INDIAN DENTAL ACADEMY
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MODIFICATION OF BEGGS TECHNIQUE
-----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
INTRODUCTIONNo 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.www.indiandentalacademy.comwww.indiandentalacademy.com
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.
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 DENTITIONIn 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 5sUpper 4s and lower 5sUpper 5s and lower 4sAsymmetric extractionsAll 6sUpper 7s and lower 8sSingle lower incisorsSingle arch extractionsInterproximal stripping is carried out in minimal discrepancy cases.In border line cases only a non extraction approach is carried out.
Begg brackets with built in torque (KAMEDA) and derotation (MOLLENHAEUR) have been introduced.
Tip edge brackets.
And most importantly ceramic brackets.
These ceramic brackets are classified
Depending upon crystal structure .MonocrystallinePolycrystalline
Depending upon the retentive mechanism.MechanicalChemicalMechano -chemical
Based upon the material constituentsPure ceramic—alumina based / zirconia
The various advantages of ceramic brackets are Esthetics .
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. www.indiandentalacademy.comwww.indiandentalacademy.com
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.
WIRESMulti looped archwires have gradually become outdated after the introduction of the following flexible wires
Co-axial sectional wires.
Titanium Molybedenum Alloy (T M A).
Supreme grade wires.
Copper NiTi wires.
Rectangular wires. www.indiandentalacademy.comwww.indiandentalacademy.com
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:
Premium : .020”
Premium Plus: .010”, .O12”, .014”, .016”, .018”
Supreme : .008”, .009”, .010”, .011”.www.indiandentalacademy.comwww.indiandentalacademy.com
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 auxiliaries3. 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.www.indiandentalacademy.comwww.indiandentalacademy.com
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.
ELASTICSTypes 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), ¼” (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.
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 Class—111
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 elasticsUsed 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 elasticsUsed 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 elasticsFirst 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
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 elasticsThese are of different types-
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 . www.indiandentalacademy.comwww.indiandentalacademy.com
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 PINPin 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.www.indiandentalacademy.comwww.indiandentalacademy.com
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.
T—PINHolds 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 PINLength of the head L –ling is reduced.Shoulder or head prevents binding of archwires and allows free tipping and sliding the teeth.www.indiandentalacademy.comwww.indiandentalacademy.com
HIGH HAT SAFETY PINGingival extension or head provides a positive point for engaging vertical or cross elastics.
SUPER HIGH HAT SAFETY PINUsed for post surgical fixation.
Head curves gingivally so that additional high hat portion can accommodate more elastics.Used with ribbon arch wires.
LINGUAL LOCK PINCan 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 PINRecommended 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 PINHas 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 PINCurved tail keeps head away from gingiva while insertions.Safety shoulder prevents binding and allows tipping and sliding.
ROUNDED HEAD SAFETY PINShoulder 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 PINRecommended for use with ceramic brackets.
TORQUING AUXILLARIES AND SPRINGSThese 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.
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 SYSTEMSince 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.
BEGG—CHUN HOON COMBINATION BRACKETS
These brackets were introduced in the early 60’s 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
-------------------------------- 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 0.025”chamber. 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
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 Howe’s 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.
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 1st 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 3rd 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
Prevention of incisor eruption.
In the combination technique bite opening is obtained by giving bite opening bends and light class II elastics.
The treatment of patients by the four stage light wire brackets system is divided into four stages
STAGE I – ORGANIZATION
Correction of class II , class III relationship.
Alignment , leveling and elimination of rotations.
Cross bite and arch width problems over corrections.
STAGE II--- CONSIDERATIONSClosure 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 DETAILINGAttainment 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.www.indiandentalacademy.comwww.indiandentalacademy.com
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
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 0.010”sectional 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. www.indiandentalacademy.comwww.indiandentalacademy.com
ROLE OF ANCHORAGE BENDS AND BITE OPENING BENDSTo 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 www.indiandentalacademy.comwww.indiandentalacademy.com
0.016 0.018 RIBBONMAXIMUM 40* 30* 5*MODERATE 30* 20* 3*MINIMUM 20* 10* 2*
BITE OPENING BEND (0.016 WIRE)
MAXIMUM BITE OPENING 30* 20*MODERATE BITE OPENING 20* 10*
ULTRA LIGHT CLASS II ELASTIC FORCEDepending 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
(40-60 gms). 3. Small overbite and large overjet--------- Light class II
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 BRACKETSIn 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. www.indiandentalacademy.comwww.indiandentalacademy.com
REASONS FOR TORQUING IN STAGE IITorquing 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 IIITreatment 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 ILevelling / Bite opening----Round wire.
STAGE IISpace closure and torquing---------Round and/or ribbon archwire.
STAGE IIIUprighting-------- Ribbon archwire
JUSTIFICATION FOR USE OF K B TECHNIQUE
Minimum treatment time.
Optimum treatment result.
Maximum post-treatment stability.
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.
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.
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.
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
Due to generous size of the vertical slot in T E bracket many auxillaries are used through out treatment.
Power pins for elastomerics.
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.
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.
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 IIIAchieve 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
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.
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 CRITERIAInter 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.
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.
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
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
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
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.
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.
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