molar distalization in begg technique / orthodontic courses by indian dental academy

MOLAR DISTALIZATION IN BEGG TECHNIQUE.

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com

www.indiandentalacademy.comwww.indiandentalacademy.com

Recent advances in mechanotherapy and change

in the concept of treatment has increased the

clinician’s interest in avoiding extractions in

moderate discrepancies. A popular method for

creating additional space within the dental arch

is by distalization of molars.

What one should look for, to consider a case for molar distalization?

1. Normal or near normal mandibular arch.

2. Profile consideration: Well developed nose and chin, have better chances of tolerating slight proclination.

3. Age of the Patient:- the success of molar distalization is greater in growing children, usually in late mixed dentition and early permanent dentition.

Mst.Sachin . Age: 9.8yrs. Mild :Class II Div. IHORIZONTAL GROWTH PATTERN

4. Inclination of Molars:- OPG forms an ideal diagnostic tool. If the first and second molars are distally angulated, the case is contra-indication for molar distalization.

5. Amount of available posterior space and 3rd molars: Usually absence of 3rd molar is advantageous for molar distalization. Distal angulation of 3rd molars is, again a contra-indication and it is indicative of posterior crowding.

6. Growth Pattern – vertical growth pattern is a contra – indication for distalization.

How to identify molar distalization case:

1. End on molar relationship with mild to moderate space requirement in the maxillary arch.

2. a) High labially placed canine / unerupted canine, with end-on or full cusp class II molar relation.

b) Ectopic eruption of 1st or 2nd pre-molars.

These above two conditions may be caused by premature loss of deciduous tooth and forward migration of the upper permanent molar.

3. During late mixed dentition, when lower E space is to be utilized for relief of lower anterior crowding. Here the lower molars are held back, and utilizing the E space anterior crowding can be corrected. In such cases molar distalization in the upper arch helps in changing a class II molar relation to Class I relation.

METHODS OF MOLAR DISTALIZATION IN COMMON USE ARE:- 1. Use of extra-oral force 2. Wilson Bimetric arch design 3. Modified Nance lingual appliance for unilateral molar distalization. 4. Pendulum appliance 5. Lip bumper 6. Use of Japanese NiTi coil springs www.indiandentalacademy.comwww.indiandentalacademy.com

7. Distal Jet Appliance

8. Jones Jig

9. K-loop appliance

10. Molar distalization with magnets

11. Removable distalization appliance

12. Sagittal appliance.Undoubtedly, most of the above mentioned molar distalization techniques can be effectively used with the Begg technique.

Biomechanics of Distalization

MODIFIED BIMETRIC ARCH DESIGN:

In our department we use a slight modification of original WILSON’S BIMETRIC ARCH. The upper arch wire is made from 0.16” premium SS wire. The arch wire is shaped in an ideal form. Cuspid circles are kept abutting the cuspid bracket. Two pear shaped loops, one on each side, are made, 6-7mm in height and 4mm in width at the top and almost touching each other at bottom.

About 45 bends is placed equally distributed on either side of the loop for simultaneous intrusion of anteriors. Mild toe in is given for molar segment.

Opening loops by 2mm on each side activates arch wire in the anterior segment, which is then ligated into brackets. This causes expansion forces in the labial or buccal direction in the incisor canine and premolar area. This expansion force is resisted by using class II elastics on elastic load reduction principle. Hence the force is transferred onto the molars, in a distal direction.

ELASTIC LOAD REDUCTION PRINCIPLE The patient is asked to use class II elastic in a definite sequence, namely – TP green elastics for 1st week, pink elastic for 2nd week and yellow for the following 2-3 weeks, all in class II fashion. The initial heavy elastic force of green elastic is required to resist the forward pushing force of the arch wire, thus transferring it in a distal direction to the molars.

As the molar becomes upright, the distally directed archwire force acting on it diminishes. Thus a slightly lesser force with pink elastics and finally with light yellow elastic is applied. About 1mm of distal movement of upper molars can be achieved per month. The archwire is activated for 3 visits for the required amount of correction. Employing this procedure, a suitable borderline case can be converted into a non-extraction case.

Ms.Vinaya/11yrs; End on bilateral, Overbite 4.5mm, Impacted left upper canine, Mild Sk Class II, Horizontal growth pattern.

Smita Naidu, 21yrs,

Moderate crowding in the upper arch, right side Cl I molar, left side end-on.

Horizontal growth pattern.

Name : Tejomini/ 28yrsSkeletal Class IIConvex profile10mm space requirement in upper arch 8mm space requirement in lower archSeverely proclined lower incisors Missing 86 8

Distalization is an effective tool in gaining additional arch length

Case selection is a very important aspect in the success of distalization.

Versatile use of modified Bimetric arch design in Begg technique is simple and yet very effective.

molar distalization in begg technique / orthodontic courses by indian dental academy

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