Beggs Modifications Ortho / Orthodontic Courses by Indian Dental Academy

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MODIFICATION OF BEGGS TECHNIQUE
CONTENTS-----

-----INTRODUCTION
-----ATTRITIONAL OCCLUSION TODAY
-----BEGG REFINEMENTS
-----MODIFIED BEGGS
-----ALKINSONS 3D UNIVERSAL BRACKET SYSTEM
-----BEGG-CHUN HOON COMBINATION BRACKET
-----THE MODULAR SELF LOCKING BRACKET SYSTEM
-----MODERN BEGGS
-----COMBINED ANCHORAGE TECHNIQUE
-----THE KAMEDIZED BEGG TECHNIQUE
-----TIP EDGE
-----BEDDTIOT
-----LINGUAL LIGHT WIRE TECHNIQUE
-----CONTROL 21 BRACKET SYSTEM
-----CONCLUSION
INTRODUCTION
No treatment modality is ever perfect. With the passage of time
its drawbacks become apparent.
Unless the treatment evolves to overcome
those drawbacks , it is likely to become stagnant and than die
slowly. Refinements also become necessary to incorporate new
concepts and technology progress.
The present day Begg differs
considerably from the original teachings of Dr Begg. It has
evolved in two distinct forms---

------REFINED BEGG
Using the same inverted ribbon arch
brackets but incorporating improvements in mechanics.
------MODIFIED BEGG
Here the core light wire philosophy has
remained the same but the bracket designs have changed ,
example combination brackets.
Over the years many authors like SIMS, SWAIN, MULIE, LYMAN
SWAGERS, TEN HOVE, HOCEVAR, KAMEDA, THOMSON and
MOLLENHAEUR have discussed the drawbacks of classical Begg
and suggested modifications in approach and technique.

The various reasons for these changes are

Change in treatment philosophy--- not all Begg practitioners
accepted the concept of attritional occlusion as a basis for
treatment planning. Attempts are being made to reconcile Begg
treatment with Andrews six keys of normal occlusion.

Change in treatment approach--- advantages of mixed dentition
treatment have been realized. Profile is given a lot of importance
and the number of extraction cases have been reduced.
In order to overcome the deficiencies in traditional Begg
treatment , Begg mechanics have been suitably modified.

Several refinements have been introduced to take advantage
of newer materials especially the wires.

Attempts have been made to combine the best in Begg with
the good aspects of other techniques.
Some of the drawbacks of conventional Begg treatment which
have necessitated the refinements are

Difficulty in obtaining proper finishing and detailing of the cases.

Difficulty in obtaining the posterior root torque.

Difficulty in intruding the upper incisors.

Difficulty in maintaining rotational control.

No safe check on crown tipping and uprighting movements.

There are some essentials which remained unchanged in Begg
mechanotherpy.

Use of light forces.

Crown tipping movements followed by root movements with
least taxing on the anchorage.

Free tipping in the initial stages due to minimum friction
between the wire and the bracket.

Use of differential forces for different movements.

A definite sequence of treatment stages.

Use of light intra-oral elastic forces.

En masse movement of anterior and posterior teeth for
correction of overjet and correction of posterior occlusion.

Separation of root moving forces from archwire forces.

Overcorrection of all displacements.

Use of round high tensile wires.
CONCEPTUAL CHANGES
During the earlier days the Begg appliance and
the theory of attritional occlusion were considered inseparable .
Today Begg treatment reconciles with present day objectives like

Andrews six keys to normal occlusion as the treatment goal for
static occlusion.

Functional occlusion requirements based on the concepts of
Roth are achieved.

A broad based diagnosis is made by taking into account patients
skeletal, dental and soft tissue characteristics.

Treatment is carried out during mixed dentition phase to utilize
growth changes and leeway space to relieve crowding.
When extraction has to be carried out, their effect on the
patients profile is considered.

Uncontrolled tipping is avoided because of the chances of
causing root resorption.

Arch form considerations are given a lot of importance.
ATTRITIONAL OCCLUSION TODAY

The relevance of attritional occlusion today

Attrition does occur in stone age man mesially and occlusally but
the magnitude is less than what Dr Begg concluded . Similar
attrition does not occur in modern man due to dietary changes.

Mesio-occlusal migration in modern man is dependent on good
tooth contacts. When there is loss of tooth , the distal to the site
moves mesially whereas those anterior move distally.
Extraction carried out in cases of tooth material excess and
antero-posterior discrepancies improve aesthetics and stability.
But extraction in some cases can jeopardize stability and
aesthetics when attritional occlusion is involved.

Andrews six keys to normal occlusion is the goal of modern
orthodontic treatment. None of Andrews normals showed any
attrition.
BEGG REFINEMENTS

DIAGNOSIS
The number of criteria regarding a proper
diagnosis have increased

Today the emphasizes is less on extractions. In border line cases
no extractions are carried out or the extractions are avoided.

The patients soft tissue profile is given a lot of importance while
planning a treatment.

Various techniques like VVTO ( Visible Visualised Treatment
Objective) introduced by MOLLENHAEUR are used in treatment
planning
Treatment is started in the mixed dentition when indicated.

Mixed dentition Begg therapy was popularized by LYMAN
WAGERS.

Growth modification procedures are given a lot of importance .

Begg therapy is combined with functional appliances and various
types of headgears wherever it is indicated.

The leeway space is utilized to correct malocclusion.
TREATMENT PLANNING IN THE PERMANENT
DENTITION

In conventional Begg first premolar extractions were carried out in
almost all the cases , regardless of the malocclusion or its effects
on the patients soft tissue profile . However all is changed now.
Instead of all the first premolars we can extract
All 5s
Upper 4s and lower 5s
Asymmetric extractions
All 6s
Single lower incisors
Single arch extractions
Interproximal stripping is carried out in minimal discrepancy
cases.
In border line cases only a non extraction approach is carried out.
DIFFERENT COMPONENTS

BRACKETS

Begg brackets with built in torque (KAMEDA) and derotation
(MOLLENHAEUR) have been introduced.

Combination brackets.

Tip edge brackets.

And most importantly ceramic brackets.
These ceramic brackets are classified

Depending upon crystal structure .
Monocrystalline
Polycrystalline

Depending upon the retentive mechanism.
Mechanical
Chemical
Mechano -chemical

Based upon the material constituents
Pure ceramicalumina based / zirconia
based
Laminated brackets.
The various advantages of ceramic brackets are
Esthetics .

Resists discoloration

Can be used in patients who are allergic to metal brackets

The various disadvantages are
Enamel abrasion in opposing teeth in deep bite cases.

Brittleness leading to fractures.

High bond strength leading to enamel fracture.

Accurate bracket positioning difficult,

High cost.
BUCCAL TUBES

Regular 0.036 x 0.045 tubes.

Kamedas oval tubes with smaller internal diameter.

Combination tubes round and rectangular.

Upper triple tubes consisting of
---- Standard Begg tube 0.036 internal diameter.
---- 0.022 x 0.028 used to engage the 0.022 x0.020
finishing arch wire after stage 3.

---- Head gear tubes.
WIRES

Multi looped archwires have gradually become outdated after the
introduction of the following flexible wires

Co-axial sectional wires.

Ni-Ti alloys.

Titanium Molybedenum Alloy (T M A).

Supreme grade wires.

Copper NiTi wires.

Rectangular wires.
Until recently the grade of wire routinely used was special
plus and for those cases resistant to bite opening Extra Special
plus was used. Recently A.J.Wilcock Scientific and Engineering
Company, the manufacturers of this wire have announced a new
series of wire grades and sizes. The fundamental difference for
the superior properties of these new wires is the use of a new
manufacturing process called Pulse straightening as against
the Spinner straightening procedure used earlier The new
grades and sizes of wire makes available are:

Sizes Available

Premium : .020

Premium Plus : .010, .O12, .014, .016, .018

Supreme : .008, .009, .010, .011.
Uses of the Newer Wilcock Wires:

The supreme grade wire of sizes .008 to .011 is used for:
1. Unraveling of crowded anterior teeth.
2. Boxed reciprocal torque auxiliaries
3. Mini uprighting springs.

When used for unraveling these wires are pinned into the
malapositioned teeth and along side the main archwire in
normally aligned teeth. They have resistance and yield diameters
very close to that of the Nickel Titanium alloys. Cost wise they
are much more economic than nickel -Titanium wires. When
used as torque auxiliaries, the lighter forces produced do not
tax the anchorage, when used as uprighting springs, they
can be slipped behind the main arch wire without removing the
pins.
ALPHA TITANIUM WIRES IN BEGG THERAPY

Titanium wires serves two functions in Refined Begg
Therapy
Rectangular and Tapered round wires .
Finishing wires.

RECTANGULAR AND TAPERED ROUND WIRES

The rectangular section is 0.018 x 0.026 and the round section
tapers from 0.019 down to 0.017. This form of wires allow two
distinct functions.

Braking or space closing arch wire.

Wires for buccal alignment.
FINISHING ALPHA TITANIUM WIRES

Dr Mollenhaeur used 0.020 x 0.020 square alpha titanium
archwire for artistic finishing.

The finishing archwires are used to connect arch form before
debonding , expand the premolar area , apply buccal root torque
in the molars and help in artistic finishing.
ELASTICS

Types of elastics:

Elastics, be it latex / non-latex type, are grouped, or, referred to,
or, segregated into different types by their differing:

Internal diameter 3/8 (9.5 mm), 5/16 (7.9 mm), (6.4
mm), 3/16 (4.8 mm) and 1/8 (3.2 mm)

Intended force values 2 Oz (57 gm), 31/2 Oz. (99 gm), 41/2
Oz.( 128 gm), 6 Oz. (170gm), and 8 Oz (227 gm) varieties. The
funda was that when stretched 3 times their diameter, the elastics
would give the force that they were marketed to be giving.
The color Yellow, Pink, Green, Blue, White, etc. The elastics
were referred to their color-coding as per the intended force value
ascribed for that type of colored elastic (even if, in practice, the
elastics were plain, non colored latex type with a pale yellow
color).

Wall thickness -- when manufactured in a greater wall thickness,
the same elastic, say 5/16 diameter, could give different forces
ranging between 2 Oz, 3 1/2 Oz, 41/2 Oz, 6 Oz, or, 8 Oz. It
would then be called Yellow, Green, Tan, Mauve, or, Fire Orange
elastic respectively.

OPTIMUM FORCE

It is observed that in the upper arch 1.5 ounces (42 gms) and in
lower arch 1.2 0unces (35 gms) of force is enough to cause
intrusion of incisors. The force values used in earlier days have
been found to be much higher. Now a days much smaller force is
suggested .

In conventional Begg Therapy the only elastics used were

Class 1
Class 11
Class111
No other force system was thought to be necessary. However , all
that has changed now. Different kinds of elastics made in different
materials , sizes and force values are used routinely. These are-

Midline elastics
Used to correct midline.
Used from upper canine to lower canine on the opposite side.
These elastics have two vectors.
Vertical
Horizontal.
The vertical vector is absorbed by heavy base wire and the
horizontal vector corrects the midline.

Cross elastics
Used to correct single tooth cross bites in posterior teeth. They
have a horizontal and vertical component and extrude the teeth
while moving them buccolingually.

Check elastics
First suggested by HOCEVAR.
In conventional Begg , most bite
opening occurs due to extrusion of the lower molar. Maxillary
teeth are usually not involved in overbite reduction. The arch wire
tend to tip the molars distally during bite opening. Vertical
anchorage can be reinforced by the modification of the class 11
elastic into a check elastic.
In this one end of the elastic is
engaged over the cinched distal end of upper arch wire , then
stretched from below the hook of the lower molar and engaged
on the inter maxillary hook of the upper arch wire www.indiandentalacademy.com
Vertical molar to molar elastic

This was suggested by MULIE, TEN HOEVE and BRANDT. They
have suggested using a vertical elastic from the distal end of the
upper arch wire to the distal end of the lower arch wire to
reinforce vertical anchorage.
The disadvantage of this is the
strain on upper anteriors. It is better to use a combination of
vertical and class 11 elastics.
Settling elastics
These are of different types-

Box elastics

These are worn during the final stages of treatment where
interdigitation is to be improved. There are various types of
box elastics.
Anterior box--------- to increase anterior overbite.

Lateral box----------- to increase anterior overbite and better
cuspid function .

Buccal box------------helps to settle posterior occlusion and
correct posterior open bite .

Trapezoid elastics
Attached to two bicuspids in one arch
and two bicuspids and a cuspid in the opposite arch. Helps
to close the interarch space , level the mandibular arch and
align teeth.

Triangular elastics
Attached to three teeth. The force is
concentrated at the apex of the triangle. E.g if a maxillary
cuspid has to be brought into better function wit the
mandibular cuspid, the triangle is formed with the apex at the
maxillary cuspid.
Up and Down finishing elastics
These elastics are worn at the end of
the treatment after the other elastics have accomplished their
purpose

In case of class II they are attached in a configuration known
as W with a tail.

In case of class III they are attached in a configuration known
as M wit a tail.

In class I patient can wear either M without a tail or W without
a tail.
PINS

There are various pins available now for a variety of uses.
These are
ONE POINT SAFETY PIN
Pin head is leveled to create true point contact.

Safety shoulder on head prevents binding on the archwire
to ensure full freedom of movement.

Available plain or with a break off notch.
DOUBLE SAFETY PIN
Permits the use of co-ax wire with plain wires.

Locks both wires securely but still permits free distal
sliding.

Can be used in stage II.
HOOK PIN
Securely retains archwire and torquing auxiliary during the
III stage.
Can be used when rotating springs are used.
It draws the archwire firmly against the base of the slot
because there is no safety shoulder.

TPIN
Holds individual teeth at desired mesio-distal inclinations.
Used during stage III to replace deactivated springs.
Used to limit free tipping at any stage.
Universal T pin has a lingual hook to positively retain arch
wire.

REGULAR SAFETY PIN
Length of the head L ling is reduced.
Shoulder or head prevents binding of archwires and allows
free tipping and sliding the teeth.
HIGH HAT SAFETY PIN
Gingival extension or head provides a positive point for
engaging vertical or cross elastics.

SUPER HIGH HAT SAFETY PIN
Used for post surgical fixation.
Head curves gingivally so that additional high hat portion
can accommodate more elastics.
Used with ribbon arch wires.

LINGUAL LOCK PIN
Can be used to engage co-ax during stage I or main arch
wire in stage III.
Tail of pin slips lingual to the arch wire while the head
retains wire but does not block pin channel.
Uprighting springs can be used without need for ligation
SECOND STAGE SAFETY PIN
Recommended in stage II with 0.018 or 0.020 wires.
Narrowed L ling to prevent binding.
Safety should prevent impingement of the head against
archwires for maximum free tipping.

SUPER SAFETY PIN
Has an elongated head and places the nose of the pin
against bracket base for maximum wire retention.
Labial shoulder or head prevents head from touching wire
and this allows tipping or sliding the teeth.

CURVED TAIL SAFETY PIN
Curved tail keeps head away from gingiva while insertions.
Safety shoulder prevents binding and allows tipping and
sliding.

ROUNDED HEAD SAFETY PIN
Shoulder on labial strikes bracket body and prevents head of
pin from binding archwire.
Permits tipping and sliding of teeth.
Head completely covers opening of the bracket slot to
prevent accidental displacement of arch wire.

CERAMIC FLEX HOOK PIN
Recommended for use with ceramic brackets.
TORQUING AUXILLARIES AND SPRINGS

These are now made in much lighter wire.

Rectangular wires in ribbon mode are also used for torquing.

Uprighting springs and mini uprighting springs made in smaller
diameter.

Bypass hooks as designed by KAMEDA are used in premolars.

MODIFIED BEGG

COMBINATION BRACKETS

It is a testimony to the genius of DR
ANGLE that the two brackets invented by him , the Ribbon Arch
and the Edgewise , have been in use for almost 3/4th of a
century. Many systems and techniques have been built around
these brackets over the years. Some shortcomings of the two
brackets were also noted by operators using them.
To combat these shortcomings ,
bracket modifications were introduced. Attempts were made to
combine two types of slots into one single bracket.
ATKINSONS 3D UNIVERSAL BRACKET SYSTEM

Since its development by DR SPENCER ATKINSON in 1928 , the
universal appliance has undergone periodic refinements without
losing its essential characteristics.

Though the brackets performed efficiently
, deficiencies does exist. JORGE FASTLIGHT felt that lateral
extending tabs or wings too bulky and that the central vertical
shaft was too narrow and shallow to accommodate the arch wires
and ligatures. The solution was to eliminate the lateral wings and
make a bracket that was wider mesiodistally and had more room
bucco-lingually.
The resulting bracket simpler to use
with greater built in leveling, rotation and torquing potential. It
had more room for ligating. There was more space for uprighting
springs. Elimination of the lateral wings provided the welding tabs
with more welding space. The bracket was called the 3 D
universal bracket because of its tridimensional mechanical
principle.
BRACKET DESIGN

Essentially a vertical shallow shaft with 2 lateral welding tabs. The
vertical shaft has 2 slot openings. The horizontal one opens
labially at the gingival third and accommodates 0.008 to 0.016
base wire. The vertical slot opens incisally near its base and
extends gingivally 1/3rd of the bracket height. It can
accommodate a single wire , either ribbon or flat from 0.008 x
0.020 to 0.016 x 0.028.

ADVANTAGES

Efficiency in leveling and correcting rotations and mesio-
distal incisal inclinations.

Permits bodily movement of teeth in a mesio-distal direction.

Torques automatically in most cases.
BEGGCHUN HOON COMBINATION
BRACKETS
These brackets were introduced in the early 60s and were
popularized by BRAINERD SWAIN. These were manufactured by
UNITEK.

The brackets were available with either
a 0.022 inch or 0.026 inch gingival slot along with an edgewise
slot. In 0.022 inch gingival slot was adequate for most cases, the
0.026 inch slot functioned better in all stages. The edgewise slot
was seldom used except in certain atypical extraction cases and
occasionally in non-extraction cases for anchorage fortification.

The molar tubes used with this appliance
system were Thromblley combination tubes with 0.022 x 0.028 x
0.25 inch edgewise and 0.036 x 0.025 inch round.

These tubes did not have welding
flanges and had to be soldered to the bands.
THE MODULAR SELF LOCKING APPLIANCE
SYSTEM

This technique was introduced by FOGEL and MAGIL in 1976. The
rationale behind the development behind this system was that ,
an appliance should be a natural power plant from which long
range continuous energy can be derived for correcting
malpositions like rotations , intrusions , extrusions , crossbites ,
midline disharmonies and locked out or partially erupted teeth.
This is essentially a light wire system using
a single pivotal bracket or twin self locking , low functional
attachments.
Both single and double insert
brackets with self locking components are present. A horizontal
slot has also been included in the receptacle to accommodate the
orthodontist who desires it. During routine treatment , the
horizontal slot is not used

INSERT BRACKET

--------------------------------
Fig. 2 Light wire insert bracket parts and dimensions
The principle module is the insert bracket
, which is made of a special soft stainless steel. The elements of
the insert bracket are
Arch wire chamber (0.025)----the round arch wire float freely in
the 0.025chamber. This chamber permits adequate tipping of the
arch wire.
Beaks ------ these are flared and form a funnel shaped entrance
for the wire. The beaks can be opened for holding or releasing the
wire.
Insert slot (0.020)--- Entrance formed by shape of beaks and
allows easy access for arch wire.
Slot apex (0.10)--- This is the constricted portion of the funnel.
It permits snapping in and retention of the wire prior to closure of
the beaks.
Seat----Base of insert bracket which rests in the grooved wing of
the receptacle for stability.
Stem ---- Extension of insert bracket which fits into the vertical
slot and holds insert bracket in position when bent at right angle.

General thickness (0.018).

Bracket head(0.70 x 0.70).

Overall length (0.235).

PLACEMENT OF THE INSERT BRACKET

The stainless steel insert bracket easily fits into the vertical
slot of the receptacle. The stem is cinched and bent laterally and
pressed snugly under the wing.

RECEPTACLE MADE IN 3 SIZES

Small 150

Medium 180

Wide 200
The receptacle is contoured for specific teeth
in the anterior and posterior segments. The 3 vertical slots
accommodate inset brackets and auxiliaries. A single slot is used
in the initial stages and mesial and distal slots are used in the
finishing stages. The receptacles are spot welded to the bands.
Archwires used = 0.014 , 0.016 , 0.018

Closure of the bracket is
accomplished by using Howes plier. The cuspid insert brackets are
closed first followed by the incisors
REMOVAL OF THE ARCH WIRE

If the arch wire is not to be reused , the wire can be
cut and each segment can be slipped out separately. If the wire
has to be reused, the insert can be opened with an insert
spreader which is an 0.012 flat bladed instrument.

MODERN BEGG

The combination of light wire and edgewise
techniques have undergone a significant evolution in orthodontics.
This is known as Modern Begg or Four stage Light wire appliance.

THE FOUR STAGE LIGHT WIRE TECHNIQUE

In the four stage bracket system,
many beneficial design features are built into the appliance and
an effort has been made to eliminate undesirable features. Each
has its own characteristics, modes and each requires different
precautions during treatment.
BRACKETS AND TUBES
The four stage brackets has a gingival Ribbon Arch
Slot which is designed to permit crown and root tipping and an
Edgewise slot for final detailing. The ribbon arch slot is an 0.020 in
slot and edgewise slot a 0.018 x 0.025 or a 0.022 x 0.028.
The molar attachments have two tubes ,
a gingivally placed 0.036 round tube using Begg mechanics and a
0.018 x0.025 or 0.022 x 0.028 inch rectangular tube , which is
placed occlusal to the Begg tube.

PLACEMENT OF BRACKETS /TUBES

The mandibular 1
st
molar tubes should be placed first. The 0.036
tube is placed is placed gingivally and the rectangular tube comes
occlusally at about the middle 3
rd
of the buccal surface of the
molar crown. The tube is placed parallel to the occlusal surface.
That is about 3.5 mm from the buccal cusp tips. This
measurements is used for all brackets except the canines and
lateral incisors which are 0.5 mm above and below this level.

ATTACHING ARCHWIRE IN THE GINGIVAL OR
EDGEWISE SLOT

During stage I wires are engaged in the
gingival slot to permit maxillary tipping. If it cannot be pinned
than ligature is used and tightened till the bracket can be pinned.

Bypass pins are used on premolar
brackets to prevent binding in the vertical or horizontal slot so
that arch wire can slide with minimum friction.

Rotations are accomplished with
elastic thread from lingual button , over correction bends in arch
wire, rotation springs or 0.009 ligature or elastic module in
straight wire slot.
BITE OPENING AND OVER BITE CORRECTIONS

Precise occlusion of the anterior teeth
during treatment is essential to

Establish anterior guidance.

Reduce trauma to teeth and bone.

Enhance correction of class II relationship

Increase incisor stability.
OVER BITE CORRECTION IS ACCOMPLISHED BY

Incisor intrusion.

Prevention of incisor eruption.

Molar elevation.

In the combination technique bite opening is
obtained by giving bite opening bends and light class II elastics.

TREATMENT TECHNIQUE

The treatment of patients by the four stage light wire brackets
system is divided into four stages

STAGE I ORGANIZATION

Overbite corrections.

Correction of class II , class III relationship.

Alignment , leveling and elimination of rotations.

Cross bite and arch width problems over corrections.

STAGE II--- CONSIDERATIONS

Closure of remaining spaces.

Retraction of incisors.

Maintenance of over bite, rotation and antero-posterior
corrections.

Continuation of over corrections.

STAGE III---CORRECTIONS OF CROWN/ROOT
INCLINATION

Torquing of anterior teeth.

Uprighting and paralleling of roots.

Continued maintenance of over bite corrections rotation and
antero-posterior relations.

Maintence of over corrections.

STAGE IV---FINAL DETAILING

Attainment of ideal arch form and co-ordination of arch width.

Attainment of desired torque.

Precise intercuspation and functional harmony an all mandibular
excursions.

Optical facial and dental esthetics.

Commencements of retentions.
COMBINATION ANCHORAGE TECHNIQUE
( C A T )
WILLIAM J THOMSON
AJO-DO 1988 MAY
Clinical experience with
combination brackets since 1978 along with input from several
clinicians slowly evolved into a true combination anchorage
technique.
With combination anchorage ,
variable anchorage capability is extensive and this control of
tooth movement is made possible by use of different types of
tooth movement and by establishing variable magnitudes of
resistance in the different brackets slots at a specific location
in the appliance.

C A T BRACKET DESIGN

Designed to be comfortable , esthetically
pleasing to the patient.
0.022 x 0.035 inch gingival or ribbon arch slot.

0.018 x 0.025 or 0.022 x 0.028 edge wise slot.

Vertical slot incorporated into bracket.
For use with uprighting , rotating
springs and auxillaries, elastics and surgical fixation hooks
and attachment of the tandem or double arch wire.
Brackets are color coded on the disto-
gingival aspect.
Maxillary red and mandibular blue.
Molar attachments have been redesigned to reduce occlusal
interferences and also come with convertible double tubes to
facilitate extending the straight wire into second molar tubes.
BRACKET AND TUBE PLACEMENT

Placement is similar to that used in straight wire
appliance.
Normally recommend to place the rectangular tube
3.5 mm from the cusp tip , all other teeth should be at the same
level except canines and upper lateral incisors. These are altered
to provide clearance during mandibular excursions. The edge
wise slot should be located 4 mm from cusp tip on canines and
3 mm on maxillary lateral incisors but molar occlusion should be
the determining factor for the choice of tube height.

TREATMENT

Aligning and retraction of the anterior teeth ,
correction of canines of class I and bite opening are accomplished
early in treatment using light wire mechanics by use of gingival
slot.

Maintenance of the bite opening , anterior
and posterior root torquing and axial alignment of teeth such as
uprighting and paralleling can be accomplished by the use of 2
tandem arch wires. The tandem technique involves the placement
of an 0.018 inch round stainless steel wire in the gingival slot to
control the bite opening. A nickel titanium tandem wire is seated
in the straight wire slot
Other tandem designs are also possible example tandem wire
segment in premolar and molar teeth used with anterior intrusion
arches are used effectively in class II div I cases. As the anterior
teeth are tipped distally in the light wire slot , the segmented
tandem arch in the edgewise slot establishes maxillary anchorage
resistance. Arch wires such as DUAL FLEX 1 and 2 have eliminated
the use of loops in phase one bite opening and aligning and
retraction mechanics. These arch wires are multi segmented wires
with round 0.016 inch stainless steel in the posterior section and
round 0.016 ni-ti in the anterior section. The rigid steel assists in
bite opening and molar control while the anterior segment is used
for alignment , leveling and retraction.
The combination bracket features a ribbon slot at the gingiva for
reduced friction and free tipping. 2, Auxiliary pins can be placed
in the vertical slot for use in retaining the base wire, in tandem
with dual wires, and as power arms or surgical hooks. A special
friction-reducing bypass clamp is used on premolars when
indicated. a, Phase lll retention pin. b, Phases I and ll retention
pin. c, Tandem, hook pin. d, Bypass clamp.

Dual Flex arch wires are designed for maximum flexibility in one
segment and rigid resistance in the others. The anterior segment
is Titanal and the posterior segment is stainless steel. A, Dual Flex
1 is used primarily for alignment of incisors and bite opening. B,
Dual Flex 2 is used primarily for alignment, torque, and anterior
anchorage resistance.
DUAL FLEX

Here the anterior segment is 0.016 x 0.022 Ni-ti and the
posterior segment is a round 0.018 inch SS which is inserted into
the light wire tube and used in cases where more post protraction
is required.

TREATMENT PHASES AND GOALS

P HASE I-------EARLY ORGANIZATION

1.Overbite correction.
2.Class I canine and molar relationship.
3.Correct and overcorrect rotations , malpositions and space
closure.

LATE ORGANIZATION

Mechanics of early phase I continues but arch wire is
placed in the edgewise slot of the anterior brackets. This permits
initial leveling of the anterior teeth and canines in a mesial and
distal direction and begins to establish anterior resistance to
minimize anterior retraction.
PHASE II-------CONSOLIDATION

Continuation of all the mechanics of phase I.

Final space closure occurs in the posterior segment.

Dual flex-2 arch wires are used.

Elastics are class I and II with 3 ounces of force.

PHASE III------UPRIGHTING AND TORQUING

1. Bite opening and all objectives achieved in phase I and II are
maintained.

2. Tandem wires are used to maintain open bite and align the
teeth. This can be a 0.016 inch Ni-ti or 0.018 inch sq Ni-ti or a
0.016 x 0.022 inch Ni-ti.

PHASE IV-----DETAILING AND FINISHING

Usually a series of Ni-ti wires ranging from 0.016 x 0.022 to
0.018 x 0.025 inch are placed. If necessary additional anterior
torque is placed in the arch wire or with torquing auxillary. Vertical
offset bends may have to be placed in the arch wire to overcome
brackets height discrepancy. In the mandibular arch a reverse
curve of spee is used for optimum leveling of the occlusal plane.
THE KAMADIZED BEGG TECHNIQUE

A series of improvements have been made in the Begg Technique
not only from a diagnostic but also from a technical stand point.
This improved technique is called the K B Technique.

The K B Technique was derived after
25 years of experience by AKIRA KAMEDA. Kameda practiced pure
Begg from 1966 to 1970 but was unsatisfied with the results. He
felt that Begg Technique had certain drawbacks like
Empirical diagnosis.

Unnecessary overtipping of teeth in the mesio-distal or labio-
lingual planes including anchor molars.

Collapse of arch form.

Rotations and mesial tipping of 2nd premolars.

Stage III was mechanically very taxing with many side effects.

Gummy smile with canting of occlusal plane.
Since 1972 , DR KAMEDA sought to rectify the deficiencies
of pure Begg and this resulted in the KB Technique.
The most important points of the K B Technique are

1. Horizontal bar tooth movement.
2. Separation of the roles of anchorage bends and bite
opening bends.
3. Tooth movement by the use of very light elastic force.
4. A way of distalising the canines.
5. Development of bypass loop pins.
6. Development of ribbon arch type buccal tubes for anchor
molars.

7. Torque and enmass movement of teeth in stage II.

8. Stage III burden lessened by transferring it to stage II.
Uprighting done in stage III.

9. Quad diagnosis i.e establishing of measuring arch length
discrepancy and determining extraction sites by means of
cephalogram correction.
HORIZONTAL BAR TOOTH MOVEMENT

1 . Most malocclusions are comprised of labio-lingually
inclined teeth than the mesio-distal tipped teeth.
2. It is unnecessary to carry out treatment by tipping teeth
mesiodistally , but necessary to move the interiors labio-
lingually.
3. In order to control the necessary tipping of teeth in the
mesio-distal direction, a principal of horizontal bar tooth
movement is used from stage I.
4. A supreme grade 0.010sectional wire is used in
conjunction with main archwires. The wires are locked
in with safety T pins which prevent teeth from tipping
mesiodistally but permit teeth to tip more labio-
lingually.
ROLE OF ANCHORAGE BENDS AND BITE OPENING
BENDS
To cope with difficult bite opening during stage I, additional bite
opening bends are placed in archwires distal to canines in
addition to anchorage bends mesial to molars.

The anchorage bend anchors the molars and open bites at
the canines.
The bite opening bends distal to canines are to open the
bite at the incisors. This brings about smooth bite opening of
upper incisors.
The amounts of anchorage bends during stage I and stage
II and bite opening bends to be used during stage I are as
follows
ANCHORAGE BEND

0.016 0.018 RIBBON
MAXIMUM 40* 30* 5*
MODERATE 30* 20* 3*
MINIMUM 20* 10* 2*

BITE OPENING BEND (0.016 WIRE)

UPPER LOWER
MAXIMUM BITE OPENING 30* 20*
MODERATE BITE OPENING 20* 10*

ULTRA LIGHT CLASS II ELASTIC FORCE

Depending upon the degree of overjet and overbite at the
beginning of stage I , class II elastic force is divided into three
stages
Large overbite and small overjet--------- No elastics.
Large overbite and large overjet---------- Ultralight class II
elastics.
(40-60 gms).
3. Small overbite and large overjet--------- Light class II
elastics
(60-70 gms).

REASONS

1. The root apex of upper and lower incisors will be depressed
towards the wider sites in the trough of the cancellous bone.
2. Depressing the incisors to decrease the bite before tipping
them lingually , prevents occurrence of gummy smile and
reduces risk of root resorption.
3. Applying ultralight elastic forces to incisors does not create any
osteoclasts nor move the area of the root apex labially. The
centre of rotation will be at the area of the root apex.
K B TUBE AND TORQUING BRACKETS

In the K B Technique it is necessary to use rectangular buccal
tubes for the anchor molars. Round wires in round tubes
reduce friction but have certain drawbacks like.

1. Anchor bends tend to roll in.

2. Correcting lingually inclined molars is difficult.

3. Directing the force of anchorage bends and bite opening bends
is difficult.
In order to solve these problems, DR KAMEDA designed a new
type of ribbon arch buccal tube.
The inside margins of the tube are
rounded to reduce friction. In addition to a vertical slot there is a 6
* distal offset to prevent molars from distobuccal rotation.
DR KAMEDA also designed and developed
brackets with angulated bases for torquing and reverse torquing.

Maxillary protrusion cases-----
20* torquing brackets is used for upper
centrals/canines.

Lateral incisors-----
Depend upon there position , can use non
torquing brackets.
If lingually placed incisors/canines-----
Can use 10* reverse torque bracket.
Mandibular protrusion cases

Lower incisors / canines----20* or 10* torquing bracket.

Upper incisors / canines----10* reverse torquing bracket.

Non torquing brackets---- upper incisor to SN less than 100*.

Reverse torquing brackets---- upper incisor to SN more than 100*.

COMBINATION ARCH WIRE

This is used during stage II. It is a single archwire whose anterior
section is rectangular and posterior section oval. These are
marketed by A.J.WILCOCK.

This combination wire is made of Alpha Titanium. It is
soft prior to insertion but gets hardened intraorally by absorbing
free hydrogen ions and turns to titanium hydride at 37*c and 100%
humidity.
REASONS FOR TORQUING IN STAGE II

Torquing with ribbon wires and torquing brackets brings
about crown movements and sometimes increases the overjet
and creates a bimaxillary protrusions.

It is thus better to torque when some extraction spaces
remain in stage II in order to accommodate any mesial
movement of the anchor units which is a common side effect.
REASONS FOR TORQUING IN STAGE II AND
UPRIGHTING IN STAGE III.

Overall tooth movements will never be completed until roots are
properly moved.

From a biological aspect, it is better to parallel or upright roots
after bringing their apices into cancellous alveolar bone.

Torquing and uprighting at the same time as in conventional
Begg can cause problems like roots touching the cortical plates or
roots not uprighted properly as they are not in cancellous bone.
DEVELOPMENT OF BYPASS LOOPS.

The bypass loop was designed in 1986.
During closure of extraction spaces in stage II the most important
thing is the 3- dimensional control of second premolars. The 2nd
premolars must be prevented from submerging , rotating or
mesially inclining during space closure. Keeping all this in mind,
the bypass loop was designed.
It is used instead of bypass clamp. The 2nd
premolars are safely bypassed when the bypass loops are locked
into the 2nd premolar brackets during space closure. The loops
are 0.030 in diameter and the premolars cannot be accidentally
torqued even when using a 0.028 x 0.022 wire.
TORQUING AND EN MASSE MOVEMENT IN
STAGE II

An 0.010 sectional supreme wire is inserted in anterior brackets
from canine to canine to maintain distance between them.

A ribbon arch wire is inserted in the buccal tubes and locked
with T pins in the anterior brackets.

For maximum torquing effect, the wires must be inserted deep
in the slots.
Power pins are placed lingual to the archwire and elastics are
hooked into them.

E-Links are placed from lingual buttons on the canines to molars
in both arches. Forces are applied from buccal and lingual sides to
close spaces effectively. Rotations of teeth can also be easily
controlled.

TREATMENT GOALS OF STAGE I , II AND III

Treatment goals in the K B Technique have been rearranged to
make the technique simple, secure and accurate.

In conventional Begg , the number of things to be done by the
operator increases as the stages advances. The patient and the
operator get tired to unduly long procedures.

In the K B Technique, complex bending procedures in stage III
were simplified by increasing the treatment goals in stage I and
starting torquing in stage II.

The tension of putting so many things together is reduced.

STAGE I
Levelling / Bite opening----Round wire.

STAGE II
Space closure and torquing---------Round and/or ribbon archwire.

STAGE III
Uprighting-------- Ribbon archwire
JUSTIFICATION FOR USE OF K B TECHNIQUE

Minimum treatment time.

Optimum treatment result.

Maximum post-treatment stability.
TIP EDGE

THE CONCEPT

The tip edge concept is to provide an edgewise type
bracket that is familiar to all orthodontists and can be used in the
simplest manner to treat malocclusions through differential tooth
movement. This is done by maintaining all that is positive
associated with an edge wise bracket (labial facing slot ) and
opposite slots, the one thing that prevents mesio-distal tipping.
THE APPLIANCE

TIP EDGE BRACKET

The T E bracket is created by removing pre
determined diagonally opposed corners from the conventional
edgewise bracket slot. This permits the desired crown tipping
required for differential tooth movement. It is designed such that
initial second order changes can be accomplished in the presence
of a straight , round arch wire and powered by light intra oral
forces. Forces for subsequent root uprighting, tip and torque are
generated by auxillaries.
Brackets are available in single , twin and
ceramic forms.
Not only do the archwire slots permit initial crown tipping but also
they are preadjusted to provide the desired final degrees of crown
tip and torque.

MOLAR TUBES

The T E molar tubes are of double configuration. A
longer round tube is positioned gingivally and a shorter
rectangular tube occlusally at the level of the premolars bracket.
ARCH WIRES

Initial arch wires are formed of high tensile 0.016
inch round SS. These wires have to overcome anterior vertical
force vectors from class I and II elastics to permit simultaneous
bite opening and antero--posterior inter arch changes.

0.014 and 0.016 inch Ni-ti are used for initial alignment.

0.022 inch SS wires are used for intermediated uprighting and
torquing and a 0.0215 x 0.028 inch SS wires are used for final
detailing
AUXILLARIES

Due to generous size of the vertical slot in T E
bracket many auxillaries are used through out treatment.

Power pins for elastomerics.

Rotating springs.

Side winder springs.

Ni-ti torque bars.

Single tooth torquing auxillaries
BITE OPENING MECHANICS

Stage I arch wire are formed from 0.016 inch high
tensile SS wire.
In extraction cases loops can be placed in the arch
wire and the anchor bend is placed several mm ahead of the
molar tube.
In deep bite cases the anchor bend as given such
that the anterior section of the wire lies in the mucobuccal fold.
The premolars should not be engaged.
In open bite or edge-edge type cases the arch wire
is relatively flat except for a 5* anchor tip in the lower arch wire
OVERJET / OVERBITE CORRECTION

This correction is accomplished along with the anterior vertical
discrepancies. This is done with the use of class I and class II
elastics. Class II elastics are not employed in high angle cases.

DIFFERENTIAL STRAIGHT ARCH
TECHNIQUE (DSAT)

The DSAT takes full advantage of TE brackets. This makes
possible the successful treatment of even the most severe of
malocclusions with a minimal number of appointments and
archwires.
Treatment is divided into three
stages. Each stage features a distinct set of treatment goals that
must be achieved before moving on to the next. Specific
archwires, elastics and auxillaries are used for that particular
stage and mixing them will lead to undesirable results.

STAGE I

GOALS OF STAGE I

Vertical correction of deep or open anterior bite.

Horizontal correction of anterior over or under jet.

Align anterior teeth to eliminate crowding or spacing.

This stage is the only stage of DSAT treatment
where arch wires are used to directly generate tooth moving
forces ( anterior alignment and bite opening ). During the rest of
the treatment they serve to preserve the vertical and lateral
dimensions , while auxillaries are used to produce all individual
movement.

When moderate to severe crowding is
present , vertical loops are employed in the anterior segments.

Rotations are corrected using rotation
springs and wherever possible the teeth are over corrected.

STAGE II

GOALS OF STAGE II

Close remaining posterior spaces.
Correct or maintain dental midline.
Correct posterior cross bite.
Achieve class I molar relations.
Over rotate severely rotated premolars.
Level anchor molars.
Maintain all corrections achieved during stage I.

In this stage other than horizontal
elastics to close spaces, class II or class III elastics are given to
maintain desired anterior tooth relation.
STAGE II ARCHWIRE AND MECHANICS

Here a high tensile 0.022 inch SS
wire is used. If the case was a deep bite one to start, then mild
bite opening sweeps are given in the upper and lower arch wires.

Also if it is a minimal anchorage
case then the arch wire may be placed in the rectangular slot so
that it will be smoother transition to a stage III arch wire.

If friction in the molar tube is of
concern then the arch wire may be inserted into the round tubes.

STAGE II BREAKING MECHANICS

In situations where excessive retraction is not warranted and
mesialization of posteriors is required , breaking auxillaries can be
used.
Side winder springs on premolars ,
canines and incisors along with 0.022 inch or a 0.0215 x 0.028
inch rectangular is used.

STAGE III

GOALS OF STAGE III

Achieve final axial inclination of all teeth.

Maintain all corrections achieved during stages I and II.

This is the longest stage of DSAT ,
usually taking about half the total treatment time. Amount of time
varies , but in an extraction case anywhere between 9-12 months.
All uprighting and torquing is accomplished by
auxillaries. The same stage II archwire can be used in stage III.

All uprighting movements are self limiting
as each tooth reaches its final mesiodistal inclination , the
uprighting surface of the tip edge arch wire slot contacts the arch
wire preventing over eruption.

When using rectangular arch wire the
torquing as well as uprighting is self limiting.
STAGE III AUXILLARIES

UPRIGHTING SPRINGS

In the DSAT side winder springs are used
compared to the regular Begg uprighting spring.
They have several advantages

More efficient since coil located over wire.

More esthetic and hygienic as it lies over the bracket.

TORQUING AUXILLARIES

Ni-ti torque bar 0.022 x 0.018 with 30* torque incorporated ,
lie beneath the base arch wire in ribbon mode.

For torquing of individual teeth an individual root torquing
auxiliary is used.
ROUND OR RECTANGULAR WIRE FOR STAGE III ?

Continuing on round wire simplifies treatment for the operator.
Also when molar torque is not required and torquing of the
anteriors is required then a round wire with torque bar can be
used along with side winder springs.

If a 0.022 SS wire is used in stage
III then a molar offset and mild bite opening curves should be
incorporated and if class II elastics are being used , the lower
arch wire width is increased by 2mm.
On the other hand generalized and
individual torquing requirements are the strongest indications for
utilizing rectangular arch wires in stage III. That would include
torquing molars , canines and incisors.

The other advantage of rectangular
stage III arch wire along with side winder springs is that the 2nd
order power delivered by the springs is translated by the internal
geometry of the tip edge bracket into third order moments. The
resulting forces are physiologic and stop when the teeth have
reached predetermined inclination.
BEGG EDGEWISE DIAGNOSIS
DETERMINED TOTALLY
INDIVIDUALIZED ORTHODONTIC -
TECHNIQUE (BEDDTIOT)

The appliance system offers the capacity to employ selected
principles and features of Begg and edgewise mechanism in
specific situations in which they are more advantageous. The
primary goal was the facility to treat each patients needs in the
manner most efficient for that individual. The intent was to
incorporate the important advantages , features and capabilities
of many fixed appliances and minimize deficiencies , making the
most of current understanding of orthodontic biomechanics and
technology
LINGUAL LIGHT WIRE TECHNIQUE

FUJITA confirmed that orthodontic treatment with brackets placed
on the lingual is possible and that there was an obvious
improvement in esthetics and increased patient acceptance for
this form of treatment.
Works of FUJITA and PAIGE show that
patients develop a positive attitude towards the improved
esthetics.
Another advantage is that the precise
positioning of the teeth become obvious without the distraction of
the brackets and wires, and lip posture is seen correctly.
BRACKET DESIGN CRITERIA

Inter bracket distance.

Topography of the lingual surface .

Ease of insertion.

Mesio-distal root control due to decrease inter bracket distance.

Begg bracket were chosen because it satisfies this design criteria
and is easily available. It is narrow and has a vertical slot for
auxillaries and lingual tooth contours on maxillary and mandibular
incisors are much less of a factor. This is because torque control
can be achieved by properly shaped auxillaries.
Initially TP 256 500 Begg bracket were used but
now unipoint combination bracket is used. The horizontal slot is
not routinely used during treatment except to unravel crowding.

ARCH WIRE DESIGN

Due to reduced inter bracket distance on the
lingual side arch wire selection is important.

The general shape of arch wires resembles
the mushroom shape and when elastics are being used horizontal
loops are placed distal to the cuspid.
mushroom elastics with horizontal loops for elastics.

The ends of any wire should never be cut
flush to the molar tube. It should be annealed and cinched back to
avoid irritation.
MOLAR TUBE AND DESIGN

A squashed oval tube design is recommended as it is comfortable
, allows molar control and takes in a ribbon arch.
The oval tube is centered mesio-distally
and should be placed as occlusally as possible on the band.

lingual cleats should be placed on the buccal surface of the band
for rotation control, cross bite correction and placement of elastics
USE OF AUXILLARIES

Uprighting springs are inserted from gingival direction where as
the arch wire from the incisal. The arms of the canine uprighting
springs are made longer as there is an inset in the arch wire distal
to the canine. The use of power arms of 0.016 x 0.022 elgiloy
secured by ligature is effective for cuspid retraction and
uprighting.
Torquing is done using Begg torquing auxiliary
but the application of force is incisal and not gingival.

ELASTICS

Class I elastics have been tolerated well by the patients but class
II elastics seem to restrict speech in some patients. So elastics
can be given from the buccal side in such cases.
TREATMENT

GOALS OF FIRST PHASE

Open the bite as necessary.

Unravel the crowding as necessary.

Obtain class I molar relationship.

Before bonding, the models should be studied and a common
distance established from the gingival portion of the bracket to
the free gingival margin. This should give proper incisal- gingival
tooth height for the anterior teeth. Molars tubes should be placed
approx 3mm from the lingual cusps and the slot of anterior teeth
approx 4mm from incisal edge
In crowding cases the canines are
retracted 1st using class I or class II elastics and space is made
and then the other teeth are engaged. Initially if the cuspid
cannot be bracketed and retraction has to occur, lingual cleats
can be bonded on the distal half of the tooth. Open coil springs
can be used also in the lingual aspect.

In deep bite situations the maxillary
and mandibular canines are retracted out of occlusion. Once they
are bracketed class II elastics are given till the bite is open and
the rest of the teeth are than bracketed.
In non extraction cases when the anteriors
cannot be bracketed then mild class II are given such that the
molar elevates and opens the bite, than the rest of the brackets
are placed.

When phase I goals are over the
treatment continues in fashionable pattern where just class I
elastics are given and final finishing is done with auxillaries.
CONTROL 21 BRACKET SYSTEM

DESIGN DETAIL

There are two different versions of control 21 system brackets;
the ribbon form control 21 , which uses round and ribbon arch
wires and the control 21 E brackets , the edgewise form that can
accommodate round , rectangular and ribbon arch wires.

Both brackets comprise two parts a BASE
and a SLIDE that inserts into the base , together forming a
variable active slot that is able to change dimension continually in
the same plane and to provide accurate and individualized tooth
movement at any time during treatment .
The brackets can be used and integrated with other bracket
systems or can be interchanged individually or wholly at any time
during treatment. It is possible therefore, to use any wires in the
brackets because the bracket slot always automatically adjusts
dimensionally to the arch wire or wires used. This important factor
means that the orthodontist is able to choose different treatment
procedures at various stages of the treatment.

The base has a V locator placed
gingivally and the slide fits into the base from the occlusal to form
the slot. A butterfly appendage at the end of the slide , when
slightly bent with ligature cutter , prevents the slide from
disengaging from the base but allows it to move within the base.
This movement of the slide allows the arch wire slot to change
dimension during treatment. The butterfly aspect of the slide can
be used for elastic engagement as it forms a natural hook.
A more advanced and more accurate
self latching slide has been developed for easy engagement and
disengagement during treatment.

INS and OUTS are built into
the slide. Designated angulation and torque are built in , so that
when the arch wire slot is closed, angulations and torque stimuli
are transmitted to the root of the tooth.
when the slide is open the stimuli are released. This process
activates tooth movement simultaneously in the horizontal,
vertical , root torque and angulations directions. A variety of slides
manufactured to deliver a range of torques and angulations is
available and can be interchanged as required. During tooth
movement , the slide is continuously and minutely moving
occluso--gingivally in the base , depending on the stimuli on the
tooth, and the tooth is intermittently and within controlled
parameters tipping , torquing and uprighting in the desired and
prescribed direction.

The bracket arch wire slot opens and
when the excessive arch wire force is dissipated , the bracket slot
commences to self close. The opening action of the brackets
protects to some degree the periodontal membrane and the tissue
supporting tooth.
The continuous slot opening
and closing enhances tipping and uprighting so that during and at
the end of arch alignment and space closure , the apices, roots
and crowns are already placed in the prescribed position ,
obviating the need for a finishing stage. Because the slides are
manufactured to achieve all types of tooth movement and are
interchangeable without debonding, the direction and extend of
angulations and torque can be altered by orthodontist at any time
during treatment. Each bracket can be specifically individualized
for torque and angulations for individual teeth.

When multiple arch wires are used ,
the slot automatically adapts to any additional or sectional wire.
This means that the arch wire height relative to the occlusal plane
does not needed to be changed as in combination brackets, and
the maximum benefits are derived from the additional wire.

Because the bracket slot is able
to adapt accurately to the arch wire , any variations in wire
dimensions resulting from anomalies in tolerance factors or
manufacturing discrepancies are negated. This results in a more
accurate prescription delivery.
When elastomeric O- rings are used with the control 21 TM
bracket system , they are mainly sited labially or buccally to the
position of the arch wire and thus friction between the two is
minimized. This results in a free and easy movement of the arch
wire in the bracket, as with self locking brackets.

The bonding surface of the
base has an integrated fingerlike structure to increase the surface
area, as well as a raised peripheral edge to increase compression
of the bonding material during bracket placement.
The base can be used independently of
the slide. Consequently, but placing only bases on premolars, the
archwire can sit above the V- locator on the base without
interference, so that all teeth can be bracket at time of bonding
and offsets are not required in the arch wire.

Where a tooth is severely
displaced, a base only is used. When the base is ligated on the
arch wire, the V- locator planes can be used to obtain root tipping
and uprighting. The wide slide opening in the base can be ligated
in such a way as to obtain initial rotations.
The molar assembly designed for the
Control 21 brackets allows for multiple arch wire use, rotation ,
angulations and torque control. The assembly consist of a twin
control 21 TM bracket base with steps in the slides to let the arch
wires freely move in the assembly. The assembly can be
shortened by the removal of one of the slides. The arch wire in a
control 21 TM molar assembly always remain in the same occlusal
relationship to the crown of the molar tooth, regardless of the
dimension or cross section of the arch wire, or the number of arch
wires used. Mesial or distal rotations are easily achieved by
leaving out the mesial or distal slide and ligating the vacant slide
opening to the arch wire. No lingual buttons or hooks are
required.
The control 21 TM bracket system is
likely to encourage a new generation of arch wire development.
E.g. an arch wire that is manufactured with differing dimensions
along its length may be used to enhance desired tooth
movements. Such a varied dimension in the wire would not
necessitate any changes in the geometry of the bracket as the
bracket slots will automatically and accurately adjust to differing
wire dimensions and will still provide maximum accuracy in the
delivery of torque and angulations.

CONCLUSION

No bracket system is perfect. All systems have there advantages
and drawbacks. It is upto the clinician to use his skills and to
overcome the deficiencies.
In this seminar various appliance
systems have been presented. It is the belief of the creators of
these appliances that the best aspects of Begg and Edgewise
appliances is incorporated in the appliance which is efficient, easy
to use and gives consistently good results.

Leader in continuing dental education

Beggs Modifications Ortho / Orthodontic Courses by Indian Dental Academy

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