BEDDTIOT

BEGGS - EDGEWISE
DIAGNOSIS DETERMINED
TOTALLY
INDIVIDUALISED ORTHODONTIC
TECHNIQUE

Dr Ashwith.B.Hegde

Richard.A.Hocevar, D.M.D
Dunedin, New Zealand

Why

Edgewise ?

( Hocevar AJO, Vol 80, number 3, Sept 1981 )

Adaptations to increase the working range and

reduce the force levels in arch wires
Ribbon or square rather than Edgewise wires

Brackets with smaller , e.g 0.018 inch arch wire

slots not recommended .

Narrow (1.3 mm) single brackets to increase the

span of wire between brackets .

Sectional arch wires and auxillaries

Elastics, elastomeric threads and ligatures.

Orthodontic force systems: Individualized

treatment with open-minded "Begg" technique
- Hocevar, AJO-DO 1982 Apr (277-291)

A "COOKBOOK" procedure in which all cases are

treated alike.
Force of the anchor bends is not normally sufficient
for upper incisors - movement is mainly simple
tipping.
Unbalanced force of the anchor bends may tip the
maxillary molar crowns distally.

 Control of the directions and types of tooth

movement is seriously limited .
Auxiliaries that control root movement cannot be
employed in the early stages of the technique

Suggested

Check Elastics - anchorage control , bite opening

Passive Torquing and Uprighting springs

The Appliance.
The intent was to incorporate the important
advantages, features, and capabilities of many
fixed appliances and minimize deficiencies,
making the most of current understanding of
orthodontic biomechanics and technology .
-Hocevar (July 1985, AJO-DO)

Beddtiot appliance
Edgewise appliance

- control and precision (having full

torque and angulation built in)

Beggs appliance -

anchorage conservation and rapid tooth

movement (of the ''light-wire differential force" approach to
biomechanics) by means of attachments that are versatile, simple,
economical, and small.

Beddtiot Philosophy

Begg principles are employed in some cases; various

edgewise techniques in others. A wide variety of
combinations may be employed easily.
Treatment is individualized.

FOUNDATIONS
Light wire
Gentle long range force systems - for
fast , efficient and major movements
of the crown and root
Minimum bracket size - maximum
interbracket arch wire span
Light , undersized wires
free play in the brackets
Extensive use of elastomeric
ligatures and elastics

Low force
levels over
great elastic
ranges

Light auxiliary round wires.- for alignment of the individual

teeth
Heavy rectangular base arch wires - Anchor teeth stability and
arch integrity.

Differential response to force

Principle Of Lever

If the total force is limited to a level that will cause

just enough strain in the crestal region to trigger
rapid movement there, the strain in the apical region
will be insufficient to cause much movement there.
The movement of the crown in the direction of the
force should be considerably greater than the
opposite movement of the apex.

Differential response to force

Translatory movement strain distribution has to

be even throughout the supporting structures of the
tooth or teeth
Requires considerably heavy force
Anchorage conservation is made difficult

Tipping movement additional time required

for to move the apical portion of the roots.
Translatory movement is faster, simpler and
more efficient if adequate anchorage is
available.

Beddtiot

Rx TIME - BEDDTIOT faster than BEGGS ?

Uncontrolled Tipping

BRACKETS

Brackets are narrow, single-width edgewise brackets

with 0.022 inch (height) 0.028 inch (faciolingual
depth) horizontal arch wire slots. On the lingual side of
the bracket is a 0.020 0.020 inch vertical slot.

The arch wire slots are ''torqued" (cut at such angles to

the brackets that they will be oriented parallel to the
plane of the arch when the teeth are positioned
properly)

Except for torque, the brackets are all

identical.Therefore, they are interchangeable; any
bracket may be used on any tooth.
Placed with its torque-indicator groove gingival, a
bracket provides lingual root torque; with the
groove occlusal, it provides lingual crown torque.

 Brackets- prewelded on both flat and curved

universal bonding pads - provides maximum
versatility.
The pads are of minimal size, and their shape
facilitates the placement of the brackets with
either end toward the gingiva - may be used for
either lingual crown or root torque.

 The brackets are milled from solid bars of

stainless steel.
. The brackets are small in all dimensions to
ensure optimal appearance and minimal lip
and cheek irritation
This also lessens occlusal interference, enamel
surface involved in bonding, and problems with
gingival proximity and oral hygiene.

A. Twin brackets

- Acute bends are required

- Can distort the wire
B. Narrow brackets - Wire is deformation much less
- Force level is much more gentle,
- Degree of deflection is more likely
to be within the elastic range of
the wire

Arch wire slot allow considerable (but limited)

mesiodistal tipping on undersized wires (on 0.016
inch, the usual working wire), as well as limited
uprighting on heavier guage wires(0.018-inch arch
wire)

Original Uprighting spring - Helix is farther from

the arch wire,
- Hook arm is slightly longer

Modified Uprighting spring

- Less bulk.
- More hygienic,
- Less likely to impinge
upon or irritate the gingiva,
- Less conspicuous in
appearance

Buccal Tubes
- 4.5 mm long, 0.022 0.028 inch "edgewise"tubes
- 25 lingual crown torque for lower
- 10 for upper first molars
- Distal end of the maxillary tube is angulated
outward 10 from the welding flanges to maintain
the proper rotation ("toe-in")

Deepbites or moderate-to-severe anchorage requirement

cases
An additional rectangular tube is carried diagonally
across the buccal surface of the basic tube, its mesial end
pointing gingivally

Outer tubeIt carries the main (working) arch wires during the biteopening and retraction phases of treatment
Inner tube carry heavy rectangular sectional wires to
lock molar and premolar teeth together( prevents tipping,
anchorage control)

Correction of Rotations
Mild corrections - offset the bracket slightly toward
the side of the tooth that is displaced lingually. Simple
engagement of the bracket on the arch wire with a
small elastomeric ligature will correct the rotation.
Moderate to Severe corrections
-gentle ligature or elastomeric thread may be
used to tie the bracket to the arch wire.
- Bayonet bends may also be used

Torque control with brackets and arch wires

- Edgewise wires required for precise control in the larger
(0.022 0.028 inch) brackets were too rigid.
- Lighter forces obtained by using more resilient rectangular
wires bent as Ribbon arch wires or Square arch wires
- Easier for the operator to work with than the heavier
edgewise wires.
- In most instances the lighter ribbon wires are
preferable to square ones.

0.022 0.016 inch ribbon arch is only one third as

forceful as a 0.022 0.028 inch edgewise wire;
yet it can provide the same precise control in
the same "edgewise" bracket

CASE REPORTS

- 20-year-old woman
- Class II, Division 1
- 8 mm overjet
- 50% overbite,
- well-aligned
mandibular dentition,
- lower incisors were
ideally positioned
First patient to undergo BEDDTIOT treatment ,
appliances placed in March 1978

- Extraction of upper I premolars

- Double buccal tubes were placed on maxillary molars
to accommodate molar-premolar sectional wires.
- Initial maxillary arch wire - 0.014 inch round,
- Initial mandibular wire - 0.018 inch arch with
a gentle bite-opening curve
- Class II elastics delivering 2 oz of force
per side full time.

7 WEEKS INTO TREATMENT

- 0.018 inch round maxillary arch

wire placed
- Class II elastics continued
- Class I max elastics started
after 2 months

6 MONTHS INTO TREATMENT

- Overjet and Overbite fully reduced

- Torquing auxillary and Uprighting
spring on max laterals and canine
for protraction of max posteriors
and closure of remaining spaces

AFTER DEBONDING ( 14 MONTHS )

Appliance removed prior

to proper finishing and
detailing because of
patient non -compliance

-14 year-old girl

- severe Class II, Division 1
- 13 mm overjet
- proclined U/L incisors,
- moderate crowding of
the lower incisors,
- Deepbite, with mand
incisors impinging palate

Treatment Plan
- Extraction of Max I premolars for correction of max
proclination
- Extraction of Mand lateral incisors for correction
of lower crowding

Treatment started with

- 0.016 inch maxillary and
- 0.012 inch mandibular SS wires ( replaced to 0.016 SS
after 1 month)
- anchorage reinforced- rectangular maxillary molar
premolar sectional wires
- Lower canine to canine elastomeric thread
- Check elastics

AFTER 7 MONTHS INTO TREATMENT

- Extraction spaces almost closed

- Lower arch changed to

0.019 X 0.019inch SS for
control of axial inclination
- 0.021 X 0.025 inch Nitinol in
max arch for torquing
of incisor roots
- Check elastics continued

1 YEAR OF TREATMENT

Lower incisors torqued and later stabilized

with 0022 X 0.016 inch SS

18 MONTHS INTO TREATMENT

- 0,018 inch SS with uprighting springs

- Incisor root torquing auxillary
- Class II elastics

AFTER DEBONDING (2 YEARS)

- 16-year-old girl
- bidental protrusion,
-prominent nose and maxilla
-overjet was 4 mm
-occlusion Class I on the left ,
and unit Class II on the right

Treatment objectives
- Overjet reduction,
- correction to Class I occlusion on the right side,
- retraction of her incisors to reduce her protrusive
appearance
Treatment plan
-Extract all four first premolars
-Use minimum-moderate anchorage mechanics( i.e
space closure by reciprocal translation by heavy
forces after the alignment and occlusion were
corrected.)

- Brackets were selected and positioned to yield ideal

final torque and angulation,
- Single tubes were used on the first molars.
- Upper and lower 0.016 inch arch wires and a Class II
elastic of 3 oz on the right side.
- After 2 months changed to 0.018 inch SS, elastics
stopped

- 1 month later 0.021 0.016 inch ribbon arch wires

were placed with canine-to-canine elastomeric chains
and heavy elastomeric threads tied from canine to
molar in each quadrant.
- elastomeric threads
and chains changed
approximately
every 6 weeks.

DEBONDED AFTER 12 MONTHS OF TREATMENT

These cases illustrate the ease and speed of

treatment, anchorage control, and versatility of
BEDDTIOT.
They demonstrate the importance of having an
appliance that facilitates both (1) tipping teeth with
light forces and (2) full, precise three-dimensional
control on the teeth.

 BEDDTIOT was designed to facilitate application of

the best modality in every situation, to handle any case,
whether it would be treated best with Begg-like
biomechanics or one of the many Edgewise approaches
- Hocevar