The Begg’s appliance —philosophy and technique, forgotton yet relevant

Introduction

The orthodontic approach pioneered by Dr. PR Begg in the mid-20th century introduced several innovative concepts. These included using light force levels, freedom from rigid three-dimensional control using ribbon or edgewise wires, tipping of teeth initially with use of light forces and round wires round wires and intraoral anchorage mechanics for more effective and faster tooth movement. Additionally, this approach facilitated major tipping movements and subsequently correct positioning of roots later using torquing auxiliaries and uprighting springs.

While there was a strong emphasis on precise three-dimensional control of tooth movement with conventional edgewise brackets and rectangular wires, often requiring extraoral anchorage, the Begg’s technique presented a new philosophy and a shift in thinking within orthodontic practice. Dr. Begg emphasised the freedom of tooth movement through tipping and introduced unique biomechanical principles and the application of differential forces. His approach marked a significant departure from the traditional Angle Era of orthodontics. A vital feature of the Begg’s appliance was its use of only round wires and auxiliary devices to achieve various tooth movements. ^,

Despite its historical significance, the Begg’s technique has diminished in popularity with the advent of contemporary pre-adjusted edgewise appliances and the discovery of newer wires. Nonetheless, the fundamental principles of the Begg’s technique continue to influence modern orthodontic practices.

Historical overview—contributions of Dr. PR begg

Dr. Percival Raymond Begg was born in 1898 in the small gold mining town of Coolgardie, Western Australia, and later grew up in South Australia. During childhood, he observed sketches of Australian Aborigines and noticed their worn, flat teeth, which sparked his curiosity about dental health. Motivated by this interest, he enrolled in the dental programme at the University of Melbourne, graduating in 1923 with a Bachelor of Dental Science (B.D.Sc) degree.

After graduation, he became acquainted with the work of Dr. Edward Angle, which prompted him to travel to Pasadena, California, in 1924 to study under Dr. Angle. At that time, Dr. Angle was still teaching the Ribbon Arch Appliance, a method he had introduced in 1916. During this period, Dr. Angle also developed the edgewise arch mechanism, which enhanced three-dimensional control in torque and allowed for easier wire placement compared to the Ribbon Arch Appliance.

In 1925 Dr. Begg returned to Australia and began practising orthodontics in Adelaide, South Australia. He was a lecturer in orthodontics at the University of Adelaide until 1964. In 1928, feeling dissatisfied with post-treatment profiles and facing issues with relapse, Dr. Begg began the reduction of tooth widths through mesiodistal stripping. Despite opposition from the Angle Society, he persevered in treating patients using the concept of attritional occlusion, which was based on the features of dentition in Aboriginal men.

In 1933, influenced by his exposure to SS White Ribbon arch brackets during his time with Dr. Angle, Dr. Begg began incorporating these brackets into his practice. After over 20 years of development, he introduced the Begg’s technique, which emphasised using light arch wires for universal tooth movement, ensuring optimal forces with minimal discomfort. This technique eliminated the need for extraoral appliances like headgear. In the early 1940s, Dr. Begg collaborated with Arthur J. Wilcock, who developed a cold-drawn, heat-treated wire with zero stress relaxation, further enhancing the advantages of the Begg’s technique.

Begg’s philosophy and the appliance

The basis of begg’s technique—the theory of attritional occlusion

Begg’s understanding of normal occlusion is based on the dentition of Stone Age humans, particularly illustrated by the Australian Aboriginal population. He defined normal occlusion as ‘anatomically correct occlusion’, which involves physiological tooth migration and wear on the proximal and occlusal surfaces of the teeth. Dr. Begg stated that attritional occlusion, characterised by wearing down tooth cusps and establishing an edge-to-edge bite among the incisors, represents anatomically correct occlusion. He believed that occlusion continually evolves throughout a person’s life.

In his 1939 doctoral thesis on the evolutionary reduction and degeneration of human jaws and teeth, Dr. Begg observed significant wear in the occlusal and proximal areas of dentition in Aboriginal people. He noted their remarkable lack of dental caries, periodontal disease and crowding.

Dr. Begg proposed that, before modern diets, human teeth experienced considerable proximal wear—an erosion of the surfaces between adjacent teeth caused by abrasive foods and the limited use of refined oral hygiene products. This wear on the proximal surfaces gradually reduced the size of the teeth in the mesiodistal dimension over time, contributing to a natural mesial and occlusal, lifelong migration of the teeth. This movement helped self-correct spacing and alignment issues. Begg observed that an attritional occlusion led to a stable and harmonious bite while decreasing crowding. This perspective formed a unique foundation for his treatment method, incorporating a biologically inspired approach to achieve and maintain proper occlusal relationships. He considered extracting first/second premolars to treat crowding and dental protrusion. ^,

The concept of differential forces and optimal orthodontic forces

In physics, differential means the difference between two or more motions or pressures. In 1956, Dr. Begg introduced the concept of differential orthodontic force. According to him, it is possible to discard excessive tooth moving forces and replace them with lighter and, therefore, more favourable forces by applying the principle of differential force.

When light forces are applied reciprocally between anterior teeth and molars with a Begg’s appliance using round wires, the anterior teeth tip relatively rapidly as the brackets allow free tipping of teeth in all directions and the molars remain almost stationary as the molar tubes prevent free mesiodistal tipping; however, an increased force level will be optimum for molar movement. Differential forces enable various tooth movements to be carried out simultaneously and more efficiently, with differential reactions generated at both ends. The types of tooth movements carried out simultaneously in the Begg’s technique are the alignment of crowded teeth, closing anterior spaces, closing extraction spaces, opening of a deep anterior overbite and posterior crossbite correction.

The best example of understanding the application of differential force to treatment is the simultaneous reduction of deep overbite and retraction of anterior teeth. The anchorage bends given on the 0.016 in. AJ Wilcock arch wires just mesial to the molar tubes intrude the anterior teeth that help correct deep overbite. These anchor bends also tip the anchor molars distally, thus preventing anchorage loss. The light class II elastic force is a differential force that helps correct deep overbite by extruding lower molars and retracting maxillary anterior teeth by palatal tipping simultaneously. Therefore, the forces used to correct deep overbite are helpful for the retraction of anterior teeth. Another example of differential force is the protraction of the posterior segments by applying braking auxiliaries during space closure in cases where anchorage loss is required.

Elimination of extraoral anchorage

A core component of the Begg’s technique is the application of light and continuous force. This gentle yet consistent force avoids excessive pressure that could cause trauma or discomfort, allowing the tooth to move gradually in response to the gentle, steady pressure. Heavy forces with rectangular wires and extraoral anchorage, commonly used with the edgewise appliances, are not required with the Begg with differential force technique and support of anchorage bends.

Tipping of crowns followed by root movements with auxiliaries

The Begg’s brackets have smaller mesiodistal widths and provide single-point contact with the round arch wires, allowing the tipping of crowns with light forces in the initial stages. Therefore, torquing auxiliaries and uprighting springs are needed to achieve correction of their labiolingual inclination and mesiodistal angulation in the last stage. ^, ^,

Components of begg’s appliance

1.
Brackets : Modified ribbon arch brackets with a 0.020 in. × 0.045 in. arch wire slot accommodates both 0.020 in. arch wires and, when needed, a 0.016 in. torquing auxiliary. Vertical slots accept lock pins and/or auxiliaries. These brackets allow 60 degrees of free tipping in the mesiodistal direction ( Fig. 52.1 ).
Figure 52.1

Components of Begg’s appliance.
- (A)
  Bondable Begg’s bracket.
- (B)
  Round buccal tube welded on a molar band.
- (C)
  Weldable lingual hook for molar band.
- (D)
  Weldable lingual cleat.
- (E)
  Bondable lingual button.
- (F)
  Completed Begg’s appliance setup on a typodont.
- (G)
  Guidelines for bracket placement.
- The brackets are placed in the centre of the tooth, viewed mesio-distally. Brackets with flat bases are used for the incisors and curved brackets on canines and premolars. The bracket slots should open towards the gingival side of the tooth. Measurements are taken from the bracket slot to the incisal edge or cusp tip. Dr. Begg recommended placement of the maxillary central incisor brackets and all other brackets at 4 mm and maxillary lateral incisors at 3.5 mm.
- (H)
  Guidelines for buccal tube placement.
- The molar buccal tubes are oriented parallel to the line bisecting the crown mesiodistally when viewed from the occlusal aspect. The tube placement is more gingival and closed to the cervical area of the molars. When viewed from the buccal aspect, the tubes must be oriented parallel to the occlusal surface. The mandibular buccal tubes are attached as far gingivally as possible to avoid arch wire distortion from the occlusal forces.
- (I)
  Flat-oval buccal tube and placement of double back arch wire for better buccolingual control in first molar extraction cases.
2.
Molar tubes : Round buccal tubes of 0.036 in. internal diameter and 0.250 in. wide are used to balance angular control on the molar and allow free sliding of arch wires. Flat-oval molar tubes are used on the second molars in cases of missing permanent first molars to have better buccolingual control ( Fig. 52.1 B).
3.
Lock pins : Lock pins hold the arch wires in the brackets. Safety lock pins made of brass or soft steel permit tipping and sliding of teeth, with dimensions providing rotational control and accepting arch wires of different sizes. Hook pins secure arch wires and torquing auxiliaries during the third stage ( Fig. 52.2 ).
Figure 52.2

The different types of lock pins used in the Begg’s technique.

(A) The lock pins are made of brass and hold the arch wires in the brackets.
- 1.
  The Stage 1 lock pin (one point safety lock pin) has a shoulder that ensures the head lies away from the bracket’s slot, allowing teeth to tip freely. The body of the lock pin reduces the arch wire slot to 0.016 in. for maximum rotational control during Stage 1.
- 2.
  The Stage 2 lock pin has a safety shoulder to prevent binding of the arch wire, and the body of the pin is reduced to open the bracket slot to accommodate 0.020 in. arch wire.
- 3.
  The Stage 3 lock pin (hook pin) design allows the entire pinhead to be inserted into the slot, thus restricting the teeth movement freedom to slide and tip. These are used on all teeth that do not require mesiodistal uprighting during Stage 3. These can be used along with the torquing auxiliaries.
- 4.
  The high hat lock pins are used when vertical elastics have to be worn.
- (B)
  Shows the placement of the lock pin in the bracket slot for holding the arch wire.
- a.
  Stage 1, b. Stage 2, c. Stage 3.
- (C)
  The bypass clamp before attachment to the premolar bracket. The clamp is positioned to hold the arch wire either high or low in relation to the bracket under the dictates of the clinical situation. Bypass clamps allow freedom to slide the arch wire in the buccal tube unrestricted by the friction of premolar pin/brackets.

Elastics : Latex elastics generate inter-arch forces during anterior bite opening not exceeding 2–2.5 Oz on each side. The colour-coded elastics used with the original Begg’s technique:

Intermaxillary elastics—2 Oz yellow elastics 5/16 in.,

3.5 Oz pink elastics 3/8 in.,

3.5 Oz red cross elastics 3/16 in.

Intramaxillary green elastics 5/16 in. 3.5 Oz at the beginning of stage 2,

Blue elastics 1/4 in. towards the end of Stage 2.

5.
Rotation spring : Springs made of 0.014 in. AJ Wilcock arch wire, with a 90-degree bent leg, efficiently rotate teeth, engaging the arch wire with a hook or bypass clamp during rotation ( Fig. 52.3 A).

Figure 52.3

Auxiliaries.

(A) Rotation spring—used during Stage 1. The spring is made of 0.014 in. Premium plus AJ Wilcock arch wire. The retentive vertical leg of the spring is inserted from the gingival side into the bracket, and the free end is bent towards the labial or buccal side of rotated tooth. The arm with the hook is engaged in the same direction. (B and C) Fabrication of four spurs palatal torquing auxiliary for the maxillary incisors. (D) Reverse/labial torquing auxiliary for the mandibular incisors. (E) Uprighting springs—clockwise and counter clockwise for correcting root angulation mesiodistally. (F) Spring-pin—a combination of lock pin and uprighting spring.
6.
Bypass clamp : Loose clamps connect the arch wire to bicuspid brackets during derotation in stage one and posterior space closure in stage two ( Fig. 52.2 C).
7.
Torquing auxiliaries : Designed to torque roots lingually or labially in stage 3, these auxiliaries use smaller dimensions than the main arch wire. 0.014 in. AJ Wilcock arch wire ( Fig. 52.3 B,C,D).
8.
Uprighting springs : These are used to upright the tipped teeth in stage 3. These are made of 0.016 in. AJ Wilcock arch wire for premolars and canines and 0.014 in. for the lateral incisors in the original Begg’s technique ( Fig. 52.3 E).
9.
Spring pins : These are prefabricated from 0.016 in. or 0.014 in., combining the security of a lock pin with mesiodistal uprighting spring capabilities; spring pins achieve desired changes without reactivation.
10.
T-pins : T-pins replace spring pins to provide stability when teeth have been excessively uprighted.

11.

Arch wire material : The Begg’s technique utilises unique AJ Wilcock arch wires made from high-quality stainless steel that is cold-drawn and heat-treated. In the 1940s, Dr. Begg collaborated with the Australian metallurgist Claude Arthur J. Wilcock to create the most suitable wires for the light wire technique. The unique properties of these wires include high resilience, tensile strength and zero-stress relaxation. Zero stress relaxation refers to the wire’s ability to deliver a constant, light elastic force over extended periods, even when subjected to external forces or occlusal pressures. The arch wires are made of a high yield strength material to maintain zero stress relaxation.

The wires are graded in the increasing order of resiliency from regular to supreme. Various grades of the AJ Wilcock arch wires are regular, regular plus, special, special plus, premium, premium plus and supreme wires.
Dr. Begg recommended special plus and higher-grade wires with high resiliency and toughness, which are needed for the technique. However, these wires are brittle. Therefore, he recommended bending these wires around the square beaks of the light wire pliers to avoid breakage. If the wire is bent around the round beak of the light wire plier, the stress on the crystalline structure is confined to a smaller area, leading to fracture. It must be bent against the square beaks in slow motion to allow the crystals to flow into new shapes without fracture. The wire has a ductile-brittle transition temperature around or slightly above the room temperature. Therefore, warming the wire by pulling through the fingers before bending is recommended to avoid fracture of the wire while bending.
These wires are available in various diameters ranging from 0.008 in. to 0.020 in.. The central arch wires are rigid, and auxiliaries are made from smaller dimensions for increased resiliency and lighter forces.

The wires are colour-coded for ease of identification and are available in variable dimensions.

Special plus—yellow, in the size of 0.014 in., 0.016 in. and 0.018 in.

Premium—purple, 0.020 in.

Premium plus—orange, 0.020 in.

Premium plus—0.010 in., 0.011 in., 0.012 in., 0.014 in., 0.016 in., and 0.018 in.

Supreme—white, 0.008 in., 0.009 in., 0.010 in., 0.011 in. and 0.012 in.

In the original light wire technique, a 0.016 in. Special plus wire is used in the first stage, while the second and third stages employ either a 0.020 in. Special plus wire or preferably a Premium 0.020 in. arch wire. Higher dimensions wires are rigid enough to maintain the arch form when elastics and auxiliaries are applied.
For upright springs, 0.016 in. wires are used for canines and premolars, while 0.014 in. wires are used for lateral incisors. The torquing auxiliaries are made from either 0.016 in. or 0.014 in. wires. The refined Begg’s technique incorporates ultra-high-tensile stainless steel supreme wires to create auxiliaries that apply lighter forces. ^, ^,

Begg’s technique and stages

Dr. Begg recommended his appliance for both mild and complicated cases. He emphasised the importance of making study models and photographs at the end of each stage: Stages 1–3. Deep impressions at the end of each stage, photographs and stage models served as valuable tools for treatment evaluation.

Unlike traditional edgewise appliances, Begg’s methodology strategically separates crown movements from root movements. The primary aim is to execute crown adjustments during the initial two stages, followed by root movements in the third stage. This distinctive technique relies on Begg’s brackets characterised by their narrowness, larger contact angle with the arch wire and the freedom they offer for teeth tipping during the first two stages. However, the long molar round tube, featuring two-point contact with the arch wire, imposes restrictions on free tipping, creating a design that facilitates nuanced reactions to applied forces without depending on external headgear for anchorage. Instead, Begg’s treatment employs anchor bends and biomechanics that involve the anterior teeth tipping against the bodily movement of posterior teeth. ^,

Dr. Begg divided the technique into Stages 1–3 to prevent overlap and avoid anchorage loss. After making the pre-treatment records and analysis, the treatment follows the sequence as described below :

Stage 1: Initial alignment

This stage mainly includes the alignment of teeth and bite opening. The objectives of stage 1 are to:

1.
Open the anterior overbite
2.
Overcorrect mesiodistal relationship of buccal segments
3.
Closure of anterior spaces
4.
Elimination of anterior crowding
5.
Overcorrection of rotated teeth
6.
Correction of posterior crossbite
7.
Orthodontic traction of impacted teeth

The above objectives are addressed using 0.016 in. AJ Wilcock special plus/premium plus arch wires. The anchorage bends are placed 5 mm mesial to the mesial end of the molar tube. The multiloop arch wires with anchor bend or an anterior sectional coaxial wire is used in conjunction with the plain 0.016 in. AJ Wilcock special plus/premium arch wires to relieve crowding ( Fig. 52.4 A). The arch wires are cinched back distal to the molars to prevent flaring of the incisors. After decrowding, 0.016 in. AJ Wilcock special plus/premium arch wires with intermaxillary circles or boot loops are used with anchor bends. The extent of the anchor bends for efficient bite opening and anchorage control during stage 1 should be such that the arch wire rests in the depth of the sulcus before being engaged into the brackets ( Fig. 52.4 B and C). The intermaxillary/cuspid circles are tied to the canines on either side in both the arches in a figure of eight manner to consolidate the anterior segment. Usually, the premolars are not bonded in the first stage to avoid their brackets interfering with the arch wire and hindering bite opening. However, when they are severely rotated, they are bonded. The bicuspid offset given distal to the canines helps remove the interference of premolar brackets in the opening of the bite. The bypass clamps can also be used on the premolars to keep the arch wire away. Light 2 Oz 5/16 in. class II elastics are used from the mandibular molar hooks to the upper cuspid inter maxillary circle ( Fig. 52.4 D). These elastics aid anchorage or bite opening bends and retract the incisors to an edge-to-edge position ( Fig. 52.4 E). Double back arch wires are used for better buccolingual control of second molars in first molar extraction cases. ^,

Possible problems during this stage include bite not opening, molar width narrowing, adverse tipping of anchor molars, no noticeable changes, buried vertical loops, elastic breakage, lost lock pins, mobile molars, labial tipping of lower anterior teeth, persistent anterior open bite, teeth not rotating and midline discrepancy. The orthodontist should keep a close watch to sustain efficient biomechanics and make changes as and when required. ^, ^,

Stage 2: Space closure

This mainly includes extraction space closure with the use of light inter- and intra-arch elastics leading to palatal tipping of the anterior crowns and tipping of canines and premolars.

Objectives of Stage 2 are to:

1.
Maintain corrections attained at the end of stage 1 treatment.
2.
Close remaining buccal spaces.

Rigid 0.020 in. AJ Wilcock arch wires are employed to maintain tooth positions and arch form attained in stage 1; anchor bends are slightly reduced as the arch wires are heavier. A total of six elastics, four class I and two class II elastics, are used in extraction cases. The class I elastics are worn from the molar hooks to the intermaxillary/cuspid circle on the arch wire ( Fig 52.5 A).

Class II or class III elastics maintain mesiodistal molar relationships and prevent relapse of deep overbite. Ligature wire tied between the cuspids and intermaxillary circles preclude the reopening of anterior spaces and maintains rotation correction. A total of six elastics, four class I and two class II elastics, are used ( Fig. 52.5 A). The characteristic appearance of ‘dishing in’ of upper and lower incisors in four premolar extraction cases marks the conclusion of the second stage in the original Begg’s technique ( Fig. 52.5 B).

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The Begg’s appliance —philosophy and technique, forgotton yet relevant

Introduction

Historical overview—contributions of Dr. PR begg

Begg’s philosophy and the appliance

The basis of begg’s technique—the theory of attritional occlusion