A cephalometric appraisal of nonextraction Begg

treatment of Class II malocclusions

Malcolm E. Meistrell, Jr., D.D.S., Thomas J. Cangialosi, D.D.S., Jose E. Lopez, D.D.S., and
Angelica Cabral-Angeles, D.D.S.
New York, N.Y.

Initial and final cephalometric evaluations are compared in a sample of 42 patients with Cl&s II
malocclusions treated in a nonextraction manner with the Begg appliance. The sample was analyzed
as a group. Subgroups of patients with Division 1 and Division 2 characteristics were analyzed
separately. To depict skeletal and dental changes, measurements were made using the sella nasion,
palatal, and mandibular planes as reference planes. The findings show that on the average: (1)
The upper first molar maintained its anteroposterior position at the same time that SNA was reduced.
This suggests a restriction of anterior maxillary growth. (2) The mandibular first molar moved
forward by 1.2 mm. Part of this change was attributed to anchorage consumption. (3) Vertical changes
in both the maxilla and the mandible were found to be within the normal range. (4) No significant
change in occlusal or mandibular plane angles was observed except for the Division 1 subgroup in
whom a Mild increase in the mandibular plane angle was observed. (AM J ORTHODDENTOFAC
ORTHOP90: 286-295, 1986.)

Key words: Begg, nonextraction, Class II, skeletal, dental

A basic principle underlying the Begg treat-

ment method is, “Occlusion is never static. It is in a
constant state of flux.“’ Occlusion should change si-
multaneously in a horizontal direction (mesial migra-
tion) and a vertical direction (continuous eruption)
throughout life. P. Raymond Begg based his philosophy
of treatment on his studies of the occlusion of Australian
aborigines. The corase diet of the aborigines abraded
the teeth not only incisally and occlusally but also in-
terproximally from the moment of their eruption into
the dental arches. He concluded that the average loss
of tooth mass as a result of attrition over the period of
a lifetime was 14 mm. This has a tendency to prevent
crowding as teeth migrate mesially. Attrition in modem
man is minimal. In light of the horizontal and vertical
changes that were observed in Stone Age man’s den-
tition, moving the maxillary dental arch distally in the
correction of Class II malocclusion is biologically un-
sound, according to Begg.
Although numerous articles in the orthodontic lit-
erature address different aspects of the Begg technique,
it is evident that the use of this technique in the non-
extraction treatment of patients with Class II malocclu-
sions requires further clarification with regard to the
movements that contribute to the Class II correction.
REVIEW OF THE LITERATURE
Originally, the Begg method was primarily an ex-
traction technique. However, it has been observed that
286
excellent results may be achieved using the Begg ap-
pliance for nonextraction treatment. In nonextraction
treatment, some adjuncts to Begg mechanics have been
used, such as bite plates, extraoral force, lip bumpers,
and the Margolis ACCO appliance. However, in 1975,
Cadman’ reported nonextraction treatment without
these adjuncts, using pure Begg mechanics. His indi-
cations for nonextraction treatment were minimum
tooth movement required, maximum intraarch space or
substantial freedom to reposition the lower incisors la-
bially in relation to the A-PO line, the presence of a
good skeletal pattern, a satisfactory relationship of tooth
size to arch length, and good growth potential. If these
factors are present, Cadinan believed it should be pos-
sible to complete nonextraction treatment within profile
and denture base requirements.
The mechanics of nonextraction treatment are es-
sentially the same as for extraction therapy with the
exception of Stage II. During the second stage of ex-
traction treatment, the excess extraction space is closed.
In nonextraction treatment, there is usually little or no
residual space remaining so that Stage II is either
very short or unnecessary. Cadman suggested that the
premolars should be left unbanded early in treat-
ment to permit their extrusion during bite opening in
Stage I.
Cadman theorized that unlike overbite correction by
leveling with a full-banded appliance, the change from
distocclusion to neutrocclusion occurs in less time and
Volume 90
Nonextraction Begg treatment of Class II malocclusions 287
Number 4
with less anchorage loss if premolars are free to adjust
to the transitional occlusion. Any arch wire engagement
of the premolars will interfere with occlusal correction
because of increased cuspal interference, which im-
pedes efficient bite opening and prolongs Class II elastic
wear with resultant anchorage loss. Cadman did not
support this with specific data. He advised banding of
premolars for the alignment of rotations and marginal
ridge heights at the end of Stage I.
However, Barre? stated that all teeth should be
banded, especially if the malocclusion is severe. Pre-
molars are banded when the case requires a specific
positional change such as rotation or alignment of mar-
ginal ridge heights. If premolars are not banded, he
suggested placing an activated coil spring between the
molar and canine. Stage III is greatly reduced because
extensive root positioning is not required. The use of
Class II mechanics is minimized in the last two stages
since it is needed only to maintain an edge-to-edge
relationship of the anterior teeth. Therefore, anchor
bends are reduced progressively as the need for elastic
wear is decreased.
In the Begg technique, anchorage is a function of
arch wire design and degree of tip-back or anchorage
bend. To quote Swain4
One of the paradoxical but pleasant surprisesof Begg non-
extraction mechanics is that the anchorage potential is often
enhanced if the anchor molars have a mesial axial inclination
at the commencement of treatment. The combination of nor-
mal anchorage bend force with light Class II elastic force
brings about a beneficial distal tipping of the molar crowns
into an upright position. Provided that the force of the Class
II elasticsis sufficiently light, the lower as well as the upper
molar crowns actually tend to move distally. This net distal
movement occurs because, although the influence of the an-
chorage bend simultaneously tends to tip the crown distally
and the roots forward, the resistanceto crown tipping is low
while the resistance to root tipping is high. Consequently,
crown tipping occurs rapidly and root tipping slowly. Such
net distal movement of mesially inclined anchor molars can
be important in non-extraction treatment becauseit provides
more arch length for teeth anterior to the molars.
One should consider the differential response to
magnitude and duration of forces. Light Class II elastic
forces should be used over the shortest period of time
to prevent forward drag of the lower posterior teeth,
keeping anchorage loss to a minimum. One to two
ounces of elastic traction is usually sufficient. Rapid
bite opening that results in minimal occlusal interfer-
ence is helpful in the reduction of treatment time.
Patient cooperation is imperative. Lastly, the rate,
amount, timing, and direction of growth can be factors
for a favorable result. Therefore, success depends on
a delicate balance of anchorage control, the magnitude
Initial
---_.
Final
I
Fig. 2
LOWS
Figs. 1 and 2. Graphic representation of initial and final
mean location of the tip of the upper and lower first molars
perpendicular to the palatal and mandibular planes, respec-
tively.
of Class II elastic force, and the duration of the force
and growth, if present.
Lateral cephalometric x-ray films taken before, dur-
ing, and after treatment are useful in observing the
changes that have taken place. Williams’ made a ceph-
alometric appraisal of the characteristic responses of
patients who had been treated with the Begg technique.
He observed the following: the lower incisors moved
bodily lingually within the alveolar process of the man-
dible; SN-GoGn increased during the third stage; at
posttreatment Point B moved forward as SN-GoGn de-
creased, reducing ANB; the occlusal plane angle in-
creased more than SN-GoGN because the heights of
the posterior and anterior teeth were influenced by treat-
ment; and as SN-GoGn decreased, Ul and SN de-
creased. Ll to APO is critical to lip balance and overbite
reduction is stable because of torquing of the maxillary
incisors.
Little can be found in the literature concerning
changes taking place in nonextraction Begg treatment,
specifically those changes that cause a correction from
Class II to Class 1. Cadmat? believed that there is distal
tipping of the upper molar caused by the amount of
anchor bend and the distal component of the Class II
elastic force transmitted through the molar stop. He
theorized that a restriction of normal maxillary growth
was present. He also believed that the lower molar
moved in an occlusal and slightly mesial direction be-
cause of the vertical and horizontal components of the
Class II mechanics. Class II mechanics may also fa-
cilitate a functional positional change of the jaw.
Napolitano6 made a similar study. His results
showed distal movement of the upper molars and mesial
movement of the lower molars. He concluded that
growth and appliance manipulation determined his
results.
Levin’ in a review of the literature on treatment
results of the Begg technique stated, “There is dis-
agreement regarding the manner in which treatment
changes are attained.”
288 Meistrell et al. Am. J. Orrhod. Dentofac. Orthop.
October 1986

Table 1. Horizontal and vertical changes in molar position in mm (all cases)

Horizontal change Vertical change
Case
ll0. c 6 6 6

1 0.15 D 3.0 M 3.0 0 7.0 0

2 4.5 D 1.5 D 2.0 G 1.5 0
3 1.0 D 1.0 M 1.5 0 1.0 0
4 - 2.5 M 2.5 0 2.0 0
5 3.5 M 3.25 M 8.0 0 8.0 0
6 1.0 M 4.0 M 3.0 0 3.0 0
7 2.0 M 1.5 M 5.5 0 1.0 0
8 1.0 M 3.0 M 1.0 0 2.0 0
9 - 3.0 M 4.5 0 3.0 0
10 3.5 M 4.0 M 3.0 0 8.0 0
11 5.0 D 1.0 M 0.5 0 5.0 0
12 2.0 M 1.0 M 4.0 0 7.0 0
13 1.0 D 2.0 M 1.0 G 2.0 0
14 3.0 M 7.0 M 7.0 0 9.0 0
15 2.0 D 2.0 M 2.0 0 2.0 0
16 2.5 M 4.0 M 5.0 0 0.5 0
17 0.5 M 1.5 D 2.0 0 3.0 G
18 1.0 M 0.75 D 2.0 G 1.5 0
19 3.0 M 4.0 M 5.0 0 3.0 0
20 1.0 D 2.0 M 2.0 0 0.5 G
21 2.0 D 1.0 M 1.0 0 1.0 0
22 - 1.0 M 0.5 0 4.0 0
23 0.75 M 1.0 M 3.25 0 1.0 0
24 0.75 D 1.0 M 5.0 0 6.0 G
25 5.0 M 4.0 M 3.375 0 5.5 0
26 1.0 D 4.25 D 4.0 0 4.0 0
27 1.5 M 2.0 M 2.0 G 1.5 0
28 1.0 D 1.0 M 1.5 0 3.0 0
29 3.5 M 1.5 M 2.0 0 5.0 0
30 1.5 M 2.0 D 1.0 0 5.0 0
31 1.5 M - 2.5 0 4.0 0
32 0.5 M 2.5 M 2.0 0 -
33 2.0 D 2.75 D 2.0 0 1.0 0
34 2.0 M 6.5 M 2.0 0 4.0 0
35 3.5 D 2.5 D 2.0 G 2.0 0
36 2.0 D 2.0 D 1.5 0 3.5 0
37 1.0 D 2.5 D 1.0 G 2.5 0
38 1.5 M 1.5 M 1.5 0 2.0 0
39 2.0 D 1.5 D 1.0 0 2.0 G
40 2.5 M 1.0 M 1.0 0 3.5 0
41 2.0 D 2.0 M 1.0 0 4.5 0
42 1.5 D 2.0 M - 1.5 0
Mean 0.22 1.2 2.1 2.6
SD 2.24 2.76 2.323 3.01
Range 5.0 D to 5.0 M 7.5 D to 7.0 M 2.0 G to 7.0 0 6.0 G to 9.0 0

OBJECTIVES OF THE STUDY
The purpose of this study was to determine cephalo-
metrically the changes that occur in the dentition and
supporting structures during the correction of a Class
II malocclusion to a Class I relationship with nonex-
traction Begg mechanics.
It is expected that the findings obtained will provide
a better understanding of the different factors affecting
treatment, and give the clinician a better understanding
of the technique and the proper indications and con-
traindications for its use.
MATERIALS AND METHODS
Forty-two patients treated at the clinic of the Ortho-
dontic Department of Columbia University or at the
private office of two of the authors were selected for
Volume 90 Nonextraction Begg treatment of Class II malocclusions 289
Number4

Table II. Cephalometric appraisal of nonextraction Class II malocclusion (all cases)

Variable Mean Dlrerence SD SE t value Probability Range

ISNA 82.46 76-92

-0.73 2.77 0.43 1.73 0.091
FSNA 81.73 77-90
ISNB 77.98 73.5-83
0.58 2.22 0.34 1.71 0.096
FSNB 78.56 74-86
IANB 4.49 l-8.5
-1.27 2.27 0.35 3.64 0.001
FANB 3.22 o-7
ISN-MP 28.69 15-42.5
-0.08 3.44 0.53 0.16 0.876
FSN-MP 28.61 12.5-43
ISN-OP 17.12 1 l-23
0.37 3.78 0.58 0.63 0.531
FSN-OP 17.49 11-25.5
ISN-PO 78.75 75-85
0.90 1.79 0.27 3.32 0.010
FSN-PO 79.67 73-88
IUl-SN 101.71 81-122
-0.93 9.66 1.49 0.62 0.537
FUl-SN 100.78 86-l 14
ILl-MP 98.41 79-108
3.67 6.94 1.00 3.66 0.001
FLl-MP 102.08 93-113
IUl-Ll 130.14 102.5-158
-2.59 12.42 1.92 1.35 0.183
Ful-Ll 127.55 106-145
ILl-APO -0.21 -lo-+6
1.68 2.38 0.37 4.58 0.0001
FLl-APO 1.47 -4-+9
IH’WAY 10.69 7-23
-1.48 3.58 0.55 2.67 0.011
FIT WAY 9.21 5-20

MP = GoGn.
N = 42.
P < 0.05.

this study. All patients had been classified as having
Class II malocclusions. There were 23 girls and 19 boys
in the sample. The age range at the start of treatment
was 10 to 16 years with a mean of 12 years 9 months.
The sample was not separated by sex because the rate
of change with age for skeletal measurements used in
the study is similar for both boys and girls.8 The molar
relation ranged from a cusp-to-cusp relation to a full
cusp, Class II relation. The overjet ranged from 0 to
14 mm with a mean of 6.5 mm and a standard deviation
of 2.79 mm.
Initially, first molars, canines, and anterior teeth
were banded (or bonded if preferred). The arches were
leveled and aligned with a multiple-loop arch wire or
a plain arch wire with a coaxial auxillary wire if crowd-
ing was present. Anchorage bends were placed anterior
to the molar tubes to initiate bite opening. If no bracket
or cuspal interferences were observed, Class II elastics
were started to consolidate interdental spaces in the
maxillary arch and to begin anterior retraction. Other-
wise, in order to conserve anchorage, Class II elastics
should be delayed until the interferences are no
longer present.
As soon as anterior segments were leveled and
aligned, and all maxillary interdental spaces were
closed, Australian 0.016 inch plain arch wires were
prepared making sure that the intermaxillary circles
were against the canine brackets. At this stage the pre-
molars were not banded or bonded. A piece of coil
spring or plastic tubing may be placed between the
molar tube and the canine bracket to maintain premolar
space and to protect the cheek from irritation.
The anchor bends were made of sufficient magni-
tude to carry the anterior segment of the arch wire to
290 Meistrell et al. Am. J. Orthod. Dentofac. Orthop.
October 1986

Table III. Cephalometric appraisal of Class II, Subdivision 1 subgroup

Variable Mean Difference SD SE t value Probabiliry Range

ISNA 81.53 78-85

-0.93 2.05 0.53 1.76 0.10
FSNA 80.60 77-90
ISNB 77.00 73.5-79
-0.10 2.13 0.55 0.18 0.858
FSNB 76.90 74-83
IANB 4.53 1-7
-0.77 1.79 0.46 1.66 0.12
FANB 3.76 0.5-7
ISN-MP 32.00 23.5-39
1.23 2.50 0.65 1.91 0.077
FSN-MP 33.23 25-43
ISN-OP 18.63 16-23
1.53 3.20 0.83 1.85 0.085
FSN-OP 20.16 16-27
ISN-PO 77.53 75-80.5
0.50 1.46 0.38 1.29 0.24
FSN-PO 78.03 75-82
IUl-SN 104.03 96-l 13
-5.03 5.19 1.34 3.76 0.002
FIJI-SN 99.0 93-107
ILl-MP 96.93 79-107.5
3.87 6.16 1.59 2.43 0.029
FLl-MP 100.80 85-112
IUl-Ll 127.33 110-145
-0.83 9.85 2.54 0.33 0.748
FUl-Ll 126.50 1 lo-142
IL1 -APO 0.50 -5-+4.5
1.77 2.57 0.66 2.66 0.019
FLl-APO 2.27 -2-+9
IH’WAY 11.27 12-22
- 1.40 5.38 1.39 1.01 0.60
FH’WAY 9.87 8-20

MP = Go&.
N = 15.
P < 0.05.

the depth of the muccobuccal fold when passive. Class
II elastic traction in the range of 1 to 2 ounces was
used.
Once Class I molar and canine relationships were
achieved, the premolars were banded and engaged onto
the arch wire. Subsequently, Stage III mechanics were
instituted as required. A brief torquing period was usu-
ally necessary to establish the correct axial relationship
of the maxillary central incisors.
Initial and final cephalometric x-ray films were
taken using a standard cephalometric technique. Pre-
treatment and posttreatment cephalometric evaluations
were compared.
The analysis consists of three separate groups of
measurements. The first group used sella as registration
point and the sella-nasion line as the reference plane.
From this configuration the following angular mea-
surements were recorded: sella nasion to Point A
(SNA), sella nasion to Point B (SNB), the difference
between SNA and SNB (ANB), the long axis of the
most anterior maxillary central incisor to the sella-na-
sion plane (Ul-SN), mandibular plane (a line drawn
from Go to Gn) to the sella-nasion Plane (SN-MP),
occlusal plane to the sella-nasion plane (SN-OP), the
sella-nasion plane to pogonion (SN-PO), interincisal an-
gle (Ul-Ll), and the distance in millimeters from the
tip of the most anterior lower central incisor along a
perpendicular to the line connecting Point A to pogo-
nion (Ll-APO).
The second group of measurements used the palatal
curvature as registration point and the palatal plane as
the reference plane. For this purpose the palatal plane
was defined as a Cartesian x axis, and the intersection
between the palatal plane and the perpendicular line
Volume 90 Nonextraction Begg treatment of Class II malocclusions 291
Number 4

Table IV. Cephalometric appraisal of Class II, Subdivision 2 subgroup

Variable Mean Difference SD SE t value Probability Range

ISNA 82.15 79-87.5

-0.95 2.95 0.93 1.02 0.335
FSNA 81.20 79-89
ISNB 78.05 73.5-83
0.60 2.80 0.88 0.68 0.515
FSNB 78.65 75-86
IANB 4.10 2-8
- 1.55 1.44 0.46 3.40 0.008
FANB 2.55 0.5-4
ISN-MP 26.90 20-39
- 0.05 3.22 1.02 0.05 0.962
FSN-MP 26.85 20-37
ISN-OP 17.65 13-22
-0.20 5.35 1.69 0.12 0.909
FSN-OP 17.45 14-25
ISN-PO 78.45 87-85
0.80 1.49 0.47 1.69 0.13
FSN-PO 79.25 74.5-88
IUl-SN 93.35 81-105
9.25 8.34 2.64 3.51 0.007
FUl-SN 102.60 95-114
ILl-MP 98.95 88-108
5.40 6.35 2.01 2.69 0.025
FLl-MP 104.35 91-111
IUI-Ll 137.00 125-158
-11.95 12.32 3.89 3.07 0.013
FUl-Ll 125.05 110-130
ILl-APO 0.10 -5-+6
2.40 2.22 0.70 3.42 0.008
FLl-APO 2.40 -l-+6
IH’WAY 9.00 7-18
21.20 2.04 0.65 1.86 0.096
FH’WAY 7.80 5-17

MP = GoGn.
N = 10.
P < 0.05.

from the tip of the maxillary first molar of the initial
headplate was defined as the origin. Relative to this
system, the initial and final positions of the mesial cusp
of the maxillary first molar were measured. Measure-
ments were made in millimeters, perpendicular and par-
allel to the palatal plane, to determine the X and Y
coordinates.
The third group of measurements was made using
the mandibular symphysis as registration and the man-
dibular plane as reference plane. Again the reference
plane (mandibular) was used as the Cartesian x axis
and the intersection between the mandibular plane and
a perpendicular line to the tip of the mesial cusp of the
lower first molar of the initial headplate was defined as
the origin. Relative to this position, the initial and final
positions of the tip of the mesial cusp of the mandibular
first molar were measured perpendicular and parallel to
the mandibular plane (X and Y coordinates) in milli-
meters.
All measurements were made for each of the 42
cases whenever possible. The computations were made
for the whole sample group and for a 15-case subgroup
of Class II, Division 1 malocclusions and a lo-case
subgroup of Class II, Division 2 malocclusions.
The data were analyzed using a DEC lO* computer
and the SPSS program.? Mean, standard deviation,
standard error, and t test for the difference of the means
between initial and final values were computed for all
angular measurements and for the difference in X and
Y positions for upper and lower first molars.
In addition, each cephalogram was superimposed
*Digital Equipment Corporation, Maynard, Mass.
Wtatistical Package for the Social Sciences.

292 Meistrell et al.
---__
(----___
:
, :
:
‘\
‘. ,I
‘\
-\ /‘I /
‘\
‘-4
-\
-\
a ‘.
‘-..
Fig. 3. Graphic representation of initial and final mean values
for cephalometric landmarks. Mean values for all cases were
used.
on millimeter graph paper. To make the superimposi-
tion, sella was defined as the origin (point o,o) and the
sella-nasion plane was defined as the x axis. X and Y
coordinate values were recorded for each of the follow-
ing landmarks: nasion, anterior nasal spine, posterior
nasal spine, Point A, Point B, tips of the crown and
root of the most anterior maxillary central incisor, tip
of the mesial cusp of the maxillary first molar, tips of
the crown and root of the most anterior mandibular
incisor, tip of the mesial cusp of the mandibular first
molar, pogonion, gnathion, and gonion. The values of
the X and Y coordinates for each of the landmarks were
averaged in total, and for Division 1 and Division 2
subgroups separately. These averages were used to con-
struct composite graphic representations of the changes
that occurred during treatment.
RESULTS
Figs. 1 and 2 graphically summarized Table 1,
which shows the changes observed in the relationship
of the maxillary and mandibular first molars to their
respective basal bones.
Table II shows the average changes computed for
each of the measurements using the complete sample
of 42 cases.
Tables III and IV show the average changes for the
Class II, Division 1, and Class II, Division 2 subgroups,
respectively.
Fig. 3 is a composite graphic representation of the
average changes that were recorded for the complete
sample. Figs. 4 and 5 are composite graphic represen-
tations of the average changes observed in the Division
2 and Division 1 subgroups, respectively.
As may be observed, the maxillary first molar
had an average change of 0.22 mm mesially. The
standard deviation was 2.24 and the range was 5.0 mm
distally to 5.0 mm mesially. The maxillary first molar
Am. .I. Orthod. Dentofac. Orthop.
October 1986
i
I-
Ii,
./‘/
Initial
:
-----
’ Fhl
’
Fig. 4. Graphic representation of initial and final values for
cephalometric landmarks, mean values for Class II, Division 2
subgroup.
had a mean movement of 2.1 mm occlusally or away
from the palatal plane. The standard deviation was
2.32 mm with a range of 6.0 mm gingivally to 9.0 mm
occlusally.
The mandibular first molar showed an average
change of 1.2 mm mesially. The standard deviation was
2.76 mm and the range was 7.5 distally to 7.0 mm
mesially. The mandibular first molar had a mean oc-
clusal movement of 2.6 mm. The standard deviation
was 3.01 mm and the range was 6.0 mm gingivally to
9.0 mm occlusally.
There was a mean decrease in SNA of - 0.73” with
a standard deviation of 2.77 and standard error of 0.43.
The t value was 1.73, indicating a nonsignificant change
in SNA with P = 0.091. SNB displayed a mean in-
crease of 0.58” with a standard deviation of 2.22 and
a standard error of 0.34. The t value was 1.71 with
P = 0.096, indicating the change in SNB was not sig-
nificant. However, the mean change in the ANB angle
of - 1.27 with standard deviation of 2.27, a standard
error of 0.35, and at value of 3.64 (P = 0.001) shows
a statistically significant change for the entire sample.
The change in the ANB angle was not significant for
the Division 1 subgroup, but was statistically significant
in the Division 2 subgroup (P = 0.008) (Tables II, III,
and IV).
As shown in Table II, the average initial value for
Sn-GoGn was 28.69”. The average final value was
28.61”. This value shows a nonsignificant difference of
-0.08” with standard deviations (SD) of 5.69 and 6.46
for the initial and final values, respectively. The stan-
dard errors (ER) were 0.00 and 0.99. The Student t test
gave a value of 0.16 and P = 0.876.
The average change in the mandibular plane angle
in the Division 1 subgroup, as presented in Table III,
was 1.2” with a standard deviation of 2.5 and a standard
error of 0.6. The Student t test value of 1.91 indicates
Volume 90
Nonextraction Begg treatment of Class II malocclusions 293
Number 4
a nonsignificant change (P = 0.077). The Division 2
subgroup had a mean change in the mandibular plane
angle of -0.05”. The Student t value was 0.05
(P = 0.077), indicating that the change was not sig-
nificant .
The SN-OP angle had an average change of
-0.37”. Student t value of 0.63 failed to show a sig-
nificant change with treatment (P = 0.531). The av-
erage change in the Division 1 subgroup was 1.5”. The
Student t test value of 1.85 shows a nonsignificant in-
crease (P = 0.085). The Division 2 subgroup also
showed a nonsignificant change of 0.2”. The t value
was 0.12 (P = 0.909).
The SN-PO angle, which was used as an indicator
of growth during treatment, had a mean change for the
entire sample of 0.92” with a standard deviation of 1.79,
a standard error of 0.27, and a t test value of 3.32
(P = 0.010). This change is statistically significant.
However, the changes found for SN-PO for the Division
1 and Division 2 subgroups were not statistically sig-
nificant. See Tables III and IV
The maxillary central incisor did not show a statis-
tically significant change in relation to SN for the
total sample (P = 0.537). However, when the individ-
ual subgroups were examined, there were significant
changes in Ul-SN. The change for the Division 1
subgroup was - 5.03 with a standard deviation of 5.19,
a standard error of 1.34, and a t value of 3.76
(P = 0.002). The change in the Division 2 subgroup
was 9.25 with a standard deviation of 8.34, standard
error of 2.64, and at value of 3.51 (P = 0.007). See
Tables III and IV.
The mandibular incisors showed statistically sig-
nificant changes in both their angular relations to the
mandibular plane and their spatial relations in terms of
the A-PO line. For the entire sample, Ll-MP increased
3.67” with a standard deviation of 6.49, standard error
of 1.00, and at value of 3.66 (P = 0.001). The change
for the Division 1 subgroup was 3.87” with a standard
deviation of 6.16, standard error of 1.59, and a t value
of 2.43 (P = 0.029). The Division 2 subgroup in-
creased 5.40” with a standard deviation of 6.35, stan-
dard error of 2.01, and at value of 2.66 (P = 0.025).
The spatial relation of the mandibular incisors changed
significantly for the entire sample. Ll-APO increased
1.68 mm with a standard deviation of 2.38, standard
error of 0.37, and a t value of 4.58 (P = 0.0001). The
Division 1 subgroup showed an increase of 1.77 mm
with a standard deviation of 2.57, standard error of
0.66, and a t value of 2.66 (P = 0.019); the Division
2 subgroup showed an increase of 2.4 mm with a stan-
dard deviation of 2.22, standard error of 0.70, and a t
value of 3.42 (P = 0.008). See Tables II, III, and IV.
lnltial
Fig. 5. Graphic representation of initial and final values for
cephalometric landmarks, mean values for Class II, Division 1
subgroup.
The interincisal angle showed a statistically signif-
icant change only in the Division 2 subgroup. The mean
decrease was 11.95” with a standard deviation of
12.32, standard error of 3.89, and a t value of 3.07
(P = 0.013). See Table IV.
The Holdaway soft-tissue angle showed a statisti-
cally significant change only in the main sample
(P = 0.11). See Tables II, III, and IV.
DISCUSSION
One of the most common criticisms of the Begg
technique is that, because it relies heavily on Class II
elastics and because of the use of light wires and anchor
bends, extrusion of the posterior teeth and changes in
the occlusal and mandibular planes are normal side
effects of treatment. These effects have been especially
attributed to the nonextraction approach. This study was
undertaken in an attempt to provide reliable evidence
relating to this controversy.
Changes in relation to the upper and lower first
molars
The small forward change of 0.22 mm observed in
the maxillary first molar suggests that the molar remains
in its same anteroposterior relationship to the maxilla.
It seems that the force of the anchorage bend and of
the Class II elastics was not sufficient to distally drive
the molar. It is interesting that the vertical change of
2.1 mm did not differ significantly from the 1.8 mm
normal vertical change reported by Riolo and as-
sociates’ for such a mean age and period of time in
their study of normal patients. Cangialosi and Meistrell’
in a series of 18 extraction cases showed an extrusion
of 0.86 mm, which was not statistically significant.
The changes associated with the mandibular first
294 Meistrell et al.
molar include a 2.6 mm occlusal change (extrusion)
that is the same as the 2.6 mm reported by Riolo and
associates. In a study of 20 cases treated with Begg
mechanics, Menzes” showed an average extrusion of
the mandibular molar of 2.87 mm. The forward 1.2
mm movement may be explained as closure of the lee-
way space, closure of existing space in the mandibular
arch, and/or loss of anchorage. In the middle the an-
chorage bend, when properly combined with Class II
elastics, exerts a translative moment/force ratio that
effectively minimizes anterior dental displacement.
This, in conjunction with minimal Class II elastic force
within the range of 1 to 2 ounces on each side, pre-
vents excessive mesial migration of the lower anterior
teeth. These findings do not support the theory that
mandibular molar extrusion is a consistent sequela of
treatment.
Changes in position of mandibular incisors
The mandibular incisors, as observed from the find-
ings of their relationship to the A-PO line, were con-
sistently proclined. Edler” also showed a proclination
of the lower incisors with an increase of 8.5” in the
incisor-mandibular plane angle and a 1.6 mm forward
positioning with regard to the A-PO line. Cain” showed
a 1.2 mm anterior change. This is in contrast to the
findings of Thompson.‘3 However, his sample was com-
posed of extraction as well as nonextraction cases,
which would account for his finding that the lower
incisor consistently approached the A-PO line during
treatment. No attempt was made during treatment to
restrain mandibular anchorage consumption other than
the use of the previously mentioned light Class II elastic
forces. It is possible that the use of lingual crown
torque-labial root torque could have decreased the la-
bial repositioning of the mandibular incisor in relation
to the A-PO line and the increase in the incisor-man-
dibular plane angle.
Changes in relation to mandibular plane
The average change in the mandibular plane angle
was -0.08”. A Student t test of 0.16 (P = 0.876)
suggests that on average the cant of the mandibular
plane was not affected by therapy. This may be graph-
ically observed in Fig. 3.
The average change in the mandibular plane angle
in the Division 1 subgroup, as may be observed from
Table III, was 1.2” with a standard deviation of 2.5 and
a standard error of 0.6. The Student t test value of 1.91
(P = 0.077) indicates a nonsignificant change. This
finding, although small, suggests that care should be
taken in using this type of therapy in high mandibular
plane angle cases. To control this tendency, the mag-
nitude of the Class II elastics must be maintained within
Am. J. Orthod. Dentofac. Orthop.
October 1986
the range of 1 to 2 ounces of force. All interferences
from brackets or cusps must be avoided.
This was not observed, however, in the Division 2
subgroup. In this group the average change in the man-
dibular plane angle was 0.05”. See Table IV.
Changes in relation to occlusal plane
The cant of the occlusal plane also showed a great
degree of stability during treatment. The average
change recorded was -0.37”. A Student value of
-0.63 failed to show a significant change in the in-
clination of the occlusal plane (P = 0.53). This is com-
patible with the findings in relation to the mandibular
plane.
In contrast, Hocevar’4 has stated that conventional
Begg Stage III mechanics tend to rotate the occlusal
plane downward anteriorly and upward posteriorly.
This can be countered by the use of anterior anchor
bends and posterior check elastics if necessary.
Because no significant extrusion of the maxillary
and mandibular molars was observed, these findings
suggest that deep overbite may be mainly corrected by
intrusion of both maxillary and mandibular incisors. It
also suggested that molar extrusion was positively co-
ordinated in such a way that the stability of the occlusal
plane was maintained throughout growth. It is inter-
esting to note that although the change in SN-OP was
not statistically significant for this sample of nonex-
traction cases, O’Reilly” noted a significant increase
for a sample of 24 extraction cases.
Nonsignificant changes were also found in the Di-
vision 1 and Division 2 subgroups. See Tables III
and IV.
Changes in relation to bony facial profile
The SNA angle was decreased by 0.74”. At the same
time SNB was increased an average of 0.58”. The sum-
mation of these two changes when rounded to the near-
est tenth brought about a reduction of 1.3” in the
ANB angle. This change was statistically significant
(P = 0.001). It appears that at the same time that an-
terior maxillary growth was restrained, the mandible
was allowed to grow freely.
Cohen” and Hanes” reported significant distal
movement of Point A. However, Cohen reported that
Point B moved distally. In contrast, Hanes reported that
the use of Class II elastics tended to nullify the unde-
sirable distal movement of Point B. The results of this
study correspond with the results of Hanes.
Possible mechanism of action
The data reported suggest that the nonextraction
Begg treatment of Class II malocclusion exerts a mul-
tifactorial influence on dental and skeltal tissues.
Volume 90 Nonextraction Begg treatment of Class II malocclusions 295
Number 4

Therapy seems to restrict maxillary anterior growth upper and lower first molars was well within the range
without changing the cant of the occlusal plane while of expected change resulting from normal growth.
allowing full mandibular growth without greatly in- 5. It appears that correction from Class II to Class
creasing the mandibular plane angle. To a great extent, I occurred as a result of the factors mentioned previously
part of the correction seems to be caused by a positive in conjunction with the direction of vertical eruptive
coordination between therapy and favorable growth. path and forward mandibular growth.
The maxillary molars, based on these findings, ap-
pear to have stayed approximately in their original spa- REFERENCES
cial relationship to the cranial base. At the same time, 1. Begg PR: Stone age man’s dentition. AM J ORTHOD 40: 298-
312, 1954.
the lower molars moved forward an average of 1.2 mm. 2. Cadman GR: Nonextraction treatment of Class II, Division 1
This forward movement may be explained by the clo- malocclusion with the Begg technique. AM J ORTHOD 68: 481-
sure of some original interdental spaces, closure of the 498, 1975.
leeway spaces, correction of rotations, and loss of an- 3. Barrer HG: Non-extraction treatment with the Begg technique.
chorage. The forward movement and tipping of the AM J ORTHOD 56: 365-378, 1969.
4. Swain BF: Begg series. 6. Non-extraction treatment with the
lower incisors is related to these changes in addition to Begg technique. J Pratt Orthod 3: 67-81, 1969.
leveling the arch and correction of anterior crowding. 5. Williams R: The cant of the occlusal and mandibular planes with
Vertically, the changes appear to be coordinated and without pure Begg treatment. J Pratt Orthod 2: 496-505,
with growth in such a manner that little or insignificant 1968.
changes were found to occur to the cant of the occlusal 6. Napolitano J: Class II Division I Begg non-extraction. Thesis
for orthodontic certificate, Columbia University, 1976.
and mandibular planes. The difference between the di- 7. Levin EF: Treatment results with the Begg technique. AM J
rection of maxillary and mandibular molar eruptive pro- ORTHOD 72: 239-260, 1977.
cesses, however, may also account for part of the 8. Riolo M, Moyers RE, McNamara JA Jr, Hunter WS: An atlas
change in molar relation from Class II to Class I. In of craniofacial growth, Monograph 2, Craniofacial Growth Se-
measuring Sn-Po at the beginning and end of treatment, ries, Ann Arbor, 1974, Center for Human Growth and Devel-
opment, University of Michigan.
it is apparent that a significant amount of mandibular 9. Cangialosi TJ, Meistrell ME: A cephalometric evaluation of
growth took place during treatment, which when added hard- and soft-tissue changes during the third stage of Begg
to the factors mentioned contributed to the correction treatment. AM J ORTHOD 81: 124-129, 1982.
from Class II to Class I. 10. Menezes DM: Changes in tooth position and vertical dimension
in severe Class II Division 1 cases during Begg treatment. Br J
CONCLUSIONS Orthod 2: 85-91, 1975.
II. Edler RJ: The effects of Begg treatment on the lower labial
The data reported from this study provide infor- segment in Class II cases. Br J Orthod 4: 123-130, 1977.
mation regarding the factors that are responsible for the 12. Cain P: Anchorage preservation in non-extraction Begg tech-
correction of Class II malocclusion to neutrocclusion nique. Thesis for orthodontic certificate, Columbia University,
using the Begg appliance. Indications and contraindi- 1979.
13. Thompsom WJ: A cephalometric evaluation of incisor position-
cations are suggested based on observed secondary
ing with the Begg appliance. Angle Orthod 44: 171-177, 1974.
effects. 14. Hocevar RA: Orthodontic force systems: Technical refinements
The following conclusions were made: for increased efficiency. AM J ORTHOD 81: l-l 1, 1982.
1. Forward maxillary growth appeared to be re- 1.5. O’Reilly MT: Treatment and posttreatment changes with the
strained because the SNA decreased and the maxillary Begg appliance. AM J ORTHOD 75: 535-547, 1979.
16. Cohen AM: Skeletal changes during the treatment of Class II/I
molars did not move forward significantly.
malocclusions. Br J Orthod 10: 147-153, 1983.
2. Conversely, forward growth of the mandible oc- 17. Hanes RA: Bony profile changes resulting from cervical traction
curred as expressed by the forward movement of Point compared with those resulting from intermaxillary elastics. AM
B, which resulted in an increase in the SNB angle. J ORTHOD 45: 353-364, 1959.
Forward mandibular growth is also indicated by an in- Reprint requests to:
crease in the angle SN-PO during treatment. Dr. Malcolm E. Meistrell, Jr.
3. Vertically, treatment and growth appeared to be Columbia University School of Dental and Oral Surgery
coordinated in such a way that stability of the mandib- 630 W. 168th Street
New York, NY 10032
ular and occlusal planes was observed.
4. The measured changes in vertical position of the