Molar Distalization in Begg Technique / Orthodontic Courses by Indian Dental Academy

MOLAR DISTALIZATION IN
BEGG TECHNIQUE.

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

Recent advances in mechanotherapy and change
in the concept of treatment has increased the
clinicians interest in avoiding extractions in
moderate discrepancies. A popular method for
creating additional space within the dental arch
is by distalization of molars.
What one should look for, to consider a case
for molar distalization?
1. Normal or near normal mandibular arch.
2. Profile consideration: Well developed nose
and chin, have better chances of tolerating
slight proclination.
3. Age of the Patient:- the success of molar
distalization is greater in growing children,
usually in late mixed dentition and early
permanent dentition.
Mst.Sachin . Age: 9.8yrs. Mild :Class II Div. I
HORIZONTAL GROWTH PATTERN
4. Inclination of Molars:- OPG forms an ideal
diagnostic tool. If the first and second molars
are distally angulated, the case is contra-
indication for molar distalization.
5. Amount of available posterior space and 3
rd

molars: Usually absence of 3
rd
molar is
advantageous for molar distalization. Distal
angulation of 3
rd
molars is, again a contra-
indication and it is indicative of posterior
crowding.
6. Growth Pattern vertical growth pattern is a
contra indication for distalization.
How to identify molar distalization case:
1. End on molar relationship with mild to
moderate space requirement in the
maxillary arch.
2. a) High labially placed canine /
unerupted canine, with end-on or full cusp
class II molar relation.
b) Ectopic eruption of 1
st
or 2
nd
pre-
molars.
These above two conditions may be caused by
premature loss of deciduous tooth and forward
migration of the upper permanent molar.
3. During late mixed dentition, when lower E
space is to be utilized for relief of lower
anterior crowding. Here the lower molars are
held back, and utilizing the E space anterior
crowding can be corrected. In such cases
molar distalization in the upper arch helps in
changing a class II molar relation to Class I
relation.
METHODS OF MOLAR DISTALIZATION
IN COMMON USE ARE:-
1. Use of extra-oral force
2. Wilson Bimetric arch design
3. Modified Nance lingual appliance for unilateral
molar distalization.
4. Pendulum appliance
5. Lip bumper
6. Use of Japanese NiTi coil springs
7. Distal Jet Appliance
8. Jones Jig
9. K-loop appliance
10. Molar distalization with magnets
11. Removable distalization appliance
12. Sagittal appliance.
Undoubtedly, most of the above mentioned molar
distalization techniques can be effectively used
with the Begg technique.
Biomechanics of Distalization
MODIFIED BIMETRIC ARCH DESIGN:
In our department we use a slight
modification of original WILSONS
BIMETRIC ARCH. The upper arch wire is
made from 0.16 premium SS wire. The arch
wire is shaped in an ideal form. Cuspid
circles are kept abutting the cuspid bracket.
Two pear shaped loops, one on each side, are
made, 6-7mm in height and 4mm in width at
the top and almost touching each other at
bottom.
About 45 bends is placed equally distributed on
either side of the loop for simultaneous intrusion of
anteriors. Mild toe in is given for molar segment.
Opening loops by 2mm on each side activates
arch wire in the anterior segment, which is then
ligated into brackets. This causes expansion
forces in the labial or buccal direction in the
incisor canine and premolar area. This
expansion force is resisted by using class II
elastics on elastic load reduction principle.
Hence the force is transferred onto the molars,
in a distal direction.
ELASTIC LOAD REDUCTION PRINCIPLE
The patient is asked to use class II elastic in a
definite sequence, namely TP green elastics for
1
st
week, pink elastic for 2
nd
week and yellow for
the following 2-3 weeks, all in class II fashion.
The initial heavy elastic force of green elastic is
required to resist the forward pushing force of the
arch wire, thus transferring it in a distal direction
to the molars.
As the molar becomes upright, the distally
directed archwire force acting on it diminishes.
Thus a slightly lesser force with pink elastics
and finally with light yellow elastic is applied.
About 1mm of distal movement of upper molars
can be achieved per month. The archwire is
activated for 3 visits for the required amount of
correction. Employing this procedure, a
suitable borderline case can be converted into a
non-extraction case.
Ms.Vinaya/11yrs; End on bilateral, Overbite
4.5mm, Impacted left upper canine, Mild Sk
Class II, Horizontal growth pattern.
Smita Naidu, 21yrs,
Moderate crowding in
the upper arch, right
side Cl I molar, left side
end-on.
Horizontal growth
pattern.
Name : Tejomini/ 28yrs
Skeletal Class II
Convex profile
10mm space requirement
in upper arch 8mm space
requirement in lower
arch
Severely proclined lower
incisors
Missing 86 8
Distalization is an effective tool in gaining
additional arch length
Case selection is a very important aspect in the
success of distalization.
Versatile use of modified Bimetric arch design in
Begg technique is simple and yet very effective.

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