American Journal of ORTHODONTICS

Volume 67, Number 5, May, 1975

ORIGINAL ARTICLES

A vade mecurn for the Begg technique:

George R. Cadman, D.M.D.*

Boston, Mass.

A n orthodontic technique may be defined as a systematic sequence of

clinical procedures to achieve the correction of malocclusion with a specific type
of appliance or with a combination of appliances.
Some orthodontic appliances, such as the edgewise arch mechanism, can be
used effectively with a variety of treatment techniques. In contrast, the Begg
method is a system that demands stringent interdependence of technique and
appliance; that is, the technique requires specific bracket design, arch wire size
and configurations, molar tube size, and molar tube placement, as well as a
specific system of procedure. Thus, the Begg appliance is designed specifically
for the Begg technique, and the instructions for appliance design and appliance
manipulation must be adhered to rigorously for optimum treatment results.
The method developed by P. Raymond Begg’ for the correction of maloc-
elusion consists essentially of tipping movements of the teeth. Two successive
tipping movements are required to achieve bodily movement-the first to posi-
tion the tooth crowns and the second to position the tooth roots. As a result of
these tipping movements, complemented by intrusion, extrusion, and rotation
of teeth whenever required, optimal occlusion, axial positioning, and alignment
of the teeth are secured.
A second important feature of this treatment is simultaneous movement of
the four incisors and canines in both the maxillary and the mandibular dental
arches after extraction of premolars-first through palatal or lingual tipping
of the crowns, followed by root torque of maxillary incisors and uprighting of
canines. The Begg technique, as originally described, relies essentially on extrac-
*Department of Orthodontics, Forsyth Dental Center, Harvard School of Dental
Medicine.

477
4 7 8 Cadman

Fig. 1. Tipping movements of teeth in the Begg technique. A, A vertical-slot bracket

designed to permit mesiodistal and buccolingual tipping of the teeth. Contact of the
arch wire between the inner surface of the vertical slot and the mesial or distal welding
flange permits control of tooth rotation. The arch wire is retained in the bracket slot with
a lock pin (not shown in this illustration). The intermaxillary elastic ring lies incisal to the
distal portion. This slight step in the arch wire results in a more definite contact of the
wire against the canine bracket without tending to enter the bracket slot. 8, Diagram of
tooth position and occlusion at end of Stage I. C, Diagram of tooth position and occlusion
at beginning of Stage III. D, In Stage III, the roots are tipped to obtain correct axial
inclinations of the teeth.

tion therapy, although it can also be used effectively for nonextraction treat-
ment.
Third, the requirements for anchorage differ radically from conventional
principles inasmuch as extraoral forces are not employed and second molars are
banded only when rotated or malpositioned. Basically, a differential response
to force is achieved among the anterior and posterior teeth through which the
position of the molars is maintained while the anterior teeth are tipped.
The Begg technique requires a special bracket. The critical factor in the
design of this bracket is that the inside dimensions of the bracket slot allow free
tipping movement without frictional binding of the arch wire. An attachment
with a horizontal slot cannot be used in the Begg technique. An edgewise
bracket, for example, will permit only slight tipping movement of a tooth
before two-point arch wire contact occurs, thereby causing bodily resistance of
the tooth to further movement.
To satisfy these requirements, a ribbon arch bracket has been modified to
provide single-point arch wire contact in the vertical plane which allows a tooth
to tip mesiodistally and buccolingually (Fig. 1, A). The bracket provides two-
 Vnde naecunl for Begg technique 479

point arch wire contact in the horizontal plane between the inner surface of
the vertical slot and the surface of either the mesial or the distal welding flange
for the control of tooth rotation.
Since its introduction in 1956,l modifications and improvements have been
made in the technique by Dr. Begg himself and by other orthodontists employ-
ing and teaching this method of treatment. The discussion of the technique
presented in this and further articles is not intended to be a representation of
the technique in its ultimate form. Continuous changes and improvements may
soon render obsolete any presentation. Moreover, orthodontists who use the
Bcgg technique may hold opinions that differ from t,he author’s in some details of
treatment.
The material will be presented as it has been used in teaching the Begg
technique at Harvard-Forsyth, with recognition of the need for didactics but
also with encouragement to expose the students to differences of opinion and
modifications of methods after an understanding of basic principles has been
attained.

Principles of treatment

Orthodontic treatment with the Begg technique is divided into three stages.
Stage I deals with the correction and, in fact, overcorrection of overjet, malalign-
ment of individual teeth, procumbency of mandibular anterior teeth,
disharmonious sagittal arch relation, and cross-bite. These corrections are
obtained by distal tipping of canines and lingual (palatal) tipping of incisors
in the case of Class II, Division 1 treatment involving the extraction of four first
premolars, Overbite is simultaneously reduced to an edge-to-edge relationship,
mainly by extrusion of mandibular molars and by intrusion of mandibular
canines and incisors, whenever possible during the time of active vertical facial
growth (Fig. 1, B).
In Stage II, spaces remaining in the buccal segments are closed either by
further palatal or lingual tipping of anterior teeth, by mesial bodily movement
of molars, or by a combination of both procedures (Fig. 1, C). In Stage III,
axial inclinations of all the teeth are corrected in as much as the teeth were
tipped in the first two stages in palatal, lingual, or distal directions while the
roots remained more or less in their original positions (Fig. 1, D) .
The treatment procedures, appliance design, and force systems employed
in the Begg technique utilize the principle of the differential response of teeth
to an applied force. A light, continuous force acting over a relatively short time
period will produce considerable movement of a tooth which is allowed to tip
freely, while a tooth subjected to the same amount of force for the same length
of time will not move appreciably if only bodily movement can occur. The
relationship of tooth movement to the amount of force, the duration of force
application, and the resistance of a tooth to movement may be expressed
qualitatively by the following equation :

Force x Time
Tooth movement = Resistance
4 8 0 Cadman

Of the three stages of treatment! Stage T lends itself most readily IO an

illustration of the irrterrelationshi~, of these factors. For this reason, the events
occurring during the first stage of the treatment of a Class 11, Division 1
malocclusion will be discussed in some detail to clarify the principles of the
Begg technique.
Reduction of owerjet. No attempt is made to proclinc the mandibular incisors
for t,lie ~orrcction of over.jet. In fact, lingual tipping of these trcth usually
occurs during the first stage of keatment. The appliance is designrd to induce
distal and palatal tipping of the maxillaq anterior teeth for the reduction
of over.jet under the influence of light Class II intermasillary elastic traction
with minimal frictional binding or othtrr mccahanical interference. Sinec t h e
resistance of these teeth to the distal tipping force is low, considrrahlc tooth
movement is obtained with a small amount of force in a relatively short period
of time.
k&ornge. In contrast, the mandibular molars arc prevented from tipping
mesially by the design of the mandibular arch wire. Although both ends of the
Class II intermaxillary elastics exert. the same amount of force, mesial movement
of the mandibular molars is minimal because of their relntivel,v great resistance
to bodily displacement.
The maxil1ar.v molars havch no anchorage function in the horizontal plant
during incisor retraction, since onl,v Class TI intcrmaxillary elastic force is used
in Stage I. However, the maxillary arch wire is tlcsigned to utilize the maxillary
molars as anchorage in the vertical plane to provide intrusive force against the
maxillary incisors and thereby prevent their extrusion by the vcrticdal component
of Class I I intermaxillary elastic forec.
Correction of d&occlusion of posterior teeth. The change from (listocclusion
to ncutrocclusion of the posterior teeth during the first stage of treatment often
occurs with a dramatic rapidity that defies simple explanation. In s u c h
instances several contributing factors may be operating simultaneously :
1. Slight distal tipping of the maxillary first molars as a result of t,he
force exerted hy the anchorage hcnds in the arch wire.
2. Slight mesial bodily movement of the mandibular first molars rcsult-
ing from the horizontal component of Class II intermaxillary elastic force.
3. Extrusion of the mandibular first molars in an occlusal and slightly
mesial direction in response to the vertical and horizontal components of
the Class II elastic force.
4. Changes in the occlusion of all t&h following anterior retraction
and bite opening which facilitate a change in the functioning position of
the mandible, encouraged by the Class I1 elastic forces.
5. Restriction of normal forward growth of the maxilla and/or the
maxillary denture by the distal force of Class II elastics but without
constraining growth of the mandible.
A combination of several or all of these factors may hring about an cntl-to-
end or cusp-to-cusp relation of the posterior teeth in a rc1ativcl.v short time,
resulting in slight mandibular repositioning to achicvc a more c+omfortablc
functional occlusion in response to propriocaeptor guiclanccl. This “ttmporary”
relationship then becomes a habitual occlusion with maximal intercduspation in
Volume 67 V,de mecum for Begg technique 481
Number 5

harmony with centric relation as further tooth movement and mandibular

growth occur.
Reduction of overbite. Although some intrusion of the mandibular anterior
teeth is expected by the force of the anchorage bends incorporated in the mandib-
ular arch wire, bite opening in Stage I occurs principally as a result of ex-
trusion of the mandibular molars by the vertical component of Class II elastic
traction. Distal tipping of the mandibular molars by the force of the anchorage
bends is prevented by the mesial component of intermaxillary force and by the
forces of occlusion.
The extrusion of the mandibular molars to the extent of obliterating the
freeway space has been claimed to maintain the mandibular and maxillary
molars in occlusion, even during mandibular rest position, thereby further
augmenting mandibular molar anchorage by introducing additional resistance
in terms of occlusal interference.2
As the maxillary anterior teeth are being tipped distally and palatally,
the anchorage bends in the maxillary arch wire provide an intrusive force acting
to balance the extrusive force exerted on the teeth by the vertical component of
Class II elastics.
The anchorage bends in the maxillary arch wire also exert a distal tipping
force on the maxillary molars. Unlike the mandibular molars, the maxillary
molars are not subject to a counteracting me&al force by Class II elastics. Usually
the relatively large resistance of the multirooted maxillary molars and the
forces of occlusion tend to minimize distal tipping. However, distal tipping
does occur when the force of the anchorage bends is too great or is exerted over
extended periods of time. This undesirable tooth movement occurs most often
in patients in whom the first stage of treatment is prolonged by such factors
as arch wire distortion, frictional binding of the arch wire, displacement of
anchorage bends into the molar tubes, and poor patient cooperation in the use
of intermaxillary elastics.
Advantages and disadvantages of the Begg technique

Any orthodontic technique has advantages and disadvantages. Among the

decisions required in treatment planning, the choice of a specific technique in-
volves weighing its advantages against its disadvantages for the correction of a
malocclusion in an individual patient, with due recognition of the training,
experience, and temperament of the operator.

Advantages
1. Efficiency of treatment, because many corrective tooth movements
occur simultaneously with relatively little appliance adjustment.
2. Minimal patient discomfort and minimal trauma to hard and soft
tissues as a result of the use of light and continuous forces.
3. Rapid esthetic improvement, achieved by early reduction of overjet
and alignment of the anterior teeth.
4. Early correction and overcorrection of rotations, possibly reducing
relapse after treatment.
5. Short treatment time resulting from the rapidity of tooth move-
 ment, continuous forces active during rstcntlt~tl pcriocls of time, antI
simultaneous execution of many corrective tooth movcmrnts.

Disadva?~ tages
1. Patient cooperation, desirable with any tcchniquc, is critical for SW-
cessful treatment with the Begg technique.
2. Distortion of the light arch wires by the mastication of tough foods
or by biting on hard objects results in malfunction of the appliance.
This problem is frequently encountered in Stage I, and the damage to
the arch wire occurs most often in the section between the mandibular
molars and canines.
3. Difficulty may be encountered in accomplishing detailed finishing
procedures.
4. Auxiliary attachments used in Stage III constitute a hazard to the
maintenance of oral hygiene.
5. Tissue trauma is thought to occur at the alveolar crest as a result
of tipping as well as root resorption from excessive tipping of the apices
of the maxillary incisors against the labial cortical plate during Stage I
and Stage 11. However, no conclusive evidence of these inferences on
tissue damage is available.
6. Steepening of an existing high mandibular plane angle may occur
as a result. of Class II intermaxillary traction.
7. The Begg technique does not lend itself to intrusion of maxillary
anterior teeth when a deep overbite is associated with overeruption of
the maxillary incisors rather than overeruption of the mandibular
incisors. A modification of the technique in which a high-pull headgear
attached to rings incorporated in the arch wire distal to the central
incisors has been used to achieve intrusive action on the maxillary anterior
teeth, when required.
8. Unpleasing flattening of the lips may occur during Stage I and
Stage II in patients in whom considerable palatal tipping of the maxillary
incisors has occurred. While this effect may be minimized by the judicious
use of braking auxiliaries to prevent excessive tipping, the appearance
of the patient during this transient stage in treatment may be undesir-
able and constitute a disadvantage of the technique.
9. Lack of understanding of the complex dynamics of the force
systems and the many subtle but important details in treatment can
lead to discouraging experiences for the inexperienced operator.
The novice starting to employ the Begg technique is confronted with a
maze of sophisticated clinical procedures, many of which differ radically from
those employed in the orthodontic techniques with which he is familiar. It
is the purpose of this article to provide a general description and classification
of details of the Begg technique as well as a step-by-step guide to the fabrication
and manipulation of the Begg appliance for the treatment of representative
malocclusions. The treatment of a Class II, Division 1 malocclusion requiring the
extraction of four first premolars affords an opportunity to discuss a wide range
 C’clde mecum f o r Beyg techlciyue 4 8 3

of basic appliance designs and manipulations to achieve an effective under-

standing of the Begg technique.

Treatment of Class II, Division 1 malocclusion, involving the extraction of four first
premolars

Provided a.s a general frame of reference, the objectives of the first three
stages of treatment of a Class II, Uivision 1 malocclusion, in which four first
prcmolars are extracted, are as follows :
Stage 1 (usually 4 to 8 months in duration)
1. Closure of anterior spaces.
2. Correction of crowding.
3. Overcorrection of rotations of anterior teeth.
4. Overcorreetion of overbite to an edge-to-edge incisor relation.
5. Overcorreetion of overjet to an edge-to-edge incisor relation.
6. Correction of cross-bites.
7. Correction of molar rotations.
8. Beginning correction of premolar rotations.
9. Overcorrection of distoeclusion of the buccal segments to slight mesiocclusion.
10. Partial correction of midline discrepancies.
11. Correction of axial inclination of mandibular incisors.
12. Beginning correction of open-bite.
Rtags II (usually 2 to 4 months in duration)
7. Completion of extraction space closure.
A. By eont,inuing retraction of anterior teeth.
R. By mcsial movement of posterior teeth.
(In anticipation of m&al movement of the cro\vns of all teeth during Stage III due
to the action of root-uprighting and torquing auxiliaries, incisors are intentionally
tipped farther lingually and canines farther distally than their desired final positions.)
2. Correction of premolar rotations by means of steel ligatures or elastic thread from buccal
or lingual attachments to arch wires or from lingual cleats of premolars to lingual cleats
of molars.
3. Completion of correction of midline discrepancies.
4. Maintenance of all anterior and posterior overcorrections achieved in Stage I (overbite,
rotations, etc.).
5. Continued correction of open-bite.
Stage ZZI (usually 6 to 9 months in duration)
1. Maintenance of all corrections and overcorrections achieved in Stage I and Stage II.
2. Correction or overeorrection of mesiodistal and labiolingual axial inclinations of all teeth.
3. Completion of correction of open-bite.
F+nishing stage

1. Detailed finishing, using ideal, coordinated arch wires to achieve final corrections and
adjustments in tooth alignment, vertical overbite, intercuspation, and arch form.
2. Band removal and closure of band spaces.

Construction of appliances, Stage I

Maxillary arch wire. Essential to the efficiency of the Begg technique is

the utilization of highly resilient wire which permits the delivery of continuous
light forces over relatively long periods of time with minimal loss of action
 4 8 4 Cadman

Fig. 2. Formation of ring in the arch wire for the engagement of elastics. A, Rings of
proper size (2 mm.) in the maxillary arch wire are formed by using the middle step
of a pair of Tweed loop-forming pliers. B, The ring is formed with the mesiai aspect
of the arch wire incisal to the distal portion. C, The arch wire mesial and distal to the
ring should be on the same horizontal plane.

resulting from the deflective or distorting forces normally encountered. Gen-

erally, 0.016 inch wire is used in the formation of the arch wire.
Vertical loops, positioned interproximally where indicated, are incorporated
in the arch wire to align the incisors while simultaneously exerting a distal
tipping force against the canines to provide the space required for incisor
alignment. The arch wire contains small rings mesial to the canine brackets
for attachment of intermaxillary elastics and for tie back of the anterior arch
segment. In addition, “tip-back” or anchorage bends, as they a.re better termed,
are incorporated in the posterior legs of the arch wire.
The arch wires are formed as the wire is unwound from the spool on which
it is supplied. This procedure eliminates the need to judge in advance the
length of wire required, which is difficult, particularly when several vertical
loops are to be made. It also avoids the inconvenience and haza.rd of an unruly
 Vade mecum for Begg technique 485

length which is manipulated close to the patient’s face. The method of arch
wire formation is as follows :
1. The end of the wire is inserted into the maxillary left molar buccal tube
so that about 3 mm. protrudes through the distal end of the tube.
2. The wire is placed into the slot of the left canine bracket and a mark is made
on the wire at the mesial aspect of the bracket with a sharp marking pencil.
3. The wire is withdrawn and a horizontal ring is formed with the middle
step of a pair of Tweed loop-forming pliers, so that the mesial portion of the wire
lies incisal to the distal portion (Fig. 2, R and B). The ring thereby makes
a positive contact against the canine bracket and does not tend to “enter” the
slot (Fig. 1, A). This configuration also facilitates placement of the intermax-
illary elastics by the patient; however, the ring should not be formed so tightly
that it will not readily permit engagement of an elastic.
After the ring is formed, the mesial and distal portions of the wire may
be brought into the same horizontal plane by grasping the ring with No. 442
pliers to bend the distal portion gingivally and the mesial portion incisally
(Fig. 2, C).
Many orthodontists advocate formation of the rings in such a manner that
the segment of arch wire between the rings lies gingival to the distal segments.
It is believed that this configuration produces a more effective intrusive force
on the incisors.
If desired, a hook may be bent into the arch wire instead of the ring. It
is imperative that the hook, when used, be angled labially, not only to prevent
contact with the labial surface of the canine, but also to prevent the intermaxil-
lary elastic from wedging between the hook and the band which would tend to
torque the canine root lingually and thus resist the desired canine movement.
4. The arch wire is replaced in the molar tube and in the canine bracket,
with the ring contacting the mesial aspect of the bracket. If the incisors are not
rotated or malposed, one should place the wire in the bracket slot of the lateral
incisor and proceed to the left central incisor and around to the right canine.
5. When the incisors are rotated or malposed to a degree that prevents
seating of the arch wire in the bracket slot without undue force, vertical loops
should be formed in the center of the interbracket area mesial and distal to
the tooth or teeth in question (Fig. 3, A).
Each time a loop is made, the portion of the arch wire already formed is
replaced in the left molar tube and seated in the left canine bracket with the
ring contacting the mesial aspect of the bracket. While the wire is held in
place with the left hand, the exact point where the bend is to be made for the
left leg of the loop is marked accurately. Care should be taken not to allow
any part of the loops to contact the teeth, brackets, or gingiva (Fig. 3, B and C) .
Generally loops are made 6 to 8 mm. long but the greater the length of a
loop, the more gentle will be the force on the tooth when the wire is engaged
in the bracket. For this reason, loops are sometimes made longer on each
side of a severely rotated tooth than for less malplaced teeth. It should be
pointed out, however, that long loops increase the possibility of irritation to
the labial or gingival tissue.
 Am. .I. Orthod.
.2fnl/
. 19ii

Fig. 3. Loop configuration in initial arch wires. A, Loops should not contact the tooth
crowns, brackets, or gingiva. The loop at the midline is made shorter than the other
loops to avoid irritation of the labial frenum. 8, Initial arch wires 6 weeks after placement.
The loops mesial to the mandibular canines were too short and did not have sufficient
resilience to avoid permanent distortion when the arch wire was engaged in the brackets.
As tooth movement occurred, the loops mesial to the mandibular right canine and distal
to the left central incisors impinged on the gingiva and contacted the necks of the
teeth, thereby establishing multipoint tooth-to-arch wire contact which impedes the
desired tipping movement.

Whenever possible, a loop between the maxillary central incisors should

be avoided. When definitely indicated, however, the labial frenum must always
be examined before a loop is formed between these teeth. The loop in this area
is made shorter than, usual for two reasons : ( 1) t,o avoid irritation t,o the
labial frenum (Fig. 3, ‘1) and (2) because a loop in the midline causes the
arch wire to assume a V shape when contracted by placement in the molar
tubes, since t.he arch wire is usually expanded in the molar area before final
insertion. IVhen the frenum attachment is very low, the loop must he diverted
to either the left or the right of the midline (Fig. 3, D) .
Loops are not used distal to rotated canines, because their presence in the
long spa.n of wire in the posterior arch segment tends to reduce molar control.
However, forcing the arch wire into the bracket slot of a distolingually rotated
canine causes lingual tipping of the molar (Fig. 1, ~1). To correct distolingual
canine rotation, the arch wire is ligated to approximate the bracket slot and
a light elastic thread ligature is tied from the lingual Imtton a r o u n d t h e
distal aspect of the canine to the arch wire (Fig. 4, R). Additional expansion
should be incorporated in the molar area to compensate for the constricting
Fig. 3, continued. Loop configuration in initial arch wires. C, Incorrect loop placement and
adiustment results in contact of the loop with the distal aspect of the lateral incisor bracket
and lock pin, thereby impeding the desired rotation and alignment of the lateral incisor.
The arch wire should be adjusted to position the loops equidistant from the lateral incisor
bracket. The ring should be in contact with and exerting slight distal pressure against the
canine bracket. D, To avoid an excessive heavy or low frenum, the midline loop may
be angulated.

action of the ligature on the arch wire. The arch wire can be engaged in the
canine bracket at a subsequent visit.
A tooth in marked linguoversion or labioversion, such as a maxillary lateral
incisor in lingual cross-bite, will often also be in considerable supraversion
due to lack of occlusion. In addition, the tooth will often have an excessive
axial inclination and further elongation will occur as it is tipped into proper
alignment. In order to achieve the required depression of the tooth by the
action of the vertical loops, the horizontal segment of the arch wire to be engaged
in the bracket is made 1 to 2 mm. gingival to the horizontal plane of the
arch wire (Fig. 5, A and B) .
As a rule, loops should be kept to a minimum. Therefore, when a tooth
is very mildly rotated, the arch wire is simply ‘%napped” into the bracket
and overcorrection bends are made at the next appointment. To avoid labial
or lingual displacement of a tooth which is to be rotated, the two bends and
the distance between them must be the same on the mesial side as on the distal
side of the tooth, the bracket being located midway between the bends after
the rotation is corrected (Fig. 5, C). As is the case with so many technical
procedures in orthodontics, judgment as to what constitutes “undue force”
comes with experience. “Undue force” cannot be defined or described accurately;
it can be demonstrated best clinically.
480 Cadman .4,m. J. Orthod.
Ma?/ 1975

Fig. 4. Correction of distolingual rotation of canine. A, Engagement of the arch wire in the
bracket of a distolingually rotated canine will cause constriction of the molar. B, The
arch wire is not engaged but is ligated to approximate the bracket slot. Molar expansion
should be incorporated to compensate for the lingual force of the elastic thread ligature
on the arch wire.

6. After all necessary loops have been made, the arch wire is again seated
in the left molar tube and held in the brackets with the left ring against the
mesial aspect of the left canine bracket. The free end of wire is seated in the
right canine bracket, and the mesial aspect of the bracket is accurately marked
on the wire.
7. The right ring is formed in such a manner that the mark on the wire
is even with the distal aspect of the ring. As was done on the left side, the
ring is formed so that the distal portion of the wire is gingival to the mesial
portion. Grasping the ring with No. 442 pliers, the operator bends the mesial
portion incisally and the distal portion gingivally in order to bring the arch
wire on either side of the ring into the same horizontal plane. Occasionally,
particularly when a vertical loop was made close to the point where the right
ring has to be formed, it is difficult to make the ring with its distal portion
gingival to the mesial portion without distorting the ring. In such instances, the
distal portion should be made incisal to the mesial portion.
8. The arch wire is cut from the spool, but the posterior segment distal to
the right ring is made about 5 mm. longer than that on the left side.
9. The arch wire is seated in all brackets and the operator ascertains that
the rings contact the mesial aspects of both canine brackets.
Each incisor rotation is noted and the corresponding vertical loops are
 for Begg technique 489

Fig. 5. Arch wire modification for individual tooth movements. A, Because the lingually
displaced maxillary right lateral incisor has a slight lingual axial inclination, labial
tipping will result in further extrusion of the tooth. B, The horizontal segment of the
arch wire between the loops was made 1 to 2 mm. gingival to the horizontal plane
of the arch wire in order to achieve depression of the overerupted lingually malposed
maxillary right lateral incisor as it was aligned. The reciprocal of the force that achieved
the lateral incisor intrusion has caused relative extrusion of the left central incisor and
canine. Incorrect bracket placement has caused extrusion of the mandibular right canine.
C, Overcorrection of rotated lateral incisors by incorporating bends in the arch wire.
The magnitude of the bends has been exaggerated for purposes of illustration. The
position of the arch wire is shown prior to its insertion into the lateral incisor brackets.
D, Vertical loops used to achieve overcorrection of rotated lateral incisors. For the purpose
of illustration, the loops are shown in the horizontal plane and the arch wire has not
yet been inserted into the lateral incisor brackets. [See text for discussion of loop
adjustments.)

adjusted slightly to overcorrect the rotation (Fig. 5, D). In order to avoid

labial or lingual displacement of the tooth to be rotated, the loops are formed
and adjusted so that the bracket assumes a location midway between the loops
when the rotation is corrected, and one leg of each loop is displaced labially
or lingually, respectively, to the same degree. To avoid cxcessivc pressure on
the teeth and/or distortion of the arch wire, this overcorrecting adjustment is
not made if a tooth is severely rotated.
The operator should examine the degree of incisor crowding and open
each loop a small amount, thereby causing the rings to press distally against
the canine brackets, which increases the canine-to-canine arch-wire segment
Fig. 6. Methods of incisor space closure. A, Closure of incisor spaces by means of vertical
loops. The intermaxillary elastic ring, which is formed 2 or 3 mm. mesial to the canine
bracket, is ligated to the bracket, thereby forcing the loops open and producing a mesial
force against the canine and a distal and palatal force against the incisors. Because the
mesial force against the canine is offset by Class II intermaxillary traction, space
closure occurs by retraction of the central incisors. Incorrect band placement has caused
extrusion of the lateral incisor. B, Closure of incisor spaces by means of a light latex
elastic. The canine lock pins are bent in a distal direction for engagement of the
elastic. To avoid impingement on the labial gingiva, the elastic is “laced” across the
incisor brackets. The intermaxillary elastic rings must be formed sufficiently to the mesial
of the canine brackets to permit the rings to move distally as the spaces close. C, Incisor
spaces closed by ligating the ring to the canine bracket with an elastic thread ligature.
Slight spaces can be closed by using an elastic thread ligature on one side and a steel
ligature on the opposite side.

to accommodate the anterior teeth in proper alignment. The arch wire should
be adjusted to re-establish a flat occlusal plane.
If the anterior teeth are spaced rather than crowded, the rings are formed
2 or 3 mm. mesial to each canine bracket, and the loops are activated as con-
traction loops to close interdental spaces when the rings arc tied back against
the canine brackets (Fig. 6, A).
In the absence of irregularities or rotations accompanying anterior spacing,
a plain arch is used with the rings formed slightly mesial to the canine brackets.
The spaces are closed by a light latex elast,ic worn 1abiall.v from the bent-over leg
 Vnde mecum for Begg technique 491

Fig. 7. Anchorage bend made opposite the molar-premolar contact point. The labial
portion of the arch wire should rest in the depth of the labial mucobuccal fold.

Fig. 8. Loop adjustment with Turbeyfill pliers. A, The tongue and groove of the plier
beaks must be held at an angle of 90 degrees to the legs of the loop. 6, The pliers are
designed for adjustment of the labiolingual inclination of an individual loop without dis-
torting the arch wire.

of the lock pin of one canine bracket to that of its antimere (Fig. 6, I?). Sub-
sequently, the rings are ligated to the canine brackets in the usual manner
to prevent reappearance of the interdental spaces.
An alternative method of closing anterior spacing in the absence of rotations
or crowding is to ligate the intermasillary elastic rings to the canine brackets
with light elastic thread ligature, the rings having been formed sufficiently to
the mesial of the brackets to allow them to move distally as the interdental
spaces close (Fig. 6, C) .
10. With the arch wire seated in the brackets, a mark is made to locate
4 9 2 Cadman

Fig. 9. Correct and incorrect arch wire form. A, Correct arch wire form with arrows indi-
cating the location of the canine curvatures, B, Incorrect arch wire form which would
cause constriction and mesiolabial rotation of the canines as well as expansion and
distolabial rotation of the lateral incisors.

the anchorage bend on each side at the molar-premolar contact point (Fig. 7).
In general, these anchorage bends should be made to such a degree that the
anterior portion will lie gingivally in the labial mucobuccal fold when the arch
wire is placed in the molar tubes.
11. The arch wire is seated in all brackets, and the position of the loops,
which should neither touch the gingiva nor protrude too far labially, is
examined. Otherwise, the arch wire must be removed to make any necessary
adjustments to individual loops. An attempt to adjust the arch wire in the mouth
will almost always result in unpredictable distortion of the arch wire and
subsequent undesired tooth movements unless pliers specifically designed for
this purpose, such as Turbeyfill pliers, are used (Fig. 8, .I and B).
12. The arch wire should be inspected for proper arch form and symmetry,
care being taken not to cause undue expansion of the canines, which would
force these teeth against the cortical plate as they are moved distally. When
viewed from the occlusal or gingival, the anterior arc of t,he wire should
continue beyond each ring or hook, curving gradually in the area of the canine
bracket, then continue posteriorly in a straight line through the molar tube
(Fig. 9). The arch wire form should be modified to correspond to the patient’s
dentoalveolar arch, and the prominence of the canine curvatures should
be formed to correlate with the labiolingual diameters of the canine
crowns.
13. One most important final inspection is to sight along the arch wire as
it enters the molar tubes. The anchor bends should “roll” neither buccally
nor lingually and the arch wire should enter the molar tubes exactly at the
6 o’clock position and exit from the distal portion of the tube at the l:! o’clock
position (Fig. 10, A).
Failure to keep this vertical relationship between the arch wire and the molar
tube is probably the greatest cause of loss of molar control, particularly in
the first stage of treatment (Fig, 10, C) .
 V&e mecum for Begg techwique 4 9 3

Fig. 10. Diagrams illustrating the critical relation of arch wires to molar buccal tubes
f o r m a i n t e n a n c e o f m o l a r c o n t r o l . A, M a x i l l a r y r i g h t f i r s t m o l a r i l l u s t r a t i n g c o r r e c t
position of arch wire at its entrance into (mesial view) and its exit from (distal view]
the tube. B, Mandibular right first molar showing correct position of arch wire in buccal
tube at its entry [mesial view] and exit (distal view). C, Rotation of maxillary molars
caused by (1) Incorrect angulation of the buccal tubes, which should have been placed
at right angles to the mesial surface of the molars. (Unless distolingual molar bends are
made, the arch wire does not enter the molar tubes at the 6 o’clock position.) (2)
Anchorage bends formed too far mesial to the molar tubes, thereby increasing the
possibility of lateral distortion or “roll” of the arch wire in the area of the bends.

When the molar is slightly rotated, the arch wire is adjusted by incorporat-
ing very slight toe-in or toe-out at the anchorage bend. When placed in the
molar tubes and seated in the anterior brackets, the arch wire then enters the
molar tube at about the 7 o’clock or the 5 o’clock position, depending on the
direction of rotation action indicated. The amount of toe-in or toe-out should
be controlled to avoid causing the bend to roll buccally or lingually.
In the construction of all arch wires a slight distobuccal molar bend (“toe-
out”) is also required when the posterior ends of the arch are expanded. In
fact, the toe-out bend is proportional to the amount of expansion in order to
4 9 4 Cadman

Fig. 11. A method of ligating the intermaxillary elastic ring to the canine bracket in order
not to interfere with distal tipping of the canine. Although tied loosely to avoid binding,
the ligature will not slip or rotate. Thus, the twisted end will remain in place and will
not cause lip irritation. The twisted end is formed at the occlusal rather than at the
gingival aspect of the arch wire in order to resist displacement by forces of occlusion.
A, An 0.009 inch steel ligature is passed lingual to the arch wire distal to the canine
bracket. 6, The gingival end of the ligature is brought occlusally labial to the arch wire
and passed through the ring in a gingival direction. C, The gingival end of the ligature is
brought occlusally and distally, and slight tension is applied to cause the ligature to
cross the labial aspect of the bracket in a figure-of-eight configuration, D, A hemostat or
Mathieu surgical needle holder is used to form the twist at the distolabial aspect of
the point of entry of the arch wire into the bracket slot. The ligature is held at an angle
of 45 degrees to the occlusal, vertical, and transverse planes while the twist is formed.
E and F, The twisted portion of the ligature is cut to a length of approximately 2.5 mm.
G, The twisted end of the ligature is tucked lingual to the arch wire by rotating the
ligature director in a clockwise direction (counterclockwise when ligating the maxil1ar.y
left ring to the left canine bracket). The twisted portion is curved gingivally and mesially
to increase its rigidity and thereby enhance its resistance to displacement. H, In order to
avoid binding, which would impede distal tipping of the canine, the ligature should
not be under tension and the twisted end should not be wedged between the arch
wire and the bracket flange or band (or perforated base or adhesive if direct bonded
attachments are used, as in this illustration). Formation of the twisted end at an angle
of 45 degrees to the occlusal, vertical, and transverse planes [illustration D) has enabled
the entire twisted portion to occupy a position that offers minimum irritation to the
labial mucosa.
 Vade mecwn for Begg technique 495

Fig. 11, E through H. For legend see opposite page.

assume the important 6 o’clock-12 o’clock positions when the arch is contracted
for placement into the molar tubes.
If a molar should exhibit more than a mild degree of mesiolingual rotation,
the rotational correction can be achieved most efficiently by tying an elastic
thread ligature from the lingual button around the mesial aspect of the molar
to the arch wire. Additional expansion should be placed in the canine area
of the arch wire to counteract the lingual pull of the elastic ligature.
With a severe molar rotation, it may be necessary to place a considerable
bayonet or toe-in bend in the arch wire for correction. If needed, the anchorage
bends may be reduced accordingly. After correction of molar rotation, the
usual anchorage bends are placed and Class II elastic traction of 11/2 to 2
ounces is initiated.
14. With the arch wire seated in the brackets, the ends are cut about 2
mm. distal to the molar tubes. It is good practice to smooth and anneal the
ends of the arch wire to facilitate the making of a slight gingival or lingual
bend distal to the molar tubes to avoid irritating the cheeks or injuring the
fingers when the patient places the elastics.
15. The rings should not be ligated to the canine brackets at the appoint-
ment when the arch wire is first placed if crowding is present. However, in the
case of spacing or normal alignment, the rings should be ligated to the canine
bracket.
The ligature is made in a figure-of-eight form, and it should rest on the
Fig. 12. Arch wire maintained in correct relation to premolar brackets in Stage I and
Stage II. A, If a ligature is used, it is tied loosely enough to avoid interference with
the bite-opening action of the arch wire and yet firmly enough to prevent the arch wire
from slipping gingivally or occlusally to the bracket. 6, Retaining ring used in place of
ligature.

labial surface of the vertical portion of the bracket. Shaped in this way, the
ligature will not interfere with the distal tipping of the canine and, although
the ligation is tied loosely, the twisted end will not tend to slip out and cause
lip irritation (Fig. 11, A to H).
16. The arch wire is never engaged in the second premolar brackets in
Stage I of the Begg technique; nor is it allowed to enter the bracket slot. Other-
wise, frictional binding would result, which would interfere with the free
sliding of the arch wire through the molar tubes as the extraction spaces close
as well as impede bite opening and retraction of anterior teeth. In the absence
of premolar rotations, many operators delay banding the premolars until the
extraction spaces are almost closed to avoid interferencc of the premolar
brackets with the arch wire.
The arch wire is ligated loosely against the buccal aspect of the premolar
brackets with 0.009 inch ligatures passed through the pin channels of the
brackets (Fig. 12, A) or by means of by-pass clamps or retaining rings (Fig. 12,
B), for the following reasons :
A. To reduce the possibility of arch wire deformation by forces of
mastication.
B. To prevent displacement of the arch wire into the bracket slots or
onto the occlusal aspect of the brackets.
C. To prevent displacement of the second premolars as a result of
inadvertent overclosure of the extraction spaces.
The force of the arch wire against the buccal surfaces of the premolar
brackets may cause lingual tipping of the second premolars and/or labial tipping
of the canines. Therefore, if the second premolars are banded in Stage I or
Stage II, slight horizontal offset bends are formed in the arch wire distal to
the canines to maintain correct buccolingual position of the premolars and
canines (Fig. 13).
 Vnde mecuvn for Begg technique 497

Fig. 13. Buccal offset bends formed distal to the canines to prevent labial tipping of
the canines or lingual tipping of the premolars when premolars are banded in Stages I
and II. Slight distolingual bends are placed in the molar areas to compensate for the
rotational forces of horizontal elastics used in Stage Il.

Fig. 14. Small rings are formed in the mandibular arch wire, using the end step of a
pair of Tweed loop-forming pliers, to avoid irritation of the labial mucous membrane.

Mandibular a,& wire. The mandibular arch wire is formed in the same way
as the maxillary arch wire, using 0.016 inch wire to resist the forces of
mastication and to offer sufficient, bite-opening action. A small ring is formed
mesial to each canine bracket, using the smallest step of the Tweed loop-forming
pliers. Intermaxillary elastics are not usually engaged in the rings of the
mandibular arch wire during Stage I; therefore, small rings can be formed to
minimize the possibility of irritation to the labial mueosa (Fig. 14). Because
the action of Class II elastics tends to tip the mandibular molars lingually,
considerable expansion is incorporated in the molar area of the mandibular
arch wire, usually about 5 mm. on each side. When placing this arch wire
expansion in the molar area, some expansion must also be placed in the canine
area to prevent lingual constriction of the canines when the wire is placed
in the molar tubes. Moreover, a larger amount of expansion is used in an arch
wire containing loops than in a plain arch wire, inasmuch as the presence
of loops decreases the effectiveness of any expansion incorporated in the arch
wire.
Care must be taken that the wire enters the molar tubes at the 72 o’clock
position and exits at the 6 o’clock position (Fig. 10, B) .
It is imperative that the ends of the arch wire protrude through the distal
aspect of the molar tubes (Fig. 15, A). If the wire is cut too short anct the
ends lie inside the tubes, considerable frictional binding will occur and prevent
the canines from tipping distally int,o the extraction spaces. Furthermore, any
gingival flexion of the buccal portion of the arch wire from forces of mastica-
tion will have a racheting effect and cause the incisors to tip labially (Fig.
15, B).
Summary of Stage I treatme~zt. Tn the first stage of treatment of a Class
Fig. 15. Importance of location of distal ends of arch wire. A, End of arch wire must
protrude through distal aspect of molar tube to avoid frictional binding (B). 8, Termination
of the arch wire within the molar buccal tube will impede the free distal movement of
the arch wire through the tube. Furthermore, flexion of the arch wire by forces of
mastication (A) will produce a racheting action at the point of contact of the end of
the arch wire with the inner wall of the tube (B), thereby causing undesirable labial
tipping of the incisors (C).

II, Division 1 malocclusion, the action of the arch wires and the Class I1
intermaxillarp elastics should accomplish the simultaneous correction or over-
correction of the overbite, overjet, crowding, rotations, and cross-bites. Anterior
spaces have been closed and distocclusion has been corrected to neutrocclusion.
The time required to attain the objectives of Stage 1 is usual1.v 5 to 8
months. Although the optimum time between appointments is 1 to 6 weeks,
it is advisable to examine the patient at 3-week intervals at the beginning
of treatment if looped arch wires are employecl. in orticr to make adjustments
that will prevent the loops from irritating the lips or impinging on the labial
gingiva.

Construction of appliances, Stage II

In Stage II, remaining extraction spaces are closed, correction of premolar

rotations is completed, and midline discrepancies are corrected, while the end-to-
end incisor relation attained in Stage T is maint,ained.
In general, Stage II mechanics should not bc started until (I) the bite has
opened to an end-to-end incisal ?elation, (2) the distocclusion of posterior teeth
has been overcorrected, and (3) all anterior rotations have been slightly over-
corrected by means of bayonet bends in the arch wires ( E’ig. 1, B)
The same 0.016 inch arch wires used during the first stage of treatment ma!
be used during Stage II if they have not been distorted. Anchorage bends are
located about 1 mm. mesial to the molar-premolar caontact points, and again
the magnitude of the anchorage bends is determined by inspecting the anterior
portion of each arch wire which should lie deeply in the labial mucobuccal
fold when placed in the molar tubes.
Because horizontal elastics used in Stage IT tend to rotate the molars
mesiolingually, slight “toe-in” bends are made in the molar areas t,o prevent
molar rotation (Fig. 13). Intcrmaxillary hooks or rings are ligated t,o t h e
canine brackets, as in Stage I.
The arch wire should be held loosely against the buccal aspect of the pre-
molar brackets by ligatures or bypass clamps to prevent buc*cal or lingual
crowding of these teeth after the extraction spaces close. If the premolars were
not banded at the beginning of treatment, bands should be cemented on these
teeth prior to closure of the extraction spaces. As in Stage I, the arch wire is not
engaged in the premolar brackets. Slight horizontal offset bends are formed
in the arch wire distal to the canines to maintain the correct buccolingual
position of the premolars and canines (Fig. 13).
All remaining premolar and molar rotations must be corrected during Stage
II, usually by means of elastic thread or steel ligatures, again avoiding any
kind of ligation that may bind the arch wire and impede its freedom to slide
distally through the molar tubes. Exceptions, such as the use of “brakes,” and
their indications will be discussed later.
A horizontal elastic providing about 2 ounces of pull is used in each quadrant
from the intermaxillary ring on the arch wire to the hook at the mesial aspect
of the molar tube. Horizontal elastics should not be engaged over the distal ends
of the molar tubes, as this greatly increases the tendency of molars to rotate
mesiolingually. Each horizontal elastic is twisted one half-turn when it is placed
to reduce the possibility of gingival irritation and also of food impaction.
Occasionally the treatment plan calls for litt,lc or no retraction of the anterior
teeth but, instead, more than the usual amount of mesial movement of the molars
and second premolars for the closure of extraction spaces. To prevent further
distal tipping of the canines and lingual tipping of the incisors in such a condi-
tion, uprighting springs may be placed in the canine and/or lateral incisor
brackets to act as “brakes” during Stage II. A torquing auxiliary made of 0.014
inch wire may also be used. The uprighting springs or torquing auxiliary are
adjusted to provide only slight force on the roots of the respective teeth. Their
purpose in this application is not to obtain root movement but to prevent further
crown tipping, as deepening of the overbite may result from excessive forces
exerted by the auxiliaries in this stage of treatment.
The importance of achieving optimal bite opening prior to the use of braking
auxiliaries must be emphasized; the presence of even passively adjusted upright-
ing springs or torquing auxiliaries will impede the bite-opening action of the
Begg appliance.
If only horizontal elastics are used, the overbite and overjet will often reap-
pear; therefore, horizontal elastics should be worn at all times, but Class II elas-
tics should he continued just to maintain end-to-end incisor relation (Fig. 16,
d). All elastics are changed daily, and the patient is instructed to examine the
incisors each day to determine if Class II rlastics are being worn for a sufficient
time period during the day to keep the end-to-end relation.
As the extraction spaces close (they often do not all close at the same time),
the horizontal elastics arc discontinued to prcvcnt molar rotation, the slight
distolingual molar bends are removed from the arch wire, and the molars are
ligated to the premolars and canines by means of 0.011 or 0.012 inch steel liga-
tures connecting the rcsprctive lingual buttons or cleats (Fig. 16, B).
Care should be taken to ensure that the occlusal edge of the distal aspect
of the canine band is not caught under the contour of the mesial surface of the
premolar or under the gingival edge of the mesial aspect of the premolar band
F i g . 1 6 . C l o s u r e o f e x t r a c t i o n s p a c e s i n S t a g e Il. A, E l a s t i c c o n f i g u r a t i o n u s e d d u r i n g
Stage II. Class II intermaxillary elastics are used as much as needed to maintain the end-
t o - e n d i n c i s o r r e l a t i o n . 8, L i g a t i o n o f l i n g u a l b u t t o n s t o p r e v e n t o p e n i n g o f e x t r a c t i o n
spaces. The twisted end of the ligature should be tucked in contact with the distal surface
of the canine band to prevent irritation of the tongue or gingiva. C, Overclosure of
e x t r a c t i o n s p a c e w h i c h w i l l i m p e d e o r p r e v e n t u p r i g h t i n g o f t h e c a n i n e . D , E, and F ,
O c c l u s i o n a t t h e e n d o f S t a g e I. The arch wires have been engaged in the premolar
brackets to obtain alignment preparatory to placement of Stage III base arch wires.
 Vtrde mecum for Regg techique 501

when the canines are severely tipped at the end of Stage II. This condition
impedes or prevents later uprighting and occlusal alignment of the canines in
Stage III (Fig. 16, C) .
The correction of midline deviations usually occurs during Stages 1 and II
without the need for any modification of the treatment procedures already
described. For example, the extraction space may close first on the right side
of the maxillary arch with the appearance of an accompanying midline devia-
tion to the right. As the extraction space on the left side continues to close by
distal tipping of the left anterior teeth, the midline will shift to the left until
extraction space closure is complete, at which time the midline deviation no
longer exists.
In Stage II the action of the horizontal elastics has resulted in complete
closure of the extraction spaces, premolar rotations have been corrected by means
of elastic thread ligatures, midline discrepancies in most instances have been
eliminated, and the end-to-end incisor relation has been maintained by the USA
of Class II intermaxillary elastics (Figs. 1, C and 16, D, E, and B) .
The time required for the second stage of treatment varies, depending on the
amount of crowding, overjet, and overbite present in the malocclu-
sion. In a severely crowded Class II malocclusion the extraction spaces may be
closed completely by the correction of crowding, overjet, and overbite, and by
the correction of distocclusion to neutrocclusion. In this instance there would be
no Stage II. In contrast, more than half of t,he extraction spaces may remain
t’o be closed during Stage II in the treatment of a malocclusion with little crowd-
ing, slight overjet, and mild overbite. If brakes are used to prevent excessive
distal, lingual, or palatal tipping of the canines and incisors, Stage II will
require a considerably greater period of time than would be needed for closure
of extraction spaces by tipping of the anterior teeth. In general, the time
required for Stage II is 1 to 4 months.
During the first two stages of treatment the maxillary and mandibular
canines and lateral incisors have been tipped distally, the second premolars
have been tipped mesially, and the maxillary central incisors and often the
maxillary lateral incisors have been tipped palatally. In Stage III the axial
inclinations of all teeth are corrected by root movements while neutrocclusion
and the overcorrection of rotations and overbite are maintained.

Construction of appliances, Stage III

Before the third stage of treatment is started, the following conditions

should exist, assuming a malocclusion with excessive vertical overbite (Figs.
1, C and 16, D, E, and P) :
1. Overbite and overjet overcorrected with an end-to-end relation of
incisors.
2. Canines, premolars, and molars occluding in slight mesiocclusion.
3. All rotations corrected or overcorrected.
4. All spaces closed.
5. Molars in upright position.
The lingual buttons, hooks, or cleats on the molars, premolars, and canines
in the respective quadrants are ligated together tightly with 0.011 or 0.012
502 Cadman

inch steel ligatures (Fig. 16, U). The> ligation is startetl on the molar, twist,cd
between eaeh pair of lingual attachmcnt,s, a n d the “pig-tail” formed a t the
mesial aspect of the premolar is t,urnctl in against the mesial aspect of the
premolar band or the distal asp& of the canine band to prrlvrnt irritation oi
either the tongue or the gingiva. Failure to ligate the bnccal teeth tightly to-
gether will result in reopening of extract,ion spaces when the premolar and
canine roots are uprighted.
The various uprighting and torquing auxiliaries used in Stage III tend to
distort the base arch wires, causing deepening of the overbite, open-bite in the
canine-premolar area, and expansion of the maxillary molars (Fig. 17, A). To
resist these distorting forces, stronger arch wires arc used (0.018 inch for the
mandibular arch wire and 0.018 or 0.020 inch for the maxillary arch wire),
and appropriate compensations arc made in the formation of these base arch
wires (see below). The purpose of the rtlativcly strong base arch wires is to
maintain arch form and to resist the distorting action of the auxiliaries rather
than induce tooth movement, which is achieved by activation of the auxiliaries.
If the premolars are not aligned suffieicntly for easy bracket engagement of
0.018 inch wire, the 0.016 inch arch wire used in Stage II should be used as a
“pre-Stage III arch wire” to obtain the desired alignment in all planes bcforc
proceeding with 0.018 inch arch wire.
The maxillary and mandibular base arch wires arc formed as in Stage I with
the following modifications :
Mcrxillary Bflse a.rch w i r e
1. Either 0.018 or 0.020 inch wire is used. The bracket, slots should be opened
slightly to accommodate the 0.020 inch base arch wire w&h special pliers de-
signed for the purpose, such as the Wagers bracket-opening pliers, unless
brackets with a 0.020 inch slot were selected when the teeth were banded.
2. Rings for the engag’cmcnt of (Yass II intermaxillary elastics are located
1 mm. mesial to each canine bracket. The crowns of the distally tipped lateral
incisors and canines occupy more space in the dental arch than they will when
they are upright.ed. Inasmuch as the roots of these teeth will be tipped distally
sufficiently for purposes of stability as well as to produce a slight mesial angula-
tion of the crowns for esthetic reasons, the crowns will again occupy slightly
more arch space than when they were in an upright position. If the rings
contact the canine brackets at the start of Stage 111, anterior spacing will occur
during uprighting of the incisors and cdanines and there is no provision for
space closure by ligation of the rings to the canine brackets.
Failure to ligate routinely the rings to the canine brackets during Stage
III will usually result in spacing of the incisors (Fig. 17, B) . However, ligating
the rings too tightly may bind the six anterior teeth together, thereby impeding
root uprighting and, in addition, producing mesiolingual rotation of the canines.
3. Anchorage bends are reduced or removed to avoid distal tipping of the
maxillary molars. The arch wire should just “touch” the mesial opening of the
huccal tubes at the 6 o’clock position without exerting tipping action.
4. Because of the reduction of the anchor bend, an occlusal blend may be
needed between the molar tube and t,he premolar bracket in order to bring the
 Vade mecum for Begg technique 503

marginal ridges of the molar and premolar to the same oeclusal level (Fig. 17,
C). When making this bend, the change in marginal ridge height which will
accompany uprighting of a mesially tipped premolar should be taken into
consideration.
5. A molar offset in the horizontal plane is made in the Stage III base arch
wires because of the difference in buccolingual dimensions of the molars and
second premolars. These bends are placed 1 to 2 mm. mesial to the molar tubes.
6. Because of the greater diameter of the base arch wire, the occlusal level
of the arch segment anterior to the rings will be lower than that of the arch
segment posterior to the rings. This differential is greater with 0.020 inch
arch wire than when an arch wire of smaller diameter is used. Compensating
bends for this discrepancy are made as described for the Stage I arch wire (see
Fig. 2, C).
7. The reciprocal action of the canine- and premolar-uprighting springs
tends to distort the base arch wire gingivally in the section between these
teeth when the arms of the uprighting springs are hooked over the arch wire.
Also, the reciprocal action of the incisal torquing auxiliary distorts the base
arch wire occlusally in the central incisor area (Fig. 17, A). These two groups
of forces may cause deepening of the overbite, particularly of the central in-
cisors, and open-bite in the canine-premolar areas.
To compensate for the above distorting forces, a slight “V” bend is made
in the base arch wire distal to the canines, which will “bow” the incisal section of
the arch wire gingivally (Fig. 17, D and F). This modification will produce
an intrusive force on the central incisors and a slight extrusive force on the
canines and premolars. The extent of the “V” bend should be sufficient to bring
the anterior section of the arch wire to the level of the gingival margin of the
central incisors when the arch wire is seated in the molar tubes and premolar
brackets.
8. Another untoward force resulting from activation of the incisor-torquing
auxiliary may tip the molars buccally. The palatal force of the torquing
auxiliary against the maxillary central incisor roots produces a reciprocal
intrusive force on the arch wire at the lateral incisor and canine brackets
(Fig. 17, A). This intrusive force is transmitted to’ the buccal surfaces of the
premolars and molars through the premolar brackets and molar tubes. Strong
palatal incisor root-torquing force exerted over an extended period of time
thereby causes the premolars and molars to intrude and tip buccally. To com-
pensate for this undesirable side effect, the posterior section of the base arch
wire is constricted, the amount of constriction depending on the size of the
base arch wire as well as on the anticipated duration and extent of incisor
torque needed (Fig. 17, E) .
An average constriction of the arch wire would bring the molar portion of
the base arch wire to lie on the tips of the lingual cusps of the molars when
the arch wire is held over the occlusal aspect of the dental arch to determine
arch form. Care should be taken that this compensating constriction of the base
arch wire in the molar area does not result in either expansion or constriction
of the canines when the arch wire is placed in the molar tubes. Molar
Fig. 17. Adjustments of maxillary Stage III arch wire. A, Forces exerted by uprighting
and torquing auxiliaries which tend to distort the occlusal plane of the base arch wire.
B, Incisor spacing caused by the reciprocal action of uprighting springs and torquing
auxiliary, resulting from failure to ligate the intermaxillary elastic rings to the canine
brackets during Stage III. C, Occlusal bend in arch wire mesial to the molar tube to main-
tain correct vertical molar-premolar relation. The mandibular molar buccal tubes have
been located as far gingivally as possible in order to minimize arch wire distortion by
forces of mastication. Vertical step-up bends may be required mesial to the molars
when the second premolars are engaged in order to maintain the marginal ridges of
the molars and premolars at the same occlusal level.

intrusion, if it occurs, may be controlled by the use of vertical elastics between

the maxillary and mandibular molars.
Cinching back the ends of the arch wire tightly at the distal aspect of the
molar tubes is another cause of molar expansion as well as distobuccal molar
rotation during Stage 111. The tlistal movement. of the c a n i n e r o o t s a n d
lateral incisor roots during their upright,ing and the palatal movement of
the incisor roots during toryuing result in a forward movement of the crowns
of all the maxillary t&h in Stage IIl. If the arch wire is cinched back, this
mesial force transmitted to the distobuccal aspect of the molars may tip these
teeth buccally and rotate them tlistobuccally to an alarming degree unless
the required compensations are incorporated in the formation of the arch
wire. Experienced operators may cinch back the arch wire, thereby avoiding
the need for the ligation of lingual buttons to prevent the reopening of extraction
spaces as canine and premolar uprighting is effected. However, subtle but
critical adjustments of the hascx ilr(‘h wire arc required to maintain molar
 Vade mecum for Begg technique 505

Fig. 17, continued. Adjustments of maxillary Stage III arch wire. D, Slight V bends
distal to the canines have produced a gingival “bow” in the incisal area of the arch
wire. Unequal bends in the arch wire illustrated resulted in undesirable asymmetry
in the incisal area, which will produce unequal depressing forces on the left and right
incisors. E, Posterior portions of base arch wire constricted to compensate for expansion
effect of torquing auxiliary. Slight constriction should be incorporated in the canine area
to avoid expansion of the canines when the arch wire is placed in the molar tubes. F,
Passive position of base arch wire after incorporation of the bands to compensate for
distorting forces of auxiliaries (see Al.

control, and the novice is cautioned against this procedure until he has had
considerable experience with the technique.
After all adjustments have been made, the arch wire is seated in the
molar tubes and tied into the premolar brackets using 0.009 inch steel ligatures
instead of pins. If the arch wire is found to lie gingival to the incisor bracket
slots, it is ligated temporarily into one of the incisor brackets.
When ligating the arch wire into the bracket of a tooth which is to be
uprighted, one should always tie the ligature on the side toward which the
coronal end of the tooth is to be tipped; that is, canines and lateral incisors
should be ligated on the mesial side, second premolars on the distal side, etc.
(Fig. 18, A). Otherwise, the uprighting action of the springs would be impeded
by the “snubbing” effect of the ligature (Fig. 18, B and C). The twisted end
of the ligature should be formed at the mesial or distal aspect of the occlusal
end of the pin channel, then cut short enough that it can be tucked gingivally
snug against the mesial or distal side of the bracket to avoid lip irritation.
Incisor-torquing auxiliary. While several designs of torquing auxiliaries are
available, the simplest one and the one most frequently used employs two
F i g . 18. A r c h w i r e l i g a t i o n p r i o r t o p l a c e m e n t o f u p r i g h t i n g s p r i n g s . A, L i g a t i o n o f t h e
base arch wire should be made on the side toward which the crown is to be tipped (shown
by arrow]. The ligature will become looser as the tooth uprights. B, Incorrect ligation of
arch wire for a tooth that is to be uprighted in the direction shown by arrow. The ligature
will tighten as the tooth uprights, which will prevent or impair the uprighting action. C,
Canine and lateral incisor uprighting has progressed satisfactorily, but uprighting of the
s e c o n d p r e m o l a r w a s i m p e d e d . T h e p r e m o l a r was ligated on the mesial side instead of
on the distal side. Consequently, the ligature became tighter as the root tipped
mesially and uprighting could not proceed. D, Diagram of Stage III assembly with
torquing auxiliary for central incisors. E, Auxiliary for palatal root torque of maxillary
central and lateral incisors has been pinned into the central incisor brackets. Because
the right central incisor was rotated distolingually prior to treatment, the bracket has
been placed to the distal of the center of the crown to enhance overcorrection of the
rotation. However, this eccentric bracket location causes the torquing loop to contact the
right central incisor crown too far to the distal of its center. The distal arms of the
auxiliary should lie directly above the canine brackets, exerting neither expansion nor
constriction force on the canines when ligated into the brackets. F, Auxiliary used to
torque both central and lateral incisors.
 Vade mecum for Begg technique 507

Fig. 18, E and F. For legend, see opposite page.

loops, each exerting a force in a palatal direction against the center of the
gingival third of the central incisor crown (Fig. 18, D). The incisor roots
are thus moved palatally, with the fulcrum at the point of contact of the base
arch wire with the bracket.
Formation of central incisor-torquing azcxilia,ry. To form the torquing
auxiliary, a straight length of 0.016 inch wire is placed in the brackets of the
maxillary left canine and the lateral and central incisors, the end of the
wire being midway between the canine and premolar brackets.
A mark is made on the wire 2 mm. distal to the bracket of the left central
incisor with a sharp marking pencil, and a gingival bend of approximately
45 degrees is made. This bend will become the distal leg of the torquing loop
for the left central incisor. The loop is completed in such a manner that its
end contacts the center of the labial surface of the central incisor about 2 mm.
from the gingival margin.
The partially formed auxiliary is placed in the left central incisor bracket
with the mesial leg of the loop against the distal side of the bracket. The wire
is marked at the distal aspect of the right central incisor bracket and a
gingival bend of approximately 135 degrees is made toward the mesial side.
The latter will be the mesial leg of the torquing loop for the right central incisor.
The operator now completes the loop, being careful to make it in the same
plane labiolingually, at the same angle mesiodistally, and of exactly the same
length as the torquing loop previously formed for the left central incisor.
The auxiliary is placed in the six anterior brackets. The loops should
contact the center of each central incisor, 2 to 3 mm. incisally from the gingival
margin. The wire is marked and cut midway between the right canine and
premolar brackets.
Fig. 19. Asymmetrical torquing auxiliaries. A, A u x i l i a r y u s e d t o p r o d u c e palatal r o o t
torque of the maxillary right central and lateral incisors. The ends of the auxiliary are
terminated distal to the canine brackets. Because the central incisor loop is formed
mesial to the bracket and the lateral incisor loop is formed distal to the bracket, mesio-
distal movement of the auxiliary is prevented. B, Auxiliary used to produce buccal root
torque and palatal crown torque of the maxillary left second premolar. To prevent
mesiodistal movement of the auxiliary, a loop stop has been incorporated at the mesial
aspect of the molar tube, and the end of the auxiliary is cinched back at the distal end
of the tube. The opposite end of the auxiliary is terminated distal to the right canine
bracket.

Holding the auxiliary with the light-wire pliers at the bottom of tho
distal leg of the left loop, the loops facing toward him ;It an angle of approxi-
mately 30 degrees from the horizontal. the operator bends the lrft end of the
wire toward himself slightly.
The operator now holds the bottom of the distal leg of the right loop at)
exactly the same angle and bends the right end of the wire tht same amount
as the distal leg of the left loop, Thrsc two bends establish the plmc of the
horizontal portion of the auxiliary relative to the loops.
Keeping the loops at the same angle (approximately 30 dcgrccs) t o
the horizontal, one holds the wire with the pliers ant1 c o n t o u r s e a c h e n d
of the auxiliary distal to the loops in the horizontal plant until it is shaped to
a somewhat smaller arc than that of the base arch wire. This smaller arc
is necessary because of the fact that when the auxiliary is seated in the central
incisor brackets, the portions which arc to br: seated in the lateral incisor and
canine brackets are displaced labially as the loops contact t,he necks of the
central incisors. The arc should be shaped in such a manner that, when the
auxiliary is pinned into the central incisor brackets, t,hc free ends lie gingival
to, but neither labial nor lingual to, thr opcilin,v of the lateral incisor and
ca.nine bracket slots.
The torquing auxiliary and the base arch wire are pinned into the central
incisor brackets, with the auxiliary lying gingival to the base arch (Fig. 18, E) .
The distal ends of the auxiliary are ligated into the lateral incisor and canine
brackets, with the ligatures tied on the mesial a.spect of the brackets. The
intermaxillary rings are ligated lightly to the canine brackets ; otherwise, spacing
of the anterior teeth may occur as a result of the various forces active during
Stage III.
 Vnde rnecun~ for Begg technique 509

Fig. 20. Reciprocal torquing auxiliary to produce simultaneous palatal root torque of
the central incisors and labial root torque of the lateral incisors. The lateral-incisor-
torquing arms are adjusted to avoid contact with the labial aspect of the base arch wire.

In most instances the above-described torquing auxiliary acting only on the

central incisors is sufficient. However, if torquing of the lateral incisors is
required also, an auxiliary with a loop for each of the four incisors is made
in a similar manner, with the distal ends engaged in the canine brackets and
terminated midway between the canine and premolar brackets (Fig. 18, P).
Torquing loops for the lateral incisors should contact these teeth at or slightly
mesial to the centers of their crowns. Contact of the loops on the distal surfaces
or on the distal aspect of the labial surfaces may impede distal root tipping
by the uprighting springs.
Occasionally, a.n asymmetrical torquing auxiliary is indicated, as shown
in Fig. 19, A, for palatal root torque only to the maxillary right central and
lateral incisors. An auxiliary can be used also to correct the buccolingual axial
inclination of a premolar (Fig. 19, B) .
At the end of Stage III the maxillary lateral incisors frequently exhibit an
excessive labial axial inclination and palpation of the alveolar process reveals
a depression instead of the usual contour labial to the roots of these teeth. In
this instance labial root torque of the lateral incisors in addition to palatal
root torque of the central incisors is therefore required. A reciprocal torquing
auxiliary (Fig. 20) to accomplish these simultaneous tooth movements was
first described by Sain.” Because considerable reciprocal forces arc produced
when it is engaged in the incisor bracket slots, 0.014 inch wire instead of 0.016
inch wire may be used to form this auxiliary. Its activation does not produce
significant vertical force components; therefore, little extrusion of the incisors
is experienced as torquing occurs.
Uprighting springs. Springs made of 0.014 inch wire are used for uprighting
canines and premolars while springs made of 0.012 inch wire are often used for
uprighting incisors.
Uprighting springs are placed in the pin channels of the brackets. The
helix should wind in a lingual direction (that is, toward the tooth surface)
and lie on the gingival aspect of the arch wire at the opening of the bracket
slot. The length of the hook is made slightly greater than the diameter of
 .l ii!. .I. Odhod.
Iln1, 1 n7.7

Fig. 21. Action of short-arm and long-arm uprighting springs, A, The hooks of short-arm
uprighting springs will slide along the arch wire and approach each other as the teeth
u p r i g h t . 8, I f l o n g - a r m u p r i g h t i n g s p r i n g s a r e u s e d , t h e a r m s o f t h e p r e m o l a r a n d
canine springs cross each other. As the teeth upright, the hooks slide along the arch
wire and approach the adjacent brackets. The occlusal legs of long-arm uprighting springs
should be bent over as they protrude from the pin channel to prevent dislodging of the
spring. The ends of bent-over legs should be turned in toward the tooth to prevent lip
irritation.

the helix to keep the arm of the spring parallel to the arch wire in the
vertical plane. To avoid a rotating force on the tooth, tht arm of t,he spring
is offset buccally to make it parallel to the arch wire in the horizontal plane
(Fig. 18, A).
To place an uprighting spring in the premolar bracket, tht stem of the spring
is inserted into the gingiva.1 opening of the pin channel ant1 the hook is graspecl
with the tips of ligature cutting pliers and engaged over the occlusal aspcet of the
arch wire mcsial to the second premolar bracket, with the short, leg of the
hook toward the lingual. Tn placing the spring, care should be taken not to
distort, or reduce the action of the helix.
The uprighting springs for canines antI lateral incisors are placed in the
same ma.nner as uprighting springs for premolars, but the arms are hooked over
the arch wire distal to the respective brackets.
Arms of uprighting springs must hc s h o r t enough t,o lcavc a t l e a s t 2
mm. between the hooks of the cnninc and premolar springs after placement.
When the teeth upright, the hooks will move along the ilrclr wire, the premolar
spring hooks moving mesiallv a71il the canine spring hooks moving distally
(Fig. 21, 11). If these hooks come in contact, the spring force will open the
extraction space and the uprighting action of the auxiliary will be impaired. For
the same reason, sufficient clcarancc must bc provided b&wren t h e h o o k s of
t,hc lateral-incisor-uprighting springs and the intermaxillary elastic rings to
permit distal tra,vcl of the hooks on the arch wire as the lateral incisors are
uprighted.
Occasionally, when the mesiodistal ( d r o w n diameters of canines and premolar%
arc small, it is not possible to place the short-arm type of uprighting springs
without the hooks contacting each other. In such instances uprighting springs
with long arms are used, the arms crossing over each other so t,hat, the hook of
Fig. 22. Extrusion of the mandibular right lateral incisor resulting from loss of the
ligature (or failure to place the ligature). The position of the hook when disengaged
indicates nearly complete expenditure of energy in the helix associated with the extru-
sion of the tooth.
Fig. 23. The presence of large rings mesial to the mandibular canines leaves little room
for the placement and action of the lateral-incisor-uprighting springs. Insufficient space
existing between the uprighting spring hooks and the rings necessitated uprighting
springs with excessively short arms, activation of which has resulted in distortion of the
springs.

the canine spring is located on the arch wire just‘ distal to the hook of the
premolar spring (Fig. 21, B). Sufficient distance must exist between the
hooks and the brackets to prevent contact by the hook of the canine spring with
the premolar bracket or band and to avoid contact with the canine bracket
or band by the hook of the premolar spring as the teeth upright. The horizontal
arms may need to be shortened as uprighting occurs to prevent space opening,
tooth rotation, and impairment of the uprighting action which may result
from contact of the hooks with the adjacent brackets or bands.
The degree of activation of the uprighting springs depends on (1) the
size of the wire from which the springs are made, (2) the diameter of the helix,
(3) the number of turns in the helix, (4) the length of the arm of the spring,
and (5) the size of the root of the tooth being uprighted.
Whenever an uprighting spring is used, the base arch wire must always be
ligated into the bracket; otherwise, considerable extrusion of the tooth will
occur if the arch wire slips out of the bracket box from under the helix of the
uprighting spring (Fig. 22).
Mand~ibuluar base arck wire. The 0.018 inch mandibular arch wire is made
in an ideal arch form. However, because the greater strength of the 0.018 inch
wire requires less compensation for the lingual component of Class II elastic
force, about 3 mm. of expansion is used on each side. For the same reason, the
anchorage bends are decreased in order to avoid tipping the molars distally.
The rings are formed about 0.5 mm. mesial to the canine brackets. The
end step of a pair of Tweed loop-forming pliers is used to form rings with
a small diameter (Fig. 14). Small rings occupy less arch wire space between the
mandibular canines and lateral incisors, thereby providing more space for the
horizontal arms of the lateral-incisor-uprighting springs which will be used
during Stage III (Fig. 23).
512 Cadman

As in the maxillary base arch wire, a slight, V hd is made distal to the

canines to compensate for the distorting a&ion of the caninc- and premolar-up-
righting springs, Since a torquing auxiliary is not used on the lower central
incisors, the resulting gingival “how” of the arc11 wire in t,tic incisor arca is
flattened to avoid a relative depression of the central incisors.
The arch wire is placed in the molar tuhcs, pinned int,o the central incisor
brackets, and ligated into the brackets of the premolars (at the distal aspect),
canines (at the mesial aspect), and lateral incisors (at the mesial aspect), as
was done in the maxillary arch. The intermaxillary rings are ligated to the
canine brackets.
Uprighting springs are placed in the brackets of the premolars, canines,
and lateral incisors in the same manner as in the maxillary arch.
This completes the construction and initial adjustment of the Stage III
arch wires and auxiliaries, Because of the distal pressure of the uprighting
springs on the roots of the canines and lateral incisors, and also because of
the lingual pressure of the torquing auxiliary on the roots of the maxillary
. .
nicisors, anterior overbite and/or overjet usually reappear during Stage
III if Class II elastics are not worn. However, the amount and duration of
Class II elastic traction required to maintain overcorrection of the overbite
a’nd overjet vary among patients. For this reason, the patient is instructed
to examine the incisor teeth daily and t,o use Class TI elastics as much as
necessary to maintain the end-to-end incisor relation.
(This article will be concluded in the June kme. Referewes for the entire
article will appear at that time.)