begg's technique-ortho / orthodontic courses by indian dental academy
TRANSCRIPT
INDIAN DENTAL ACADEMY
Leader in continuing dental education
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CONTENTS CONTENTS --
1.Introduction1.Introduction2.Philosophy2.Philosophy3.Advantages3.Advantages4.Disadvantages4.Disadvantages5.The appliance components5.The appliance components
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INTRODUCTIONINTRODUCTION
An orthodontic technique is defined An orthodontic technique is defined asas
“ “A systematic sequence of clinical A systematic sequence of clinical
procedures to achieve the correction procedures to achieve the correction of malocclusion with a combination of malocclusion with a combination of appliance”of appliance”
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THE PHILOSOPHYTHE PHILOSOPHY
Attritional occlusionAttritional occlusion
Differential forceDifferential force
Light continuous forceLight continuous force
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1.ATTRITIONAL OCCLUSION1.ATTRITIONAL OCCLUSION
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2.DIFFERENTIAL FORCE2.DIFFERENTIAL FORCE
Concept given by – Concept given by – Dr.Begg in Dr.Begg in 19381938
Storey and Smith –Storey and Smith –
“ “Optimal range of force values are Optimal range of force values are there, for every tooth that produces there, for every tooth that produces the max. rate of tooth movement”the max. rate of tooth movement”
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1.To move the canines distally – 150-1.To move the canines distally – 150-200gms200gms
2.To move the molars mesially -300-2.To move the molars mesially -300-500gms500gms
3.Forces less than this will cause no 3.Forces less than this will cause no discernible bodily movement of the discernible bodily movement of the caninecanine
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The amount of force required to The amount of force required to move the teeth is in positive ratio to move the teeth is in positive ratio to the surface area of the tooth root, the surface area of the tooth root, attached to the periodontiumattached to the periodontium
The ratio of the area of contact in the The ratio of the area of contact in the canine : molar is appox. 3:8 (Storey canine : molar is appox. 3:8 (Storey and Smith )and Smith )
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OPTIMAL FORCE VALUESOPTIMAL FORCE VALUES
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Thus , by increasing the force values Thus , by increasing the force values above the optimal force levels , above the optimal force levels , causes decreased rate of distal causes decreased rate of distal movement of the canines , which movement of the canines , which finally approaches finally approaches ZEROZERO
Further increase in the force value Further increase in the force value causes the molars to move forwardscauses the molars to move forwards
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THE CONCEPT OF STOREY AND THE CONCEPT OF STOREY AND SMITHSMITH
The concept of undermining resorption The concept of undermining resorption
UNDERMINING RESORPTIONUNDERMINING RESORPTION excessive orthodontic forcesexcessive orthodontic forces
periodontal membrane and toothperiodontal membrane and tooth investing bone get compressedinvesting bone get compressed
Blood vessels compressedBlood vessels compressedwww.indiandentalacademy.comwww.indiandentalacademy.com
blood supply cut offblood supply cut off
inadequate blood supply causes necrosis inadequate blood supply causes necrosis
Almost no tooth movement till Almost no tooth movement till hyalinized tissue is removedhyalinized tissue is removed
Movement is intermittent & much Movement is intermittent & much
slower,when compared to light wire forcesslower,when compared to light wire forces
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LIGHT FORCESLIGHT FORCES Light forces donot cause pain n Light forces donot cause pain n discomfort to the patientdiscomfort to the patient
no loosening of the teeth,and no loosening of the teeth,and causes causes
frontal resorptionfrontal resorption
Rapid tooth movement Rapid tooth movement www.indiandentalacademy.comwww.indiandentalacademy.com
DIFFERENTIAL FORCEDIFFERENTIAL FORCE In physics and mechanicsIn physics and mechanics – –
Differential is defined as Differential is defined as “DIFFERENCE OF 2 OR MORE “DIFFERENCE OF 2 OR MORE MOTIONS OR PRESSURESMOTIONS OR PRESSURES
Differential forceDifferential force is defined as forces is defined as forces which aid one another reciprocally which aid one another reciprocally when they are used concurrentlywhen they are used concurrently
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A force that results in a different rate A force that results in a different rate of tooth movement at one end than of tooth movement at one end than the other. the other. (Mollenhauer)(Mollenhauer)
Location, rate, and degree of the Location, rate, and degree of the change is determined by the relative change is determined by the relative root areas, and mechanics at each root areas, and mechanics at each end, plus the amount of the force end, plus the amount of the force appliedapplied
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EXAMPLES OF DIFFRENTIAL EXAMPLES OF DIFFRENTIAL FORCE APPLICATIONFORCE APPLICATION
1.Reduction of anterior deep bite –1.Reduction of anterior deep bite – anchor bends are given in upper and lower 0.016’’ round arch anchor bends are given in upper and lower 0.016’’ round arch
wires ,mesial to the molar tubeswires ,mesial to the molar tubes
Force is so light that anchor molars do not appear to move at all and Force is so light that anchor molars do not appear to move at all and nor do they tip.nor do they tip.
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Only clinically discernible Only clinically discernible movements are, RAPID gingival movements are, RAPID gingival movements of upper and lower teethmovements of upper and lower teeth
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2.Closing of extraction spaces2.Closing of extraction spaces – –
Crowns of the 6-anterior teeth are Crowns of the 6-anterior teeth are tipped back simultaneously by tipped back simultaneously by horizontal space–closing elastics horizontal space–closing elastics rapidly without causing much mesial rapidly without causing much mesial movement of the 1movement of the 1stst permanent molars. permanent molars.
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CLOSING OF EXTRACTION CLOSING OF EXTRACTION SPACESSPACES
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Anchor bendsAnchor bends in the arch wire prevent the mesial tipping of the molars. in the arch wire prevent the mesial tipping of the molars.
Anchor bends also give the roots of anchor molars TOE-HOLD in the bone Anchor bends also give the roots of anchor molars TOE-HOLD in the bone
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TOOTH MOVEMENTSTOOTH MOVEMENTS
In the Begg’s technique, employment In the Begg’s technique, employment of differential forces makes various of differential forces makes various categories of tooth movements categories of tooth movements simultaneously and far more simultaneously and far more efficiently.efficiently.
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EXAMPLES –EXAMPLES –
1.Aligning crowded teeth1.Aligning crowded teeth 2.Opening deep bites2.Opening deep bites
3.Closing open bites3.Closing open bites
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5.Correcting antero-posterior 5.Correcting antero-posterior relationsrelations
6.Correcting cross-bites6.Correcting cross-bites
7.Correcting axial relations and7.Correcting axial relations and
8.Guiding into occlusion unerupted 8.Guiding into occlusion unerupted and impacted teethand impacted teeth
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When several groups of tooth When several groups of tooth movements are carried out movements are carried out simultaneously with differential simultaneously with differential forces, each group reciprocally aids forces, each group reciprocally aids all other groups .Thus, each action is all other groups .Thus, each action is more successfully and easily more successfully and easily accomplished .accomplished .
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ThusThus, EXTRA-ORAL ANCHORAGE, EXTRA-ORAL ANCHORAGE is is not required in the treatment of any not required in the treatment of any cases with this technique (because cases with this technique (because light and differential forces are used)light and differential forces are used)
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There is no need to take arch wires There is no need to take arch wires off at each appointment, off at each appointment,
BECAUSE ,BECAUSE , the range over which the resilient the range over which the resilient
fine arch wires will move teeth fine arch wires will move teeth without reactivation is greatwithout reactivation is great
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3.LIGHT FORCES3.LIGHT FORCES
Excessive forces are unfavorable to Excessive forces are unfavorable to the tissues ( Storey and Smith)the tissues ( Storey and Smith)
Thus, round arch wires are used to Thus, round arch wires are used to deliver light forces that result in deliver light forces that result in rapid tooth movement and less rapid tooth movement and less patient discomfortpatient discomfort
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THE BRACKET SELECTIONTHE BRACKET SELECTION Initially, TIE-BRACKETS were Initially, TIE-BRACKETS were
used ,but they caused binding of thin used ,but they caused binding of thin round arch wires as soon as the round arch wires as soon as the teeth tipped mesially or distallyteeth tipped mesially or distally
This binding of arch wires caused This binding of arch wires caused excessive loss of anchorage and excessive loss of anchorage and
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This required, use of extra-oral This required, use of extra-oral anchorageanchorage
A trial was then made with the A trial was then made with the STANDARD RIBBON ARCH BRACKETSTANDARD RIBBON ARCH BRACKET
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It was found too loose with 0.018’’ It was found too loose with 0.018’’ wire, later 0.016’’ wires were THUS wire, later 0.016’’ wires were THUS usedused
In light wire technique it is necessary In light wire technique it is necessary to use a bracket that will permit to use a bracket that will permit simple simple labial, lingual, mesial and labial, lingual, mesial and distaldistal tipping tipping of the crowns of all of the crowns of all teeth except the anchor molarsteeth except the anchor molars
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EXTAORAL ANCHORAGEEXTAORAL ANCHORAGE With this technique the dental With this technique the dental
arches are, as a result of applying arches are, as a result of applying differential arch force and rubber differential arch force and rubber ligature force values, taken so far ligature force values, taken so far back in the jaws that ample back in the jaws that ample allowance is made for the inevitable allowance is made for the inevitable forward movement of the dental forward movement of the dental archesarches
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This usually occurs when axial This usually occurs when axial inclinations of the teeth are inclinations of the teeth are corrected later in the treatmentcorrected later in the treatment
Thus , extra-oral anchorage is never Thus , extra-oral anchorage is never required.required.
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DISTINCTIVE FEATURES OF BEGG’S DISTINCTIVE FEATURES OF BEGG’S PHILOSOPHY AND TREATMENTPHILOSOPHY AND TREATMENT
1.Begg’s philosophy recognizes the 1.Begg’s philosophy recognizes the fallacy of always maintaining the full fallacy of always maintaining the full complement of teeth, concludes that complement of teeth, concludes that extraction is necessary at timesextraction is necessary at times
2.Preparation of anchorage is often 2.Preparation of anchorage is often unnecessaryunnecessary
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3.Differential force3.Differential force4.Light continuous force4.Light continuous force5.Cold drawn, extra-hard , stainless 5.Cold drawn, extra-hard , stainless
steel round wire, with good steel round wire, with good resiliency and ZERO-STRESS resiliency and ZERO-STRESS RELAXATION is usedRELAXATION is used
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6.Modified ribbon arch bracket is used.6.Modified ribbon arch bracket is used.
(Wire and bracket have a single point (Wire and bracket have a single point of contact in the vertical plane and of contact in the vertical plane and
2-point contact in the horizontal 2-point contact in the horizontal plane)plane)
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7.Two successive tipping movements 7.Two successive tipping movements are required to achieve bodily are required to achieve bodily movement -first to position the tooth movement -first to position the tooth crowns and the second to position crowns and the second to position the tooth rootsthe tooth roots
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The Begg technique is divided into 3-The Begg technique is divided into 3-stages without any over-lapping stages without any over-lapping STAGESSTAGES
This is chiefly to prevent anchorage This is chiefly to prevent anchorage failurefailure
All tooth movements in each step are All tooth movements in each step are done simultaneouslydone simultaneously
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ADVANTAGESADVANTAGES
Efficiency of treatment, as many Efficiency of treatment, as many corrective tooth movements occur corrective tooth movements occur simultaneously with little appliance simultaneously with little appliance adjustmentadjustment
Light forces are used, causes Light forces are used, causes minimal patient discomfort and minimal patient discomfort and tissue traumatissue trauma
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Rapid esthetic Rapid esthetic improvement,achieved by early improvement,achieved by early reduction of over-jet and quick reduction of over-jet and quick alignment of anterior teethalignment of anterior teeth
Early correction of Early correction of rotations ,probably reducing relapserotations ,probably reducing relapse
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Short treatment time due to rapidity Short treatment time due to rapidity of tooth movements and of tooth movements and simultaneous execution of of many simultaneous execution of of many corrective tooth movementscorrective tooth movements
Efficient anchorage controlEfficient anchorage control
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Quick and effective opening of deep Quick and effective opening of deep over-bitesover-bites
En-masse movement of anterior and En-masse movement of anterior and posterior groups of teeth posterior groups of teeth
Roots can be efficiently uprightned Roots can be efficiently uprightned and torquedand torqued
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ability to torque a single root ability to torque a single root without appreciable reciprocal without appreciable reciprocal effects on adjacent teetheffects on adjacent teeth
Minimal demand of patient co-Minimal demand of patient co-operationoperation
Low cost of treatmentLow cost of treatmentwww.indiandentalacademy.comwww.indiandentalacademy.com
DISADVANTAGEOUSDISADVANTAGEOUS The round arch wire and the ribbon The round arch wire and the ribbon
arch bracket relationship was unable arch bracket relationship was unable to give precise control required for to give precise control required for fine finishing.fine finishing.
Posterior root torque is difficult due Posterior root torque is difficult due to wire-bracket relationto wire-bracket relation
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Rotational control is poor in 1Rotational control is poor in 1stst and and 22ndnd stages of treatment with the use stages of treatment with the use of under size wireof under size wire
During bite –opening, true intrusion During bite –opening, true intrusion of upper incisors was nil or minimalof upper incisors was nil or minimal
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Over-use of class II elastics caused-Over-use of class II elastics caused-
1.Lack of upper incisor intrusion1.Lack of upper incisor intrusion 2.Undesirable proclination of lower 2.Undesirable proclination of lower
incisorincisor 3.Unfovourable tipping of mandibular 3.Unfovourable tipping of mandibular
and occlusal planesand occlusal planes
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Uncontrolled tipping of the teeth Uncontrolled tipping of the teeth which occurs in the 1which occurs in the 1stst and the 2 and the 2ndnd stages causes –ROOT RESORPTION stages causes –ROOT RESORPTION
Excess of uncontrolled tipping in the Excess of uncontrolled tipping in the first two stages necessitated a long first two stages necessitated a long 33rdrd stage for root corrections stage for root corrections
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Over emphasis on tooth material Over emphasis on tooth material reduction often resulted in ruined reduction often resulted in ruined profilesprofiles
There was no fail safe mechanism to There was no fail safe mechanism to check the tipping or check the tipping or uprighting/torquing movements , uprighting/torquing movements , because the bracket permitted because the bracket permitted excessive mesio-distal and labio-excessive mesio-distal and labio-lingual movementslingual movements
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THE BEGG APPLIANCE THE BEGG APPLIANCE COMPONENTSCOMPONENTS
COMPONENTS –COMPONENTS – 1.Modified ribbon arch bracket1.Modified ribbon arch bracket
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2.Molar tubes2.Molar tubes a).Round b).Ovala).Round b).Oval
c).Combination tubec).Combination tube
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Round molar tube –Round molar tube – Internal diameter -0.036’’Internal diameter -0.036’’ Length – 0.025’’Length – 0.025’’
Oval molar tubes –Oval molar tubes – Internal diameter -0.072’’x 0.024’’Internal diameter -0.072’’x 0.024’’ Length – 0.200’’Length – 0.200’’
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Molar attachments in Begg are Molar attachments in Begg are designed to permit free mesio-distal designed to permit free mesio-distal tippingtipping
Usually 1Usually 1stst permanent molars are the permanent molars are the anchor teethanchor teeth
22ndnd molar is used as the anchor tooth, molar is used as the anchor tooth, when 1when 1stst molar is missing or molar is missing or indicated for extractionindicated for extraction
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3.Lock pin3.Lock pina).First stage pins / One point safety a).First stage pins / One point safety
lock pins –lock pins –
Have shoulders that keeps the head Have shoulders that keeps the head of the pin outside the bracket slotof the pin outside the bracket slot
shoulder
Head
TailBodybevel
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Thus, permits the use of the full Thus, permits the use of the full height of the slotheight of the slot FULL HEIGHT
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Permitting full freedom for sliding of Permitting full freedom for sliding of the teeth over the arch wire and their the teeth over the arch wire and their tippingtipping
Used - in the 1Used - in the 1stst stage of treatment stage of treatment with 0.016’’ arch wirewith 0.016’’ arch wire
Body of the lock pin reduces the arch Body of the lock pin reduces the arch wire slot to 0.016’’wire slot to 0.016’’
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Beveled (one-point) under-surface of Beveled (one-point) under-surface of the head permits free mesio-distal the head permits free mesio-distal tipping tipping
BEVEL
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b).Second stage safety lock-pin –b).Second stage safety lock-pin –
Shoulder on head insures free mesio-Shoulder on head insures free mesio-distal tipping, safety shoulders distal tipping, safety shoulders prevents binding on arch wireprevents binding on arch wire
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Body of the pin ,i.e the labio-lingual Body of the pin ,i.e the labio-lingual width is dimensioned to fit properly width is dimensioned to fit properly in TP 256-500 bracket in conjunction in TP 256-500 bracket in conjunction with 0.020’’arch wire ,used during with 0.020’’arch wire ,used during stage IIstage II
Slot 0.020’’
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3.HOOK PINS –3.HOOK PINS –
Used in all teeth which donot require Used in all teeth which donot require mesio-distal uprighting during stage mesio-distal uprighting during stage 33
Also, when more than one wire is to Also, when more than one wire is to be engagedbe engaged
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Absence of safety shoulder , along Absence of safety shoulder , along with hook-shaped head , assures with hook-shaped head , assures positive locking of torqueing auxillary positive locking of torqueing auxillary and the main arch wireand the main arch wire
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4.High hat pin –4.High hat pin –
Used during any stage when vertical Used during any stage when vertical elastics are to be worn, extension elastics are to be worn, extension over the head facilitates engagement over the head facilitates engagement of elasticsof elastics
Allows free slidingAllows free sliding and tipping and tipping
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5.T-Pin –5.T-Pin –
Meant to be used as “BRAKES” in the Meant to be used as “BRAKES” in the finishing stage when corrected finishing stage when corrected angulations of teeth have to be angulations of teeth have to be maintainedmaintained
There are two typesThere are two types of t-pinsof t-pins Angulated and Angulated and Non-angulatedNon-angulated
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ARCH WIRESARCH WIRES Australian arch wire is used (A.J -WILCOCK)Australian arch wire is used (A.J -WILCOCK)
Round , high tensile strength , stainless Round , high tensile strength , stainless steel wires, heat treated and cold drawn steel wires, heat treated and cold drawn are used are used
The various grades of AUSTRALIAN WIRES The various grades of AUSTRALIAN WIRES available areavailable are
1.Regular (White)1.Regular (White) 2.Regular plus (Green)2.Regular plus (Green)
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3.Special (Black)3.Special (Black)4.Special plus (Orange)4.Special plus (Orange)5.Extra special plus (Blue)5.Extra special plus (Blue)
Recently 3-more newer grades have beRecently 3-more newer grades have beadded –added –6.Premium6.Premium7.Premium plus7.Premium plus8.Supreme8.Supreme
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PROPERTIES OF AUSTRALIAN WIRE –PROPERTIES OF AUSTRALIAN WIRE –
a).Higher tensile strengtha).Higher tensile strengthb).Greater working rangeb).Greater working rangec).Good flexibility /Spring backc).Good flexibility /Spring backd).Good resieliency (greater resistance d).Good resieliency (greater resistance
to permanent deformation as well as to permanent deformation as well as greater release of energy on greater release of energy on deactivation)deactivation)
e)Zero- stress relaxatione)Zero- stress relaxationf)Good toughnessf)Good toughness
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The wire is extremely tough and The wire is extremely tough and should be bent slowly or otherwise should be bent slowly or otherwise breaksbreaks
A quick bend fractures through the A quick bend fractures through the metallic crystals ,whereas slow metallic crystals ,whereas slow bending gives crystals time to flow bending gives crystals time to flow into new shapes without fracturinginto new shapes without fracturing
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Wire is more likelyWire is more likely to break when the to break when the round beak ratherround beak rather than the flat beak than the flat beak is usedis used
With round beak the two points of With round beak the two points of stress are directly opposite to each stress are directly opposite to each otherother
ForcesOff-set
Stress- concentration
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Also , bending along the flat beak Also , bending along the flat beak provides a greater area to dissipate provides a greater area to dissipate the stresses , whereas around the the stresses , whereas around the round beak the stress on the round beak the stress on the crystalline structure is confined to a crystalline structure is confined to a small areasmall area
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OTHER AUXILLARIES USEDOTHER AUXILLARIES USED
1.Elastics –force exerted is 60-70 gms1.Elastics –force exerted is 60-70 gms2.Elastic tie material- To derotate 2.Elastic tie material- To derotate
teeth or to guide eruption of teethteeth or to guide eruption of teeth3.Stainless steel ligatures3.Stainless steel ligatures4.Elastomeric rings -1.5-2.0 mm dia 4.Elastomeric rings -1.5-2.0 mm dia 5.Lingual buttons5.Lingual buttons6.Ball-end hooks6.Ball-end hooks
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SUMMARYSUMMARYFinally , it is the philosophy of LightFinally , it is the philosophy of Lightcontinuous forces , use of differentialcontinuous forces , use of differentialforces and balance of arch length and forces and balance of arch length and tooth material which is the key tooth material which is the key foundation of this technique offoundation of this technique oftreatment.treatment.Further advances in the material sciences Further advances in the material sciences
andandadvent of newer wires has refined this advent of newer wires has refined this technique to advancement and bettement.technique to advancement and bettement.www.indiandentalacademy.comwww.indiandentalacademy.com
REFERENCESREFERENCES
1.Begg and Kesling -31.Begg and Kesling -3rdrd edition edition2.Mollenhauer’s manual2.Mollenhauer’s manual3.Fletcher –The Begg appliance and 3.Fletcher –The Begg appliance and
techniquetechnique4.Cadman article4.Cadman article5.Refined begg5.Refined begg6.Graber and swain6.Graber and swain
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