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 Table of Contents  
CASE REPORT
Year : 2019  |  Volume : 53  |  Issue : 1  |  Page : 57-61

Begg's Revisited: Report of a Case


1 Prof., Department of Orthodontics and Dentofacial Orthopaedics, AECS Maaruti College of Dental Science and Research Centre, Bengaluru, Karnataka, India
2 Private Practitioner, Department of Orthodontics and Dentofacial Orthopaedics, AECS Maaruti College of Dental Science and Research Centre, Bengaluru, Karnataka, India
3 Assoc Prof., Department of Orthodontics and Dentofacial Orthopaedics, AECS Maaruti College of Dental Science and Research Centre, Bengaluru, Karnataka, India
4 Senior Lecturer, Department of Orthodontics and Dentofacial Orthopaedics, AECS Maaruti College of Dental Science and Research Centre, Bengaluru, Karnataka, India

Date of Submission12-Apr-2018
Date of Acceptance02-Nov-2018
Date of Web Publication04-Feb-2019

Correspondence Address:
Dr. Sougenia G Murthy
Department of Orthodontics and Dentofacial Orthopaedics, AECS Maaruti College of Dental Science and Research Centre, Bengaluru - 560 076, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jios.jios_71_18

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  Abstract 


Begg's technique is based on a unique approach to treat the orthodontic cases by using light forces with the objective of moving the teeth with optimal forces. The foremost etiology of skeletal Class III malocclusion being a genetic inheritance, here we report a case of a female patient, 12 years and 6 months of age who visited to our department with a chief complaint of the highly placed upper right front tooth. The preliminary analysis was performed and diagnosed with Angle's Class I malocclusion with a skeletal Class III. Begg's appliance (TP) was opted for proclination of teeth and followed by placing of 0.013 copper-nickel-titanium archwires in upper and lower arch. 0.016 AJ Wilcock reverse curve of Spee were placed in upper and lower arches subsequently. Proclination of the upper anterior teeth due to uncontrolled tipping significantly improved the facial profile, improvement in upper anterior crossbite with adequate overjet and overbite were obtained.

Keywords: Beggor appliance, copper-nickel titanium arch wires, inheritance, malocclusion, skeletal Class III


How to cite this article:
Laxmikanth S M, Murthy SG, Shetty S, Kar AM. Begg's Revisited: Report of a Case. J Indian Orthod Soc 2019;53:57-61

How to cite this URL:
Laxmikanth S M, Murthy SG, Shetty S, Kar AM. Begg's Revisited: Report of a Case. J Indian Orthod Soc [serial online] 2019 [cited 2019 Apr 26];53:57-61. Available from: http://www.jios.in/text.asp?2019/53/1/57/251556




  Introduction Top


The teeth alignment and leveling comprise the preliminary clinical phase of any orthodontic procedure with fixed appliances.[1] It has been an established principle in orthodontics that light and continuous forces are desirable, physiologic, and controlled tooth movement can be achieved.[2],[3],[4] The Begg's appliance, first introduced by Raymond Begg in 1956, offers light forces, unipoint contact between bracket and archwire, thereby eliminating friction and binding. The copper-nickel-titanium (Cu-NiTi) archwire has lower modules of elasticity as they would show similar deformations, before lower activation loadings, presenting a high capacity to fit brackets of misplaced teeth, with less discomfort to the patient and lower possibility to create root resorption.[5] For this purpose, it has been suggested the super-elastic archwires which offer force-bending curve with a defined baseline and a larger activation range can be incorporated. The objective of the case report is to obtain a stable dental articulation, good esthetics, and skeletal harmony using a combination of Begg's brackets and Cu-NiTi archwires.


  Case Report Top


A female patient 12 years and 6 months of age visited the outpatient of our department with a chief compliant of the highly placed upper right front tooth. The preliminary analysis was performed. Pre-treatment extra-oral [Figure 1] and intra-oral photographs were taken [Figure 2]. It was noticed she presented with a symmetrical concave profile. Cephalometric analysis showed a skeletal Class III jaw base relationship (ANB-3°) with a retrognathic maxilla with average mandible, horizontal mandibular plane angle. On clinical examination, both canine and molar were Class I on both sides with cross bite in the upper anterior region, overjet of −1 mm and overbite of about −1.5 mm [Figure 2]. On model analysis, the arch discrepancy was 8 mm in the maxilla and 0 mm in the mandible.
Figure 1: Pre-treatment extraoral photograph of the patient

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Figure 2: Pre-treatment intraoral photograph of the patient

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The patient was diagnosed to have Angle's Class I malocclusion with a skeletal class III jaw base relationship, buccally placed upper right canine, crossbite in relation to upper anterior region, retruded upper and protruded lower lip [Figure 3] and [Figure 4]. Treatment objectives were to correct buccally placed upper right canine, crossbite in the upper anterior region, rotation in mandibular second premolar (35), obtain a good facial profile, and achieve acceptable functional occlusion.
Figure 3: Pre-treatment orthopantomogram

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Figure 4: Pre-treatment Cephalogram

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With the above obtained detailed analysis of the patient's profile, the planned treatment for this patient was decided as nonextraction with Begg's appliance. The idea was to use the unipoint contact and light force, with Cu-NiTi archwires to achieve expansion and to correct buccally placed canine. It has to be noted and taken into consideration that other treatment modalities such as growth modulation, camouflage, and surgery [Table 1]. The face mask was optimal still 5%–10% of growth was remaining and surgery was not planned due to lack of patient's compliance.
Table 1: Flow chart showing the treatment alternatives

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Treatment progress

Begg's appliance (TP) was used, and 0.013 Cu-NiTi archwires in upper and lower arches were placed [Figure 5]. Posterior bite blocks were placed on upper and lower first and second molars to disocclude the occlusion, the lingual button was bonded on 33, 35 and couple was generated using E chain to de-rotate second premolar (35) [Figure 6].
Figure 5: Upper and lower bonding and banding and 0.013 copper-nickel-titanium arch Wires placed

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Figure 6: Lingual button bonded on 33 and 35 and couple was generated using E-chain to De-rotate 35

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After a month, highly placed canine was leveled and aligned. 0.016” Heat activated NiTi with the reverse curve of Spee (RCS) was placed for a month. During the following month, 0.016” AJ Wilcock with RCS was placed to allow proclination of the upper anterior teeth to achieve an edge-to-edge bite [Figure 7]. 0.016” AJ Wilcock wire was placed in upper arch with stopper placed mesial to first molar and 4 mm excess wire in the anterior region to allow further proclination of the teeth to achieve the desired overjet [Figure 8]. Overjet of 1.5 mm was observed after a month and mild spacing was seen in the upper anterior region. Consolidation using ligature wire (0.010") was done in the upper anterior region.
Figure 7: 0.016 AJ Wilcock with reverse curve of Spee placed in upper arch

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Figure 8: 0.016 AJ Wilcock wire with stopper placed mesial to molar and 4 mm excess wire in the anterior region was placed in the upper arch

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Treatment results

Proclined upper anterior teeth significantly improved the facial profile, class I canine and molar relationship were maintained, and ideal intercuspation of the teeth was achieved. The upper anterior cross bite was correct with adequate overjet and overbite. Root parallelism was maintained. Cephalometric superimposing showed the proclination of upper anterior, decreased the interincisal angle, and mandibular plane angle [Figure 9] and [Table 2]. Post treatment intraoral and extraoral photographs were taken as a follow-up record [Figure 10], [Figure 11], [Figure 12].
Figure 9: Image showing cephalometric superimposition

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Table 2: The comparison of cephalometric analysis interpretations pretreatment and posttreatment

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Figure 10: (a) Post-treatment intraoral photograph of the patient. (b) Post-treatment extraoral photograph of the patient

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Figure 11: Post-treatment orthopantomogram

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Figure 12: Post-treatment Cephalogram

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  Discussion Top


The present article is a case report of 12 years 6 months old female with skeletal Class III pattern is treated by camouflage approach. Orthodontic camouflage is a practicable alternative for the treatment of the mild-to-moderate skeletal discrepancies of the maxillary structures with the aim of correcting the occlusal relationships in patients who prefer not to be treated surgically for variable acceptable reasons such as patient's compliance and feasibility.[6],[7] The treatment options included the use of Class III elastics, facemask, interproximal reduction, and extractions. Patient's noncompliance with the use of elastics and facemask and refusal to undergo extraction. Thus opted the use of alternative methods.

Advantages of Begg's appliance system includes light forces so that the position of the molars is not affected because of which anchorage conservation is easier, the treatment results are usually rapid, movement of all teeth towards and beyond their desired final position is initiated at the start of treatment so that finally the overcorrected position of the teeth to compensate for the relapse is achieved.

Shortcomings in Begg's technique include distortion of light archwires by the mastication of tough foods or by biting on hard objects results in malformation of the appliance.

Begg's appliance has similar advantages as that of a passive self-ligating system. Use of Begg's technique allowed a larger range of tipping movement of teeth which was significant but limited skeletal changes were seen. Vertical loops were made in 0.016” AJ Wilcock archwire and kept compressed against mesial ends of molar tubes resulted in proclined incisors. Thus, overjet was achieved.

Cu-NiTi is a quaternary alloy, which has a distinct advantage over the formerly available NiTi alloys. Even small or minimal activations will generate a near constant force. It is more resistant to permanent deformation and exhibits excellent spring back distinctiveness. Due to the lower hysteresis of Cu-NiTi, the loading forces are smaller than their NiTi counterparts, making wire engagement in the bracket slot easier.[7]

The clinical applications of Cu-NiTi archwires are owing to its light and continuous forces, more resistance to permanent deformation, fast and efficient tooth movement, and easy to engage.

Merits of treatment results: Well-aligned teeth, achieved normal overjet, and overbite. Demerits: Proclined upper incisors achieved.


  Conclusion Top


The skeletal Class III with anterior crossbite was successfully treated by nonextraction. This noninvasive approach was a feasible option for the patient. Each individual should be treated based on his or her own personal expectation, combined with the orthodontist professional advice. In an era of newer or expensive bracket system and appliance, the simple and almost extinct Begg's brackets combined with newer arch wires can also give us equal good, if not better results in treating patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Evans TJ, Durning P. Orthodontic products update. Aligning arch wires. The shape of things to come? A fourth and fifth phase of force delivery. Br J Orthod 1996;114:269-75.  Back to cited text no. 1
    
2.
Cobb NW 3rd, Kula KS, Phillips C, Proffit WR. Efficiency of multi-strand steel, superelastic Ni-Ti and ion-implanted Ni-Ti archwires for initial alignment. Clin Orthod Res 1998;1:12-9.  Back to cited text no. 2
    
3.
Dalstra M, Melsen B. Does the transition temperature of Cu-NiTi archwires affect the amount of tooth movement during alignment? Orthod Craniofac Res 2004;7:21-5.  Back to cited text no. 3
    
4.
Gravina MA, Quintao CA, Koo D, Elias CN. Mechanical properties of nickel titanium and steel alloys under stress – Strain test. Korean J Orthod 2003;33:465-74.  Back to cited text no. 4
    
5.
Sachdeva R. Sure-smile: Technology-driven solution for orthodontics. Tex Dent J 2002;119:608-15.  Back to cited text no. 5
    
6.
Pattanaik S, Mohammad N, Parida S, Sahoo SN. Treatment modalities for skeletal class III malocclusion: Early to late treatment. IJSS Case Rep Rev 2016;2:8.  Back to cited text no. 6
    
7.
Bhandari P, Anbuselvan GJ. Nonsurgical management of class III malocclusion: A case report. J Indian Acad Dent Spec Res 2014;1:35-8.  Back to cited text no. 7
  [Full text]  


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
 
 
    Tables

  [Table 1], [Table 2]



 

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