American Journal of ORTHODONTICS

Volume 68, Number 5, November, 1975

ORIGINAL ARTICLES

Nonextraction treatment of Class II,

Division I malocclusion with the
Begg technique
George R. Cadman, D.M.D.
Boston, Mass.

T he treatment method for correction of malocclusion originated by

P. Raymond Begg of Adelaide, Australia, was predicated on the extraction of
four first premolars.’ The increased acceptance of this new method and the
perfection of the technique during the last decade have paralleled a trend toward
nonextraction therapy in the United States. This apparent conflict between the
conceptual principle of treatment planning and the basic tenet of the Begg
technique has not been resolved if judged by the scarcity of reports on non-
extraction treatment with the Begg technique.
I have observed that many clinicians who employ the Begg technique for
nonextraction treatment of Class II, Division I malocclusion utilize adjuncts
such as extra-oral anchorage, bite plates, lip bumpers, and the Margolis ACCO
either prior to or in conjunction with the Begg appliance, with excellent and
stable results. The purpose of the present article is to demonstrate that the
Begg technique can be used without these adjuncts in nonextraction treatment,
that is, in its original form in which all tooth movements are achieved by adher-
ing to the principle of differential response of the teeth to light continuous
forces inherent in the arch wire configurations, intermaxillary elastics, and
torquing and uprighting auxiliaries of the Begg technique.
The procedures for nonextraction treatment of Class II, Division I maloc-
clusion will be described in a discussion of the three classic stages of the Begg
technique, preceded by an explanation of omitting premolar banding during
Stage I and the requirements for the construction of maxillary and mandibular

From the Forsyth Dental Center-Harvard School of Dental Medicine.

481
482 Cadrnan

Fig. 1. A, B, and C, Premolars are not banded in Stage I to minimize occlusal

interference in the transition from distocclusion to neutrocclusion. Photographs were
made at 6-week intervals. D, Closure of incisor spaces by means of a light latex
elastic spanning the incisors and attached to horizontally bent pins in the canine brackets.
Crossing the elastic between the teeth facilitates oral hygiene. The bent-over pins in the
incisor brackets serve as stops to prevent gingival impingement by the elastic.

arch wires. In addition to a malocclusion treated without extractions, a maloc-

clusion in which the permanent maxillary second molars were cstracted will
be shown.
Much of the appliance construction and manipulat.ion will be the same as that
described for extraction treatment.2 Therefore, the details of technique which
are common to both extraction and nonextraction treatment will not be repeated
in this article. For the purpose of this discussion, it is assumed that such factors
as facial profile, available space for tooth alignment, muscular dynamics, and
anticipated growth trends have been taken into consideration as part of diagnosis
and in arriving at the plan of treatment.
In most instances of nonextraction treatment, particularly if the malocclusion
is marginal in terms of available space, the conservation of anchorage is
obviously critical. If treatment is to be successful, careful consideration should
be given to the principles of differential response to forces and every effort
must be made to guard scrupulously against the numerous factors that may
interfere with the efficient operation of the appliance.
Differential force response demands that both the magnitude and the dura-
tion of forces that tend to cause anchorage loss are minimized. Therefore, light
elastic traction, usually 1 to 2 ounces, is employed in nonextraction treatment.
In fact, the lighter the force of Class II elastics and the less time Class II elastics
are used, the more successful will be the treatment. in terms of anchorage con-
servation.
Volume 68 Nonextraction treatment with Begg technique 483
Num her 5

Fig. 1 (Cont’d). E, To close incisor spaces, an elastic thread ligature is passed through the ring
and around the arch wire distal to the canine bracket. The ring must be formed sufficiently
mesial to the bracket to permit the arch wire to slide distally as the spaces close. F, Vertical
loops incorporated in a 0.016 inch arch wire for the alignment of rotated or crowded maxil-
lary incisors. A short loop is used in the midline to avoid irritation of the labial frenum.
G, A method of ligating the intermaxillary elastic ring to the canine bracket in order not
to interfere with distal tipping of the canine. Although loosely tied to avoid binding,
the ligature wll not slip or rotate; thus, the twisted end will remain in place and will
not cause lip irritation. The twisted end is formed at the occlusal rather than at the
gingival aspect of the arch wire in order to resist displacement by forces of mastication.

Rapid bite opening, minimal occlusal interference during tooth movements,

freedom from binding and a.ppliance distortion, faithful patient cooperation,
and other factors discussed earlie? are essential to successful treatment. To these
considerations must be added the rate, amount, timing, and direction of growth
during treatment, particularly in Class II and Class III malocclusions, as
well as the presence of a deep overbite resisting correction.
Treatment procedures

Premolar Banding. In general, premolars are not banded during Stage I in

nonextraction treatment of Class II malocclusion, for the following reasons:
1. Tooth movements associated with bite opening in the first stage of the
Begg technique do not include extrusion of premolars, unlike the leveling
process in overbite correction with other techniques that employ multibanded
appliances.
2. The change from distocclusion to neutrocclusion occurs in minimal time,
and with minimal anchorage loss, if the premolars are free to adjust to the
transitional occlusion (Fig. 1, A, B, and 6’). Arch wire engagement in the
premolar brackets during this change may interfere with this occlusal adjust-
484 Cadman

ment by causing increased cuspal interference and thereby prolonging the need
for Class II elastic traction, with resulting anchorage loss.
3. As in extraction treatment, interference of premolar bracket,s with the
arch wires impedes the bite-opening action of the appliance which, in t,urn,
prolongs the use of Class II elastic traction with consequent loss of anchorage.
Therefore, the banding of premolars generally is delayed until the end of Stagt
I, at which time alignment, of rotated or malpositioned premolars can be achieved
without interference with the correction of overbite and distocclusion and with
minimal loss of anchorage.
Maxillary arch Gre. If spacing is present between the maxillary anterior
teeth, the spaces are closed by one of the following methods, using 0.016 inch
arch wires :
1. Activation of space-closing loops by ligation of the intermaxillary rings or
hooks, formed a sufficient distance (2 or 3 mm.) mesial to the canine brackets,
tightly against the brackets which will open the loops in the arch wire.
2. The spanning of a latex elastic across the maxillary incisors from the pin
of one canine bracket to that of its antimere. Since the rings are placed slightly
mesial to the canine brackets, the arch wire can slide distally when t,he, spaces
close. The intermaxillary rings are not ligated to the canine brackets (Fig. 1, D).
3. Ligation of the mesially placed intermaxillary rings to the canine brackets
with light elastic thread ligatures (Fig. 1, E) . If only slight spaces are present,
the ring on one side may be ligated with a steel ligature to contact the canine
bracket and the opposite ring may be tied with an elastic t,hread.
When spaces exist distal to the canines or premolars, the arch wire must be
free to move distally through the molar tubes while the spaces close by distal
tipping of the anterior teeth. Therefore, mo1a.r loop stops are not used until
all interdental spaces have been closed, Crowding or rotations of anterior teeth
are corrected by means of appropriate loop configurations in the arch wire (Fig.
1, 8’) unless only minor deviations prevail which permit correction by a plain
arch wire. The initial looped arch wires should be replaced by plain arch wires as
soon as alignment of the anterior teeth is accomplished.
If the premolars have not been banded and interdental spaces do not exist
distal to the canines or premolars, some provision must be made to prevent
lingual or buccal crowding of the premolars as a result of the retraction of the
six anterior teeth by the interma.xillary elastics. The preservation of posterior
arch length from the molars to the canines is provided by short vertical loop
stops, about 3 mm. in height, incorporated in the arch wire mesial to the molars.
The distal legs of these stops must be in definite contact with the mesial aspect
of the molar tubes when the arch wire is engaged in the brackets of the canines
and incisors. The loop stops are usually angled slightly buccally to avoid contact,
with the molar band or impingement on the gingiva.
These loop stops constitute an increase in the total length of arch wire
between the molars and the canines which decreases the intruding force on the
anterior teeth. They also may contribute to a loss of molar control because of
the increased flexibility of this unsupported area of arch wire. Therefore, the
molar loop stops are made as short as possible but long enough to permit slight-
adjustments of arch wire length.
volume
Number
68
6
Nonextraction treatment with Begg technique 485

Fig. 2. A, Molar loop stops and ligated rings located slightly mesial to canine brackets
serve to maintain molar-to-canine arch length. B, Buccal displacement of the mandibular
right first premolar and lingual displacement of the second premolar resulting from failure
to incorporate molar loop stops in the mandibular arch wire.

The rings for intermaxillary elastic traction should be formed 1 mm. mesial
to each canine bracket and ligated to the brackets to prevent spacing of the
incisors. A method of ligation that minimizes the possibilities of frictional
binding and irritation of the labial mucosa has been discussed in a previous
article2 (Fig. 1, G). Failure to ligate the rings may result in incisor spacing
during Class II elastic traction if the overbite impedes palatal tipping of the
maxillary incisors while the canines are free of occlusal interference.
Anchorage bends are placed at the mesial legs of the molar loop stops. As
in extraction treatment, anchorage bends are made to such an extent that the
anterior portion of the arch wire lies in the depth of the mucobuccal fold when
the ends of the arch wire are placed in the molar tubes. The arch wire is
expanded about 2 mm. on each side in the molar areas.
Mandibular arch wire. The mandibular arch wire is made in the same manner
as the maxillary arch wire. Because malocclusions exhibiting crowding of mandib-
ular anterior teeth are not usually treated without extractions, anterior loops
are rarely required in the mandibular arch wire in nonextraction treatment.
In the formation of the mandibular arch wire, 0.016 inch and occasionally
0.018 inch wire is used to minimize distortion of the long span of wire from
the molars to the canines during mastication. Such distortion can cause mesial
tipping of the molars during Class II elastic traction. Jt also destroys the bite-
opening action of the arch wire, necessitating longer use of intermaxillary
elastics and resulting loss of anchorage. Positive contact of the molar loop
stops against the molar tubes together with ligation of the intermaxillary rings
to the canine brackets is of paramount importance to maintain arch length and
to prevent buccal or lingual crowding of unbanded premolars (Fig. 2, A and B) .
When spaces exist distal to the canines or premolars, the arch wire must be
free to move distally through the molar tubes while the spaces close by distal
tipping of the anterior teeth. Therefore, molar loop stops are not used until all
spaces have been closed.
486 Cadman

Fig. 3. A, Gingivai offset formed in mandibular arch wire to avoid distortion from masti-
catory forces. 6 and C, To avoid distortion from occlusal forces, gingival offsets are formed
in the premolar segment of the 0.018 inch mandibular arch wire. The vertical part of the
distal offset bend contacts the molar tube and serves as a molar stop. The distal bend of
the offset is increased in degree to function as an anchorage bend.

In nonextraction treatment, the mandibular molars have less tendency to

tip lingually because lighter Class II elastic force, usually 1 to 2 ounces, is
employed. Consequently, only about 3 mm. of expansion is placed on each side
of the mandibular arch wire in the molar areas.
A horizontal molar offset bend is used occasionally to ensure that the mandib-
ular arch wire lies close to the buccal surfaces of the premolars, thereby avoid-
ing irritation to the buccal mucosa and minimizing distortion of the arch wire
from the forces of mastication.
Occasionally, when persistent arch wire distortion is encountered, gingival
offset bends are formed distal to the canines and mesial to the molars to free
these unsupported and, therefore, vulnerable spans of arch wire from the
opposing dentition (Fig. 3, A, B, and C) . Because the additional length of arch
wire decreases the intrusive force on the anterior teeth, 0.018 inch wire is fre-
quently used when this modification is employed.
At the mesial legs of the molar loop stops, anchorage bends are made to such
a degree that, as stated repeatedly, the anterior portion of the arch wire lies
in the depth of the mucobuccal fold. Seated in the anterior brackets, the arch
wire should be examined for the important 12 o’clock-6 o’clock positions of
entrance into and exit from the molar tubes (Fig. 4, A).
Volume 68 Nonextraction treatmed with Begg technique 487
Nun& be?- 5

MESIAL DISTAL

Fig. 4. A, Mandibular right first molar, showing correct position of arch wire in buccal
tube at its entry (mesial view) and exit (distal view). B, Termination of the arch wire
within the molar buccal tube will impede the free distal movement of the arch wire
through the tube. Furthermore, flexion of the arch wire by forces of mastication (A) will
produce a ratcheting action at the point of contact of the end of the arch wire with the
inner wall of the tube (B), thereby causing undesirable labial tipping of the incisors (C).

It is essential that the ends of the arch wire extend 2 to 3 mm. beyond the
distal aspect of the molar tubes. If they are drawn into the tubes between
appointments by flexion of the arch wire from masticatory forces, the resultant
ratcheting action causes marked labial tipping of the incisors (Fig. 4, B) .

Treatment stages

Class II nonextraction treatment effectively consists of Stages I and III.

Stage II is bypassed, unless considerable generalized spacing existed in the
original malocclusion.
Stage I. The objectives of Stage I are the same as those enumerated in the
discussion of extraction treatment.2 However, overbite and overjet are frequently
not overcorrected to an end-to-end incisor relation and distocclusion is not
always overcorrected to a slight m&occlusion because of anchorage considera-
tions. In the treatment of a malocclusion that is considered to be marginal in
terms of available space, an attempt to achieve overcorrection may prolong the
use of Class II elastc traction and cause critical loss of anchorage. The overcor-
rection of overbite and distocclusion thereby would be obtained to a consider-
able degree by undesirable mesial translation of the mandibular molars and
labial tipping of the mandibular incisor crowns.
 In the absence of excessive overbite, crowded m;~xillary and chrior tret,h ;I w
ligated loosely to the arch wire at first, and bracket engagement is tl(~la~eti until
sufficient, distal movement of the posterior teeth has o(~curred IO ptt~*l~rit wntcrior
alignment without pro&nation. Thr distal f’orrc 01’ (‘lass TI cllastics is
transmitted to the maxillary canines through the rings contacting t hc mcsial
aspect of the canine brackets and to the maxillary molars through the loop
stops contacting the molar tubes. Thereby, simultaneous distal tipping of the
maxillary canines, molars, and premolars occurs. The ant,crior vertical loops arc
adjusted progressively to provide the incrcasc in arc*11lrngth requirctl for align-
ment of the crowded teeth.
If the malocclusion exhibits crowded maxillary incisors with an cxcessivt>
overbite, initial bracket engangement of the crowtled incisors is obtained, with
vertical loops used where required. Alignment of these teeth prior to tlistal
movement of the molars, premolars, and canines produces a labial t,ipping ol’ the
incisor crowns and a concomitant increase in overjet I fi’ig. 1, ;l, B, and (9.
This transitory condition is corrected as distal uprighting of the posterior t,eeth
and retraction of the incisors occur simultaneously under the influence of light
Class II elastic traction in the prescncc of active and fa\-orable facial growth.
It may appear desirable to avoid this “round trip” of the maxillary incisors
by delaying the correction of incisor crowding until distal movement ot’ the
posterior teeth has been obtained. However, the intrusive force of the arch wire
on the maxillary incisors is required for rapid bite opening and elimination of
incisal occlusal interference, These tooth movements contribute to anchorage
conservation by facilitating the achievement of neutroccdlusion, thereby minimix-
ing the time required for Class II traction.
The looped arch wire is replaced by a plain 0.016 inch arch n-irct as soon as the
incisors are aligned, in order to obtain more efficient overbite correction and
control of arch form, as well as for greater patient comfort and better oral
hygiene.
At each appointment the appliances should be examined for any conditions
that may result in a loss of anchorage. Factors interfering with bite opening
or impeding distal tipping of the maxillary teeth, which have bce~ mentioned
previously in the discussion of problems cncountrrcd in cxt,raction treatment,’
must be carefully avoided. Particular attention should be paid to distortion of
the mandibular arch wire in the buccal segments, and whenever this is
encountered one should make appropriate modifications of the arch wire, such
as gingival offsets in the buccal areas and/or an increase in arch IT--iresize to
0.018 inch (Fig. 3, A, B, and (r). The patient’s cooperation, both in wearing
intermaxillary elastics as directed and in refraining from distorting the arch
wires, is of utmost importance.
During Stage I it will be observed that spaces present in the mandibular
premolar segments usually close by distal tipping of the canines and lingual
tipping of the mandibular incisors. This tooth movement is equivalent to that
which occurs in the mandibular arch during the first stage of extraction treat-
ment, and it is indicative of good anchorage conservation. Failure of space
closure may indicate undesirable conditions, such as binding of the arch wire
Volume 68 Nonextraction treatment with Begg technique 409
Num her 5

in the brackets or tubes, occlusal interference, arch wire distortion, and tongue
thrust or tongue posture.
Except in unusual conditions, uprighting springs or “brakes” are not used
in either the maxillary or the mandibular arch during Stage I. Their action
would interfere with bite opening, retraction of anterior teeth, and correction
of the distocclusion and lead to anchorage loss by prolonging the need for Class
II intermaxillary force.
Light Class II elastics, exerting 1 to 2 ounces of force, are used continuously
throughout Stage I. However, when neutrocclusion is established and overbite
and overjet are corrected, elastics are discontinued or used only sparingly to
maintain the correction achieved so far. Anchorage is thus conserved by
minimizing the length of time during which this force is active. The maxillary
anchorage bends should be removed, and when Class II elastics are discontinued
or the time of their use is decreased the mandibular anchorage bends should be
reduced to prevent distal tipping of the molars (Fig. 5).
At this stage, the patient should be examined carefully to determine that
centric occlusion coincides with centric relation. The discontinuance of Class II
elastics in the presence of a “mandibular slide” or dual bite will invite relapse
toward distocclusion and a return of overbite and overjet.
The mechanism of the change from distocclusion to neutrocclusion observed
during the first stage of extraction treatment with the Begg technique has been
discussed in a previous article.2 The correction of distocclusion also frequently
occurs with dramatic rapidity in nonextraction treatment. The factors contribut-
ing to this change may be as follows :
1. Distal tipping of the maxillary first molars as a result of the force
exerted by the anchorage bends and by the distal component of Class II
elastic force transmitted to the molars through the loop stops.
2. Extrusion of the mandibular first molars in an occlusal and slightly
mesial direction in response to the vertical and horizontal components of
the Class II elastic force.
3. Changes in occlusion of all teeth following anterior retraction and
bite opening which facilitate a change in the functional position of the
mandible, encouraged by the Class II elastic force.
4. Restriction of normal forward growth of the maxilla and/or the
maxillary denture by the distal force of Class II elastics, but without
constraining growth of the mandible.
5. Slight mesial bodily movement of the mandibular first molars result-
ing from the horizontal component of Class II intermaxillary elastic force.
In nonextraction treatment, this change should be considered a contribut-
ing although generally undesirable factor.
Several or all of the foregoing factors may combine to bring about a cusp-to-
CUSP relation of the posterior teeth in a relatively short period of time, resulting
in slight mandibular repositioning to a more functional occlusion in response
to proprioceptor guidance. This intermediate relationship then becomes a
habitual occlusion with maximal intercuspation in harmony with centric relation
as further tooth movement and mandibular growth occur.
490 Cadman

Fig. 5. A gingival bow in the incisal segment of the arch wire to obtain intrusion of
the centralincisorshas been produced by a V bend formed distal to the canines. Prolonged
action of the maxillary anchorage bend has caused excessive distal tipping of the maxil-
lary molar, and failure to reduce the mandibular anchorage bend when the use of
Class II elastics was discontinued has resulted in distal tipping of the mandibular right
molar. Moreover, spacing has occurred in both arches and the loop stops have been
adjusted to an appropriate distance mesial to the respective buccal tubes.
Fig. 6. The rotated mandibular left second premolar has been corrected by means of an
elastic thread ligature tied from the lingual button to the arch wire. A bypass clamp
holds the arch wire in contact with the buccal aspect of the bracket, thereby preventing
displacement of the premolar.
Fig. 7. Vertical anchorage for incisor intrusion is provided without concomitant distal tipping
of the maxillary molars (see Fig. 5) by the banding of maxillary premolars in Stage III.
The anchorage bends have been removed and, because the premolars are banded, the
maxillary arch wire does not incorporate molar stops. Failure to ligate the intermaxillary
elastic rings to the canine brackets has resulted in spacing of the maxillary incisors. The
arch wire has not been properly seated in the slot of the second premolar bracket.

Stage III. Rotated premolars are banded and the arch wire is engaged in
their brackets. When the degree of rotation does not permit bracket engagement,
the rotation is corrected by means of an elastic thread ligated to the lingual
button of the premolar, passed mesially or distally through the contact point
according to the required direction of rotation, and ligated to the arch wire. A
ligature or bypass clamp should be used to hold the arch wire in contact with
the buccal aspect of the premolar bracket during rotation and until bracket
engagement is obtained (Fig. 6).
Alternatively, the arch wire may be modified to permit bracket engagement
of the rotated premolars with slight pressure. The arch wire is adjusted at SUC-
cessive appointments to complete correction of the rotated teeth.
Volume 68 Nonextractio?z treatment with Begg technique 491
Num her 5

Properly aligned premolars are usually not banded unless considerable

canine and lateral incisor uprighting and torquing of incisors are required. In
that event, it may be desirable to band the maxillary premolars and to use
lightly activated uprighting springs to increase the anchorage available in the
maxillary arch. Likewise, mandibular premolars may be banded and lightly
activated uprighting springs used to augment mandibular anchorage when con-
siderable Class II intermaxillary traction is required to maintain the corrected
overbite and overjet during Stage III. It should be mentioned, however, that
prolonged use of uprighting springs, even with mild activation, may tip the
premolar roots mesially, thereby producing a net anchora.ge loss.
Ideal maxillary and mandibular 0.018 inch arch wires are formed with
molar offset bends and, if indicated, appropriate bends to maintain corrected
rotations. The extent of the anchorage bends required in both the maxillary and
mandibular arch wires is determined by the amount and duration of Class II
intermaxillary traction anticipated in Stage III. If the maxillary incisors
require palatal root torque, or if considerable distal tipping of the roots of the
maxillary lateral incisors and canines is indicated, the need for Class II
intermaxillary force may be anticipated to prevent forward translation of the
maxillary denture.
Anchorage bends are required in the maxillary arch wire to prevent extrusion
of the incisors by the vertical component of the Class II elastic traction. How-
ever, to avoid excessive distal tipping of the maxillary molars, the anchorage
bends are reduced to a degree judged to be sufficient to prevent incisor extrusion.
Use of the maxillary anchorage bends to prevent incisor extrusion incident to
prolonged use of the torquing auxiliary will cause excessive distal tipping of
the maxillary molars (Fig. 5). For this reason, the maxillary premolars may
be banded for additional anchorage in the vertical plane if the maxillary incisors
require extensive palatal root torque (Fig. 7).
If palatal root torque of the maxillary incisors is not required and if only
minor distal tipping of the roots of the maxillary lateral incisors and canines
is indicated, less Class II elastic traction will be needed and the maxillary
anchorage bends are reduced accordingly.
In the mandibular arch wire, anchorage bends are reduced to serve only for
the prevention of mesial tipping of the molars by the force of Class II elastics.
The mandibular arch wire is expanded about 2 mm. on each side in the molar
areas.
The degree of molar constriction placed in the maxillary arch wire is
determined by the diameter of the wire and the amount of palatal incisor root
torque needed. In the treatment of Class II, Division 1 malocclusions without
extraction, less incisor torque is generally required than in extraction treatment ;
consequently, less constriction is made in the posterior segments of the maxillary
arch wire.
AS in Stage III of extraction treatment, a gingival ‘(bow” is formed in the
in&al portion of the maxillary arch wire, the degree of which is determined
by the amount of lingual incisor root torque required (Fig. 5).
In both maxillary and mandibular arch wires, vertical bends should be made
492 Cadman Arc J. Orthod.
November 1975

Fig. 8. The mandibular molar buccal tubes have been located as far gingivally as possible
in order to minimize arch wire distortion by forces of mastication. Vertical step-up bends
may be required mesial to the molars when the second premolars are engaged in order to
maintain the marginal ridges of the molars and premolars at the same occlusal level.
Fig. 9. Lingual movement of the apices of the mandibular incisors, frequently observed
in Begg treatment.

if required between the molars and the second premolars, if the later are banded,
in order to keep the occlusal marginal ridges of the molars and premolars at
the same occlusal level (Fig. 8).
During Stage III, Class II intermaxillary elastics are used for no other
purpose than to prevent recurrence of deep overbite or overjet as a result of
the reciprocal forces of the torquing and uprighting auxiliaries. The patient is
instructed to examine the occlusal relation of his anterior teeth each day and to
use Class II elastics only as much as needed to maintain the overbite and overjet
corrections achieved in Stage I.
Uprighting springs usually will be required for final alignment of the
maxillary and mandibular lateral incisors, frequently for the maxillary canines,
and occasionally for the maxillary premolars. As the uprighting of each tooth is
completed, its respective uprighting spring is made passive and left in position.
When the axial inclinations of all tipped teeth have been overcorrected slightly,
the auxiliaries are removed and the a.rch wires coordinated ant1 adjusted as
needed for detailed finishing procedures.
It is good practice to obtain dental casts at this time. Examination of such
casts frequently will reveal conditions which should receive attention before
the bands are removed.
Attention should be called to a characteristic response of mandibular incisors
to the forces employed in the Begg technique of treatment. Superposed trac-
ings of serial cephalometric radiographs made during treatment reveal lingual
movement of the apices of the mandibular incisor into the symphysis (Fig. 9).
Because of this apical movement, some increase in the axial inclination of the
mandibular incisors may be expected in nonextraction treatment, even in the
absence of labial movement of the incisor crowns. For this reason, the axial
inclination of the mandibular incisors (IMPA) is considered to be less significant
in the evaluation of orthodontic tooth movement than a measurement that
relates the position of the mandibular incisor crowns to a plane of the face
(linear distance of mandibular incisor to the N-Pog line, to the true vertical
plane, or to the A-Pog line) .3
Volume
Number
68
5
Nonextraction treatment with Begg technique 493

Fig. 10. Nonextraction treatment of a Class II, Division I malocclusion. A, Et, and C, Pre-
treatment intraoral photographs. D, E, and F, Posttreatment intraoral photographs. G,
Tracings of pretreatment and posttreatment cephalometric radiographs superimposed on
the anterior cranial base area. H, Tracings of pretreatment and posttreatment radiographs
of maxilla superposed on pterygomaxillary fissure and nasal floor. I, Pretreatment and
posttreatment tracings of the mandibe superposed on the lingual aspect of the sym-
physis, mandibular canal, and third molar crown outline. Although the incisor-mandibular
plane angle increased slightly, the apex moved lingually while the crown remained in
essentially the same position relative to the facial plane.

Space closure and occlusal “settling” are achieved in the same manner as was
described for extraction treatment.* Impressions are then made for the contruc-
tion of retaining appliances which have been determined in the treatment plan
to be most effective for the individual patient.
The results of nonextraction treatment are illustrated in Fig. 10. The patient,
a girl aged 11 years 8 months, had a malocclusion with distocclusion on the right
side and cusp-to-cusp relation on the left, a 4 mm. overjet, moderate maxillary
incisor and canine crowding with rotations, and a 6 mm. (70 per cent) overbite.
The mandibular teeth were well aligned, but the curve of Spee was exaggerated.
Cephalometric analysis revealed a harmonious, orthognathic skeletal pattern,
494 Cadman

Fig. 10 (Cont’d). For legend, see page 493.

well within the normal range. The premenarcheal age of the patient, together
with the presence of open epiphyses observed in the hand-wrist radiographs,
suggested that orthodontic treatment would coincide with adolescent growth.
Inspection of the superposed cephalometric tracings reveals over-all facial
growth, primarily in a vertical direction, as shown clearly in the mandible.
Maxillary superposition indicates posterior movement of point A and relative
distal movement of the incisors and molars without appreciable extrusion of
these teeth. Superposition of tracings of the mandible shows extrusion and
distal tipping of the molar crowns and lingual movement of the incisor apices,
while the incisor crowns remained essentially in their original positions.

Maxillary second molar extraction treatment

Although this article has focused on a discussion of nonextraction treatment,

the procedures described may be employed also in the treatment of Class II,
Division 1 malocclusions in which the permanent maxillary second molars are
extracted. It may be the treatment of choice for a patient in whom little or no
mandibular growth is anticipated and whose Class II malocclusion exhibits
the following characteristics :
1. Adequate space in the mandibular arch for normal alignment of the
teeth and correction of excessive curve of Spee without labial movement
of the incisor crowns.
2. Excessive mesio-axial inclination of the maxillary molars, frequently
accompanied by mesiolingual rotation.
3. Excessive incisal overbite.
4. Moderate crowding and/or protrusion of maxillary anterior teeth.
Volume 68 Nonextraction treatment with Begg technique 495
Num her 5

Fig. 11. The transition from distocclusion illustrated by photographs made at successive
appointments. A, Original malocclusion, B, C, and D, Occlusal changes observed at 3-week
intervals following alignment of maxillary incisors by means of looped arch wires. The
absence of premolar bands minimized interference with distal tipping of the molars,
premolars, and canines as well as with the bite-opening action of the arch wire. Max-
illary second permanent molars’ were extracted because little further mandibular growth
was anticipated and, in addition, radiographs indicated the presence of well-formed,
favorably positioned maxillary third molars. Although double buccal tube attachments
were used on the maxillary molar bands, extraoral force was not employed. incisor
alignment prior to distal movement of the posterior teeth has resulted in temporary labial
tipping of the incisors.

5. Radiographic evidence of well-formed, favorably positioned, and un-

erupted third molars.
The arch wire formation and treatment procedures are essentially the same
as those described for nonextraction treatment. Rapid distal tipping of the first
molars into the extraction spaces can be anticipated. In the absence of occlusal
interferences, the molar tipping will be accompanied by distal tipping of the
maxillary premolars and canines. Fig. 1, P and Fig. 11, A, B, C, and D illustrate
the change from distocclusion to neutrocclusion during a period of 12 weeks.
Although distal “uprighting” of mesially inclined maxillary molars contri-
butes to bite opening in Stage I, excessive distal tipping of the molars may
occur as a result of prolonged use of strong anchorage bends in the maxillary
arch wire (Fig. 5). Distally inclined maxillary molars do not provide efficient
anchorage in the vertical plane. For this reason, banding of the maxillary
premolars may be indicated in the third stage of treatment to augment vertical
anchorage for the maintenance of the corrected incisal overbite if considerable
palatal incisor root torque is required (Fig. 7).
4% Cadman

Fig. 12. Extraction of permanent maxillary second molars for the treatment of a Class
II, Division I malocclusion. A, 8, and C, Pretreatment intraoral photograph, D, E, and
F, Posttreatment intraoral photographs. G, Pretreatment and posttreatment tracings super-
posed on the anterior cranial base area. The maxillary first molars tipped distally and
the maxillary third molars exhibited a favorable path of eruption. H, Pretreatment and
posttreatment tracings of the mandibe superposed on the lingual aspect of the sym-
physis, mandibular canal, and unerupted third molar. Although the incisor-mandibular
plane angle has increased, the incisor crown remained in essentially the same relation
to the facial plane while the incisor apex has moved lingually.

Extraction of permanent maxillary second molars was prescribed for the

treatment of a 14year-old girl with a Class II skeletal and facial pattern, a
prominent chin, and a deep mental sulcus (Fig. 12). Her malocclusion was
characterized by distocclusion of the posterior teeth on the right side and a
cusp-to-cusp relation of the left canines, premolars, and molars. A deep, imping-
ing overbite, a 5 mm. overjet, and crowding and rotation of maxillary incisors
were present. The mandibular arch exhibited slight incisor crowding and an
Volume 68 Nonextraction treatment wath Begg technique 497
Number 5

Fig. 12 (to&d). For legend, see opposite page.

exaggerated curve of Spee. Measurements of relative mesiodistal crown

diameters of the maxillary and mandibular incisors and canines (Bolton
analysis) revealed an anterior interarch discrepancy of 2.2 mm., a result of
excessive width of the mandibular teeth. Because the mandibular lateral incisors
were exceptionally wide, reduction of the mesiodistal diameter of these teeth,
in addition to slight stripping of the central incisors and canines, was accomp-
lished following band removal to obtain a compatible relationship with the
maxillary anterior teeth.
The patient’s age, physical development, and skeletal maturation assessed
from the hand-wrist radiograph indicated that no major growth spurt should
be expected during treatment. This limitation, in addition to profile considera-
tions and the radiographic evidence of favorably positioned unerupted maxillary
third molars, suggested extraction of permanent maxillary second molars to
facilitate correction of the distocclusion with minimal taxation of mandibular
anchorage by Class II elastic traction.
Although analysis of the cephalometric tracings revealed considerable
mandibular growth, it should be pointed out that the pretreatment radiograph
was made 8 months before the start of active treatment, and during this time
the greater amount of mandibular growth was observed. Serial cephalometric
radiographs indicated that little growth occurred during active treatment.
Absence of significant growth changes in the maxillary area is indicated
by the lack of positional change of the nasal floor and palate relative to the
anterior cranial base. The maxillary incisor crowns remained in their original
anteroposterior positions while their roots moved palatally. The maxillary first
molars showed slight distal root movement, in addition to distal tipping of
their crowns, and the unerupted third molars moved favorably in a mesial and
 498 Cadman

oc~lusal direction. The mandibular first molars were extruded with slight tlistal
uprighting and some mesial root movement. The (drowns of the mandibnla,r
incisors remained in their original positions, while their apices mo~tl toward
the lingual a,spect of the symphysis.

Conclusion

In conclusion, I wish to emphasize that the Begg technique is not restricted

to extraction treatment. Moreover, the technique has the inherent potential for
nonextraction treatment of Class II, Division 1 malocclusions without adjuncts.
The author wishes to express sincere appreciation to Cocnraad F. A. Moorrees, professor
of orthodontics, for his valuable collaboration in the preparation of this article, and to
Anna Marie Gron, associate professor of orthodontics, for the cephalometric analyses.

REFERENCES
1. Begg, P. R.: Differential force in orthodontic treatment, AM. J. ORTHOD. 42: 481-510, 1956.
2. Cadman, G. R.: A vade mecum for the Begg technique, AM. J. ORTHOD. 67: 477-512,
601-624, 1975.
3. Williams, B. T.: Cephalometric appraisal of the light wire technique. In Begg, P. R., and
Kesling, P. C.: Begg orthodontic theory and technique, Philadelphia, 1965, W. B. Saunders
Company.

140 Fenuray

There are inhibitions, sometimes hereditary, sometimes due to bad or perverted

function of the mouth, nose, and throat, which will militate against, or utterly prevent
the securing of an ideal result. Among them, are cases which are so pronounced that
they cannot be stimulated to a size which is even large enough to be in proportion to
the rest of the face. Thirty-two teeth in normal occlusion might not be too large for this
particular face, but the jaws cannot be stimulated to a sufficient development to permit
these teeth to remain in normal alinement and relation, and there are rare cases where
even twenty-eight, cannot be so accommodated. In other words, in our civilized race,
it is possible for the jaws to be so inhibited in their growth, that the best orthodontic
treatment cannot bring them up to a size which will accommodate all the teeth, and when
in an effort to do this, the teeth are tipped outward and forward, to produce a so-called
normal occlusion, a relapse will surely take place, as pointed out by Lundstrom. (Kelsey,
Harry E.: The Value of Early and Scientifically Correct Diagnosis of Malocclusion as Corn..
pared With Experimental Diagnosis, The International Journal of Orthodontia, Oral Sur-
gery and Radiography, predecessor of the American Journal of Orthodontics, February,
1928, p. 159.)