attachments in beggs technique-ortho / orthodontic courses by indian dental academy

Attachments & Auxiliaries In Begg’s Attachments & Auxiliaries In Begg’s Technique – Description & ApplicationTechnique – Description & Application

www.indiandentalacademy.comwww.indiandentalacademy.com

INDIAN DENTAL ACADEMY

Leader in continuing dental educationwww.indiandentalacademy.com

THE BEGG TECHNIQUE -an unique approach to ortho Rx. -Designed to permit teeth to

move towards their anatomically correct position in jaws under the influence of very light forces.

- Light i.o force Light i.o force no undue strain on anchor no undue strain on anchor

- currents of mesial migration on large post. currents of mesial migration on large post. teeth teeth rapid tooth movement in presence of rapid tooth movement in presence of round arch wire & narrow brackets.round arch wire & narrow brackets.

- Permits the teeth to move independently of Permits the teeth to move independently of one another one another

tipping freely in early stagestipping freely in early stages detailed root positioning in final stages. detailed root positioning in final stages.

Historical backgroundHistorical backgroundRaymond begg Raymond begg used Ribbon arch appliance at used Ribbon arch appliance at

Angle’s school before he returned to Angle’s school before he returned to Australia in nov. 1925.Australia in nov. 1925.

Working independently in Adelaide he Working independently in Adelaide he adoptedadopted

extextn n was often necessarywas often necessary original ribbon arch brackets but original ribbon arch brackets but

turned them upside down, slot facing turned them upside down, slot facing gingivallygingivally www.indiandentalacademy.comwww.indiandentalacademy.com

Replaced precious metal rectangular wire Replaced precious metal rectangular wire with high st. 0.016” s.s wire (A.J. Wilcock)with high st. 0.016” s.s wire (A.J. Wilcock)

Added auxiliary springs to control root Added auxiliary springs to control root position.position.

In resultant appliance friction was In resultant appliance friction was minimized minimized

small contact area between bracket & small contact area between bracket & wire wire

small force of wire against bracket. small force of wire against bracket. www.indiandentalacademy.comwww.indiandentalacademy.com

Attachments used in Begg’s Attachments used in Begg’s Technique are Technique are

Brackets Brackets & lock pins& lock pins BandsBands Molar tubesMolar tubes Ball end HooksBall end Hooks Lingual AttachmentsLingual Attachments

The primary function of attachmentsThe primary function of attachments --transmit forces of activation from wires transmit forces of activation from wires & elastics to teeth & & elastics to teeth & transmit forces of transmit forces of tissue resistance back to wires & elastics.tissue resistance back to wires & elastics.

This depends uponThis depends upon - functional design- functional design - limitations inherent to their location on, - limitations inherent to their location on,

& orientation to, the crown.& orientation to, the crown.www.indiandentalacademy.comwww.indiandentalacademy.com

Design of Bracket & TubesDesign of Bracket & Tubes

The design of the attach. on all teeth The design of the attach. on all teeth except molar must permit free crown except molar must permit free crown tipping by aw & e during first 2 stages tipping by aw & e during first 2 stages & also permit root tipping by auxiliaries & also permit root tipping by auxiliaries used with aw & e during 3used with aw & e during 3rdrd stage. stage.

Molar tube must provide that molars can Molar tube must provide that molars can

be placed & maintained in upright be placed & maintained in upright position without tipping or rotation. position without tipping or rotation.

BracketsBracketsMain attachmentMain attachmentModified ribbon arch brackets - slots facing

gingivally ( narrow brackets – permit free tipping in all the direction)

It has a slot to carry the arch wire and a vertical slot to carry the lock pin to hold wire

Requirements for a light wire Requirements for a light wire bracketbracket

• Ease of arch wire engagement Ease of arch wire engagement • Mean to guide both tail and headMean to guide both tail and head of lock pin.of lock pin.• Positive retention of arch wire in Positive retention of arch wire in all 3 stages.all 3 stages.• Free tipping and sliding of arch wireFree tipping and sliding of arch wire..

• Ability to effect and hold rotations.Ability to effect and hold rotations.• Ability to prevent accidental tipping in Ability to prevent accidental tipping in

stage 3.stage 3.• Facility to use spring pins or rotation Facility to use spring pins or rotation

springs with by-pass clamps.springs with by-pass clamps.• Should not deform under occlusal loadShould not deform under occlusal load• Maximum comfortMaximum comfort

.015”

.020”

.122”

Dimensions - (TP 256 )

Depth of slot- 0.020” Height of slot -0.045” Base dim. -.122”x.125”

Pin slot dim. – 0.020” s.s sheath thickness- 0.015”

Classification of bracketsClassification of bracketsAccording to constitutionAccording to constitution Metallic (stainless steel)Metallic (stainless steel)

bondablebondable weld ableweld able

Non Metallic (Aesthetic)Non Metallic (Aesthetic) plasticplastic

ceramicceramicAccording to placementAccording to placement Labial Labial

Lingual Lingual According to anatomical basesAccording to anatomical bases Flat Flat CurvedCurved

Bondable brackets may have jigs for Bondable brackets may have jigs for positioning ranging height from 31/2 to 41/2 positioning ranging height from 31/2 to 41/2 mm.mm. www.indiandentalacademy.comwww.indiandentalacademy.com

Metallic bracketsMetallic brackets StrengthStrength -must be made of good quality s.s -must be made of good quality s.s

sheets of minimum thickness 0.015” sheets of minimum thickness 0.015” slot depth must not exceed 0.022”slot depth must not exceed 0.022” for rotational controlfor rotational control

Weld able bracket can be welded on band it Weld able bracket can be welded on band it can be with flat base or curved basecan be with flat base or curved base

For bondable bracketsFor bondable brackets – – strong union of bonding mesh with the strong union of bonding mesh with the

proper base by way of brazing is proper base by way of brazing is essential, essential,

done without obliterating mesh holesdone without obliterating mesh holes..

Mesh Mesh Mini meshMini mesh (TP 256 -050)-(TP 256 -050)- smallest base available smallest base available same size of bracket same size of bracket more estheticmore esthetic

Super mini meshSuper mini mesh (TP (TP 256-150256-150)) - -larger than mini mesh larger than mini mesh

extends slightly beyond the extends slightly beyond the bracket basebracket base

more bonding surfacemore bonding surfacewww.indiandentalacademy.comwww.indiandentalacademy.com

Esthetic bracketsEsthetic brackets

Plastic bracketsPlastic bracketsMade of polycarbonatesMade of polycarbonatesAvailable in tooth color or crystal clear Available in tooth color or crystal clear

plasticplasticFlat for centrals Flat for centrals Curved for cuspids & bicuspidsCurved for cuspids & bicuspids

Ceramic bracketsCeramic brackets

Esthetic bracketEsthetic bracket

Ceramaflex II 256 begg(TP labs) having Ceramaflex II 256 begg(TP labs) having

all unique feature of metal brackets all unique feature of metal brackets

Polycrystalline alumina manuf. by injection Polycrystalline alumina manuf. by injection

molding. Base is polycarbonate for easy molding. Base is polycarbonate for easy

debonding.debonding.www.indiandentalacademy.comwww.indiandentalacademy.com

Slots are formed during molding not Slots are formed during molding not milled so resist to stress cracks.milled so resist to stress cracks.

Pins – modified pins s.s/brass and Pins – modified pins s.s/brass and nylon pins (for nylon pins bending nylon pins (for nylon pins bending special heating device “nylon lock special heating device “nylon lock pin iron”pin iron” button) button)

Stage III mini up righting springs, ni ti Stage III mini up righting springs, ni ti tourquing barstourquing bars

Anatomical basesAnatomical bases

Flat base for incisorsFlat base for incisorsBracket flange and base curved for Bracket flange and base curved for

cuspid & bicuspid – lack rotational cuspid & bicuspid – lack rotational controlcontrol

Bracket flange flat and base curved –Bracket flange flat and base curved –provide maximum rotational controlprovide maximum rotational control

Clockwise bracketsClockwise brackets anticlockwise bracketsanticlockwise bracketswww.indiandentalacademy.comwww.indiandentalacademy.com

Other types of bracketsOther types of brackets LTD limited tipping design bracketsLTD limited tipping design brackets With built in torque – Kameda With built in torque – Kameda

bracketsbrackets Combination bracketsCombination brackets Tip edge bracketsTip edge brackets

Lock pinsLock pins - - essential to hold the wire in bracket essential to hold the wire in bracket

& allows the force to be transmitted from arch & allows the force to be transmitted from arch

wire & elastics to teeth.wire & elastics to teeth.

Made from soft s.s or brass (nylon for ceramic) Made from soft s.s or brass (nylon for ceramic)

must be soft to permit easy bending close to must be soft to permit easy bending close to

bracket vertical wallbracket vertical wall

Types of lock pinsTypes of lock pinsOne point safety lock pinOne point safety lock pin Used during first stage with 0.016” wireUsed during first stage with 0.016” wire shoulder on labial surface of headshoulder on labial surface of head Beveled under surface Beveled under surface tipping(35% tipping(35%

more)more) Lab-lin width of pin in slot area is 0.024” Lab-lin width of pin in slot area is 0.024”

sosorotational control with 0.016” wirerotational control with 0.016” wire Available plain or with brake- off notchAvailable plain or with brake- off notch

Second stage Safety lock pinsSecond stage Safety lock pins Shoulder on labial surface of head ensure Shoulder on labial surface of head ensure free mesiodistal tippingfree mesiodistal tipping Lab-lin width of pin(0.020”) reduced 0.004” Lab-lin width of pin(0.020”) reduced 0.004” as compare to stage 1 pins to permit use as compare to stage 1 pins to permit use with 0.018”or 0.020” inch wirewith 0.018”or 0.020” inch wire Available with brake- off notchAvailable with brake- off notch

Hook pinsHook pins Used on all teeth that do not req. m-d Used on all teeth that do not req. m-d

tippingtipping Absence of Shoulder and hook shape Absence of Shoulder and hook shape

permits positive locking of arch wire and permits positive locking of arch wire and auxiliaries auxiliaries

in 3in 3rdrd stage. stage. Hold to use wire against bracket in ant. Hold to use wire against bracket in ant.

tooth with rotating spring.tooth with rotating spring.

High hat pinsHigh hat pinsPin with an extension on head to readilyPin with an extension on head to readily accept vertical or cross elasticsaccept vertical or cross elastics Can be used in any stageCan be used in any stage

Super high hatSuper high hat Indicated for fixation the segments with Indicated for fixation the segments with elastics following surgeryelastics following surgery

T pinsT pins Lock pin with broad head that controls the Lock pin with broad head that controls the

mesiodistal inclination of toothmesiodistal inclination of tooth Normally used in 3Normally used in 3rdrd stage to replace stage to replace

deactivated m-d springs as a mean of m-d deactivated m-d springs as a mean of m-d

stabilitystability Can be used to limit free tipping in any Can be used to limit free tipping in any

stage. stage. www.indiandentalacademy.comwww.indiandentalacademy.com

TypesTypesUniversal T pinsUniversal T pins (s.s) (s.s) has lingual hook to has lingual hook to

retain arch wire with slight pressure head retain arch wire with slight pressure head takes a set to hold the tooth at any angle takes a set to hold the tooth at any angle

Original T pinsOriginal T pins (s.s or brass) (s.s or brass) 90º, 10º left & 10º right90º, 10º left & 10º right

Ceramaflex pins Ceramaflex pins modified pinsmodified pinsUsed with ceramic bracketsUsed with ceramic bracketsBulkier than its metallic versionBulkier than its metallic versions.s/brass and nylon pinss.s/brass and nylon pins For nylon pins bending For nylon pins bending special heating special heating

device “nylon lock pin iron”device “nylon lock pin iron” button buttonwww.indiandentalacademy.comwww.indiandentalacademy.com

Lingual pinLingual pinTo lock the wire in bracket during stage 3 To lock the wire in bracket during stage 3

when plain uprighting springs are used.when plain uprighting springs are used.

Spring pinSpring pin A combination of safety lock pin and A combination of safety lock pin and

uprighting spring uprighting spring Eliminates the need for ligating the arch Eliminates the need for ligating the arch

wire wire to the bracketto the bracket

BandsBands Although bonding has replaced the banding Although bonding has replaced the banding

there are number of indicationthere are number of indication Teeth that will receive heavy intermittent Teeth that will receive heavy intermittent

forces against attach. e.g.. Molarforces against attach. e.g.. Molar Teeth req. both labial & lingual attach.Teeth req. both labial & lingual attach. Teeth with short clinical crownTeeth with short clinical crown Tooth surface incompatible to bondingTooth surface incompatible to bonding

Although there are exceptions, the Although there are exceptions, the rule in cotemporary orthodonticsrule in cotemporary orthodontics

Anteriors Anteriors bonded bonded

PremolarsPremolars bonded or banded bonded or banded depending upon height of c .crown & depending upon height of c .crown & need for lingual attach.need for lingual attach.

molars molars pref. banding pref. bandingwww.indiandentalacademy.comwww.indiandentalacademy.com

Dimensions of bands commonly usedDimensions of bands commonly usedMolarsMolars 0.006” x 0.18” or 0.006” x 0.20”0.006” x 0.18” or 0.006” x 0.20”Bicuspids Bicuspids 0.004” x 0.15” or 0.005” x 0.15”0.004” x 0.15” or 0.005” x 0.15”AnteriorsAnteriors 0.004” x 0.125” or 0.003” x 0.004” x 0.125” or 0.003” x

0.125” 0.125”

Bands Bands can be custom made or preformed (with can be custom made or preformed (with

or without attach.)or without attach.)www.indiandentalacademy.comwww.indiandentalacademy.com

Molar tubesMolar tubesDesigned to permit free m-d sliding of arch Designed to permit free m-d sliding of arch

wire wire free distolingual tipping of anterior free distolingual tipping of anterior teethteeth

TubesTubes –weld able, solder able or bondable –weld able, solder able or bondable with hook or without hookwith hook or without hook with vertical slot (uprighting springs)with vertical slot (uprighting springs) 2 to 6 degree distolingual offset tubes are 2 to 6 degree distolingual offset tubes are

also available also availablewww.indiandentalacademy.comwww.indiandentalacademy.com

Types of molar tubesTypes of molar tubesRoundRound dim-0.036”inside diameter x0.25” long dim-0.036”inside diameter x0.25” long

Placed on buccal surface 1st p molarPlaced on buccal surface 1st p molar

Convertible round tube Convertible round tube Dim. Of regular round tubeDim. Of regular round tube By placing an insert the internal diameter By placing an insert the internal diameter

changed from 0.036” to 0.021” to reduce the changed from 0.036” to 0.021” to reduce the play between wire & tube during stage 3play between wire & tube during stage 3

Flat oval tubeFlat oval tube Dim- 0.027” x 0.50” internal diameter, 0.200” Dim- 0.027” x 0.50” internal diameter, 0.200”

long,long, when 1when 1stst p molar is missing used on 2 p molar is missing used on 2ndnd molar molar

(smaller root).(smaller root). Also used in mandibular arch on 1Also used in mandibular arch on 1stst

permanent molar when man-2permanent molar when man-2ndnd pm is pm is missing.missing.

Interchangeable tubeInterchangeable tube permits switching from a double back permits switching from a double back

archarch wire to a straight back arch wire with wire to a straight back arch wire with out loosing mechanical advantage and out loosing mechanical advantage and change of tubechange of tube

End tabEnd tab

Combination tubeCombination tube Consist of gingival round tube Consist of gingival round tube

0.036”diametre x 6.2mm long0.036”diametre x 6.2mm long & & rectangular (ribbon) occlusal tube 0.025”x rectangular (ribbon) occlusal tube 0.025”x 0.018” dia x 5.5 mm long0.018” dia x 5.5 mm long

used when finishing is done by used when finishing is done by rectangular wire.rectangular wire.

Additional round tubeAdditional round tube Placed on molars for engaging lip Placed on molars for engaging lip

bumpers, head gears, EVVA bumpers, head gears, EVVA (Experimental fixed appliance activator) (Experimental fixed appliance activator) etc.etc.

Placed gingival to main tube except Placed gingival to main tube except for EVVA appliance (occlusal)for EVVA appliance (occlusal)

Ball end hookBall end hook For the hook less tube ball end hook is For the hook less tube ball end hook is

placed at the mesial end of molar tube with placed at the mesial end of molar tube with free end directed gingivally and distally.free end directed gingivally and distally.

Prevents rotation of molars as Prevents rotation of molars as compared to elastic attached to distal end. compared to elastic attached to distal end. Especially useful in short clinical crown.Especially useful in short clinical crown. Increased patient cooperationIncreased patient cooperation..

Lingual attachmentsLingual attachmentsLingual button or cleatLingual button or cleatPlaced on lingual surface of teeth for Placed on lingual surface of teeth for

attachment of c. elastics, e. thread, wire attachment of c. elastics, e. thread, wire ligatureligature

Placed on m-d center unless severe Placed on m-d center unless severe crowding crowding

is present or tooth is rotatedis present or tooth is rotatedcan be bondable or weld ablecan be bondable or weld able

Lingual cleats are used instead of button Lingual cleats are used instead of button because they provide greater versatility because they provide greater versatility for attachment of elastics.for attachment of elastics.www.indiandentalacademy.comwww.indiandentalacademy.com

Cleats are not rigid, so adjustableCleats are not rigid, so adjustable continue to retain elastic as teeth changes its continue to retain elastic as teeth changes its

positionposition Low profile can be flattened if impinge on Low profile can be flattened if impinge on

tongue.tongue. In case of tongue thrusting one leg can be In case of tongue thrusting one leg can be

projectedprojected Welding flange is thin and flexible no distort Welding flange is thin and flexible no distort

lingual surface of bandlingual surface of band

Disadv.Disadv. occasionally irritates tongue, may distort occasionally irritates tongue, may distort by chewing forceby chewing forcewww.indiandentalacademy.comwww.indiandentalacademy.com

Cleat LugCleat Lug Made from heavier metal Made from heavier metal Placed lingually in gingival 1/3 of molar Placed lingually in gingival 1/3 of molar

bandband Can bear good pressure Can bear good pressure Facilitate proper pushing of bands at their Facilitate proper pushing of bands at their

proper placesproper places

Hooks for elasticsHooks for elasticslingual side can be placed vertically lingual side can be placed vertically

(free end extending gingivally) for (free end extending gingivally) for cross elasticscross elastics

For applying elastics or e. thread for For applying elastics or e. thread for rotational movement.rotational movement.

Seating lug hookSeating lug hook

Has flat or curved basesHas flat or curved bases

Can be used on lingual surfaces on all teethCan be used on lingual surfaces on all teeth

Used for placement of elastics and for easy Used for placement of elastics and for easy

insertion and removal of bandinsertion and removal of band

Lingual sheathLingual sheathThis is used to put auxiliaries This is used to put auxiliaries

like expanders or TPAlike expanders or TPA Internal diameter 0.036”Internal diameter 0.036”

By pass clampsBy pass clampsProvide a simple means of loosely connecting Provide a simple means of loosely connecting

an arch wire to buccal surface of bracket.an arch wire to buccal surface of bracket.Ordinarily used on bicuspidsOrdinarily used on bicuspidsPermit vertical & rotational control during Permit vertical & rotational control during post. space closurepost. space closureNor. not used in stage INor. not used in stage ITwo levels of attachment are possible.Two levels of attachment are possible.

C clampC clamp (Lyman(Lyman Wagers , 1967 , JCO) Wagers , 1967 , JCO)

Provide a simple means of loosely Provide a simple means of loosely connecting an arch wire to buccal surface connecting an arch wire to buccal surface of bracket.of bracket.

Ordinarily used on bicuspidsOrdinarily used on bicuspidsMade from .018 wire.Made from .018 wire.can be placed on bands prior to can be placed on bands prior to their cementation in the mouth.their cementation in the mouth.

Placement of Placement of AttachmentAttachment

Brackets placementBrackets placementHeight Height 4mm from incisal edge 4mm from incisal edge

except l.i 3.5 mmexcept l.i 3.5 mmM-DM-D centre of tooth (on centre of tooth (on

rotated tooth slight off rotated tooth slight off centre – 1 mm closure to centre – 1 mm closure to the proximal surface that the proximal surface that is rotated towards lingual)is rotated towards lingual)

Brackets are placed on these heightsBrackets are placed on these heights

Size of torquing auxiliaries for hygienic Size of torquing auxiliaries for hygienic considerationconsideration

Mechanics permits generation of an adequate Mechanics permits generation of an adequate moment (intrusive force) for proper m/f ratio moment (intrusive force) for proper m/f ratio in achieving controlled tipping in first stagein achieving controlled tipping in first stage

If distance is less If distance is less ↑chances of occlusal ↑chances of occlusal interference and/or bracket displacementinterference and/or bracket displacement

If distance is If distance is ↑↑, diff. to maintain dental , diff. to maintain dental arch length and rotations because arch arch length and rotations because arch wire will be below the contact area wire will be below the contact area between the teeth. between the teeth.

Bracket placement on fractured teethBracket placement on fractured teeth If deep # bracket may be placed inverted so If deep # bracket may be placed inverted so

that slot is still at 4 mm .that slot is still at 4 mm . If shallow #it may be trimmed down and If shallow #it may be trimmed down and

bracket is placed from thatbracket is placed from that surface surface

If cupid to be used as lateral incisor tip If cupid to be used as lateral incisor tip may be reduced prior to bondingmay be reduced prior to bonding

Lingual buttons & Lingual buttons & cleatscleats

positioned directly opp. To positioned directly opp. To area of arch wire area of arch wire engagementengagement

To permit free m-d tipping To permit free m-d tipping & uprighting& uprighting

Buccal tubesBuccal tubesFrom buccal mesial end of From buccal mesial end of

tube is in line with centre tube is in line with centre of mb cusp of mb cusp

Mandibular tube should be Mandibular tube should be

placed as gingivally as placed as gingivally as possible to keep arch wire possible to keep arch wire away from occlusal plane.away from occlusal plane.

Elastic hookElastic hookpositioned so that the positioned so that the

elastic will pull from a elastic will pull from a point as near to the point as near to the center of crown as center of crown as possiblepossible

Power armsPower armsUsed for selective maxillary incisor intrusion toUsed for selective maxillary incisor intrusion to

minimize gummy smile in cases of VMEminimize gummy smile in cases of VME

Deep bite cases where molar extrusion in bite Deep bite cases where molar extrusion in bite opening is undesirable.opening is undesirable.

To avoid canting of plane during RxTo avoid canting of plane during Rx

Reduce torque req. on incisors Reduce torque req. on incisors www.indiandentalacademy.comwww.indiandentalacademy.com

0.017”x 0.025” or large size wire0.017”x 0.025” or large size wire,, 5-7 mm in length, 5-7 mm in length, Follow contour of alveolus. Follow contour of alveolus. Soldered to band just above the Soldered to band just above the

molar tube.molar tube.

Auxiliaries Used in Begg’s techniqueAuxiliaries Used in Begg’s techniqueIt is indicated and possible with Begg tech. to It is indicated and possible with Begg tech. to

employ multidirectional forces simultaneously employ multidirectional forces simultaneously for axial correction of teeth. for axial correction of teeth.

The inherent design of attachments used in The inherent design of attachments used in tech. allows for use of auxiliaries in tech. allows for use of auxiliaries in conjunction with main arch wire.conjunction with main arch wire.

It is through the effective use of auxiliaries that It is through the effective use of auxiliaries that the axial position of teeth are controlled.the axial position of teeth are controlled.

ClassificationClassification Auxiliaries used in stage IAuxiliaries used in stage I -Rotation springs-Rotation springs --Mollenhauer’s Aligning AuxiliaryMollenhauer’s Aligning Auxiliary (MAA) (MAA)

Auxiliaries used in stage IIAuxiliaries used in stage II - - Braking AuxiliariesBraking Auxiliaries

Passive uprighting springs, Passive uprighting springs, TTorquing Auxiliaries (2 spur,4 spur, reverse orquing Auxiliaries (2 spur,4 spur, reverse

torque, reciprocal torque, MAA), torque, reciprocal torque, MAA), T pins, T pins, Combination wiresCombination wires

--MAAMAA -Rotation springs-Rotation springs - Mini uprighting springs- Mini uprighting springs

Auxiliaries used in stage IIIAuxiliaries used in stage III --Root tipping auxiliariesRoot tipping auxiliaries Mesiodistal uprighting springsMesiodistal uprighting springs Mini uprighting springsMini uprighting springs

- - Root torquing auxiliaries Root torquing auxiliaries Two spur auxiliaryTwo spur auxiliary Four spur auxiliaryFour spur auxiliary Pre-wound auxiliary Pre-wound auxiliary Reciprocal torquing auxiliary Reciprocal torquing auxiliary Reverse torquing auxiliaryReverse torquing auxiliary Kitchton torquing auxiliary Kitchton torquing auxiliary Universal torquing auxiliaryUniversal torquing auxiliary Torque BarsTorque Bars

Rotation springsRotation springs Most efficient & versatile (no lig. attach. Req.) Most efficient & versatile (no lig. attach. Req.)

meanmean 0.014” & 0.016”0.014” & 0.016” Vertical leg inserted in bracket slot from Vertical leg inserted in bracket slot from

gingival side, holding activating arm perpand. gingival side, holding activating arm perpand. to labial surface, 2 bends in vertical leg, hook to labial surface, 2 bends in vertical leg, hook the lever the lever

arm over arch wirearm over arch wirewww.indiandentalacademy.comwww.indiandentalacademy.com

Necessary to securely connect to arch wire Necessary to securely connect to arch wire hook pin for ant., bypass clamps for hook pin for ant., bypass clamps for

bicuspidbicuspid tooth may go linguallytooth may go lingually

Once tooth is rotated to desired position, ligated to Once tooth is rotated to desired position, ligated to adjacent tooth or archwire or pinned in arch wire.adjacent tooth or archwire or pinned in arch wire.

ProblemsProblems Should not be used more than 6 weeks (2 point Should not be used more than 6 weeks (2 point

contact) restrict free mesiodistal tippingcontact) restrict free mesiodistal tipping Exerts more lateral force on arch wire move the Exerts more lateral force on arch wire move the

molar more readily than less powerful elastic molar more readily than less powerful elastic thread tiesthread ties

Mollenhauer’s Aligning Auxiliary (MAA)Mollenhauer’s Aligning Auxiliary (MAA)

In the classic Begg philosophy crown tipping In the classic Begg philosophy crown tipping

& root movements- totally bifurcated, & root movements- totally bifurcated,

becausebecauseRoot movement in early stages- loss of Root movement in early stages- loss of

anchorageanchorage

Lingual root tip of incisor – extrusion of incisor Lingual root tip of incisor – extrusion of incisor

and bite deepeningand bite deepeningwww.indiandentalacademy.comwww.indiandentalacademy.com

MAA attempts root control from the MAA attempts root control from the very beginning without significantly very beginning without significantly affecting anchorage & intrusionaffecting anchorage & intrusion

This is possible by using stiff base wire This is possible by using stiff base wire (0.018” premium plus) & ultra light (0.018” premium plus) & ultra light force from MAA (0.009” supreme).force from MAA (0.009” supreme).

Development of MAADevelopment of MAA Mollenhauer –rectangles made in 0.010 “ wire Mollenhauer –rectangles made in 0.010 “ wire

for reciprocal torque on adjacent incisors for reciprocal torque on adjacent incisors (SPECS)(SPECS) too heavy force too heavy force

In 1984, on request of Mollenhauer , A. J. In 1984, on request of Mollenhauer , A. J. Wilcock made 0.009” supreme wireWilcock made 0.009” supreme wire

Initially he used it similar to niti or co-axial wire.Initially he used it similar to niti or co-axial wire.

Later boxed aux. named Later boxed aux. named “ “ An Aligning auxiliary for ribbon arch bracket”.An Aligning auxiliary for ribbon arch bracket”.

Requirements of MAARequirements of MAAMust generate very light root moving forcesMust generate very light root moving forces

when reciprocal torque is required with the when reciprocal torque is required with the adjacent rectangle must not diverge by adjacent rectangle must not diverge by more than 45more than 4500

Auxiliary should resist deformation (resilient Auxiliary should resist deformation (resilient supreme grade pulse straighten wire)supreme grade pulse straighten wire)

Base wire should be able to resist vertical Base wire should be able to resist vertical and transverse reactive forces from MAAand transverse reactive forces from MAA

For lingual root torque For lingual root torque Mollenhauer engaged Mollenhauer engaged MAA first & base MAA first & base arch wire piggy backarch wire piggy back

but rectangles lift away but rectangles lift away from the tooth from the tooth surface. So, Thickest surface. So, Thickest possible pins possible pins (ceramaflex) used.(ceramaflex) used.

ADVANTAGES OF MAAADVANTAGES OF MAAsimultaneous intrusion and retraction of incisorssimultaneous intrusion and retraction of incisorsof rapid bodily alignment of anterior teeth with of rapid bodily alignment of anterior teeth with

gentle forcesgentle forcesStable resultsStable resultsReciprocablility of torquing forces on instanding Reciprocablility of torquing forces on instanding

laterals or palatally placed canines.laterals or palatally placed canines.Periodontal advantages – gingival dehiscences Periodontal advantages – gingival dehiscences

associated with prolonged labial root torquing is associated with prolonged labial root torquing is eliminated eliminated

Short stage threeShort stage threePossibility of growing cortical bone at point Possibility of growing cortical bone at point

A & point B.A & point B.

Various applications of MAAVarious applications of MAAbodily alignment of crowded teethbodily alignment of crowded teeth

To apply labial root torque on lower incisors To apply labial root torque on lower incisors in growing brachyfacial cases. in growing brachyfacial cases.

Can also be used for labial root torque on Can also be used for labial root torque on upper incisors in class III cases.upper incisors in class III cases.

By bending more +ve Torque as a By bending more +ve Torque as a braking mechanismbraking mechanism

For controlling mesio-distal tipping For controlling mesio-distal tipping (MAA tip)(MAA tip)

Modification of MAAModification of MAAWith available pins holding down the boxes With available pins holding down the boxes

for lingual root torque was difficult. So, for lingual root torque was difficult. So, torquing action of MAA is directly applied on torquing action of MAA is directly applied on gingival surface of teeth. For this base wire gingival surface of teeth. For this base wire is engaged first and MAA is engaged piggy is engaged first and MAA is engaged piggy back.back.

When reciprocal root torque is When reciprocal root torque is required on adjacent teeth the required on adjacent teeth the concerned box rides over the main concerned box rides over the main arch wire with a cross over band and arch wire with a cross over band and pressed against the incisor surface of pressed against the incisor surface of the crownthe crown

Braking auxiliariesBraking auxiliaries – – in minimum in minimum anchorage cases where extractions were anchorage cases where extractions were performed there is need to prevent the performed there is need to prevent the anterior from over retracting. This can be anterior from over retracting. This can be done bydone byPassive uprighting springs Passive uprighting springs

(made in 0.018” wire)(made in 0.018” wire)www.indiandentalacademy.comwww.indiandentalacademy.com

Torquing auxiliaries (2 spur, 4 spur, reciprocal Torquing auxiliaries (2 spur, 4 spur, reciprocal torquing aux., reverse torquing aux. MAA torquing aux., reverse torquing aux. MAA designed in 0.010” wire or 0.011” wire)designed in 0.010” wire or 0.011” wire)

Combination wires - SS or Alpha Titanium wire, Combination wires - SS or Alpha Titanium wire, anterior segment is 0.022” x o.018” (ribbon anterior segment is 0.022” x o.018” (ribbon mode) and posterior segment is 0.018” round.mode) and posterior segment is 0.018” round.

Angulated T pinAngulated T pin

Root tipping auxiliariesRoot tipping auxiliariesthe paralleling auxiliaries commonly the paralleling auxiliaries commonly termed as, uprighting springstermed as, uprighting springs

used to perform MD root movements or used to perform MD root movements or to create resistance to crown to create resistance to crown movements.movements.

Generally speaking paralleling Generally speaking paralleling auxiliaries is a helical spring with a auxiliaries is a helical spring with a stem to engage the pin channel of stem to engage the pin channel of bracket and an activating arm which bracket and an activating arm which attaches on arch wire.attaches on arch wire. www.indiandentalacademy.comwww.indiandentalacademy.com

Uprighting spring first introduced by Begg Uprighting spring first introduced by Begg – – 1961 original spring had a coil and 1961 original spring had a coil and a long lever arma long lever arm

PrinciplePrincipleEmploys the principle of potential energy of the Employs the principle of potential energy of the

resilient arch wire. resilient arch wire.

Energy is expended in flexing the lever arm to Energy is expended in flexing the lever arm to engage the arch wire. So energy is stored in engage the arch wire. So energy is stored in coilscoils . .

During unloading force tends to produce a During unloading force tends to produce a mechanical couple which has its end at mechanical couple which has its end at the crown and apical position of root the crown and apical position of root with centre of resistance disposed about with centre of resistance disposed about 40 % along the root length from crest 40 % along the root length from crest above.above.

since crown is ligated root movement since crown is ligated root movement occursoccurs www.indiandentalacademy.comwww.indiandentalacademy.com

Force system employed by Auxiliary. depends Force system employed by Auxiliary. depends upon- upon-

Gauge of wire usedGauge of wire used Resiliency of wire usedResiliency of wire used Size of helixSize of helix Number of coils in the springNumber of coils in the spring Direction of activationDirection of activationConstructionConstruction

0.014” A. J. Wilcock wire0.014” A. J. Wilcock wire0.016” & 0.018 “ wire can be used 0.016” & 0.018 “ wire can be used

Tooth Tooth gaugegauge coilscoilsMaxillary and Maxillary and mandibularmandibular caninecanine

0.016” or 0.016” or 0.0180.018

Maxillary and Maxillary and mandibular 2mandibular 2ndnd premolar premolar

0.016”0.016” 22

Maxillary lateralsMaxillary laterals 0.014”0.014” 22

Mandibular lateralsMandibular laterals 0.014”0.014” 33

Begg’s recommendations

To produce an effective forceTo produce an effective forceThe helicals and arms of the spring should be in The helicals and arms of the spring should be in

the same plane as to the long axis of the teeth the same plane as to the long axis of the teeth and the arch. and the arch.

Incorrect positioning will rotate the teeth or tip Incorrect positioning will rotate the teeth or tip the roots too far buccal or lingual.the roots too far buccal or lingual.

when utilizing root tipping springs its essential to when utilizing root tipping springs its essential to ligate the base arch wire to slot (elongation)ligate the base arch wire to slot (elongation)

In extraction cases uprighting springs should be In extraction cases uprighting springs should be used on both teeth's adjacent to extraction used on both teeth's adjacent to extraction sites.sites.

with earlier the arms of springs employ at with earlier the arms of springs employ at extraction sites overlap each other when extraction sites overlap each other when hooked in position.hooked in position.

Recent shorter springs are self retaining and Recent shorter springs are self retaining and don't interfere with springs of adjacent teethdon't interfere with springs of adjacent teeth

Spring pinsSpring pinsdeveloped by begg to overcome the difficulty developed by begg to overcome the difficulty

of spring pressing against the arch wireof spring pressing against the arch wire causing it to move in occlusal direction causing it to move in occlusal direction leading to elongation of teeth.leading to elongation of teeth.

Compound uprighting springCompound uprighting springlever arm is not engaged on arch wire. But lever arm is not engaged on arch wire. But arms of two springs are held together by a arms of two springs are held together by a tube.tube.

No special advantage. Ease of placement.No special advantage. Ease of placement.www.indiandentalacademy.comwww.indiandentalacademy.com

Double spring pin & double uprighting springDouble spring pin & double uprighting springTwo springs made from same wire.Two springs made from same wire. More resilient.More resilient. Produce less force due to presence of third Produce less force due to presence of third

coil. coil. Also avoid proximal space opening which can Also avoid proximal space opening which can

be closed by activating the central loopbe closed by activating the central loop..Can be used only on teeth which require the Can be used only on teeth which require the

teeth to move in opposite directions.teeth to move in opposite directions.

Mini uprighting springsMini uprighting springsmini (0.009” supreme)mini (0.009” supreme) midi (0.010”– 0.012” supreme). midi (0.010”– 0.012” supreme).

They differ from older springs in They differ from older springs in

1. the coil of spring is twice the size of wire, 1. the coil of spring is twice the size of wire, former springs which was four timesformer springs which was four times

2. 2. the stem of spring runs tangential to the the stem of spring runs tangential to the coil older spring the stem was radial to he coil.coil older spring the stem was radial to he coil.

Activation is 100 % (stem and the active arm Activation is 100 % (stem and the active arm are in one line making angle of 180 degrees).are in one line making angle of 180 degrees).

Securing the springsSecuring the springs

AdvantagesAdvantages1.1. Light continuous forceLight continuous force2.2. Much less taxation to anchorageMuch less taxation to anchorage3.3. Better aestheticsBetter aesthetics4.4. Ease in maintaining oral hygieneEase in maintaining oral hygiene

0.010” for incisor teeth0.010” for incisor teeth 0.012” for canines and premolars0.012” for canines and premolars

Torquing auxiliariesTorquing auxiliariesAt the end of stage II anterior teeth will At the end of stage II anterior teeth will

be tipped lingually & present a dished in be tipped lingually & present a dished in appearance. appearance.

The palatal movement of the upper The palatal movement of the upper central incisors roots combined with central incisors roots combined with distal and palatal movement of distal and palatal movement of maxillary lateral incisor roots is maxillary lateral incisor roots is commonly referred to as root torquecommonly referred to as root torque. .

Four spur torquing auxiliaryFour spur torquing auxiliary

This was the original torquing mechanism This was the original torquing mechanism used by Begg. used by Begg.

Spurs rest against labial surface of upper Spurs rest against labial surface of upper central and lateral incisors bend in central and lateral incisors bend in 0.016” main arch wire. 0.016” main arch wire.

This has been refined to four spur This has been refined to four spur torquing auxiliary made of 0.014” 0r torquing auxiliary made of 0.014” 0r 0.016” wire or 0.012” premium plus 0.016” wire or 0.012” premium plus pulse straightened wirepulse straightened wirewww.indiandentalacademy.comwww.indiandentalacademy.com

ConstructionConstruction

Activation – Activation – using the light wire pliers auxiliary is formed using the light wire pliers auxiliary is formed

into an arch smaller than anterior portion of into an arch smaller than anterior portion of patients dental archpatients dental arch

with the spurs in nearly horizontal position(25º-with the spurs in nearly horizontal position(25º-

30ºfrom hori. plane) 30ºfrom hori. plane)

for 0.012” premium plus pulse straightened for 0.012” premium plus pulse straightened wire0º from hori. plane) wire0º from hori. plane)

increasing the lingual bands at the base of increasing the lingual bands at the base of distal leg of each spur, placing a slight V bend distal leg of each spur, placing a slight V bend or curve between the spurs.or curve between the spurs.www.indiandentalacademy.comwww.indiandentalacademy.com

Cuspid curveCuspid curveIn passive state the curvature will appear to In passive state the curvature will appear to

drop below the level of arch wire drop below the level of arch wire when torque auxiliary is applied distal arms when torque auxiliary is applied distal arms

will rotated by supers will follow the will rotated by supers will follow the curvature of main arch wire.curvature of main arch wire.

Short force spur auxiliaryShort force spur auxiliarydoes not engage cuspid bracket bend does not engage cuspid bracket bend

from 0.018” .from 0.018” .torque force is comparable to 0.016” torque force is comparable to 0.016”

auxiliary that extends distal to cuspid auxiliary that extends distal to cuspid brackets.brackets.

Two spur torquing auxiliaryTwo spur torquing auxiliaryIf felt that only central incisors If felt that only central incisors

require torque the two spur auxiliary is require torque the two spur auxiliary is used. used.

Made in 0.014” or 0.016” wireMade in 0.014” or 0.016” wire

Reciprocal torquing auxiliaryReciprocal torquing auxiliaryused when central incisor root will used when central incisor root will

have to be move lingually and lateral have to be move lingually and lateral incisor roots labiallyincisor roots labially

often needed when laterals are bodily often needed when laterals are bodily displaced lingually, prior to treatment. displaced lingually, prior to treatment.

Made in 0.014” or 0.016” wireMade in 0.014” or 0.016” wire

One to one reciprocal torquing auxiliaryOne to one reciprocal torquing auxiliaryindicated when two adjacent teeth indicated when two adjacent teeth

require root torque in opposite direction. require root torque in opposite direction. Usually applied in lower anterior teeth. Usually applied in lower anterior teeth.

Reverse torquing auxiliaryReverse torquing auxiliaryreverse root torquing auxiliary has reverse root torquing auxiliary has

the objective of repositioning the the objective of repositioning the mandibular incisor roots and bringing mandibular incisor roots and bringing them forward in a controlled mannerthem forward in a controlled manner

Indications Indications 1.1. Bimaxillary proclination or class II div. 1Bimaxillary proclination or class II div. 1

2.2. Almost all non-extraction casesAlmost all non-extraction cases 3. To increase the mandibular anchorage3. To increase the mandibular anchorage

To upright mandibular incisors in To upright mandibular incisors in third stage two types are usedthird stage two types are used

Brandt typeBrandt type Udder typeUdder type

Brandt typeBrandt type Fabricated from 0.014 “ resilient wire.Fabricated from 0.014 “ resilient wire. Easy to fabricate . Easy to fabricate . Good activation control.Good activation control. Easy to maintain hygiene. Easy to maintain hygiene. Easily fitted incisally distal to each bracket.Easily fitted incisally distal to each bracket. Activation should be moderate. Activation should be moderate. Buccal arm either end distal to canine but Buccal arm either end distal to canine but

passes through molar teethpasses through molar teethwww.indiandentalacademy.comwww.indiandentalacademy.com

Udder typeUdder type 0.014 “ or 0.016 “. 0.014 “ or 0.016 “. There is no bracket There is no bracket

engagement except for engagement except for canine.canine.

Difficult to activate for Difficult to activate for individual teeth.individual teeth.

Difficult to maintain oral Difficult to maintain oral hygiene.hygiene.

Pre–wound torquing auxiliary (mouse Pre–wound torquing auxiliary (mouse trap type)trap type)

Designed by Begg in 1955. Designed by Begg in 1955. Bending was originally hand done but now Bending was originally hand done but now

available commercially in graded size.available commercially in graded size. Usually wound from 0.014 “ – 0.016 “ round wire Usually wound from 0.014 “ – 0.016 “ round wire

about a 0.020 “ main arch wire.about a 0.020 “ main arch wire. AA small incisal offset or V in the midline of the small incisal offset or V in the midline of the

main arch acts as reciprocating stop for auxiliarymain arch acts as reciprocating stop for auxiliarywww.indiandentalacademy.comwww.indiandentalacademy.com

activated by meeting the resistance of stop in activated by meeting the resistance of stop in the midline of arch wire. the midline of arch wire.

It is posssible to remove one or both torque It is posssible to remove one or both torque base from lateral incisor as these teeth base from lateral incisor as these teeth become adequately torqued without reducing become adequately torqued without reducing the force on cental incisorsthe force on cental incisors. .

When maxillary incisors needs their roots to When maxillary incisors needs their roots to be brought labially the lateral torque bars are be brought labially the lateral torque bars are overwound so that they fall in plane 90 overwound so that they fall in plane 90 degree to plane to central torque bar.degree to plane to central torque bar.www.indiandentalacademy.comwww.indiandentalacademy.com

AdvantagesAdvantages- Torquing arms has contact with tooth over a Torquing arms has contact with tooth over a

larger arealarger area- Easier to engage and can be prefabricatedEasier to engage and can be prefabricated- Does not loose efficiency if distal torquing Does not loose efficiency if distal torquing

artm is cut offartm is cut off

DisadvantagesDisadvantages- difficult to fabricatedifficult to fabricate- Single root torquing or reverse root torquing Single root torquing or reverse root torquing

is impossibleis impossible- Unilateral torquing is impossibleUnilateral torquing is impossible

Kitchton Torquing AuxiliaryKitchton Torquing Auxiliary (KITCHTON, 1967, JCO)(KITCHTON, 1967, JCO) Produce strong action should onlyProduce strong action should only be used in conjunction with a heavy be used in conjunction with a heavy archwire (.020 to .025 ) .archwire (.020 to .025 ) .

Types Types the two-tooth auxiliary(0.016”) the two-tooth auxiliary(0.016”) the four-tooth auxiliary.the four-tooth auxiliary.

Individual Torquing AuxiliaryIndividual Torquing Auxiliary ((A. J. O'MEARA A. J. O'MEARA JCO 1986JCO 1986))

lingual root torque for individuallingual root torque for individualteeth. It is activated by extendingteeth. It is activated by extendingterminal hooks over the arch wire. terminal hooks over the arch wire. Activation can be increased byActivation can be increased by shortening the hooks, or by shortening the hooks, or by displacing the outer arms displacing the outer arms lingually relative to the body lingually relative to the body of the spring.of the spring.

Uprighting Torquing Auxiliary Uprighting Torquing Auxiliary ((A. J. O'MEARA JCO A. J. O'MEARA JCO 19861986))

similar to a pin uprighting spring. similar to a pin uprighting spring. provides root torque as well as provides root torque as well as uprightinguprighting. . spring is engaged in the bracket spring is engaged in the bracket above the main archwire. above the main archwire. it is activated by extending the hook it is activated by extending the hook over the archwire.over the archwire. also helps lock the archwire in thealso helps lock the archwire in the bracket.bracket.

Single root torquing AuxiliarySingle root torquing Auxiliary (kesling) (kesling) Useful for any tooth except molarUseful for any tooth except molar Made from 0.012” premium plus wireMade from 0.012” premium plus wire

buccal palatalbuccal palatalwww.indiandentalacademy.comwww.indiandentalacademy.com

Universal Torquing AuxiliaryUniversal Torquing Auxiliary (JACK PERLOW JCO 1973)(JACK PERLOW JCO 1973) can be used can be used on extraction and non-extraction cases; on extraction and non-extraction cases; on upper and lower teeth; on upper and lower teeth; on centrals or laterals; on centrals or laterals; for labial or lingual torque.for labial or lingual torque. on .020 round wire in a Begg technique on .020 round wire in a Begg technique on edgewise wireon edgewise wire on a Hawley retainer. ( .012 wire), since a on a Hawley retainer. ( .012 wire), since a

heavier auxiliary will dislodge the retainer.heavier auxiliary will dislodge the retainer.www.indiandentalacademy.comwww.indiandentalacademy.com

Reverse torquing aux. for controlling the roots Reverse torquing aux. for controlling the roots of canines and premolarsof canines and premolars (Tan, JCO, (Tan, JCO, 1987)1987)

Made from.014" wire in conjunction with Made from.014" wire in conjunction with an .018" or .020" main archwire, an .018" or .020" main archwire,

effective to perform an extensive labial effective to perform an extensive labial canine root movement to produce a canine canine root movement to produce a canine eminence. eminence.

For palatally impacted canines which For palatally impacted canines which require labial root torque.require labial root torque.

Buccal root torque on molars Buccal root torque on molars during third stageduring third stage if molar crown rolled if molar crown rolled

buccally roots need torquebuccally roots need torque0.014’ wire, 0.014’ wire, boot design,boot design,twisted lingually & toe intwisted lingually & toe in

Torque BarsTorque BarsNew concept of torqueNew concept of torque..

Eliminates torque spurs. Eliminates torque spurs. Dramatically improves appearance and oral Dramatically improves appearance and oral

hygiene. hygiene. Formed from resilient 0.025 x 0.19 “ NiTi with 30 Formed from resilient 0.025 x 0.19 “ NiTi with 30

degree lingual torque angle which provide gentle degree lingual torque angle which provide gentle continuous forces during stage III. continuous forces during stage III.

Placed gingival to main arch wire.Placed gingival to main arch wire. www.indiandentalacademy.comwww.indiandentalacademy.com

Retained with hook pins or spring pins. Retained with hook pins or spring pins.

Main arch wire should be modified by slightly Main arch wire should be modified by slightly constricting the anterior segment between constricting the anterior segment between cuspidscuspids

by placing a mild bite opening bend distal to by placing a mild bite opening bend distal to cuspid bracket.cuspid bracket.

Safety BarSafety Bar To prevent inadvertent labiolingual To prevent inadvertent labiolingual

torquing of roots of lower ant. Teeth torquing of roots of lower ant. Teeth (0.196” x 0.026” rectangular wire)(0.196” x 0.026” rectangular wire)

Prevents Mesial spring pin pressure on Prevents Mesial spring pin pressure on crowns of cuspids, laterals and centrals crowns of cuspids, laterals and centrals from causing the roots of adj. teeth to be from causing the roots of adj. teeth to be move lab-lin. move lab-lin.

ConclusionConclusion the light wire technique is considered unique the light wire technique is considered unique

among orthodontic treatment techniques in among orthodontic treatment techniques in that the success with it depends on the that the success with it depends on the employment of correct amount of tooth employment of correct amount of tooth moving forces throughout its three stages.moving forces throughout its three stages.

We have a variety of tools to choose from and it We have a variety of tools to choose from and it is important that we employ the right ones to is important that we employ the right ones to achieve the goals of structural balance , achieve the goals of structural balance , aesthetic harmony and functional efficiency.aesthetic harmony and functional efficiency.

Thank youwww.indiandentalacademy.comLeader in continuing dental education

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