Begg Stage 2-OrTHO / orthodontic courses by Indian dental academy

Beggs Second Phase Beggs Second Phase of Treatment of Treatment

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Contents Contents Objectives of second stageObjectives of second stage Construction of appliance Construction of appliance Treatment procedureTreatment procedure Problem encounteredProblem encountered


Reason for second stageReason for second stage To prevent the posterior teeth from To prevent the posterior teeth from

being moved too far mesially.being moved too far mesially. Insufficient space left in buccal Insufficient space left in buccal

segment to move the anterior teeth segment to move the anterior teeth far enough back on to basal bone. far enough back on to basal bone.


Objectives of second stageObjectives of second stage Maintain all the correction achieved Maintain all the correction achieved

during first stageduring first stage Close any remaining extraction spaceClose any remaining extraction space Correction of premolar rotation is Correction of premolar rotation is

completed.completed. To correct the Midline discrepancies. To correct the Midline discrepancies.


Characteristic tooth movement Characteristic tooth movement of second stageof second stage

Retracting of anterior teeth Retracting of anterior teeth Maintaining the anchor molars Maintaining the anchor molars

upright & in Class I upright & in Class I Correction of crossbite relationship Correction of crossbite relationship

and rotating bicuspid.and rotating bicuspid.


Characteristic wires and Characteristic wires and ElasticsElastics

Plain round wiresPlain round wires Horizontal ElasticsHorizontal Elastics Class II elasticsClass II elastics


Arch WireArch Wire Heavier 0.018 or 0.020 inch arch wire.Heavier 0.018 or 0.020 inch arch wire. Anchor bend -1mm mesial to molar tubeAnchor bend -1mm mesial to molar tube ““Toe in” bend in molar areasToe in” bend in molar areas Intermaxillary hook are ligated to canine Intermaxillary hook are ligated to canine

bracket.bracket. Arch wire should be held loosely against Arch wire should be held loosely against

the buccal aspect of the premolar the buccal aspect of the premolar brackets to prevent buccal or lingual brackets to prevent buccal or lingual crowding after the extraction space crowding after the extraction space closureclosure


Cement the premolar .Cement the premolar .

Slight horizontal offset bents are Slight horizontal offset bents are form distal to the canine to maintain form distal to the canine to maintain the correct buccolingual position of the correct buccolingual position of premolars and canines.premolars and canines.

““Stage 2” safety lock pins are usedStage 2” safety lock pins are used


Elastics Elastics Space closing elastics are called Space closing elastics are called

horizontal elastics or intramaxillary horizontal elastics or intramaxillary elastics.elastics.

Six elastics are worn simultaneously Six elastics are worn simultaneously


Twist together the two ends of the Twist together the two ends of the ligature wire that holds the arch wire ligature wire that holds the arch wire to the buccal surface of the second to the buccal surface of the second premolar bracket.premolar bracket.


Wearing of horizontal elastics from Wearing of horizontal elastics from the buccal surface of molar creates a the buccal surface of molar creates a rotational force on molars.rotational force on molars.


Methods of correcting an anchor Methods of correcting an anchor molar that has rotated distobuccally.molar that has rotated distobuccally.


Control of Bicuspid HeightControl of Bicuspid Height Use of bypass clamp and reversing them- Use of bypass clamp and reversing them-

to bring the bicuspid to the occlusal plane to bring the bicuspid to the occlusal plane and hold them there ,ready for the arch and hold them there ,ready for the arch wire to be placed in the bracket slot.wire to be placed in the bracket slot.

Bicuspid can be rotated with elastic thread Bicuspid can be rotated with elastic thread & held overrotated with a steel ligature tie.& held overrotated with a steel ligature tie.


Correction of midline Correction of midline discrepanciesdiscrepancies

Anterior intermaxillary cross elastics Anterior intermaxillary cross elastics are used. are used.

Diagonal Elastic Light intra-maxillary Elasticswww.indiandentalacademy.comwww.indiandentalacademy.com

Midline discrepancies disappear Midline discrepancies disappear during the first stage of treatment as during the first stage of treatment as a result of the arch wires being a result of the arch wires being contoured in such a ways as to contoured in such a ways as to eliminate a difference in form of one eliminate a difference in form of one side of the dental arch, compared side of the dental arch, compared that of other side.that of other side.


Shaping arch wires for Shaping arch wires for correcting asymmetrical dental correcting asymmetrical dental

arch form arch form Eliminated by shaping the arch wire Eliminated by shaping the arch wire

to produce bilateral symmetry of to produce bilateral symmetry of dental arch.dental arch.


Breaking mechanics Breaking mechanics If anterior teeth exhibit a tendency for If anterior teeth exhibit a tendency for

excessive lingual tipping during stage II excessive lingual tipping during stage II use braking mechanics.use braking mechanics.

Passive mesiodistal root uprighting spring Passive mesiodistal root uprighting spring on canine & lower anterior braking arches on canine & lower anterior braking arches establish anterior anchorage mechanics. establish anterior anchorage mechanics.


To further encourage the mesial To further encourage the mesial movement of lower posterior teeth, movement of lower posterior teeth, the strength of the mandibular the strength of the mandibular horizontal elastics is increased from horizontal elastics is increased from 2 ½ ounces to 2 ½ ounces to

6 or 8 ounces.6 or 8 ounces. This brings into play the principles of This brings into play the principles of

differential force. differential force.


Shortening length of double-Shortening length of double-back Arch wires back Arch wires

Timely placement of small vertical takeup Timely placement of small vertical takeup loops in the buccal section of arch wireloops in the buccal section of arch wire

Loops are first made distal to the cuspid Loops are first made distal to the cuspid brackets.brackets.

If necessary to shorten the doubled-back If necessary to shorten the doubled-back arch wire again, similar takeup loops are arch wire again, similar takeup loops are made just mesial to the anchor bend. made just mesial to the anchor bend.


Teeth Position at the end of Teeth Position at the end of second stage of treatment second stage of treatment

““Tipping back” or “Dishing in”of the six Tipping back” or “Dishing in”of the six upper and lower anterior teeth is most upper and lower anterior teeth is most favorable state of affair as far as the favorable state of affair as far as the success of the final result of treatment is success of the final result of treatment is concerned. concerned.


1.Ant. Bite closing:1.Ant. Bite closing:CauseCause RemedyRemedyA.Not enough A.Not enough

bite-opening bite-opening bends bends placed in placed in the the archwiresarchwires..

B.Bite B.Bite opening opening bend bend bitten out bitten out or arch or arch wire wire distorteddistorted

A. Remove arch wires and A. Remove arch wires and place proper bite opening place proper bite opening bends.bends.

A. Educate patient in the A. Educate patient in the importance of proper diet to importance of proper diet to prevent further distortion.prevent further distortion.

B. Remove , correct and B. Remove , correct and replace archwire.replace archwire.

Problems that may be encountered during the Second stage and their remedies


1.1. Ant. Bite closing:Ant. Bite closing:

CauseCause RemedyRemedyC. Patient not C. Patient not wearing wearing intermaxillary intermaxillary elastics properlyelastics properly

D. Anchor molars out D. Anchor molars out of occlusionof occlusion

A.Educate the patientA.Educate the patient

A. Discontinue class II or Cl A. Discontinue class II or Cl III. Use horizontal elastic III. Use horizontal elastic from molar to inter max from molar to inter max hook or inter max hook or inter max elastics from molar to elastics from molar to molars to move the molars to move the molars towards one molars towards one another.another.


CauseCause RemedyRemedyA. Excessive wearing A. Excessive wearing of CL II elasticsof CL II elastics

A.Discontinue Cl II elasticsA.Discontinue Cl II elastics

2. Ant teeth assuming CL III 2. Ant teeth assuming CL III relationship:relationship:


CauseCause RemedyRemedyA. Failure to tie with A. Failure to tie with steel ligature wires from steel ligature wires from the inter max hook the inter max hook distal to cuspid distal to cuspid brackets.brackets.

A.Make necessary tie with A.Make necessary tie with steel ligature wires.steel ligature wires.

B.B. Intermaxillary circles Intermaxillary circles formed too far apartformed too far apart

A.Remove arch wire and A.Remove arch wire and roll one or both circles roll one or both circles mesially, Replace and mesially, Replace and tie with steel ligature tie with steel ligature wirewire

3. Space developing between ant teeth3. Space developing between ant teeth


4. Anchor Molars rotating distobuccally4. Anchor Molars rotating distobuccally

Cause:Cause: Remedy:Remedy:

A. Toe-out on arch A. Toe-out on arch wirewire

B. Too much force B. Too much force from hz elasticsfrom hz elastics

A. Place toe –in at the A. Place toe –in at the distal end of the arch distal end of the arch wirewire

A. Use lighter hz A. Use lighter hz elasticselastics

B. Tie elastic thread B. Tie elastic thread from cuspid lingual from cuspid lingual button to the lingual button to the lingual hooks on the molarshooks on the molars


5. Posterior spaces not closing5. Posterior spaces not closing

Cause:Cause: Remedy:Remedy:A.Pt not wearing A.Pt not wearing

elastics.elastics.

B.Arch wire not free to B.Arch wire not free to slide distally slide distally through the buccal through the buccal tubetube

A.Educate the patientA.Educate the patient

A. Remove source of A. Remove source of resistance like end of resistance like end of arch wire striking arch wire striking second molar and second molar and anchor bend in to anchor bend in to molar tube.molar tube.


6. Second bicuspid tipping mesially in 6. Second bicuspid tipping mesially in 11stst bicuspid extraction case bicuspid extraction case

Cause:Cause: Remedy:Remedy:A. Slight expected A. Slight expected

mesial movement mesial movement of anchor molarof anchor molar

B. Abnormal loss of B. Abnormal loss of anchorageanchorage

A. Continue to guard A. Continue to guard anchorageanchorage

A. Increase anchor A. Increase anchor bendsbends

B. Decrease elastic B. Decrease elastic forceforce

C. Check for loose C. Check for loose molar bands or loose molar bands or loose molar tubes.molar tubes.


Thank youThank you

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Begg Stage 2-OrTHO / orthodontic courses by Indian dental academy

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