Advances in Dental Ceramics / orthodontic courses by Indian dental academy
Modern Begg – / orthodontic courses by Indian dental academy
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Transcript of Modern Begg – / orthodontic courses by Indian dental academy
Modern Begg – Beddtiot & CAT
Techniques. INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
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Introduction Conventional Begg – empirical and cook
book trt.Begg operators – limitations - need to diverge from orthodox trt. Contemporary trt. goals & strategies –
incorporated into Begg practice.
Modern Begg.Refined Begg.
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Modern Begg.
Follows Begg principles – large extent.
Brackets – modified ( other than Ribbon
arch type – used in conventional Begg)
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BEDDTIOT.(Begg Edgewise Diagnosis Determined
Totally Individualised Orthodontic Technique.)Offers capacity to employ selected principles
andfeatures of Begg and Edgewise mechanisms – specific situations – most advantageous.
Primary GoalFacility to treat each patient’s needs – most efficient for that individual.
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Strong points in Begg Technique:Proficiency in bite opening.( with elastics )Differential response to force. pitting limited tipping x translation.
optimal ant. movement, anchorage conservation.Edgewise appl.
Precise control.Facilitates anch. Expenditure.
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Foundations:Light wire.
Gentle, long range force systems
Min. bracket size – max. interbracket
span.
Light undersized wires.
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Differential response to force.Simple horizontal force Tooth tip.Crestal bone – exp. 3x times more force
thanapical bone.Crestal region – force sufficient – rapid
toothmovement.Apical region – insufficient force.
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Less bone around the neck of the tooth than apex.
strain near the alveolar crest.Stress in apical region. Above factors –
multiply each other. powerful adv. – very light “simple tipping
forces”.www.indiandentalacademy.co
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Retraction – tipping + uprighting
Adv. – anchorage conserved.
Effective translatory retraction – greater
force – greater anchorage loss.
Repositioning roots after tipping – reaction
strain – insufficient for anchor loss
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Modern orthodontic system – concerned:Interdental relationships.Facial str. & appearance.Orientation of the dentition in the face.Oral function.
Best approach – determined by diagnosis.Appliance – versatile.
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Brackets.
Dimensions:
Narrow, single width – edgewise br.
( 0.050 inch or 1.3 mm).
Horizontal slot – 0.022” ( height ) x 0.028”
(faciolingual depth).
Vertical slot – 0.020 x 0.020”.
Archwire slots – torqued..
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Torque values - 0°, 5°, 10°, 15°, 20°.All brackets identical - except for torque.
Torque indicator groove - gingival – lingual root torque.
- occlusal – lingual crown torquewww.indiandentalacademy.co
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Brackets: bonding preferred. Prewelded – flat/curved – universal bonding
pads.Advantages:
Facially facing archwire slots – engagement of archwire easy.
Small dimensions – . lip & cheek irritation. occlusal interference. bonding enamel surface. problems with gingival proximity & oral hygiene.
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Interbracket – long resilient span - archwire.
Wire – less distortion.Less elastic range requd. force.
Considerable ( limited ) tipping . 0.016 wires - 10° distal crown tipping.
0.018 wires - 5° mesial crown tipping (uprighting)“braking” – not required.
Vertical slotUprighting springs Turned 90° - miniature buccal tube.
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Uprighting springs.
Original RecentOriginal. Helix farther from archwire.Hook arm – no extra offset
reqd.
RecentMore hygienic. irritation on gingiva.Appearance –less conspicuouswww.indiandentalacademy.co
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Buccal Tubes:Dimensions:
4.5 mm long, 0.022 x 0.028” – edgewise.
lingual crown torque, 25° – lower. 10° - Upper.Distal end of max. tube - 10° outward
angulation. ( toe- in).Headgear tube – 0.051” – occlusal & buccal.
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In cases with deep bite/ moderate - severe anchorage req
Addnl. Rect. Tube – diagonally across –
buccal surface of basic tube –mesial end pointing gingivally.
Dimensions.4.5mm long, 0.022 x 0.028”.Outer tube ( Addnl. Tube ) - 15°angulation to inner tube.www.indiandentalacademy.co
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Bite Opening:Outer tubes – main arch wire – bite opening &
retraction phases.Gingival angulation – effective built in anchor
bends.( actual bend - - 25° ).Inner tubes – Rect. sectional wires – lock PM & Molar.
single large tooth – C.R mesial than - C.R of Molar
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Bite opening – more potent – check elastics.Intrusive force - - less tendency to tip –anchor units distally.
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Rotations:Early belief – rotation control difficult.
Offset bracket – side of tooth disp. lingually.
Overcorrection – thickwalled – elastomeric
lig.- placed on wire – before insertion.
Bayonet bends.
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Torque control: Disadv. Of larger slot – 0.022 x 0.028 – large
wires used – precise control – Rigid.Overcome – resilient rect. Wires – ribbon mode.
Sizes used:Square wires.0.0190.0200.0210.022
0.020 x
0.016”
0.021 x
0.016”
0.022 x
0.016”
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Newer non steel alloy archwires –Extremely resilient – gentle forcesApprop. size – precise bracket engagement.Esthetic & Hygienic. ( eliminate – aux.)
Torqued brackets build trt. into the appl.Facial root torque – lower incisors – augmentanchorage.
0.022 x 0.016” , 5° torque.
Limit tipping of upper incisors - palatal torque.
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Important adv. - BEDDTIOT –
Facility for both 3 dimensional control & simple
bracketLimited tipping – light forces
Facilitate application of the best modality in every
situation.www.indiandentalacademy.co
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Combined Anchorage TechniqueVariable Anchorage systems.Design of the attachment –
provides optimum light wire & straight wire trt. capabilities.
Four stage light wire appliance successful collaboration b/w Begg practitioners & UnitekBeneficial design features – adv. of Begg & St.
wire.
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Advantages & Disadv. of the two tech.Begg light wire appl.
Advantages:Light optimum force –( 60 – 90 g )Continuous force.Min. friction.Rapid alignment, leveling , rotation of ant. teeth.Rapid overbite correction.Simultaneous crown tipping.Continuous paralleling of roots at extn. sites.Continuous torquing.Extra oral force unnecessary.www.indiandentalacademy.co
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Disadvantages.
Diff. – co-ordinating max. & mand. arch
Diff. – bilateral symmetry.
Premolar & molar torque control – diff.
Diff. in stabilizing teeth – final artistic
positioning.
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Straight wire appliance.Advantages:
Precise control – PM & M torque.Bilateral symmetry – BL inclinations – readily attained.Bilateral symetry of arch form. bends in archwires.FinishingSelf limitation of movmt. & stabilization of teeth- final detailing.
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Disadvantages. force levels – wider bracket, interbracket span.Rapid ant. alignment diff.Overbite correction diff.Addnl. anchorage – necessary- friction.Extra oral force – reqd.Alignment – incisors & canines – in sequence.
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Dynamic & Static anchorage.Dynamic anchorageIt comprises – physical
forces generated by the
appl. – in a complex
interrelationship – equally
effective forces – biologic
environment.
Light wire force sys.
Biologic force sys.
Unipoint contacts
Muscle action
Anchor bend Tooth morph & mass.
Archwire Cuspal interlock.
Aux. wire Freeway & fnl. Paths.
Tipping force Occl. Force & migr.
Intr forces Bone densityExtrusive forces
Growth
Rot. Forces Habits www.indiandentalacademy.co
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Static Anchorage.Increasing the forces – within the appl. Lesseffect of the biologic force sys.
CAT – dynamic & static anchorage resistance dev. - applied – certain stages – trt. program.Stage I & II Dynamic.Stage III Dynamic / Static.Stage IV Static.
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Four Stage Light wire Appliance:Appl. – vehicle – transmitting force – teeth &indirectly – bone & soft tissue.Design of appl. Elements, positioning,
adjustments & manipulations – imp. – max. trt. efforts.
Caution:Prudent to use conventional approach – each
trt. stage – as long as progress is good.www.indiandentalacademy.co
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Brackets.Gingival or Ribbon arch slot – free
tipping, no binding.Edgewise slot – precise final
detailing. Three bracket types – optimal
rotations, tipping & torque.
Base beveled – friction or binding with archwire.
Torque, tip, in –out – sp. vary for each
tooth.www.indiandentalacademy.co
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Molar tube:
0.036 round tube – gingivally.( Begg )
0.018 x 0.025” or 0.022 x 0.028”.
Tubes - 7° offset – addnl. molar control – Stage II.
0.018 x 0.025 slot – recommended.
Conventional tubes – preferred to convertible tubes.
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Placement of brackets & tubes:All teeth except 2nd molars – receive
attachment – as soon as practical: increase force control.
Mandibular 1st molar tubes – placed first.0.036 tube – gingival margin.rect. Tube – middle third of crown.edgewise tube – 3.5 mm – tip of buccal cusp of 1st molar.3.5 mm – std. for all brackets,EXCEPT, Canines & upper LI br.canine br. – 0.5 mm gingivally, LI br - 0.5 mm incisally.www.indiandentalacademy.co
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Treatment technique:Trt. divided into 4 stages.
Stage I - Organization.Overbite correction.Cl. II or Cl. III correction.Alignment, levelling, elimination of rotations- incisors.Correction of crossbite & archwidth problems.Overcorrection
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Stage II. Consolidation.Closure of remaining spaces.Retraction of incisors.Maintenance of overbite, rotations, antero-post. corrections.Overcorrection.
Stage III. Correction of crown & root inclination.Uprighting & paralleling of roots.Torquing of ant. teeth.Maintenance of corrections.
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Stage IV. Final detailing.Attainment – ideal arch form & co-ordination of archwidth.
Attainment – desired torque.
Precise intercuspation & fnl. harmony.
Optimal facial & dental esthetics.
Commencement of retention.www.indiandentalacademy.co
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Stage I.Archwires:Initiated – 0.016 round wires – Begg slot.Cl II elastic force – lingual rolling – lower molar.Mild exp. – ¼ ” – reqd.45° anchor bend – 1-2 mm mesial – molar tube.In severe crowding –
Multiloop – deep bite/ max. anchorage cases.Niti – shallow bites / min. anchorage req.
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Anchor bends-Intrusive + labial movement.Extrudes & tips – molars – distally.
Class II elastic force:Combination of intrusive + retractive forces – Center of rotn.- more apical – max. lingual crown tipping.
Elastics:Very light elastic forces.2 -3 oz. – 24 hrs a day.
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Stage II.End of stage I – occl. organized appearance.St. II begins – consolidation of the dentition.Goals in Stage I – not reduced.
Elastics:Intrarch elastics – max. ant. retrcn. & gen. space consolidation. 2-3 oz.Six elastics – used.Elastics eliminated – space closed. Arch wire bent distal to molar tube.
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Archwire:
0.018” round wire.
25° anchorage bend, 5° toe in bend.
Toe in bend – counter act rotational
moment –
inter arch elastics.www.indiandentalacademy.co
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Stage III.Crown & root coordination/ torquing &
parallelingstage.
All spaces closed.Crown tipping may be considerable.All corrections – maintained. Molars & canine – Class I reln.post. occlsn. – inter locked – min. anchor loss- subsequent – torquing & uprighting.
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Pre stage III reqd. – occasionally. Reevaluation of br. ht & posn. – recommended.
Archwires:Maxillary:
0.020 dia.Constr. To Omega shape.Anchor bend 0 - 5°.Inset bend into molar tube.Vertical bend – premolar slot.V bend distal to canines.Cinched .Overcorrected. www.indiandentalacademy.co
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Mandibular:0.018 or 0.020 dia.Exp. ¼ ” bilaterally.Inset bend – molar tube.Vertical bend into premolar.V bend distal to canines.Anchor bend of 5° - 10°.Cinched.Overcorrected.
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Auxiliaries:Uprighting springs.
Two forms.Safety ligature – hold tooth – archwire.Safety lock spring – safety extension – holds wire in gingival slot.
Wire size used – 0.014 or 0.016.Torquing Aux.
0.016 wire – four spur/ two spur.
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Stage III – complicated.
Constant monitoring –reqd.
In CAT – absolute determination – final uprighting,
B-L placement, torque – not reqd.
Straight wire slot – final artistic finishing - teeth.
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Stage IV.Trt. done in edgewise slot.Preangulated,pretorqued, in – out
features – precise crown & root pos’n.
Stage IV – not a substitute – Stage III – Begg.
Excellent bite opening.Enmasse retrcn. of incisors – Stage I & II.Rapid uprighting – canine & PM roots.Torque of incisors – Stage III.
All these adv. to be used to greatest extent – Begg mech. www.indiandentalacademy.co
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Stage IV:Primarily to increase – effectiveness & precision- final detailing. hygiene problems – auxiliary springs.Lingual crown torque of post. teeth.Establish bilateral symmetry – uprighting.Achieve – proper paralleling & torque.Coordinate arch form & width.
Second molars:More optimal occlusal reln.To obtain best arch form.Coordinate crown & root torque of post. teeth.
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To get levelling - two preliminary – round wires –
0.016 or 0.018 Nitinol wire.Edge wise slot mech. – alignment adequate.Wires used.0.017 x 0.025 NiTi.0.016 x 0.022 , 0,018 x 0.025 – SS.Max. torque benefit – 0.018 x 0.025 ss.Post. teeth good axial incl. –
reduce force levels – 0.018 round .www.indiandentalacademy.co
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Final Detailing.Adjustments / modifications – archwires -Discrepancies – size, symmetry, fn. of teeth.Repositioning br. / 1st order or 2nd order
bends.Settling – 0.014 wire + vertical elastics.
Finishing & Retention:Bonded canine to canine – lower.Hawleys Appliance – Upper.www.indiandentalacademy.co
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Advantages of CAT.Enhances trt. potentials.Accumulates trt. advantages.Reduces response time.Enhances muscular effects.Simplifies co-operation.Variable anchorage effects.Reduced energy losses.Diversity of three slots.Controlled tipping & translation.Goal oriented trt.Establishes positive profile control
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Conclusion.
CAT system is a biomechanical approach to
treatment which enables the clinician to vary
the treatment technique, vary the type of
movements and vary the resistance anchorage
to simplify co-operation and to definitely
expand the opportunity to overcome problems
and enhance success of trt.
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Thank you
For more details please visit www.indiandentalacademy.com
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