Abstract
To
The Editor,
Journal of Indian Orthodontic Society
I request you to kindly publish the following view point in the journal.
I read with great interest the case report “Begg’s revisited: report of a case” in the January–March 2019 issue of the Journal of Indian Orthodontic Society. I would like to compliment the authors for their courage in treating and publishing a case using Begg appliance that most practitioners, for no valid reason, consider an obsolete appliance. Doing camouflage for a class III patient of 12 years of age is a debatable issue, and I will not go into the pros and cons of it. However, I would like to make the following comments regarding the mechanics used:
The authors have used uncontrolled tipping throughout the treatment. While uncontrolled tipping for a short period may be desirable in those cases wherein root apices are very close to the labial or lingual cortical plates to begin with, prolonged uncontrolled tipping is undesirable because it is known to cause root resorption. In Modern Begg practice, controlled tipping of incisors is achieved by using Mollenhauer aligning auxiliary or a braided ribbon NiTi sectional.
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Using any fixed appliance solely for uncontrolled tipping is only slightly better than doing treatment with removable appliances.
As far back as the 1890s, Calvin Case demonstrated the efficacy of labial root torque on upper incisors in class III patients (reported later in 1917)
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for improvement of profile by way of deposition of bone at point A, which lifts the base of the upper lip. Such torque application should be a mandatory part of class III camouflage. Begg torqueing auxiliaries are excellent for any type of torque application. I do not comprehend why such torque application was not considered in this case, which certainly would have improved the profile much more than what is shown.
I do not wish to appear excessively critical or harsh. However, Begg treatment acquired a bad name in the past because many people simply attempted uncontrolled tipping in class II correction and did not proceed with the torque correction in the third stage. I do not wish the youngsters to follow that wrong path. With the knowledge of advanced biomechanics and the presently available means, treatment with any appliance must aim at perfection and not just at the patient’s satisfaction of some improvement in the profile.
March 5, 2019