Topics of the day:
1. Re: Begg Brackets. Mini screew implants
All brackets currently in use have their advantages and disadvantages, as yet there is no ideal bracket. In spite of being classified as old and relegated to the museum, the Begg bracket used intelligently together with auxiliaries (uprighting, rotating and torquing springs) is still a very efficient intra oral machine. Its feature of minimal friction between the archwire and bracket is something all current brackets still try to achieve.
I would imagine that one of the reasons the archwire slot was placed gingival was to allow the placement of auxiliaries such as the uprighting spring. If the uprighting spring is placed in from the occlusal it may interfere with the occlusion, particularly when placed in the mandibular arch. However, in lingual orthodontics we use the Begg bracket with the slot facing occlusal, this allows the archwire to be inserted from the occlusal. Auxiliaries such as uprighting springs may be inserted from both the occlusal and gingival aspect. When inserted form the occlusal aspect, there maybe occlusal interference, to avoid such interference, Dr Andre Hugo modified the uprighting spring so that the helix of the spring is at the side of the bracket rather than on the occlusal. These auxiliaries are described in a Lingual course manual by Drs A Hugo and Z Webber as well as in "Orthodontic Pearls" Edited by E Mizrahi, published by Taylor and Francis, 2004, Chapter 10. ISBN 1-84184-252-4
As someone once said "If you really want to move a tooth, use a Begg bracket" I believe that the tooth does not know what type of bracket has been placed on its surface, the final result is not dependant on the bracket but rather on the philosophy and hands of the clinician.
Mini Screw Implants
Mini screw implants are essentially small titanium alloy bone screws which can be placed intra orally in just about any location to suit the anchorage requirement of a particular case. They may be placed in the buccal alveolar ridge, generally between the roots of the second premolar and first molar, or palatally between the roots of the first and second molar as well as many other sites.
They are easy to place and remove, as opposed to the mini plates, they do not require incision and reflection of the mucosa. They provide instant, solid bony anchorage in either the vertical plane e.g. for intrusion of overerrupted teeth, or in the horizontal plane for the mesial or distal movement of teeth. Their use is limited only by the ingenuity of the individual clinician and I believe they will become widely used in the near future.
They are manufactured by a variety of companies and there is some variation in the design of the head of the screw. Essentially the head will be of the "flat or post" design, the clinician will select the design that suits a particular location taking into consideration patient comfort and ease of access for the placement of elastics, wires or springs. One piece of advice, keep the head of the screw in attached mucosa and not in the unattached mucosa of the sulcus.
Dr E Mizrahi
One very good use for a Begg bracket in an edgewise system, is correction of incisor crossbite (usually affecting a lateral incisor). After opening the necessary space with a coil spring, bond a Begg bracket (slot gingival) on the palatal aspect of the offending tooth. Using a "full thickness" base arch for "anchorage" tie a lassoo around the tooth in crossbite engaging the Begg bracket slot, and the tooth will "jump the bite" in one visit. (No bite plane necessary)
To Dr. Moskowitz
Do you feel the same way about Tip Edge as you do Begg?
We have 5 cases presently under way in which we used micro-screws (2 of the cases used Imtek screws) to intrude the posterior segments. 2 of the cases involve closing of anterior open bites (other option was Lefort I impaction, b/c the open bite is substantial and not due to tongue posture or habit), 1 involves impaction of the teeth in Quad I to correct a canted occlusal plane, and the last 2 involve using the microscrews as anchorage to protract the posterior segments (I am one of those patients : since I lost #47 and #48 was present, I opted to protract #48 rather than go with an implant to replace #47 - call me crazy).
My surgeon and I saw some cases and decided to go ahead (while advising our patients that there may be limitations to what we may achieve...) with these 4 patients. The surgical component seemed pretty straight forward without too many complications (in one patient both screws were lost before loading, and we are now in the process of implanting two more screws, and in myself the screw had to be removed and repositioned more coronally b/c it was near the junction between the attached gingiva and free gingiva - and tissue grew around the screw head), and the orthodontic aspect seems equally as simple. The only thing left is to see how well it works (all cases were started within the past 2 months). I will keep you advised and hopefully be able to upload som Pixs.
I believe that Great Lakes Orthodontics has a course. Roy King
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