Nonextraction treatment with the

Begg technique
Harry G. Barrer, B.S., D.D.S.
Readinq, Pa.

I n 1959 American orthodontists were introduced to the Begg method of

orthodontic treatment. This method is based on the philosophy that the teeth
are in a state of flux and follow a predictable pattern, resulting in a dynamic
occlusal relationship. I t follows that this movement requires space in which to
occur. I t may be found intra-arch, interarch, or distributed within the three
dimensions of the confines of the total functional mass. I t may be naturally
available or artificially produced.
Since orthodontic correction most often revolves around the need for space,
the availability of space becomes a keystone to treatment. When it is naturally
plentiful, conservative treatment is possible. When space is obviously lacking,
radical procedures are required and surgical intervention is the solution. Be-
tween these opposite conditions are the problems that tax our ability to estab-
lish differential diagnosis, because if space is available, though hidden, proper
diagnosis can reveal it, p r o p e r treatment planning can incorporate it for cor-
rection, and proper appliance t h e r a p y can utilize it for resolution of the maloc-
clusion.
In the beginning, the Begg technique was thought of as a routine extraction
procedure. Its philosophy was basic to its mechanics, and its mechanics were
categoric. W h a t has happened to these basics over the years after hundreds of
orthodontists have accepted Begg t h e r a p y as their means for correcting ortho-
dontic problems?
I n looking back over my own experience and that of m a n y others with whom
I have been in contact, I am impressed by the lack of any major change. Where
change has occurred, it has been qualitative r a t h e r than quantitative.
We find that the philosophy remains intact. Changes in mechanotherapy

Presented at the meeting of the Northeastern Society of Orthodontists, March 9

to 11, ]969, and of the Orthodontic Alumni Society of Columbia University, June
9, 1969.
365
366 Barrer A,~. & Orthodontics
October 1969

have been m i n o r and routine, while in the previously negleeted area of differ°
ential diagnosis there has been clarification of goals and the diagnostic indica-
tions for the reduetion of tooth material are more distinct. Even posttreatment
evahlation of results indicates a regular pattern. Tooth movenmnts arc specific.
rogular, and predictable, and the validity oil these findings has been verified by
a m l m b e r of separate investigations.
Mechanically, the goal of Stage 1 t r e a t m e n t is still to open the bite am t
establish a Class I relationship of the posterior teeth. Stage 2 is for closing all
intra-arch space, and in Stage 3 all root-positioning corrections are made. I~,--
dividual malrelations of tim teeth ~re usually fully corrected in the first sta~e
of treatment. This includes rotations, supra- and infra-eruption, deviations in
arch form, and cross-bite relationships. A n y malposition still present at the
end of Stage 1 m a y be carried over and corrected in Stage 2. IIowever, these
shouhl all be resolved prior to the start of Stage 3, or successful and complete
correction will be diffieult to obtain. A m a j o r advantage of the Begg technique
is its ability to complete all these movenlents sinmltaneously.
The philosol)hy of a dynamic occlusion still dictates the use of a freely acting
appliance that effects controlled dental movement as a result of the stimulation
ot! light forces, a eoneept t h a t has been reinforced by a n u m b e r of papers, th,~
most regent being the report of l)onaht R. Poulton. *
The corrective ability of Begg mechanical t r e a t m e n t has been u p g r a d e d by
refinement rather than technical ehanges. The shapes of some of the auxiliaries
have been modified, but ultimately these appliances still work in the same man-
nor, although with greater efficiency.
The goals of Stage 1 are accomplished in the same way, but today's h a r d e r
wires make our task easierd The use of elastie ligature slings '~ or modifiM
Pleteher coil tension removes patient responsibility in Stage 2. The use of a
heavier base arch wire in Stage 3 gives us better control. With such an arch,
we can offset the reciprocal forces of the more efficient torquing auxiliaries that
tend to depress the canines or flare the posterior teeth bueeally. At the ~ n l e
time, the arch resists the depressing action of the u p r i g h t i n g spring's on file
molars. Arch form is better stabilized and more easily maintained.
~)ne m a j o r change does become evident, though, and that is in regard to the
early idea that Begg t h e r a p y was I)rimarily an extraction procedure. Now, with
more acute diagnostic and t r e a t m e n t - p l a n n i n g procedures and with a better
understanding of the mechanics of tooth movement, Begg principles can bc
used with excellent suceess in nonextraetion t r e a t m e n t over a wider spectrum of
cases. Background information on these ehanges is presented in recent articles
by Brainerd P. Swain '~ and Raleigh T. Williams. ~
[n our early use of Begg therapy, the final deeision between extraction and
nonextraetion was left very much in the air. There were no true guidelines
based on postretention evaluation of cases, t)f course, this kind of decision
is rightfully a funetion of diagnosis or, to lie moi~ exact., a variable to be
exanlined in relation to other variables. I n the Begg group Williams s has made
the greatest eontritmtion to t r e a t m e n t planning. H e was a m o n g the first to
evaluate serial eephalometric studies of Begg eases and relate his findings to
diagnosis and t r e a t m e n t goals.
volume 56
Number 4
Nonextraction treatment with Begg technique 367

Diagnosis is based on the relationship of the teeth to each other and to the
bone base and on the combined effect of this relationship on the facial profile.
Williams finds, as did Downs, ttoldaway, Ricketts, and others, that an accept-
able facial outline is dependent on the position of the lower incisor. An accept-
able dental profile is seen when the incisal edge of this tooth approximates the
AP line. A second factor is the position of the upper incisor. This tooth is in

i i

Fig. 1. Cephalometric measurements of acceptable dental-skeletal relationships used in

diagnosis and treatment planning.

Fig. 2. Cephalometric measurements before and after treatment (treatment goal).

368 Barrer A,,. J. Orthodontics
October t969

a satisfaeto~ ~ position when it is in contact with the lower incisor and when il
is at approximately 104 degrees to NS. With a nornlal skeletal pattern, these
relationships result in an acceptable facial harmony (Fig. 1).
With this as a guide, treatment planning can be standardized within reason-
able limits. The goal for any generM treatment plml would be to finish treatment
with the lower central incisor on A P and the u p p e r (;entral incisor at approxi-
mately 95 degrees to NS, with an ANB angh~ of not more than 5 degrees. This
would allow for settling changes and a realization of our final p u r p o s e - - a lmr-
monious, dentofacial relationship (Fig. 2). This concept offers a reasonable gt'id
t',r analyzing spatial requirements and extrapolating treatment procedure.
With the purpose being to place the lower incisor on AP, the following diag-
nostic questions:' are asked:
1. Will (~l) unraveling dental crowding, (b) leveling the occlusal
plane, or (~'/ correcting the molars to a Class 1 relationship place the
lower central incisor too far forward of the A P line ?
2. Will torquing requirements place lower incisors too f a r forward
of AP, by either (a) loss of anchor due to supportive Class I I mechanics
or (b) moving point A too far distally in relation to point P ?
3. Will favorable mandibular growth move lower incisors too far for-
ward in relation to point A ?
If these conditions can be answered negatively, intra-areh space is adequate.
I f any one of these conditions is positive, space production is required. I n the
first instance, treatment is routine and conservative. In the second, teeth must
be sacrificed to accomplish treatment goals.
It has been established that a tooth resists a given force in direct proportion
to its root surface area 6 and that tooth movement is inversely proportional to an
increasing force beyond an optinmm. Thus, when teeth are grouped into units
to resist or autnnent the amoun| of force being applied, they can be moved
either mesially or distally into available space. Therefore, if our diagnostic
evaluation shows that there is suffieient intra-areh space to position the teeth
properly, or if ~lreh length can be increased and dental correction obtained
without violating the profile or A P line beyond acceptance, nonextraction ther-
apy is indicated (and vice versa).
In the Begg technique, dentofacial harmony is obtained by the discretionary
use of this form of differential force application to move the teeth to proper
relationship with the A P line within the natural space available or within the
space established by the judicious removal of teeth. I t is within the discretion
of the operator to determine whether the space requirements are available in any
given ease as determined by his evaluation of the diagnostic material in relation
to the criteria herein stated.
A decision to treat conservatively indicates the presence of a good skeletal
pattern, a satisfactory relationship of tooth size to arch length, and a potential
for good future growth. These conditions make it possible to complete treatment
within profile requirements. Not infrequently, dental malrelationship can be
resolved without recourse to extraction, and Begg technique lends itself to such
therapy.
~oZu,ne ~6
Number 4 N o , extraction treatment with Begg technique 369

Actual appliance manipulation parallels extraction therapy with exceptions

as dictated by the usual criteria of the three stages of treatment. As in extrac-
tion cases, it is also the goal of nonextraction treatment to open the bite and
establish a neutral occlusion, to close intra-arch spaces, and to align the teeth
properly in axial harmony with each other and basal bone. Often one or more
of these desired conditions may already exist, thereby eliminating a treatment
step. For example, the second stage of treatment is often unnecessary because
the small amount of intra-arch space present in these cases readily closes with
the routine use of Class II mechanics. The same applies to Stage 3, which may
be quite abbreviated because, as a rule, major root movement is not required
in nonextraction treatment.
The key to successful nonextraction therapy is the ability to set up reason-
ably stable posterior anchorage. This allows us to obtain the corrections required,
including the placing or maintaining of the lower anterior teeth on AP. It can
be accomplished through the application of proper appliance therapy and force.
It includes correct utilization of anchor bends in the arch wire and the use of
light Class I I force over the shortest period of time for minimum fox,yard drag
on the lower posterior teeth.
Nonextraetion cases, by definition, must present a combination of minimum
treatment requirements, maximum intra-arch space, or substantial freedom to
position the lower anterior teeth in relation to the AP line. Swain 4 discusses an
additional favorable factor. He points out : "One of the paradoxical but pleasant

Fig. 3. Routine appliance structure. Premolar positions good.

Fig. 4. Routine appliance structure with slightly active coil springs to guard arch length
in premolar area.
370 Barrett Am. ,L Orthodontics
October 1969

surprises of Begg non-extraction mechanics is that anchorage potential is often

enhanced if the anchor molars have a mesial axial inclination at commencement
.f' treatment." He exI)lains f u r t h e r : " I f the anchor molars exhibit a mesial
inclination at eommencement of treatment, the combination of normal anchorage
bend force with the slightly subnormal Class I I elastic force usually employed
in non-extraction treatment brings about a beneficial distal tipping of the molar'
erowns into an upright position. In addition, and provided that the ~lass l]
elastic force is sufficiently light, the lower as well as the u p p e r molar crowns
aetua]ly tend to move distally. This net distal movement oceurs because, al-
though the influence of the anchorage bend simultaneously tends to tip the
crown [Link] and the root forward, the resistance to crown tipping' is low while
the resistance to root tipping is high. Consequently crown tipping responds
rapidly and root tipping slowly. Such net distal movement of mesially inclined
anchor molam ean be important in non-extraction treatment because it provides
more arch length for teeth anterior to these molars."

Fig. 5. Class I double protrusion with sufflcient available intra-arch space. Composite
shows profile improved; ANB angle decreased 4 degrees; good growth; positive skeletal
changes; good incisor-AP relation; occlusal plane angle closed.
Volume 56 Nonextraction tretttment w i t h Begg technique 371
Number 4

Fig. 5--cont'd. For legend, see opposite page.

372 Ba'rrer A m . J. Orthodontic,~
October" 1969

This observation should be given impm'tant consideration in the determina-

tion of space awfilability. However, experience dictates eaution against ow,>
exuberance in distal tipping. In faet, we should talk instead of distal uprighting.
Strong anehor bends tip the molar erowns back, valse the mesial marginal rid~ze,
and cause the ~'oots to move mesially in the bone. Subsequent nprig'hting', be-
(,nuse of normal 17unction and the dynamics of oeelusion, will again position the
(.town forward over the new root apex position and result in a fina[ net loss oil
;n'eh length and the posttreatment annoyance ol: anterior collapse and crowding.
lit beeomes obvious, then, that it] nonextraetion eases success depends on a
delicate balance between anehov eontrol, (~lass ] I mechanics, and the duration
o1: fovee application. Or in seleeted eases (meaning correct diagnosis), the utiliza-
tion of p r o p e r meehanies (meaning light for(-e), and with rapid movemenl
(meaning the Begg' ~ype of t h e r a p y ) , nonextraetion treatment can be completely
successful. Aids in this di~'eetion are a good tooth/bone relationship, u oo~l

./'

Fig. 6. Class I malocclusion with moderate crowding and full profile. Composite shows
satisfactory profile; 1 degree increase in ANB angle; growth more downward than for-
ward; Y axis opened and SN-MP angle closed; moderate improvement in incisor-AP
relation; occlusal plane angle opened.
~'ozu.~e 56
Number 4 No,extraction treatment with, Beqg technique 373

Fig. 6--cont'd. For legend, see opposite page.

374 Barter A.~. J. Orthodontic.~-
October 1 9~;f!

growth, and perhaps, in ('lass Jr, l)ivision 1 and (~lass l/, 1)ivision 2 ~ses, :~
bonus of some corrective man(libular r(,1)osturing as we su('c('(~d in r;~I)i~l]5
opening and freeing the bite.
The mechanics of nonextraction treatment are t l w sam(~ as for extracti(m
l h e r a p y ; there are only some quantitative changes, l)el)en(ling on the severit3
of the problem, banding m a y include all the teeth or only the first nlolars ~n(l
anterior teeth (Fig. 3). The [Link] are banded when they require specifi,
I)ositional change or if they are to be included in the anchor unit. Nol int!rv.
quent]y the5" must be rotated or nloved for arch f o r m or ]eve]ing of the o(!e]usai
I)]anc. ] f the premolars are banded, the same rules a p p l y to keep the arch fry,,
of bin(ling, as in extraction therapy. The arch wire is ~mt p u t in the bra(:k(~t slot
until the teeth attain StaKe 3 positions. Bel:ore this stage, the prenlo]ars 1nay h(,
hung' on the arch wire with free-moving ]ig'atm'e ties or the commercially

Fig. 7. Class II, Division 1 malocclusion with close-bite and full profile. Composite
shows good improvement in profile; good improvement in ANB angle, growth generally
good; Y axis and SN-MP angle good; very satisfactory improvement in incisor-AP relation;
occlusal plane unchanged.
vozume56
Number 4
No,extraction treatment with Begg technique 375

supplied C clamps, When the premolars are not banded, it is often expedient to
place a mildly activated open-coil spring between the molar tube and the canine
bracket (Fig. 4). These act as live washers and prevent possible accidental re-
duction of arch length which may force one of the premolars out of the arch.
Nonextraction treatment is successful almost in direct proportion to the
rate of bite opening. The more rapidly this occurs, the less strain there is on the
anchor units. Therefore, where possible, treatment should not be started unless

Fig. 7 ~ c o n t ' d . For legend, see opposite page.

376 Barrer Am. J. Orthodontics
O c t o b e r 1969

the canines can be banded because of their importance in creating a fulcrum

without which the light-gauge arch wires find it difficult to produce the forces
that open the bite, position the molars, and establish arch form.
Nonextraction therapy does dictate some changes in mechanics, since we
must deal with a longer arch span throughout the three stages of treatment.
This affects the anchor bends, which must be somewhat increased because of the
longer span of wire. As in extraction therapy, the bends must be kept close h~
the molar tubes to be active. An advantage in this direction is that we do no1
have to close extensive space, so that the anchor bends can be placed close to
the molar tubes without danger of passing into the lumen.
Arch wire form can usually be more idea], with less lateral force in the
areas of the canines and molars, because of a generally reduced need for Class
II mechanics. The rules for using vertical loops and other corrective bends are
the same.

Fig. 8. Class II, Division 1 malocclusion; severe close-bite with retruded face. Composite
shows good improvement in profile; very good improvement in ANB angle; growth more
downward than forward (good); Y axis and SN-MP angle increased; good improvement
in incisor-AP relation; occlusal plane angle opened.
vNouzmu bmeer5 64 Nonextraction treatment with Begg technique 377

Class II elastic mechanics must be controlled carefully. Two ounces or less,

measured, is the rule. This is especially true if the lower molars are not in a
favorable position and must be allowed to upright distally. The more favorable
the position of this tooth, the more freedom there is in increasing elastic force,
especially when there is a good lower arch and when the need for Class I I elas-
tics is of short duration.
In most cases, Stage ] is very similar to extraction treatment. Stage 2 is

Fig. 8--cont'd. For legend, see opposite page.

378 Barrer a m J. Orthodont~c.s
October 1969

often eliminated since we do not have marked intra-areh space. Stage 3 m o v e

ments are greatly reduced, as these cases do not require extensive root reposition-
ing. As a result, use of elastics in the last two stages is minimized and the pa~
tient is t a u g h t to wear elastics on need only, using the anterior teeth as his
guide, endeavoring to maintain them in an edge-to-edge position.
Since each stage of t r e a t m e n t requires less Class I I mechanics, anchor bends
can be reduced progressively and the arehes adjusted to ideal form. The fim~]
Stage 3 arches are constructed ot! 0.018 to 0.022 inch hard wire and contain all
the cosmetic bends required to overwork and finish the ease with as much finesse
as we can expect from a n y full-bamted technique.
The point to remember in nonextraction t r e a t m e n t is t h a t the ease usually
starts out with reasonably conservative discrepancies, the teeth are moved only
moderately, and basic etiology is not altered. Therefore, relapse toward the
original malocclusion is an ever-present problem, and eareful ow~rcorrection am i
good retention techniques are essential. I t is preferable to retain these eases with
a rubber tooth positioner, when this cannot be used, a H a w l e y retainer can be
serviceable if it is well made and carefully fitted.
in conclusion. I weuhl like to point out that, as the result of a study oi; ~
series of eases (Figs. 5, 6, 7, and 8), it: was found that Begg t r e a t m e n t can make
v ( r y significant changes in the angles of SNA, ANB, 1 to 1, and 1 to SN.
Marked lineal: changes can also be made between the ante-r~or teeth a n d A P . As
a. rule, the changes in SNB, ocelusal phme to SN, and SN to MP, though signifi-
cant, are not marked, [Link] there seems to be , o correlation between the changes
produced in the Y axis, m a m l i b u t a r plane, (,r ocelusal plane.:
The application of Begg's principles of treatment to nonextraetion cases is
quite adequate, successful, and justified where properly applied.
REFERENCES
1. Poulton, D. R.: Evaluation of space-closing techniques with the aid of laminagraphic.
~ephalometrics, A~. J. OR'rHODONT~CS 54: 899-918, 1968.
2. Sw'tin, B. F.: In Graber, T. M.: Current orthodontic concepts and techniques, Philadeli)hia ,
1969, W. B. Saunders~ Company, vol. 2~ p. 720.
3. Barter, H. G.: Elastic thread with the Begg technique, J. Pratt. Orthodontics 1: 122-123,
3967.
4. Swain, B. F.: Begg non-extraction treatment, J. Praet. Orthodontics 3: 67-81, 1968.
5. Williams, R,.: The diagnostic line, A.~f. J. OIvrHoDo.','TI(~S 55: 458-476, 1969.
6. Freenmn, D. C.: Root surface area related to anchorage i~1 the Begg teehniqu% Master's
thesis, Uniw~rsity of Tennessee, 1965.
7. Prezanno, E. P.. and Lynch, V.: Cephalometric analysis of before and after Begg-treatcd
Class I cases, thesis for certificate in orthodontics, Columbia University, 1969.

216 N. 6th St.