10.

5005/jp-journals-10021-1046
CASE REPORT
Mrunal Aley

Simultaneous Intrusion and Retraction in Begg

Appliance and Evaluation of Same by
Non-numerical Approach by Esthetic Analysis
Mrunal Aley

ABSTRACT

Many appliances, labial and lingual have emerged with different mechanics for simultaneous intrusion and retraction. Nowadays, the
temporary anchorage devices are advocated as a method of augmenting anchorage. The present case utilizes the conventional technique
of archwire modification according to Hocevar in Begg's technique for true incisor intrusion and simultaneous retraction. A non-numeric
approach analysis called esthetic analysis is used for lower third of face to evaluate the treatment results.
Keywords: Transpalatal arch (TPA), Aesthetic analysis (AA), Intrusion and retraction (IR).

How to cite this article: Aley M. Simultaneous Intrusion and Retraction in Begg Appliance and Evaluation of Same by Non-numerical
Approach by Esthetic Analysis. J Ind Orthod Soc 2011;45(4):256-259.

INTRODUCTION The treatment procedure to be chosen from the above should

The conventional Begg appliance was often criticized for
effecting bite opening by extrusion of lower molars. However,
the trend of using relatively heavy elastics and less rigid base
wires has changed over the years; with more emphasis being
placed on true incisor intrusion where needed and minimizing
lower molar extrusion by minimal use of Class II elastics or
alternate elastics, such as palatal elastics or elastics to power
arms in high angle cases.
This case report will emphasize on these methods of
simultaneous incisor intrusion and anterior teeth retraction (IR).
It will also highlight the different archwire modifications for
improving the efficiency of incisor intrusion.
Methods of Bite Opening
Bite opening, as mentioned by Proffit1-3 could be done by either
of the following, either individually or in combination
a. Uprighting of incisors
b. Premolar or molar extrusion
c. True incisor intrusion.
Associate Professor
Department of Orthodontics, Sharad Pawar Dental College, Datta
Meghe Institute of Medical Sciences, Nagpur, Maharashtra, India
Corresponding Author: Mrunal Aley, Associate Professor
Department of Orthodontics, Sharad Pawar Dental College, Datta
Meghe Institute of Medical Sciences, Nagpur, Maharashtra, India
e-mail: mrunalaley@gmail.com
Received on: 2/9/11
Accepted after Revision: 25/12/11
be based on certain criteria as under:
a. Age of the patient: Extrusion of posteriors would be more
stable in younger individuals because of the compensating
vertical growth of the ramus.4
b. Growth pattern: A horizontal grower would again, during
growing years, tolerate posterior extrusion. However, in
normal or vertical growers, molar extrusion should be
avoided.
c. Incisor exposure at rest: This factor would determine which
incisors need to be intruded. If the exposure of upper
incisors is more than 3 to 4 mm at rest, true intrusion is
warranted. On the contrary, if the incisor exposure is normal
and there is a deep curve of Spee in an average grower,
lower incisor intrusion would be more essential. The limits
of orthodontic incisor intrusion would be in the range of
3 to 4 mm. Therefore, incisor exposure above 5 to 6 mm at
rest should be given a second thought for a combined
surgical-orthodontic treatment regime.
d. The facial profile: If the facial outline can tolerate or benefit
from some incisor uprighting and where the space
discrepancy is mild-moderate, incisor uprighting could be
carried out. But one must remember that this kind of bite-
opening if overdone, could prove to be a cause of instability
of the treatment procedure.
Advantages with Begg Therapy
It is well accepted that the intrusion efficiency is maximized
with bypass mechanics. Utility arches, Burstone’s intrusion
arches, etc. utilize this mode to get true intrusion.5
Begg mechanics has been utilizing the desired force vectors
and with a proper understanding of the force systems, one can
achieve intrusion of all six anteriors in a single continuous
archwire.

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Simultaneous Intrusion and Retraction in Begg Appliance and Evaluation of Same by Non-numerical Approach by Esthetic Analysis
Other than the conventional anchor (tipback bend),
modifications have been proposed by several authors.6-8
Advantages of the Hocevars modification in archwire along
with TPA (transpalatal arch) are as follows:
1. The archwire produces two vertical vectors:
a. The vertical force for the anterior dentition and
b. Extra vertical intrusive force acting on the anterior teeth
from labial side directed gingivally. So, the controlled
intrusive effect on the anterior teeth intrude without
molar extrusion.
2. Second, the Class I and II elastic force is not altered during
intrusion and retraction.
3. The biomechanics is simpler to understand and patient’s
compliance is not affected.3
4. A single continuous archwire solves the purpose for effective
incisor intrusion by passing the cuspid.
5. The moment created on the molars is negated by the TPA
in all the three planes of space if the archwire is properly
fabricated with appropriate anchor bend and bends located
at mesial and distal to canine.
Checklist at the End of Stage I
a. Molar relationship—Preferably a Class I; however, not
always necessary. The important point would be to check
for distally tipped upper molars, lingually rolled lower
molars which need to be corrected before taking the stage
records.
b. Canine relationship—Needs to be a Class I
c. Midlines—Matching
d. Overjet and overbite—Nil (Edge-to-edge)
e. Crowding and crossbites—Relieved
f. Individual torqueing if needed.
DETAILS OF THE PRESENT CASE
In the present case report, a skeletal Class II relation (Figs 1
and 2) with dentoalveolar Class I relation with proclination in
upper and crowding in lower arch was treated with extraction
of all bicuspids (first premolar).
Fig. 2: Pretreatment photographs intraoral (buccal and occlusal view)
The Journal of Indian Orthodontic Society, October-December 2011;45(4):256-259
JIOS
Fig. 1: Pretreatment extraoral photographs
After aligning the upper and lower arch, care was taken
that there was active intrusion and retraction of upper anteriors.
The case required critical anchorage in upper and lower arch
so the upper arch was attached with a transpalatal arch for
anchorage conservation. Care were taken that there is no
negative effect on the molars while intrusion and retraction of
upper anteriors was undertaken.
The simultaneous intrusion and retraction carried in this
case could effectively loose anchorage in vertical, sagittal and
transverse plane. To nullify this, the transpalatal arch is effective
to counteract the reciprocal forces generated in all three planes
of space due to simultaneous intrusion and retraction of anteriors
along with proper bends in the archwire. The archwire in the
anterior segment in Hocevar’s modification is subjected to bends
mesial and distal to canine so that it has an extrusive effect on
the canine and intrusive component on the anteriors favouring
the magnitude of force toward the center of resistance favouring
more axial in direction combined with the Class I and II elastic
force.1,4
The forces acting on the anterior teeth during simultaneous
(IR) intrusion and retraction are as follows:9
1. Intrusive effect on the anterior teeth due to the accessory
bends.
2. Extrusive component of force on the canine.
3. Distal tipping force negated by the TPA.
4. Extrusive force on the lower molar due to Class II elastic
force negated by using ultra light force, such as pink elastic.
5. The combined effect of Class I and II elastic not only change
the axial inclination of the anterior teeth but also contributes
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Mrunal Aley

Fig. 3: Postretraction photographs done by Hocevar’s modification in archwire

to the simultaneous intrusion and retraction as the forces
from elastics generated during the various functional
movements and parafunctional movements. The force values
generated due to stretching of Class II elastics during
functional movements has a major role in intrusion as it
favors vectors in distal movement of teeth and thereby
correcting the axial inclination. The Class I elastic force
reduces as the distance of stretch reduces due to utilization
of extraction space in simultaneous intrusion and retraction.
6. The Class I elastic force can be increased at the end of
retraction (Fig. 3).
DISCUSSION
The mechanics in continuous archwire has to be understood
with the counterbalancing forces. Since, Begg mechanics utilizes
the differential force principle with the current enhanced quality
of AJ Willcock wires. The clinician with their clinical
experiences can utilize the biomechanics toward the intended
tooth movement. The Hocevar’s modification was utilized in
this case as the patients clinical finding suggested true intrusion
of anteriors.
Since, there was a controlled intrusion and retraction
achieved in this case. This exemplifies that the continuous arch
mechanics has potential of achieving results as achieved through
the utility arches in preadjusted appliance, segmental arch
technique and others stage three mechanics of Beggs appliance
done in upper and lower arch (Fig. 4).8-10 Individual forgiving
can also be used (Fig. 5).
In this case, the esthetic analysis of the profile was used for
evaluating the position of the incisors as this analysis
concentrates on the lower third of the face pertaining to the
position of anterior tooth in upper and lower arch. Also it
emphasizes the anterior limit of chin, the lip position and
thickness (Fig. 6).9
In this case, the patient’s pretreatment profile according to
the esthetic analysis was showing upper and lower lip eversion
along with proclination of upper teeth and retrusive chin
position. The post-treatment profile analysis revealed the
amount of incisor intrusion and retraction achieved in this case.
The incisor position achieved in this case was normal according
to the esthetic analysis (Fig. 6). However, the chin was still
retrusive which preexisted. The ideal treatment protocol would

Fig. 4: During stage III of Begg biomechanics with under arch made up of 0.014 premium plus archwire on
0.018 base archwire for lower reverse torque

258 JAYPEE

Simultaneous Intrusion and Retraction in Begg Appliance and Evaluation of Same by Non-numerical Approach by Esthetic Analysis
Fig. 5: Single tooth torquing auxillary for buccal root torque with 0.014
premium plus on 0.018 base archwire lower left canine as it was placed
lingually
Fig. 6: Postretraction cephalogram with esthetic analysis of NM Bass
for lower third face depicted by the white lines perpendicular to esthetic
horizontal running through the point A, Sn, 50% upper lip soft tissue
thickness, 25% soft tissue thickness, horizontal line at the lip junction
be the combined surgical and orthodontic approach. The results
received with camouflage therapy is appreciable in this case
(Figs 7 to 9).
CONCLUSION
The present case exhibits that the appliance whether using Beggs
or preadjusted appliance, knowledge of biomechanics is
essential for effective tooth movement with anchorage
conservation can minimize the chances of undesirable tooth
movements. Application of non-numerical approach for the
evaluation of the profile is an easy method to identify the
problems of lower third of face and the treatment result achieved
in such cases.
REFERENCES
1. Kameda A. New thoughts on old and new techniques: Begg
and Tip-Edge (Part I). Summary of KB (Revised) Begg
Technique. Jap J Begg Orthod 1980;12:1.
2. Reitan K. Biomechanical principles and retractions in Graber
TM, Swain BF (Eds). Current orthodontic principles and
techniques (3rd ed). St Louis: CV Mosby 1985;178.
The Journal of Indian Orthodontic Society, October-December 2011;45(4):256-259
JIOS
Fig. 7: Pre- and posttreatment extraoral profile
Fig. 8: Pre- and postfrontal
Fig. 9: Pre- and posttreatment superimposition created in Adobe
Photoshop software to denote the changes in upper incisor position
and soft tissue enhancement of the profile achieved in the case
3. William R. Profit with Herry W Fields. Jr contemporary
orthodontics (2nd ed).
4. Refined Begg for modern times. Dr Vijay P Jayade (1st ed).
5. Hoeve AT, Mulie RM. The effect of anteroposterior incisor
repositioning on the palatal cortex studied with laminagraphy.
J Clin Orthod 1976;10:804-22.
6. Hocevar RA. Understanding, planning and managing tooth
movement: Orthodontic force system theory. Am J Orthod
1981;80:457-77.
7. Mollenhauer B. New approaches to the Begg technique. Aust
Orthod J 1987;10(2):67-89.
8. Kesling C. Begg theory and technique.
9. NM Bass. Measurement of the profile angle and the aesthetic
analysis of the facial profile. J Orthod 2003;30:03-09.
10. Sims MR. Looped system: A contemporary reassessment. Am J
Orthod 1972;61:278.
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