed
cephalomctric tracings, of two Class II, Division 1 malocclusions treated with the
extraction of four first premolars are shown in Figs. 33 and 34.

Problems encountered during treatment and their causes

Although the details of various procedures have been incorporated in the

foregoing discussion of technique, clinical results frequently reveal that their
importance in construction and adjustments of arch wires and the application of
elastic traction is more critical than generally assumed. To clarify the specific
effect of subtle variations in technique, problems and their causation will be re-
viewed according to their oceurrenee during each stage of treatment. This listing
has proved to be valuable as a reference guide in our teaching experience, and its
careful study has contributed to a better mldcrstanding of the key principles of
the Begg technique.
Problems iv& Strrge I
1. Failure to correct deep overbite
A. Patient not wearing Class II elastics continuously
B. Arch wire distorted- by occlusal forces, resulting from :
( 1) Mandibular molar tube positioned insufficiently gingivally,
bringing anchorage bend into occlusal contact with maxillary premolar
(Fig. 28, A)
(2) Patient biting on hard food or objects (Fig. 28, B and C)
C. Insufficient anchorage bends in maxillary and/or mandibular arch
wires
Fig. 28. Conditions impeding bite opening. A, Because the mandibular molar tube is
positioned too far occlusally, the mandibular arch wire is vulnerable to distortion in
the area of the anchorage bend by the maxillary premolar. B, Distortion of the arch wire
mesial to the mandibular right molar by occlusal forces. The resulting loss of the
anchorage bend will cause mesial tipping of the molar, lingual tipping of the molar,
and accentuation of overbite. C, The mandibular molar tube is positioned too far oc-
clusally. The maxillary arch wire has been distorted by a hard object, and the resulting
decrease in bite-opening action has contributed to occlusal interference of the canines.
D, Mandibular arch wire caught on the occlusal aspect of the premolar bracket. This
condition reduces the intrusive force of the arch wire on the mandibular canine and in-
cisors. E, Unsatisfactory bite opening caused by incorrect bracket location. The maxillary
central incisor bands were placed too far gingivally, resulting in relative extrusion of
these teeth. This condition, in turn, interferes with incisor retraction.
Volume 67 Vnde mecum for Begg technique 613
Nunzber 6

D. Anchorage bend formed too far mesially from buccal tube (Fig.
10, 0
E. Anchorage bend displaced into molar tube
F. Insufficient Class II elastic traction
G. Use of horizontal elastics
H. Use of torquing auxiliary
I. IJse of uprighting springs
J. Arch wire in premolar bracket slot or caught on occlusal aspect of
premolar bracket (Fig. 28, D)
K. Arch wire contacting gingival aspect of premolar bypass clamp,
thereby impeding intrusive action on canines and incisors
L. Bruxism or clenching habit which prevents molar extrusion by the
vertical component of Class II elastic traction
M. Incorrect bracket placement causing relative extrusion of one or
more incisors (Fig. 28, E)
N. Absence of sufficient freeway space to permit molar extrusion
2. Maxillary anterior teeth not retracting satisfactorily
A. Patient not wearing Class II elastics continuously
B. Arch wire binding. At each appointment, before any adjustments
are made, the operator should place his fingernails against the mesial sur-
face of the rings and determine that the arch wire can slide freely. The
following factors must be considered as causes of arch wire binding:
(1) In anterior brackets
(a) Pins locked too tightly
(b) Brackets bent from blow, or from excessive pressure during
seating of band
(c) Ligature from ring to canine bracket tied or caught incisal
or gingival to the lock pin; as a result arch wire binds and distal
tipping of canine is impeded
(d) Elastic ring or hook entering canine bracket
(2) In premolar area
(a) Arch wire pinned in premolar bracket slot
(b) Ligature or bypass clamp too tight.
(3) In molar area
(a) Anchorage bend displaced into molar tube
(b) Distal end of arch wire impinging on gingiva
(c) Distal end of arch wire contacting second molar (Fig. 29)
(d) Distal end of arch wire inside molar tube (Fig. 15, B)
C. Loops contacting anterior tooth or gingival tissue, thereby estab-
lishing two-point contact which prevents free tipping of anterior teeth
D. Pins bent toward distal and impinging on occlusal aspect of arch
wire, thus preventing or impeding distal tipping of teeth
E. Occlusal interference of incisors or canines
(1) Unsatisfactory bite opening
(2) Incorrect arch form (constricted maxillary canines, expanded
mandibular canines)
6 14 Cadnun

Fig. 29. The mandibular arch wire is prevented from moving distally through the molar
tube because of contact of the end of the arch wire and the second molar. Incorrect band
placement has caused relative extrusion of the maxillary and mandibular left canines.

Fig. 30. Loss of mandibular molar control. A, Failure to incorporate sufficient expansion
in the posterior areas of the mandibulat arch wire has resulted in lingual tipping of the
molars by the forces of Class II elastics. Additional lingual tipping of the left molar
has been caused by constriction of the left side of the arch wire by the force of the
elastic thread ligature used to correct the rotation of the left canine. 8, Distortion of the
arch wire by occlusal forces has caused the anchorage bend to roll bucally, thereby
producing a distolingual rotation of the mandibular left molar.

(3) incorrect bracket placement which causes relative extrusion of

anterior tooth or teeth (Fig. 28, E’)
I?. Canines forced against labial or lingual cortical plates
G. Lip, tongue, or finger-sucking habits
H. Class II elastics wedged between hook and labial surface of canines,
thereby impeding free distal tipping of canine
I. Excessive expansion of loops in initial arch wire which flares inci-
sors labially
Fig. 31. Incisor spacing resulting from failure to ligate elastic rings to canine brackets.
Distortion of the maxillary arch wire in the right premolar area has caused unsatisfactory
bite opening on the right side. The resulting occlusal interference of the right canines has
impeded distal tipping of the maxillary right canine and has caused excessive tipping
of the mandibular right canine. The mandibular midline has shifted to the right, and
the maxillary midline has shifted to the left.

J. Uprighting springs or torquing auxiliary used inappropriately in

Stage I
3. Mandibular m&ars tipping lingually
A. Insufficient expansion in arch wire (Fig. 30, A)
B. Excessive Class II elastic traction
C. Incorrectly formed anchorage bends
D. Arch wire distorted
(1) From occlusal forces during mastication (hard foods, etc.)
(Fig. 28, B)
(2) From occlusion with maxillary second premolars (Fig. 28, A)
E. Prolonged use of loop arch wires
4. Mandibular molars tipping mesially
A. Arch wire distorted
B. Excessive Class II elastic traction
C. Insufficient anchorage bends
D. Arch wire caught under gingival aspect of premolar bracket
E. Arch wire does not enter buccal tube at, 12 o’clock position
5. Mandibular molars rotating (usually mesiolingually)
A. Incorrectly formed anchorage bend which fails to achieve 6 o’clock
-12 o’clock position of arch wire in molar tubes
B. Arch wire distorted from occlusal forces, causing anchorage bend
to “roll” lingually or buccally (Fig. 30, B)
C. Use of horizontal elastics in Stage I
D. Incorrectly located molar tube
E. Excessive intermaxillary elastic traction
6. Anterior spacing
A. Intermaxillary rings or hooks not tied back to canine brackets
(Fig. 31)
 A,,,. J. Orthod.
.Jwm 1975

Fig. 32. A, 8, and C, The occlusal interference of the left canines has caused the mandib-
ular left canine to tip distally more than the right mandibular canine while Class II
elastic force was applied. Concurrently, the distal tipping of the maxillary left canine
has been impeded. The maxillary midline was deflected to the right, and the mandibular
midline has been shifted to the left. An almost passive uprighting spring has been
placed as a “brake” in the mandibular left canine bracket to prevent further distal
tipping until neutrocclusion of the left canines is obtained and to aid in midline correc-
tion. D, Interdental spacing caused by incorrect band placement. The mandibular second
premolar has been extruded because the band and bracket are positioned too far
gingivally, thereby impeding closure of the second premolar extraction space. E and F,
Opening of extraction spaces by interference of uprighting springs. The ligature tying
the lingual buttons of the maxillary left canine, premolar, and molar together was
dislodged; consequently, the action of the uprighting springs separated the canine and
premolar. The canine-uprighting spring subsequently became unhooked. The patient en-
gaged the hook of the uprighting spring on the arch wire mesial to the hook of the
premolar-uprighting spring instead of crossing over it, thereby causing a further increase
in the space. G, Incisor rotation caused by incorrect formation and/or placement of
torquing auxillary. Contact of the torquing auxiliary loop on the distal aspect of the
labial surface has produced distolingual rotation of the maxillary right central incisor.

B. Excessive expansion of loops in initial arch wire

C. Excessive length of arch wire between intermaxillary rings or hooks
7. Difficulty in correction or ovcrcorrection of anterior rotations
A. Bracket slot enlarged by distortion
(1) During welding of bracket to band
(2) From a blow on anterior teeth
(3) From occlusal strike of maxillary incisors against mandibular
incisor brackets
 Vade mecum for Begg techGque 617

Fig. 32, C through G. For legend, see opposite page.

(4) From excessive pressure on bracket when seating band

8. Canine on one side tipping distally more slowly than its antimere
A. Occlusal interference (Figs. 31 and 32, A, B and C)
B. Binding of arch wire on one side
C. Any other condition, existing unilaterally, outlined under section
2 above
9. Loss of mandibular anchorage
A. May be caused by any conditions enumerated in sections 1, 2, 3, 4,
5, or 8
10. Maxillary molars rotating or tipping
A. Incorrectly formed anchorage bends (Fig. 10, C)
B. Anchorage bends formed too far mesially (Fig. IO, C)
C. Arch wire distortion
D. Incorrect buccolingual angulation of molar tube
 AWL. J. Orthod.
618 Cadman dww 19 7.5

Problems in Stage 11
1. Molar rotation (usually mesiolingually)
A. Insufficient molar toe-in bends in arch wire (Fig. 24)
B. Arch wire distorted from occlusal forces (usually in mandibular
arch wire)
C. Horizontal elastic force too great
D. Elastic engaged on distal aspect of buccal tube instead of on mesial
hook
E. Incorrect buccolingual angulation of molar tube
2. Bite deepens
A. Class II elastics not worn as much as required to maintain end-to-
end incisor relation
B. Horizontal elastic force too strong in proportion to Class II elastic
force
C. Arch wires distorted, reducing bite-opening action of anchor bends
D. Other causes enumerated in problems encountered in Stage I
3. Extraction spaces do not close
A. Elastics not worn as directed
B. Occlusal interference of premolars and/or canines (Fig. 32, U)
C. Discrepancy in relative size of maxillary and mandibular second
premolars
D. Binding of arch wire
(1) Causes enumerated in problems of Stage I
Problems in Stage III
1. Bite deepens
A. Class II elastics not worn as directed
B. Base arch wires incorrectly formed with insufficient gingival ‘(bow”
in incisor area to compensate for extrusive force of torquing auxiliary
C. Excessive torque force on maxillary incisors
D. Excessive force of canine and premolar uprighting springs
E. Base arch wire not rigid enough (0.016 inch instead of 0.018 or
0.020 inch)
F. Bruxism or clenching habit
2. Overjet reappears
A. Class II elastics not worn as directed
B. Excessive torquing force
3. Maxillary molar tip buccally
A. Base arch wire cinched back at distal aspect of molar tubes without
required compensation in arch wire form
B. Lingual cleats or buttons not tied to premolars and canines
C. Base arch wire incorrectly formed-not enough constriction in
molar area
D. Base arch wire not rigid enough
E. Torquing auxiliary not constricted enough in form
F. Excessive or prolonged torquing force
4. Molars rotate mesiolingually
Volume 67 Vade ~~ecw)~ for Kegg techwiquc! 619
Nuna her 6

A. Base arch wire cinched back at distal aspect of molar tubes without
required c,ampcnsation in arch wire form
B. Lingual cleats or buttons not ligated to premolars and canines
C. Base arch wire incorrectly formed
D. Base arch wire distorted in area of anchorage bend
R. Incorrect placement of buccal tube
5. Anterior spacing
A. Rings contacting canine brackets. Incisors may occupy less space
in arch as they are uprighted
B. Rings not ligated to canine brackets (Fig. 1’7, B)
C. Labial force against maxillary incisors by mandibular incisors as
a result of bite deepening
6. Class III incisor relation develops with overbite (Fig. 25). This con-
dition should be corrected immediately with Class III elastics, as it will
prevent lingual root torque of the maxillary incisors and cause labial tipping
of the mandibular incisors with loss of mandibular anchorage
A. Class II elastic traction too great or too prolonged
B. Mandibular anterior spacing resulting from failure to ligate rings
to canine brackets
7. Kxtraction spaces open
A. Lingual cleats or buttons not ligated or ligated 1oosel.y
B. Lingual cleats or buttons tied with ligatures of less than 0.011 inch
diameter which will stretch uncler forces of occlusion
C. Hooks of uprighting springs prevented from sliding freely along
the base arch wire because of interference with other uprighting springs,
intermaxillary elastic rings, brackets, or bands (Fig. 32, E and P)
D. Bracket of opposing tooth located too far gingivally, resulting in
“plunger cusp” action (Fig. 32, D)
8. Extrusion of tooth being uprightctl
A. Failure to ligate base arch wire into bracket (Fig. 22)
B. Broken ligature
C. Anchorage bend in the mandibular base arch wire located too far
mesially, causing extrusion of the second premolar
9. Failure of tooth to upright
A. Ligature tied on wrong side of bracket (Fig. 18, H and C)
B. Overclosurc of cstraction spaces, resulting in ocrlusal edge of distal
aspect of caaninc bantl catching uncler mcsial eontour of premolar or under
gingival edge of mcsial of premolar hand (Fig. 16, C)
(1. Similar condition with lateral incisor and canine
I). l~ingual ligatures or ring-to-canine bracket ligatures too tight
E. Hook of uprighting spring not free to slide along base arch wire be-
cause of interference with other uprighting spring, ring, bracket, or band
F. J)istortcd uprighting spring
(:. Bintling of base artah wire in bracket,
II. Incorrect placrmcnt of uprighting springs
10. Failarc to achieve incisor torque
Fig. 33. Dental casts of a Class II, Division I malocclusion in which four first premolars
were extracted. A, 6, and C, Pretreatment casts: right, frontal, and left views. D, E, and
F, Posttreatment casts: right, frontal, and left views. G and H, Pretreatment and post-
treatment casts: occlusal views. I, Pretreatment and posttreatment cephalometric tracings
of patient whose dental casts are shown in A through H. Tracings are registered on
anterior cranial base.

A. Insufficient force of torquing auxiliary

(1) Torquing auxiliary formed of 0.014 inch instead of 0.016 inch
wire
(a) Troops insufficiently angulatcd from vertical
(b) Arc of auxiliary not constricted enough to provide sufficient
force when engaged in incisor brackets
B. Base arch wire binding in incisor brackets
 Vade mecum for Begg technique 621

Fig. 33, I. For legend, see opposite page.

C. Intermaxillary rings tied too tightly to canine brackets

D. Maxillary incisors occluding lingual to mandibular incisors (Fig.
25)
11. Canines rotate mesiolingually
A. Intermaxillary rings tied too tightly
B. Lingual cleats or buttons ligated too tightly
C. Bracket incorrectly located
D. Incorrect base arch wire form in area of canine curvature
E. Bracket slot enlarged
12. Canines rotate distolingually
A. Incorrect bracket placement
B. Distortion or incorrect placement of uprighting spring, with helix
distal to bracket and exerting pressure lingually against distolabial sur-
face of canine
C. Arm of uprighting springs not parallel to arch wire in horizontal
plane
D. ltings in contact with canine brackets at beginning of Stage III
E. Bracket slot enlarged
F. Arch wire incorrectly formed
13. Premolars rotate mesiolingually
A. Causes listed in paragraph 12, but actions in opposite directions
B. Bracket slot enlarged
C. ldingual cleat or button not included in ligation from molar to
canine
14. Incisors rotate
Fig. 34. Dental casts of a Class II, Division 1 malocclclsion in which four first premolars
were extracted. A, 6, and C, Pretreatment casts: right, frontal, and left views. D, E, and
F, Posttreatment casts: right, frontal, and left views. G and H, Pretreatment and post-
treatment casts: occlusal views. I, Pretreatment and posttreatment cephalometric tracings
of patient whose dental casts are shown in A through H. Tracings are registered on
anterior cranial base.

A. Incorrect bracket placement

B. Bracket slot enlarged
C. Original rotation not corrected and maintained with rotation bend
in arch wire
D. Loop of torquing auxiliary does not contact tooth in center of
crown (Fig. 32, G)
E. Distorted uprighting spring
15. Midline discrepancy
A. Skeletal asymmetry
 l’ude fw Begg techdque
~H~‘c~o)L 623

Fig. 34, 1. For legend, see opposite page.

B. Tooth size discrepancy

C. Asymmetrical arrangement of dentition in one jaw
D. Loss of anchorage on one side during Stage I or Stage II
(See also discussion of correction of midline deviations in section on
treatment procedures, Stage III.)

Epilogue

The introduction of the Begg technique in 1956 had considerable impact be-
cause of its radical departure from conventional concepts at the time. Adelaide
soon became a Mecca for orthodontists, and many of our colleagues made their
pilgrimages to the distant continent of Australia. Upon returning to their home-
lands they enthusiastically shared experiences with others and began to teach
the new method. BrandV even organized a correspondence course and exchange
of Kodachromes to document treatment progress at the University of Groningen
in The Netherlands after having conducted an introductory typodont course.
Dr. Begg and his associate, Dr. Simms, traveled widely throughout the
world in response to numerous invitations. In the United States Kesling and
Rocke’ became the foremost promoters of the method, providing highly organized
cdontinuing education courses, and many orthodontic departments made provi-
sions to teach the Brgg technique in their graduate programs. Moreover, Begg
societies and study groups were founded and papers began to appear in the litera-
ture, as well as textbooks” and chapters in leading textbooks.”
Orthodontists were attracted to the new technique at first because its light
and continuous force application promised a more biologic, tissue response than
tbt heavy forces that prc>\ailetl at the time in the edgewise technique. Its cffi-
cirney to elicit simultaneous movement of many teeth and the superiority of its
potential for torquing incisors were quickly recognized. Moreover, the three
clear-cut stages of treatment suggested a simplicity of procedure.
“Kealing , H . I)., and Rocke, R. A., Orthodontic Center, Westville, In&
 ‘l’et early results were not ;11\\21ystlliwuraging ; clisal’I)oiritlucIit fol low~ttl~ ;m(l
critique was lcveletl. The prcsunwtl sirllplicity of p~~wc~lurc was clwepti\x~, ;IIICI
it, soon became apparent that the prwision of tooth nlovrmrllt, the dficGwc~- of
therapy, and the achievement of optimal results tlemallclrtl wnsiclcrable clinical
sophistication and technical subtlety. ( ‘riti~al asswsmel~t of progress cwntually
brought the reward of bet,ter untlerstanclirtg, and an epprwiation was gained of
the importance and cffcct of’ milluto variations in twhnique 011 tooth movement.
This vade mecum has been wmpilccl to present a sptcmatic treatise of the
Begg technique in which the details of prowdure have lmw emphasized as then
relate to the occurrence and prevention of undesirable response, These guidelines
have been developed for the IIarvarJ-F’orsyth teaching program of the Begg
technique, which dates back to 1958. They have hwn cxtcntletl to involve not
only ext,raction treatment but also nonextraction treatment of Class II, Division
1 malocclusion, as well as extraction aiicl nonextraction treatment. of’ Class II,
Division 2 malodusion, treatment of (Yass III malocclusion, ilIlt the use of
extraoral force.
The author wishes to express sincere appreciation to Coenraad F. A. Moorrees, professor
of orthodontics, Harvard School of Dental Medicine and the Forsvth 1)ental Center, Boston,
Massachusetts, for his valuable collaboration in the preparation and editing of this article.

REFERENCES
1. Begg, P. K. : Differential force in orthodontic treatment, AM. J. OKTIIOIL 42: 4X1 -510, 1956.
2. McDowell, C. H.: The hidden force, Angle Orthod. 37: 109-131, 1967.
3. Hain, ;1. A.: Keciprocul reverse torquing auxiliaries for the Beg-g technique, .J. Prart.
Orthotl. 3: 358-361, 1969.
4. Jirnnllt, R.: (:orrespondence teaching, Austr. Orthotl. Bull. 5: l-k-21, 1967.
5. Ibgg, 1’. Et., and Resling, P. C.: Hegg orthodontic theory and technique, Philadelphia, \V. FL
Saunders Company, 1965.
6. Swain, R. F. : Regg differential light forces technic, in Grnl)er, ‘I’. IL : Current orthodontic1
concepts and techniques, Philadelphia, TV. B. Saunders Company, Vol. 2, 1969.

140 Tlr~ Fcnwny (OBl15)