American Journal of ORTHODONTICS

Volume

71, Number

1, January,

ORIGINAL

1977

ARTICLES

The differential force method of

orthodontic treatment
P. R. Begg,

D.D.Sc., L.D.S., B.D.Sc., and Peter C. Kesling,

Adelaide, South Australia,

Many

D.D.S.

and Westville, Ind.

wish to learn but few the price will pay.

3uveua1,
first century A.D.

his essay is being written to explain the light wire differential force
technique free of unnecessary and incorrect variations. It is hoped that this will
help eliminate the confusion that has been caused by several published accounts
which, while purporting
to describe this treatment, actually are misleading because they contain retrogressive alterations.
Some orthodontists now employing this technique have received only practical
training in the manipulation
of the appliances and very little teaching on its
theoretic basis. Therefore, a brief description of Stone Age mans attritional occlusion, the basis upon which this method was developed, is also included. Unless
this section is carefully studied, the part describing appliance therapy will be of
little value to those using this method to treat patients.
This essay is an abridged
and revised
version
of two lectures
delivered
at the fortyfifth
annual
meeting
of the Great
Lakes
Society
of Orthodontists,
Oct. 5 to 9, 1974.
We wish to thank
all members
of the Kesling
and Rocke
Group
of Westville,
Ind.
Without
their
illustrations
and records
of appliance
therapy
throughout
treatment,
this essay would not achieve
its purpose.

Also, to dissuade orthodontists from attempting to employ edgewise brackets

in conjunction with this technique, a brief analysis of root-moving forces delivered by the edgewise appliance is included.
In the hope of holding the attention of the more clinically oriented orthodontists and of making this article less dreary, the records of treated cases and recent
improvements in this method will be interspersed throughout its entirety.
1

Am. J. Orthod.
January
1977

Fig.

1. Tree gtment

the

extent

to
(the

t he

size

of
of

with
the

and
lower
upper
left fir st permanent

havi e previc susiy

the

protrusion

been

Begg
of

jaws,

the

the
right

severest
and

molars)
published

differential
anterior
left
were
in the

force
teeth

condition
first

1961,

of

I (P.

premolars

extracted
July,

method.

and

prior
issue

This

excess
R.

Begg)
also

to

appliance
this

the

tooth
have

and
of

is, from
of
the

Sitandpc

subsi &a rice

treatec

Eight

upper

anI d lower

therapy.

( TI7ese

JOURNAL.)

hint of
re lative
teeth
right
rc tcords

Differential

force method

Fig. 2. A, Molar
band
with
buccal
tube
(0.036
inch inner
diameter
and 0.250
inch long,
0.914
mm. I.D. and 0.635
mm. long) and intermaxillary
hook
attached
to buccal
surface.
Note that tube is positioned
near the gingival
band
margin,
to help prevent
the arch wire
from
being
distorted
from
occlusal
forces.
A ball-ended
hook
is also
attached
to the
lingual
surface
of each
molar
band
to accept
elastics
or ligature
ties,
if necessary.
6,
Modified
ribbon
arch bracket
(TP 256-500)
especially
designed
for light wire
technique,
prewelded
to a preformed
band.
Will accept
0.016
inch (0.406
mm.)
arch wires
in Stage
1, and 0.018
or 0.020
inch (0.457
or 0.508
mm.)
wires
in Stages
2 and 3. Permits
free
crown
tipping
or controlled
root torque
when
required.

The treatment of a severe malocclusion is shown in Fig. 1. This patients teeth

were so large, compared with the space available in her jaws, that eight teeth (the
four first premolars and the four first permanent molars) had to be extracted
prior to appliance therapy. Very few patients (2 to 3 per cent) have such severe
malocclusions as to require the pretreatment
ext,raction of these eight teeth.
Development

of the

light

wire

differential

force

technique

Early variations of the edgewise technique. This method would not have been
developed if one of us (P. R. Begg) had not been taught by Dr. Edward H. Angle
in 1924-25 to use the edgewise appliance. We owe him a debt beyond repayment.
However, in contrast to the original nonextraction method of using the edgewise mechanism as taught by Dr. Angle, I (P. R. Begg) began to extract
teeth prior to treatment, when necessary. This decision was made as a result of
studying Stone Age Australian aboriginal and other dentitions in relation to the
etiology of malocclusion.
In 1928 Australian orthodontists were shown the results of treatment with
the edgewise mechanism after extraction of the four first premolars in those patients who inherited teeth too large for their jaws. The only change made at that
time in Dr. Angles edgewise mechanism was the use of large round buccal molar
tubes instead of rectangular
tubes. These round tubes have evolved into the
smaller buccal tubes that we now employ in conjunction with the modified ribbon arch brackets (Fig. 2). This change was made so that frictional binding of
arch wires would not prevent horizontal elastics from closing extraction spaces.
Also, many of these patients had to wear headgear. These orthodontists were, with
the exception of Dr. Stanley Wilkinson, noncommittal concerning these treatment
results. They were surprised by the unorthodoxy of pretreatment
tooth extractions.
From 1928 until the present day tooth extraction has continued to be used
as an adjunct to orthodontic treatment whenever this appears to be necessary.
It was recognition of the fact that the lifelong hereditary forces of mesial
migration and continual eruption are very light that led to the discarding of the

Am. J. Orthod.
Januarf~
1977

Fig. 3A.

Facial

photographs

years

at the

beginning

old

before
of nonextraction

(top)

and

after

treatment,

treatment
which

(bottom].
lasted

Patient

was

12

13 months.

edgewise treatment method. This change was made in order to simulate Nature
by employing light continuous orthodontic force values instead of the heavy intermittent forces used in the edgewise technique. A metallurgist, Arthur .J. Wilcock of Victoria, Australia, was able, after years of experimentation,
to produce
arch wire material suitable for the technique.
The fact that the lighter force values employed cause less loosening of teeth,
less discomfort, and less damage to roots and tooth-invcst,ing tissues is evidence
that these forces arc optimal for tissue tolerance. The records of a patient treated
with this technique, using these light force values and directly bonded brackets,
are shown in Fig. 3.
Those orthodontists who use this method properly, and who formerly used the
edgewise technique, report that their average treatment time is much less than
that previously required. Furthermore, it now takes only one third to one fourth
the chair time for each patient.
This technique and orthodontic ccphalomrtrics were developed concurrently,
but independently
of one another. Most anthropologists and biomctricians con
sider that it is impossible to locate landmarks accurately on lateral cephalometric
head films. For this and other reasons, we hare never felt secure in following any
of these concepts in the planning of our patients treatment.

Fig.

3, B to

that

this

the

end

of

anterior
ments

are
seen

a tooth

3,

edge

to

to

on
help

views
plus

profile,

on
worn

the

six

molar
upper

of
upper

a tooth

of
the

dental

teeth

the

positioner

of

for

indicated

C, Occlusion

nonextraction

at

cases).

I. Direct

D, Final

bonded

occlusion.

in nonextraction

before
dental

decision
end

teeth.

of teeth.

Note
attach-

Stage

cases.

The

3 was
patient

results.

arches

at the

anterior

Diagnosis

treatment.

is Class
teeth.

situation

treatment

to

extraction

relationship
the

force method

in most

anterior

location
to

the

simultaneously

six
retain

prior

without

and
the

led

F, Alignment

mass.
had

arch

soft-tissue

occur

as is normally

positioner

upper

treated

edge,

in place

(5 months),

the

2 malocclusion

2 (which

in

attachments
patient

Division

E to G. E, Occlusal

as the

of tooth

II,

be successfully

1 and

be
short

spaces
well

could

teeth

relatively

Fig.

B, Class

Stages

can

wore

D.

patient

Diferentinl

to
of

G,

3 months.

treatment.
arches

treat

Stages
Arch

form

this
1 and
and

The

presence

relative

to

patient

without

2.

Note

tooth

the

of

basal

slight

bone,

as

a reduction
direct

alignment

bonded
after

the

Am. J. O?%hod.
January
1977

:li

Fig. 3H. a and b, Molded

polycarbonate
bracket
and special
lock pin of the type
used
in the treatment
of this patient.
c, Small stainless
steel mesh pad which,
when
spot-welded
to the base of the metal
bracket
permits
it to be bonded
directly
to the tooth
surface.

Treatment procedures must be based on knowledge gained from studying the

occlusion of Stone Age man. Of primary concern is the difference between unworn and attritional tooth mass, together with the realization that everyone has
his own hereditary rate of continual mesial migration and vertical eruption of
the teeth. Treatment planning is made with these concepts in mind. This propdure is more accurate than depending upon static, two-dimensional
cephalometrics. The lack of attrition in the presence of mesial migration and continual
eruption indicates the need for reduction of tooth mass in most patients.
Recognition,

use,

and

teaching

of the

technique

It is fortunate that, 18 years ago, I)r. H. I). Kesling and I)r. (George Dinham
visited my (I. R. Beggs) office in Adelaide, observed differential force treatment,
and were impressed with it. They also seemed, in this short time, to get the message
about attritional occlusion, mesial migration, and the continual eruption of teeth.
It was also fortunate that they had the foresight and determination to go back to
their homes in the United States and, in spite of many disappointments,
to
persevere with the differential force trcat,ment, using the proper appliances. They
not only used the differential forcr light wire treatment method themselves, but
Dr. H. I). Kesling instilled into his partners in the Orthodontic Group at Westville, Indiana, the urge and determination to use this method from that time on.
By the time they had completed their first 100 cases with this technique, the
Orthodontic Center at Westville was completed. Two hundred fifty men were
invited and attended t,hree different showings of this work. From these showings,
there developed a demand for training. In the last 15 years they have given forty
short basic courses to well-attended classes and also more than 100 short refresher
courses.
Hundreds of so-trained men have had this success and report that it has
changed their lives. They are now ablr to achieve more stable results, and both
the patients and their parents are happier and more pleased. Appointments
are
usually scheduled at 6- to 8-week intervals. This enables the operator to successfully treat more patients and/or have much more leisure time for himself and
his family.
This treatment has been devised so that capable orthodontists can render bct-

Differential

Fig. 4A. Before-and

illustrated
in Fig.
the upper
anterior

after-treatment
photographs
of the patient
4, B to I. Note
improved
facial
contour
and
teeth,
which
permits
normal
upper
lip contour.

force method

whose
treatment
casts
desirable
repositioning

are
of

ter treatment for all types of malocclusions, mild or severe (Figs. 44 to 41). However, this is possible only if those who use it have seriously studied its basic biologic foundations. This technique is not intended as a panacea for those who fail
to realize the potentials of other techniques.
Numerous articles properly describing this technique are in print.l- Five
journals on this technique have been published6 and contain many valuable
articles written by various orthodontists. Two editions of a textbook7-s devoted
exclusively to the theory and technique of this method have been published in
English, French, Spanish, and Italian. There have been many other articles published. Some are excellent, but others purporting to describe it are misleading because, as mentioned before, they introduce retrogressive variations. Some of the
best articles describing treatment have been published by orthodontists practicing
in .Japan., lo
However, in order to employ this method successfully, reading alone is not
sufficient-practical
training is also required. In addition to the short courses

Fig,

4, B and

the

labial

upper
that

right
the

terior
so

C. B, Views

surfaces
central

original

teeth

of

of the
incisor
anterior

force

in

overbite
in

technique,

malocclusion

has

to

model

necessary

especially

differential

original
canines

is

is absolutely

important,

the

upper

to

only).
been

patients

Tissue

banding.

C,

at

anteroposterior

of

this
are

on

the

eliminated.

the
teeth

has

(Chip

Occlusion

completely

permit

malocclusion

all

cast.

facilitate

type.

At

similar,

been

removed

distal

line

of

Stage

end

from
angle
1.

of
Note

This

relationship

of

interarch

changes

that

are

Stage

1 in

the

the

end

regardless

of
of

their

an-

original

malocclusion.

Fig.

4, D and

tooth
remaining

appear

E, Casts

made

tooth

a total
positioner

occlusion

achieved

buccal

incisors
with

E. D, The

relationships

spaces.

Note

foreshortened
at the
of

four
for

at
that
in

arch

(two

finishing

the

the
of

wires

completion

Stage

completion
final

the

during

of
have

clinical

anterior

treatment.

and

maxillary
retention.

Stage
been

crowns
view
This
and

of

because
patients
two

2.

The

maintained
the

upper

of

their

treatment
mandibular).

posterior
while
central
lingual
required
The

and

anterior

closing
and

any
lateral

inclinations.
26
patient

months,
wore

Ihfferential

Fig.

4,

four

first

F and

weeks

anchor

G.

F, Occlusal

premolars
before

molar

and
the

control

views

the

appliances
and

of

upper
partial

the

upper

second
were

placed.

closing

and

deciduous
of

G,

lower
molars

Cast

extraction

taken

force

arches
were
at

prior

to

extracted
the

end

method

treatment.

The

approximately
of

Stage

1.

Note

spaces.

mentioned previously, orthodontic students are presently being taught the technique in more than twenty university graduate programs in the United Slates.
Also, universities in Australia, Europe, and *Japan teach the method.
X few of these universities also teach students about attritional occlusion. As
far as we are aware, few, if any, undergraduate
dental students are being exposed
to the lessons to be learned from studying the development of the normal occlusion of man.
,4ttempting
to teach bthc ~~tlgcnise ilIlt the diffcrcl~tial force: methods simutaneously to university graduate orthodontic students is contradictory and, thercfore, can be confusing to both teachers and students. Those who teach the diffcrential force method have no choice other than to contradict what is taught by the
edgewise teachers. Attempts to compromise by crolving midway
treatment
methods produce treatment failures.
Many recent biologic and mechanical findings have been incorporated
into
the differential
force method. Edgewise-trained
operators find it necessary to
with t,his relatively new
discard previously held concepts in order to succeed
method.
IXttempting to use the edgewise method on some patients and the differential
force method on ot,hers results in poorer treatment results with both techniques.
Advantages

of

the

differential

force

treatment

method

1111956 many claims were made in favor of this treatment method. Since then
orthodontists using the technique have substantiated these claims. Therefore, it
now takes less courage to repeat and elaborate on these claims than was required
originally.

Fig.

4, H and

molars
righting
I, Arch
positioner

are

I. H,

in good

auxiliaries
form
after

at

Occlusal
position
during

the
the

completion
teeth

had

views

of

to

withstand

Stage

3.
of

been

cast

Stage

treatment.
brought

made
any
3

at

the

adverse
was

of

Detailed
to their

beginning

pressures

proper

months
finishing
axial

of
from
duration
was

Stage
the

3.

torquing
in

this

accomplished

inclinations

during

Maxillary
or

up-

patient.
with

Stage

3.

This differential
force mcthotl permits early repositioning ot the mandible
and maintains it throughout treatment. It is therefore not surprising that there
is, relatively speaking, minimal Ix&treatment
relapse with this method.
Universal tooth movements are possible ; sclc~tccl teeth can be held relatively
stationary while others move. The separation of tooth-moving forces from thcl
arch wire, as is the wsc tluring Stages 2 and 3, permits exact control 01cr the
duration, direction, ant1 magnitude of the forc*c applictl to cnch tooth (Fig. 5).
(This is impossible with any technique that relics on the fit bctncen the arch wire
and the bracket to create a11tl A-liver forcxx)
This ability to tlifferentiate the forces applictl to teeth (even those atljacent to
one another) makes this a most precise orthodontic tccahnique. The tlesign of the
appliance (inc~luiling auxiliaries) also permits all tooth mo~enicnts to be carried
out rapidly a~lcl over great tlistanccs without reac+ivation,
Tooth roots can be efficiently torquccl labiolinguall~- and uprighted mesiotlistally without discomfort to the pa.tients or frequent rcaetivation of the appliances. This has put a new complexion OH the diagnosis ant1 treatment of Class II,
Division 2 malocclusions.
There is greater ~OI~Irol of tooth movement with this method than with others.
Some critics mistakenly regard the rigidity of heavy arch wires iis being syiony
mous with control, nhe~l act~ually such inflexible rigidity limits and restricts tooth
movements. Because the initial rountl ;Irc:h wires nsetl in the differential force
hoaT!and light
method arc so thin, flexible. tough, ilIlt resilient, :IJ~CI lwnnsc
forces can be applied simultaneously, there is greatci* control in all phases of
treatment with this method. This makes possible the maximum movement of the
dental arches posteriorly or antcriorl;v in the jaws, both in patients requiring and
in those not requiring pretreatment reduction of tooth snbstal~(*(~.

Volume

Number

71

Diferentinl

force method

11

Fig. 5. A, Combination
uprighting
spring
and lock pin (spring-pin),
which
securely
holds
the arch
wire
in the bracket
while
uprighting
the tooth
mesiodistally.
Tail of spring
is
bent to lock assembly
into bracket.
B, Spring-pin
designed
for use in plastic
bracket.
C,
Upper
and lower
0.020
inch (0.508
mm.)
preformed
arch wires
for use during
Stage
3.
Prewound
0.012
inch (0.305
mm.)
Australian
wire
torquing
auxiliary
is in place
on the
upper
arch wire.
The use of these
relatively
heavy
arch wires
during
Stage
3 provides
precise
control
over the application
of forces
from
the auxiliary
to the individual
teeth.

Fig. 6. Treatment
of a Class
II, Division
1 malocclusion
which
did not require
pretreatment
reduction
of tooth
substance.
The teeth
were
spaced
and the jaws
were
large
enough
to hold all teeth
on basal
bone.
Therefore,
it was obvious
that the hereditary
process
of
continual
mesial
migration
would
not cause
the teeth
to become
crowded
after
treatment,
even without
prior
reduction
of tooth
substance.

Am. J. Orthod.
Janunru
19 7 7

Fig. G portrays treatment of a Class II, IIivision 1 malocclusion which did

not require pretreatment reduction of toot.h substance. This patients upper and
lower anterior teeth have been moved back bodily on basal bone. Treatment of
malocclusions which do not require pretreatment tooth extractions or the reduction of mesiodistal tooth widths is easier, simpler, and much more rapid than
when such reductions of tooth mass arc required.
This patients treatment is portrayed to refute the opinions of some writers
that it is necessary to extract, mhcn this treatment m&hod is ust~l, in ord~ to
control anchorage. Morement of this patients anterior teeth back on basal bone
is evidence that tooth extractions are not required for anchorage purposes.
Far fewer appointnicnt,s are requirrd for treatin, <I*both mild and severe COIIditions. Even those severe malocclusions that rcquirr pretreatment
removal of
eight teeth (the four first premolars and the four permanent first molars) take
less time from start to finish of treatment and require fewer appliance adjustments than were previously requirctl for the treatment of even noncxtraction
malocclusions by other methods.
50 specific t,ypes of malocclusion and associated jaw anomalies must be
eliminated for trcatmcnt consideratioll with this method.
The great distances OTW which teeth call br movvtl without reactivating arch
wires (if the proper high-quality light Australian wire is used) are hard to believe and to understand by orthodontists who do not use this method, even if
they have seen the results themselves.
With the differential
force method, it is possible simultaneously to apply
hcaryv forces to larger-rooted posterior teeth while smaller-rooted anterior teeth
are being moved by relatircly lightcr forces. These forces are in conformity with
the biologic requirements of orthodontics. This appropriate application of forces
is made possible through the resilicnc)- of the light round arch wires, the general
looseness of fit between the arch wires and the attachments, and the use of auxiliaries for the creation and application of all torque forces during the final, third
stage of treatment.
Although many orthodont,ists ha~c nsed this differential
force treatment
method for nearly two decades, the biologic concept upon which it is basedStone Age mans tlentition-is
still unique. It is also unique as far as its mechanical principle of appliance therapy is concerned. It is tliffcrent from, contrary
to, and at variance with other orthodontic treatment methods and theories.
O?le technique
to treat nil malocclusions.
Some orthodontists arc of the opinion
that it is not possible to treat all varieties of malocclusion with a single appliance
or technique. These operators treat one type of malocclusion with one appliance,
another with a second, and so on ad infinitum.
Such misconceptions point out the inefficicnc~- or lack of flexibility of the
techniques used or the lack of training or skill of the orthodont,ists.
Bepause every arch wire used to begin treatment with the differential force
method is especially shaped, the technique will accommodate all types of malocclusion. Tt is possible to begin the trcatmcilt of carh CBSCwith a diffcrt~nt mrchanism in the form of arch wires designed specifically for the unique requirements
presented.

Volunze
Number

DifSerentinl

71
1

force method

13

The patients receive the best treatment possible-not

only because of the
merits of the appliance, but because the operator is able to attain a higher degree
of competency working with one appliance than would be possible if he were using
several techniques simultaneously.
Three

stages

of treatment

with

the

differential

force

method

Appliance therapy is divided into three stages of treatment for all forms of
malocclusion. The objectives to be accomplished during each stage are as follows :
Stage 1 objectives
1. Achieve an edge-to-edge anterior tooth relationship.
A. Eliminate anterior overbite.
B. Close anterior open-bite.
C. Eliminate anterior cross-bite.
2. Align upper and lower antcri?r teeth.
A. Unravel crowding.
B. Close spaces.
3. Correct anteroposterior interarch malrelations. Maintain anterior teeth
in end-on bite in Class I and Class II malocclusions.
4. Coordinate upper and lower dental arches. Achieve symmetry.
5. Overcorrect rotations of all teeth except anchor molars.
6. Elevate impacted and unerupted teeth.
7. Correct cross-bites of posterior teeth.
The light wire appliances employed to accomplish the corrections mentioned
above can be seen in Fig. 7.
Spaces in the buccal segments created by pretreatment tooth extractions may
partially close; however, this is not a required change during Stage 1.
Many steps are taken to prevent the anchor molars from coming forward
while depressing anterior teeth and tipping them both lingually and distally.
Anchor molars are held upright while the anterior teeth are free to tip in all
directions. All tooth-moving forces from arch wires, intermaxillary
elastics, and
auxiliaries are relatively light. These steps, and others, make the use of extraoral
anchorage (and/or the well-known edgewise procedure of setting up anchorage),
not only unnecessary but detrimental to the quality of the result of treatment.
All Stage 1 movements are carried out simultaneously, and all of them must
be completed before proceeding to Stage 2.
Stage

2 objectives

1. Maintain all dental and interarch changes achieved during Stage 1.

2. Close any remaining spaces in the posterior segments.
The proper relationships of the teeth at the beginning of Stage 2 and the appliances used during this stage of treatment (except for intraoral elastics) can
be appreciated by studying Fig. 8.
With the exception of slight restraining forces placed on the teeth by the
larger-diameter
arch wires (0.020 inch, 0.508 mm.), which maintain major corrections achieved during Stage 1, all forces applied to the teeth during Stage 2
are generated from intraoral elastics.
It is chiefly during the second stage that both dental arches are placed in

14

Begg and Keslixg

Am. J. Orthod.
January
1977

Fig. 7. Appliances

(with
the exception
of elastics)
in place
at the beginning
of treatment,
start of Stage
1. A, The vertical
loops
in the lower
arch wire will align
the lower
anterior
teeth.
B and C, The anchor
bends
in the arch wires
will eliminate
the anterior
overbite
and
maintain
the anchor
molars
in upright
positions
throughout
treatment.
Also,
note
that the arch wires
do not engage
the premolar
bracket
slots but are free to slide distally
through
bypass
clamps
placed
on these teeth.
D and E show
the rotating
springs
in place
on the upper
and
lower
right
second
premolars
and
the lower
right
canine.
All these
teeth should
be overrotated
at the patients
next visit 6 weeks
later.

their most favorable positions anteroposteriorly

in the tooth-bearing parts of the
jaws. Differential forces are utilized to close any posterior spaces chiefly by moving the anterior teeth posteriorly ; however, the posterior teeth can be moved anteriorly, according to the requirements of each patient.
Because of the tendency for mesial migration, it takes relatively (but not absolutely) less orthodontic force to move large-rooted molars mesially than is required to move anterior teeth distally. Paradoxically, excessively heavy forces

Volume
71
Num her 1

fig.

8.

Diferentia.1

Typical

(0.406

mm.)

wires.

These

continued
wires

close.

second

overcorrections
close

The

of
the

during

through
upper

to

anterior

canines
Stage

and

bypass

rotated

molars.
teeth
second

beginning
retained

clamps

Stage

passive

bends

with

premolar

has

the

arch

has

closed
1 are

bends
also

premolars

to

are
ensure
as

these

held

premolars

in

1.

positions

proper

arch

which

into
of

the

arch

extraction
the

E,

slot,
The

as

other

overrotation
wires

buccolingual
in

permit

and

and

arch

come

inch

mm.)

as the

pinned

in the

teeth

pins

15

0.016

(0.508

present,

Stage

placed
a

still

wire

during

Original

2 lock

are
second

Stage

A,

inch

Stage

(reduced)
the

in

2.
0.020

on

Bayonet
and

of

essentially
are

quadrant

were

the

Anchor

second

that

the

wires

C,

the
left

in

at

with

arch

that
ties

teeth

replaced

B and

space

premolars
ligature

between

are

tipping.

distally

extraction

steel

of

wires

larger-diameter
free

slide

spaces
the

relationship
arch

force method

contact

to

by
hold

the

relationship
as

spaces

2.

retard tooth movement. This phenomenon is sometimes

small-rooted anterior teeth almost stationary while moving
terior teeth mesially with relative speed.
In mild discrepancy cases the brakes must be put
upper and lower anterior teeth from tipping and to ensure

exploited to hold the

the larger-rooted poson to prevent the six
that the molar anchor

Am. J. Orthod.
Jcmawy
1977

Fig.

9. Stage

upper

3 appliances

anterior

main

arch

incisors,

wires.

pretreatment
is

one

hold
the
during
was

and

to

illustrate

the

E, The

occlusal

Stage

of
3.

on

to

until

the

the

molar

as

views
of

different

lower

the

typodont

before

fixed

inch

in place

to

normally

nature

this

arch

wire,

photograph

and

with

from

prewound

E was

each

which
of

Arch

the

of
of

technique

therapy.

wire)

and

malocclusions

degree

maintenance
spaces

Australian
upper

mesiodistally
in

requirements

appliance
prevent

mm.
mm.)

upright

Size

of

indicate

0.305
(0.508

required

uprighting

to

inch,

0.020

premolars.

with

precise

tubes

is

first

coincide

end

(0.012

with

spring-pins
four

D and
ends

placed

the

varied

overrotations
distal

of

Prewound

place

premolars,

be

example
others.

in

C, Individual
second

extraction
can

A,

auxiliary

B and

canines,

spring-pins
from

in place.

torquing

the
wires

opening
anterior

lower
lateral
having

activation

of

tooth.

This

distinguishes
bayonet
are

while
torquing

it

bends
bent

teeth

to

around
upright
auxiliary,

taken.

teeth are able to move forward in Stage 2. In contrast to this, in severe discrepanq
cases, the six upper and lower anterior teeth must be allowed to tip freely, both
lingually and distally, during Stage 2 in order to ensure that molar anchorage
is not lost and that the upper and lower anterior teeth will be positioned properly
over basal bone at the end of treatment.

Di#erentinl

Fig.
just

10. Intraoral
photographs
of
before
completion
of paralleling

Stage
3 appliances.
A, Front
tooth
roots.
6, Side view

force method

view
of positions
of
of setup
before
tooth

17

teeth
roots

are paralleled.
C, Stage
3 setup
showing
prewound
torquing
auxiliaries
on both
upper
and
lower
preformed
arch wires.
D, End of third
stage,
when
axial
inclinations
of the
teeth
have been corrected.
Upper
prewound
torquing
auxiliary
had been cut off previously
because
the roots of the upper
anterior
teeth were properly
torqued.

In order to bring the dental arches forward as a whole, or to keep them back,
it is necessary to use brackets of the ribbon arch type. Tie brackets (now wrongly
called edgewise brackets) do not afford sufficient freedom of tooth movement to
facilitate the repositioning of the dental arches anteroposteriorly
in the jaws, as
may be required.
In other words, tie brackets, if employed instead of ribbon arch type brackets,
automatically put the brakes on. As a result the teeth of many patients are in
bimaxillary protrusion at the conclusion of treatment.
Of course, in the differential force method, the well-known and long-recognized efficient means of creating stationary and simple anchorage is also employed. This is the holding of anchor teeth upright to resist tooth-moving forces
while permitting all other teeth to tip freely.
Even if an orthodontist
were to use no other appliances than those recommended for this technique, he would have many treatment failures unless he also
strictly adhered to the proper sequence of tooth movements. For instance, if the
orthodontist
prevented free tipping of teeth and commenced root movements
before the end of the second stage of treatment, he would lose anchorage control.

A?n. J. Orthod.

Jcmo.m-1/1977

Fig. 11. Retraction

of protruding
upper
anterior
teeth
in the mixed
a removable
palatal
plate
having
a circumferential
wire.
Fixed
started
in these patients
after eruption
of the succedaneous
teeth.

Stage

dentition
appliance

by

means
therapy

of
is

3 0bjectitqe.s

1. Maintain a.11 dental and interarch changes achieved during Stages 1

and 2.
2. Correct, or overcorrect, the axial inclinations of all teeth.
Appliances used to maintain the corrections of Stages 1 and 2 and to correct
the axial inclinations of the teeth during Stage 3 can be seen in Fig. 9. Interarch
elastics are worn as required to maintain the anteroposterior relationship of the
dental arches.
Recent improvements in the tec,hnique permit the use of heavier (0.018 or
0.020 inch, 0.357 or 0.508 mm., diameter) arch wires during Stages 2 and 3. This
change to heavy, rigid arch wires was made to prevent even the slightest amount
of wandering.
At the present time it is only in t,he first stage of treatment that
the lighter 0.016 inch (0.406 mm.) arch wires are used. The use of heavy round
arch wires during Stages 2 and 3 in no way violates the principles of the differential force method. The arch wires used during these latter stages are passive retainers holding the teeth in the positions to which they have been brought in
Stage 1. The tipping springs, torquing auxiliaries, and rubber elastics are the sole
sources of tooth-moving forces in the final or third stage of treatment (Fig. 10).
The anchor molars which have been held upright since the beginning of treatment, are maintained in these positions throughout Stage 3.
in the mixed dentitiox
For reasons of esthetics, function,
Limited trea.tmext
and possible trauma, it is wrong to leave upper anterior teeth protruding until all
deciduous teeth are lost and replaced by their successors.
Fig. 11 portrays a simple method for early retraction of upper anterior teeth
in the mixed dentition by means of a removable plate. This method is far more
rapid and more comfortable than the use of headgear.
It is seldom necessary to use fixed appliances so early in life, except in Class
III treatment. Of course, rapid palatal expansion (palatal splitting) can be used,
especially during the mixed-dentition
period, as an adjunct to the differential
force method.

Vozunze
Number

71
1

Di#erential

Fig. 12. Attritional

tooth
enamel.
Fig.
third
lower
Fig.
and

Stone

occlusion

13. Occlusal
view
molar
is not fully
right

third

14. Attrition
first molars

Age

mans

of

an

Australian

of attrition
of teeth
of
erupted.
The distocclusal

aborigine.

There

force method

is a

Australian
angle
of

aborigine.
this tooth

aborigine.

The

postmortem

loss

19

of

The upper
right
occluded
with
the

molar.
of the teeth
were
almost

attritional

of an
worn

occlusion-The

old Australian
away.

basis

of present

advances

crowns

of the

premolars

in orthodontics

Man has existed for millions of years at the Stone Age cultural level. The
genetic, anatomic, functional,
and developmental pattern of his dentition has
existed thousands of times longer than that of civilized man.
The occlusal and proximal tooth relations in textbook normal occlusion are
not correct for man. They are a product of civilization and actually constitute
a gross malocclusion.
Figs. 12 and 13 portray attritional
occlusion of the teeth in Australian

Am.

J. Orthod.

Jnmuary

1977

Fig. 15. Plaster

casts
of the teeth
of two
elderly
white
men
who
lived
most
of their
lives with
Australian
aborigines.
Eating
the aborigines
food,
the crowns
of their
teeth
have
worn
away
and edge-to-edge
occlusion
of the anterior
teeth
has developed.
The
occlusal
surfaces
of the posterior
teeth
have worn
obliquely,
so that their
occlusal
planes
slope downward
from
lingual
to buccal-a
characteristic
of attritional
occlusion.

aborigines. Much more information

on this form of occlusion than can be given
here is available.l* ?, 7, *, I1 After reading these accounts of Stone Age mans dentition, some shrug off the evidence presented as only an artifact of the past. This is
absolutely false; everyone, whether he wishes to accept it or not, has inherited
predetermined
rates of mesial migration and vertical eruption of the teeth.
The occlusal and proximal surfaces of Stone Age mans deciduous and permanent teeth gradually became worn through the enamel to the dentin. In old age
the crowns of most of the teeth wore completely away (Eig. 14). Deposition of
secondary dentin prevented pulp exposure in most instances, so that these individuals had efficient masticatory mechanisms free from the diseases of dental
caries and periodontitis.
As occlusal attrition proceeded, the teeth continued to
erupt, thus compensating for the wcarin, 11away of their crowns. Simultaneously,
the teeth migrated mesially, thus maintaining proximal contact as the mesiodistal
widths of their crowns wcrc reduced.
The average amount of at,tritional reduction in the mesiodistal length of each
dental arch, upper and lower, in Stone Age man was about 23 mm. which is almost 1 inch, by the age of about 25 to 30 years. Therefore, as age advances, the
natural position for each tooth in the jaw is farther and farther mesiall;.
In order to occupy their proper posit,ions at all ages, it is necessary for the
molars to migrate over much greater distances than t,hc anterior teeth. Of course
the premolars, being intermecliatc, woultl normally migrate a distance somewhere
between the estrcmcs reprcscntrd by anterior teeth ant1 molars.
Thus, we have a long-standing precedent of millions of years for the reduction for orthodontic purposes of the lengths of dental arches in most patient,s.
This is done by the cxtrattion
and/or reduction of the mcsiodistal widths of
selected teeth.
Civilized mans teeth normally cannot migrate mesially because of their constant mesiodistal widths. The persistence, to a degree, of the hereditary forces
of mesial migrat,ion, cvcn in the absence of attrition, produces crowding and irregularity of the teeth. On the other hand, unrcstrained freedom to migrate,
which may occur after the loss of a tooth, permits posterior teeth to assume posi-

Volume
Number

71
1

Fig. 16.

Diferential

force

method

Plaster
casts
of a 56-year-old
white
farmer
who
has lived
his entire
United
States.
Extensive
attrition
and creation
of Stone
Age mans
dentition
caused
by a diet
of coarse
chewing
tobacco
for nearly
40 years.
The pulp of
right
central
incisor
became
exposed
because
the tooth
was
devitalized
from
many
years
ago and,
therefore,
there
was no secondary
dentin
formation.
Note
anterior
teeth
have
been worn
past their
height
of contours
[greatest
widths).
incisal
attrition
has also caused
a reduction
of mesiodistal
tooth dimensions.

tions farther
trition.

21

life in the
has been
the upper
a blow
that the
Therefore,

mesial in the jaws than would occur under conditions of gradual at-

Genetic
pattern of mans dent&on
developed &a attritional
environment.
Most individuals, by natural selection, evolved larger teeth than could be accommodated in their jaws in the absence of continual attritional reduction. This
ensured Stone Age man sufficient tooth substance for mastication after maturation.
Civilized mans dentition has the same genetic pattern as Stone Age mans
and is programmed
for the development of attritional occlusion. The only missing link is an abrasive diet. Fig. 15, which portrays the teeth of two white men
who lived with the Australian aborigines, and Fig. 16, which portrays the OCelusion of a current tobacco chewer, are evidence of this fact.
It is impossible for a hereditarily
new and very different form of dentitiou
as textbook normal occlusion to have evolved in such a short time. Mans dentition evolved to a form that has a high survival value under Stone Age conditions
of use. However, in civilization it is subject to disease and malformation.
Figs. 12 through 16 make it obvious that if the roots of mans teeth had not
evolved to be mesiodistally narrower than the crowns, continual mesiodistal narrowing of the crowns by attrition, coupled with the hereditary process of mesial
migration, would have caused the roots of approximating
teeth to come into contact and would have destroyed the interradicular
septa of alveolar bone through
resorptive atrophy. It may be discreet not to contemplate the fate of the fibers of
the periodontium.
Dental caries in Stone Age man was almost nonexistent ; thus, it would appear
that the sense of pulpal pain did not evolve to warn our Stone Age ancestors to
visit the nonexistent dentist. Pulpal pain, however, had survival value. It warned
man to retard the rate of tooth attrition by shifting his food to different teeth
and thus allow time for deposition of the secondary dentin in the sensitive teeth.

Fig. 17. Relationships

of lips and upper
and lower
Edge-to-edge
anterior
occlusion
permits
the lower
and lower
anterior
teeth.
Lower
anterior
teeth
tip
the upper
anterior
teeth;
this, plus continual
reduction
in low incidence
of anterior
tooth
crowding
in Stone

anterior
teeth
in attritional
occlusion.
lip to rest directly
on both the upper
labially
into an arc equal
to that
of
of mesiodistal
tooth
widths,
results
Age man.

Fig. 18. Normal

positions
of lips and anterior
teeth
in civilized
Lower
lip presses
against
labial
surfaces
of the upper
anterior
mitted
to the lower
anterior
teeth,
which
are trapped
lingual
to persistence
of juvenile
anterior
overbite.
These
factors,
plus
in the presence
of continual
mesial
migration,
account
for
crowding

usually

found

in civilized

mans

(nonattritional)
occlusion.
teeth.
This force
is transto the upper
incisors
due
lack of proximal
attrition
the
lower
anterior
tooth

dentition.

In old age some individuals WOW away their teeth faster than the rate of dcposition of secondary dentin; the result was pulp exposure and the development of
caries in the pulp chamber.
Anterior tooth relntionships
mtd lip balance in attritioml
occlusion. Stone
Age mans deciduous and permanent anterior teeth changed from an initial overbite to end-on occlusion. It is wrong to call the four upper and lower anterior
teeth incisors. Their function in mans
properly developed dentition is not to
incise food. Only carnivores use their anterior teeth, especially the canines, for
this purpose. Their anterior teeth remain sharp. This retention of an anterior
overbite throughout life by civilized man holds the six upper anterior teeth t,oo
procumbent and the lower anterior teeth too recumbent. In these positions the
bone over the labial surfaces of the upper anterior teeth is often too thin for
adequate support.
The attritional
loss, in both the deciduous and permanent dentitions, of
Stone Age mans anterior overbite, together with the wearing away of the cusps
of all of his teeth, freed the lower dental arch from the upper, permitting it to
move anteriorly. The whole mandible was also free to move in relation to the
maxilla. This often resulted in a Class III (Angle) occlusion of the teeth which,
in civilized man, is regarded as malocclusion but which is actually the proper
evolutionary occlusion for man. With this change in anteroposterior relationships
of Stone Age mans teeth and jaws, the upper and lower anterior teeth formed
arcs of equal size as they assumed an end-on occlusion.
Fig. 17 portrays the relationships of the lips and upper and lower anterior
teeth in Stone Age man. The assumption of an end-on occlusion of the anterior

Differential

force

method

23

teeth resulted in the lower lips pressing directly against both the upper and the
lower anterior teeth. Therefore, the upper anterior teeth retained their correct
axial relations and the lower anterior teeth experienced far less crowding than
civilized mans Of course, continual proximal attrition and mesial migration also
contributed to the low incidence of dental caries and anterior tooth irregularity
in Stone Age man.
Fig. 18 portrays the abnormal relationships of the lips and the anterior teeth
in civilized man.
Civilized mans lower lip presses against the upper anterior teeth which, in
turn, press against the lower teeth. The lower anterior teeth, being pressed in a
lingual direction by both the lower lip and the upper teeth, are therefore held
upright. The tips of the overbiting upper anterior teeth abnormally intervene
between the lower lip and the lower anterior teeth. This abnormal occlusion is
conducive to crowding of the lower anterior teeth. Of course, the absence of
interproximal
attrition
in civilized mans teeth increases the force which contributes to lower anterior tooth crowding.
It ceases to be a mystery to those who have studied Stone Age tooth attrition
why so many people have overlapping lower anterior teeth and why this situation
increases in severity with age. Research projects to determine the correct amount
of anterior overbite can arrive at no valid conclusions, because the retention of
an overbite throughout life is, in itself, an abnormality.
Much attention has been given to what constitutes the correct curve of Spee
in the lower dental arch and the less pronounced compensating curve in the
upper dental arch. In attritional occlusion and the absence of an anterior overbite, there is no difference between these anteroposterior
curves in the dental
arches. This is one example of the many mistakes that have been made and are
still being made because of the acceptance of civilized mans nonattritional
occlusion as correct for man.
;l1alocclusion in Stone &e man. Malocclusions and jam deformities in Stone
Age man were not entirely eliminated by natural selection because his dental
apparatus did not have to be as efficient as that of Stone Age mans prehominid
and prearboreal forebears. His hands and brains had usurped many of the functions of his teeth and jaws.
Stone Age man had Angle Class I, Class II, and Class III malocclusions with
their associated jaw deformities, but their incidence was lower than in civilized
man, This lower incidence of malocclusion in Stone Age man was, of course, due
to attritional reduction of dental arch lengths, cusps, and anterior overbites-and
the requirement of an efficient dentition to survive.
There were also some Stone Age individuals whose teeth were so relatively
large that extensive attrition did not eliminate tooth crowding.
Simulation
orthodontic

of the Stone

Age

dentition

in the

differential

force

method

of

treatment

In the differential force method Stone Age mans end-on occlusion is simulated
in the treatment of Class I and Class II malocclusions (which comprise approximately 95 per cent of all malocclusions). The overerupted upper and lower an-

Fig. 19A. Facial

photographs
ment (bottom).
Note improved

of
lip

the patient
balance

taken
before
after
treatment.

treatment

(top)

and

after

treat-

terior teeth are depressed into their sockets, thus giving them an edge-to-edge
bite. These end-on relations are held until removal of the appliances. We do this
depressing of upper and lower anterior teeth because the pretreatment deep anterior overbite in civilized man is caused by overeruption and bypassing of his
unworn upper and lower anterior teeth. The records of the treatment of a patient who originally had a deep anterior overbite are shown in Figs. 19A to 19C.
During treatment, attritional occlusion was simulated (as nearly as possible without actually attriting the teeth), at the completion of Stage 1.
The retention by civilized man of deep anterior overbite and the persistence
throughout life of deep interlocking tooth cusps prevent the wide lateral masticatory excursions of the mandible that occur in Stone Age man. In support of this,
it is found that in the skulls of Australian aborigines with attritional
occlusion:
the glenoid fossae are flattcncd, large, and shallow (Fig. 20). However, in
aborigines who live on civilized mans food, the heads of the condyles are smaller,
deeper, and not so flat and the glenoid fossae are smaller and hollowed or cupped
out instead of being shallow.
Also, in Class I and Class II malocclusions, the mandible is often repositioned

Fig.

19,

6 to

D. B, Right

2 malocclusion.
premolar
prior

was
to

first

Note

treatment,

simultaneously
teeth

have

Class

I. With

Stage

3,

of

treatment.

at

the

retainers

Cast

in
or

this

overjets
been

which

brought

this

while

This
to

all

teeth

edge,

of

Stage

3.

are

uprighted

all

Heavy

teeth
(0.020

by

the

of
the

original

situation
in

and

the

are

essentially

in

tooth

molar

cases

that

occlusion
the

have

been

corrected

inch,

0.508

mm.)

at

made
by
arch

beginning
the

of

completion

auxiliaries
wires

anterior

overcorrected

the
at

extreme

the

an

left

occurred

have
that

is

same

and

which

Note

second

extracted

right

3,

Division

left

were

upper

and

mass.

D, Cast

procedures.

the
2

II,

lower

molars

and

Stages

Class

The

deciduous

premolar

reduction

treatment

inclinations
of

overbite.

first

often
a

occlusions

simplifies

of

completion

is

edge

models
anterior
second

right

the

require

cent

lower

lower
at

of

per

Both

not

technique,
greatly

Axial

beginning

do

views

100

as the
made

patient.
or

front

than

absent.

as well
C,

and

more

congenitally

premolars.

overbites

side

the

merely

applied
act

as

auxiliaries.

mesially during treatment.

As far as can be ascertained radiographically,
in the
region of the head of the condgle and the glenoid fossa, the mandible is moved
into and held in almost Class III relations. The glenoid fossae are gradually
molded farther forward during treatment. Remolding farther forward of the
teniporomaIlclil)ular
joints occurs durin, w treatment of Class I and Class II conditions because, with the differential force method, Class II elastics are worn almost
continually from start to finish of treatment.
il research project by a graduate orthodontic student is reportedI? in the
AMERICXX
,JOURNM,
OF ORTHODONTICS
(November, 1971) to have demonstrated
on a macaque monkey that Class II intrrmasillarp
elastic force brought about
forward repositioning of the heads of the mandibular condyles.
Maintaining
both the end-on occlusion of the anterior teeth and the forward
position of the mandible during treatment of Class I and Class II malocclusions
contributes greatly to the posttreatment, stability obtained by this treatment
method. This is because the upper and lower jaws arc being allowed to occup,~

Fig.

19,

and

second

E to G. E, Occlusal

F, Casts
This

can

surfaces
ment.
lingual

premolars

made

at

be

appeciated

is

the

visible

Degree
surfaces

end

from

of torque
with

views

are
of

the

comparing

the

occlusal.
upper
of

dental

central
labial

arches

lower

1 and

Stages

by
on
view

of

unerupted;

left
2. The

Arch

form

incisors
surfaces

upper

E, in which

with
G,

prior

second

can
in

and
be

to treatment.

premolar
central
a greater
alignment
appreciated

Lower

right

is congenitally
incisors

are

portion
of
by

more
of

teeth
comparing

first

absent.
upright.

their

labial

after

treatview

of

E.

the anteroposterior
relations which havr been normal for man for millions of
years, as compared to relations they have occupied for no more than a few thousand years.
&terior
ovcrbitc
corrcctiw~
([MI
retention.
After
treatment
the anterior teeth
return to overbite relations t,hat arc considered normal and, indeed, the best possible with unworn teeth. Eiowerer, the over-all retention of the total overbite
correction is excellent. The reasons for this are fourfold :
1. The lower jaw and teeth arc overcorrected and held throughout treatment in almost Class III interarch relationships in both Class I and
and Class II malocclusions. This helps ensure proper anteroposterior
relations of the anterior teeth after the appliances have been remored.
2. Anterior overbites are corrected mainly by depressing upper and lower
anterior teeth with arch wire forcvs, not by using hitc plates to permit
temporary orercruption of posterior teeth.
3. The crowns of the upper and lower teeth are placed in positions of
balance between the lips and the tongue.
1. l!he axial inclinations of the anterior teeth a.re brought to angulations
of overcorrtdon
to eliminate any detrimental effects of the slight
settling that always acvompanics the removtil of fixed appliances.
Fig. 21 portrays treatment, with the differential force method of a scvcre
Class II, Division 1 malocclusion. When the original malocclusion is a severe

Differential

Fig. 20. Temporomandibular

tensive
attrition.
The mode
masticatory
excursions
of
that the forces
of function
joints.
In view
of this,
it
elastics
likewise
determines

force method

27

joint of an Australian
aborigine
whose
teeth
exhibited
exof function,
which
included
wide
anteroposterior
and
lateral
the mandible,
caused
this
joint
to flatten.
This
is evidence
largely
influence
the shape
and size of temporomandibular
is reasonable
to consider
that
continual
wearing
of Class
II
the positions
and
shapes
of temporomandibular
joints.

Class III or an open-bite, the anterior teeth are moved to relatively deep overbite
relations to assist in posttreatment retention.
Posttreatment stability. A unique characteristic of this treatment is that, from
the very beginning, each t,ooth is moved toward its final position. This reduces
treatment time and greatly enhances posttreatment stability. All tooth movements
are purposely overdone and held in positions of overcorrection throughout treatment. When the appliances are removed, any tendency for relapse will be toward
the ideal and in harmony with any corrections being attempted by a retainer or
tooth positioner.
Prior to treatment, the amounts of tooth attrition and mesial migration that
occurred in Stone Age man must be visualized. With this in mind, the diagnosis
of each case will be proper, to ensure that posttreatment
mesial migration will
not cause tooth crowding.
Even today, some orthodontists first treat borderline
extraction malocclusions without prior reduction of tooth substance. They do not make allowance for
the process of mesial migration in the absence of tooth attrition causing continually increasing crowding of the teeth with the passage of time. Then, after
relapse, they have the four first premolars extracted and start treatment again.
Proper study of Stone Age mans dentition could prevent this mistake.
Misconceptions

about

this

and

other

techniques

Fallacy of combining techniques. In order to treat patients properly with this

technique, it is absolutely necessary to employ the proper attachments to achieve
the desired tooth movements throughout all three stages of treatment. Treatment
will not progress properly, and results will be substandard, if brackets are used
that prevent free tipping in all directions in Stages 1 and 2 and that transmit
root-moving forces to adjacent teeth during Stage 3. At the present time the best

Am. J. Orthocl.
,Jnnunry
1977

Fig. 21. Class

II, Division
1 malocclusion
with
pronounced
excess
of tooth
substance.
The
four first premolars
were
extracted
just prior
to appliance
therapy.
Treatment
time
was
16 months.
The lengths
of the clinical
crowns
became
greater
as the patient
grew
older,
as shown
in the final photograph,
and is evidence
of continual
tooth eruption.

bracket for this technique is the modified ribbon arch type (Fig. 22). Edgewise
brackets are among those least suited for this light wire technique. At the present
time some orthodontists who are using light round arch wires in edgewise brackets
claim to be using a light round edgewise technique. This is an impossibility,
have no edges. This misconbecause the arch wires which they USC,being round,
ception has occurred because the original tic bracket invented by Edward H.
Angle has gradually become known as the edgewise bracket.
Angle placed his tiny ribbon arch wire on its edge so that it could be inserted into the tic brackets from the labial or buccal, rather than from the incisal
or occlusal as was the csasewith the ribbon arch brackets. The original greater
vertical dimension of the ribbon arch wire (0.028 inch) became the horizontal
dimension of the new edgewise arch wire.
Tic brackets prevent free tipping of tooth crowns (even when round arch
wires arc cmployxl) , because they have relatively long mesiodistal dimensions.
Therefore, even when small round wirrs arc used, all the teeth tend to receive the
same
amount of Corcc. krect tipping in all directions (which is required for all
teeth except anchor molars) is impossible. This prolongs treatment, causes a loss
of intraoral anchorage, often making extraoral anchorage necessary, and reduces
the efficiency of this method to such a degree that the over-all quality of treatment
is lowered.

Diaerentinl

Fig. 22. A, Modified

ribbon
arch bracket
nique.
It accepts
0.016
inch (0.406
mm.)
the various
auxiliaries
for individual
tooth
lock pin with
beveled
underside
of head,
lock pin designed
to work
in conjunction
arch wires
during
Stage
2. D, Third-stage
mesiodistal

force method

29

(TP 256-500)
designed
specifically
for this techor 0.020
inch (0.508
mm.)
arch wires
and
all
movement
described
in this article.
B, Safety
for maximum
tipping
during
Stage
1. C, Safety
with
0.018
or 0.020
inch (0.457
or 0.508
mm.)
lock pin used whenever
teeth
do not require

uprighting.

T
0A

Fig. 23. A, When

root-moving
forces
are generated
main
arch
wire,
undesired
and/or
inappropriate
teeth.
Not only
is the pressure
transmitted
to the
and causes
unnecessary
periodontal
changes
and
technique,
one or more
teeth
can be uprighted
without
the application
of tooth-moving
pressures
the desired
reasons
why

amount
of force
the Begg technique

to

each
is the

and delivered
by deflection
of the
forces
are often
applied
to adjacant
lateral
incisor
excessive,
it is undesired
patient
discomfort.
8, In the light
wire
mesiodistally
or torqued
labiolingually
to adjacent
teeth.
This ability
to apply

tooth,
independent
of
most precise
orthodontic

its neighbors,
technique.

is one

of

the

Tie brackets also make it impossible to control the application of tooth-moving

forces on adjacent teeth (Fig, 23). When modified ribbon arch brackets are used,
each tooth can receive the desired amount and direction of force and is free to
move independently from its neighbor.
From the foregoing, it should be clear that it is even more difficult to attempt
this light mire technique with tie brackets than it is to attempt the edgewise technique with round arch wire. Some orthodontists have actually condemned the
differential force method after having failed to obtain good treatment results by
merely using light round arch mires with tie brackets. The conclusion they should
have reached is that one cannot USC the edgewise technique without employing
edgewise arch wires.

30

Begg and Keslillg

AWL. J. O&hod.
January
1977

Fig. 24. Individual

root-tipping
spring-pins
in place
at the beginning
of Stage
3. Springs
are wound
from
wires
of different
diameters
to deliver
varying
amounts
of force related
to requirements
of individual
teeth.
Force
values
are given
to show
variety
possible
and are not necessarily
those
recommended
for each
tooth.
Note
third-stage
lock pins
in place on central
incisors
to prevent
undesired
free tipping.

The lewd tril)-l!)l?r~crrrrrlzled lr&*erse crificism.

The differential force method has been criticized because upper and lower anterior teeth arc taken on the
round trip-tipping
the crowns of the teeth lingually and later torquing their
roots distally. The critics of this procedure assume that harm is done to the roots
of the teeth by this procedure. There is no evidence to support this assumption.
In fact, less force is escrtcd on the teeth by moving them back in this manner
than is required if they are moved bodily. Also, teeth move more rapidly when
they are first tipped and then uprightcd.
Actually, the edgewise technique can take teeth on a greater round trip
than is done with the differential force method. For example, anchorage preparation in the edgewise technique often requires the USCof Class III intermaxillary
elastics in order to help the tip-back bends tip t,he crowns of all lower anterior
and posterior teeth posteriorly. Fnrthcrmorc,
during this edgewise anchorage
preparation, headgear is used to restrain all of the teeth of the upper dental arch
from being moved forward by the force exerted by the heavy Class III intermaxillary elastics.
Extraoral forces are also used in the edgewise techniqut to move the maxillary
posterior teeth distally in the correction of many nonextraction Class II malocclnsions. IIowcver, because mesial migration is the natural mode of movement for
the human dentition, it is not surprising that malocclusions treated in this manner
often tend to rclapsc when the extraoral force is removed.
Relative disproportionnte
rr~~~~liccxtio~~~
of tooth root-moving
forces
by edgewise
arch
wire.
When the edgewise technique is used, the arch wires, the brackets, and
the molar tubes arc rectangular so that, all CJf the teeth in each dental arch arc
WC single, rigid unit. When the edgewise
tightly fettered together. They hccomc
arch wire is utilized to upright teeth mesiodistally or torque them labiolingually,
the smaller-rooted anterior teoth receive the greatest amount of force. Conversely,
the large molar teeth on the extrcmc ends of an edgewise arch wire receive the
lightest torque forces, and these forces remain active through greater ranges of
movement.
An occlusion best suited to the root-moving forces delivered by the edgcwisc
mechanism would
br one in which the larger-rooted anchor molars were in the

Diferential

Fig. 25. Treatment

of a severe
Class
II, Division
2 malocclusion.
were
extracted
3 weeks
before
placing
appliances.
This
previously
regarded
as the most difficult
to treat,
and relapse
tion of the light wire
differential
force
method
has made
it
the ease with
which
deep
anterior
overbites
are corrected
distances
is accomplished.

force

method

31

The four first premolars

type
of malocclusion
was
was common.
The introducsimple
to treat
because
of
and
root torque
over
great

midline and the smaller-rooted incisors at the distal ends of the dental arch. Of
course, it is ridiculous to suggest such a. drastic rearrangement of mans teeth so
that the forces generated by an orthodontic appliance are properly distributed.
Fig. 24 depicts the manner by which root-moving forces are related to the requirements of each individual tooth in the light wire technique.
Furthermore,
since each tooth has its own periodontal membrane, it is capable of a rate and degree of movement independent of its neighbors and antagonists. This is another reason for not holding the teeth in each dental arch rigidly
together as a single unit.
Reflecting on the above, it is not surprising that it is necessary to use extraoral force to control tooth movements with the edgewise technique. It is also understandable why many edgewise men have begun to use round wire. Of course,
as was mentioned before, without rectangular wire there is no edgewise technique-and
the tie bracket has nothing to offer the operator, except perhaps
familiarity and an unwarranted sense of security.
Correction

of severe

anteroposterior

dental

and

interarch

relationships

The dental arches can be moved anteriorly or posteriorly in the jaws, according to the requirements of each individual case. Under some circumstances
one dental arch, either upper or lower, can be moved anteriorly while the opposite

Am. J. Orthod.
Jamuarll
1977

dental arch is moved posteriorly in the jaw. This is brought about by utilizing appropriate variations in tooth-moving force values, as well as by changing the directions in which the forces are applied.
Obviously, severe Class II conditions such as those shown in Fig. 25 cannot
be completely corrected by merely moving the anterior teeth back through boric.
If this were attempted, the apices of the roots of these teeth would hart to ht
mored 14 or 15 mm. posteriorly. Such great changes in the bodily positions of
upper anterior teeth are impractical and unnecessary, if not impossible.
If tho mandible itself (including the C(Jndykir
heads) were not brought JOYward in the treatment of severe Class II malocclusions, the lower anterior teeth
would be moved so far forward that their roots would be denuded of their periodontal tissues. In short, the lower anterior teeth would be extracted by being
moved out through the labial cortical plate of bone before their crowns could
occlude with the upper anterior teeth, if t,he mandible were not repositioned.
It is obvious, then, that the successful treatment of a severe Class II, IXvision
1 malocclusion (as shown in Fig. 26) is the result of moving the upper dental
arch posteriorly and the lower dental arch and mandible anteriorly.
In order to accomplish permanent anterior repositioning of the mandible by
orthodontic treatment, it is necessary to wear Class TI intermaxillary
elastics
through almost the entire period of treatment. The correction must be made at
the beginning of trratmcnt atltl maintainrtl to permit remotlcling of articnlar surfaces and adaptat,ion of muscles and their attachments. If headgear treatment
replaces, q)r appears t,o rcducc, the need for Class II elastics tluring treatment,
the desired permanent forward movement of the mandiblr will be lost. Of c?ourse,
the use of Class III elastics for anc~horagv preparation or in an attempt, to correct
a midline dental discrc~pancy will also prthvcxnt this desirctl pcrmancnt, mandibular
repositioning.
The pulling forward, by means of rcvttrsc headgear, 01 tlcntal arches with
well-occluding small t,ectti in persons who have prominent chin points and noses
and tight thin lips is incorrect and prone to relapse. These patients have problems which might better be solved by plastic surgeons. This apparent backward
position of the dental arches, although displeasing to those who like full lips, is
correct for the patients. When their dental arches arc pulled forward in the jaws
by reverse headgear, the IalGal surfaces of the roots of their anterior tvt)th ma>
bccomr denuded of tooth-sul)l)ortilig
tissues.
Failure to reduce t,hcxappropriate amount of tooth substance in both dental
arches lcads to posttrcatmcnt relapse. Nonextrac*tion treatment as taught by Angle
resulted in a far higher incidcncc of relapse and impaction of third permanent
molars t,han occurs in paticxnts totlay \vho ha\r pretreatment
removal of a sufficient amount of tooth substance. The avoiclancc, tlven today, of prctreatmcnt tooth
reduction by sonic orthodontists because a full-mouthed appearance is consideretl
to be attractivr is the cause of many relapses.
Ideal
and

sequence

of force

values

delivered

by fully

activated

light

arch

wires

auxiliaries

It is imperative
Arthur .J. Wilcock.

to use the best quality of arch wire material produced by

This light arch wire, being very resilient, moves tee01 over

Differenfial

Fig.

26.

and
clusion
this
in
two

Treatment

marked
because
patient

Treatment
used

contact
first
time

during

completion

the

a Class
of

active

17

1 malocclusion

substance

relative

and

left

treatment.
the

permanent
was

II, Division

right
for

with

treatment.
of

tooth

upper

presented

proximal
upper

of

excess

upper
molars

first

months.

Only
upper

appliance

jaw

that

the

the
five
third

arch

upper
lower

wires
molars

This

had

been
first

Just

two

severe

size.

premolars

premolars.

and

The

two

second
Note

with

to

prior
first

method

force

bimaxillary
is

protrusion

mutilation

extracted

molars

appliance

premolars

(three

upper

and

erupted

into

normal

maloc-

years

permanent
to

33

before
were

therapy
were

two

the

extracted.
lower)

occlusion

were
after

therapy.

long distances without having to be frequently reshaped for continued activation.

If Mr. Wilcock had not persevered until he produced arch wire with the necessary properties, this treatment method could not have been evolved.
When first applied, arch wires and auxiliaries deliver their maximal forces
and, as the teeth move, these forces gradually
decrease. Fortunately,
this
sequence of force value application is ideal for maximum rates of tooth movement.
Frequent reshaping of arch wires is detrimental
because it causes minute
changes in the directions of force, which reduce the rate at which the teeth more.
Rectangular arch wires must, because of their rigidity, be frequently reactivated during treatment. Therefore, when first changing to the differential force
method, operators must discard their habits of seeing the patients every 3 or 4
weeks for adjustments. Not being familiar with the appearance of teeth as they
respond to the initial arch wires, they may be tempted to reactivate them. Of

Am.

J. Ovthod.

Jan.uary1977

Fig. 27.

Treatment
of a patient
with
Class
II, Division
1 malocclusion.
The four first premolars
were
extracted.
The same
upper
and lower
arch wires
of 0.016
inch (0.406
mm.)
diameter
were
used throughout
treatment
without
once being
removed
from
the mouth.
Active
treatment
time was just under
10 months.
For further
explanation,
see text.

course, if an arch wire becomes distorted, it is imperative to correct it as soon

as possible because tooth movements are so ra.pid that such distortions could
rapidly move teeth far from their correct paths, Normally, appointments with
this method are at intervals of 6 weeks.
Fig. 27 portrays treatment of a patient with a Class II, Division 1 malocclusion. The four first premolars were extracted 3 weeks before the start of appliance therapy. The same upper and lower arch wires of 0.016 inch (0.406 mm.)
diameter were used throughout treatment without once being removed from the
to place the arch
mouth. Two adjustments vvcre made durin, 0 treatment-first,
wires in the slots of the brackets of the four second premolars after the extraction
spaces were closed and, second, to place uprighting
springs and torquing auxiliaries at the beginning of the final stage of treatment. The distal free ends of the
arch wires were kept cinched tightly against the molar tubes to prevent rcopening of extraction spaces during the final stage. Treatment time was under
10 months. When the most powerful canine root-tipping springs made from 0.018
inch (0.457 mm.) Australian wire are used, canine roots can be tipped back even
farther and more rapidly than was done for this patient.
The benefits of placing fully activated arch wires and auxiliaries are manifold :

Differential

Fig. 28. Drawings

begin
treatment

of fully
activated
0.016
inch (0.406
mm.)
arch
of the Class
II, Division
1 extraction
case (A) and

nonextraction
case (8) shown.
The amount
wires
can be appreciated
by noting
where
the models
at the left. Casts
in the center
brackets.
Casts at the right show
the results

force method

35

wires
actually
used
the Class
II, Division

to
2

of bite opening
or anchor
bends
in the arch
the anterior
portions
of the arch wires
rest on
show
the arch wires
engaged
in the anterior
of treatment
for each case.

1. The rates of tooth movement are increased.

2. Reciprocal forces are caused to become more efficient.
3. Variations in both the values and directions of tooth-moving
forces
(changes which retard tooth movement and are inevitable whenever
appliances are reactivated) are eliminated.
4. Chairside time is reduced.
5. The number of appointments
required throughout
treatment is reduced.
6. The over-all treatment time is greatly reduced.
The initial arch wires made from Wilcock stainless steel wire for two malocclusions are portrayed in Fig. 28. They are so resilient that, when properly activated, they can deliver the proper tooth-moving forces for up to 3 months without
being reactivated.

36

Am. J. Orthod.
JamuarU
19 7 7

Begg cmd Keslillg

The forces exerted by these arch wires are proportionate to the requirements
of each individual tooth. They cause far less discomfort to patients than the
forces from rigid rectangular arch wires which have to be frequently reactivated
throughout treatment. Also, the fact that these highly resilient wires can deliver
the desired forces over a great range of tooth movement eliminates the need for
frequent adjustments. This also adds greatly to the patients comfort.
In this method, arch wires and tooth-moving
auxiliaries still have toothmoving forces in them at the completion of treatment. Therefore, the appliances
must be removed before too much ovcrmovement occurs.
Attritional

occlusion-The

key

to future

advances

in dentistry

Textbook normal occlusion is erroneously accepted as the foundation,

the
starting point, the basis, the one grand object of dentistry as a whole. Because of
this, advances in many branches of dentistry, including orthodontics, have been
retarded or misdirected.
The refined soft food of civilized man is accelerating the rate of evolutionary
reduction and degeneration of his teeth because the teeth now have a lower survival value than in Stone Age man. It is hard to imagine that the whole method
of modern food production will be modified in order to promote dental and periodontal health.
Some day, as a partial solution to this problem, orthodontists ma.y augment
their mechanotherapy with some form of equilibration and continual reduction
of tooth substance.
This could be accomplished by mechanical stripping and grinding at regular
intervals carefully related to each patients rates of eruption and mesial migration. Patients could bc instructed
to use chewing gum containing varying
amounts of tough roughage and carborundum
dust to wear away cusps
and
proximal surfaces.
If civilized mans teeth were subject to such controlled attrition, orthodontists
would not have the problem of orthodontic extraction spaces sometimes remaining
slightly open after treatment. There would be no intcrdigitating
tooth CUSPS to
interfere with closure of these sma.11spaces by the hereditary process of mrsial
migration.
Tears ago a dentist reported that he gave a patient chewing gum with a
gritty substance incorporated into it in order to equilibrate his teeth. The patients occlusion began to improve, but this treatment was quickly discontinued as
soon as interproximal
attrition was observed. The dentist feared that loss of oncpoint proximal contacts would, according to G. V. Blacks teaching, be harmful.
The roots of civilized mans teeth cannot migrate closer together because their
crowns do not become narrower mesiodistally. This prevents the fibers of the
periodontal membranes from becoming shorter with increasing age, as occurs
naturally in Stone Age man. Therefore, the transseptal fibers of the periodontal
membrane in civilized man are subjected to ever-increasing and presumably destructive stretching forces. Periodontists who complain that artificial reduction
of the widths of teeth causes harmful compression of periodontal membranes and
their fibers need to study Stone Age dentitions.

Volunae
Nwmber

71

Diflerentinl

CIVILIZED

A
n

A~AECC

29.

gingiva
from
too

Diagrammatic
of

shallow

attrition.
space.

to
The

harbor
gingival

October,

and

to

A&
of

civilized

Friction
bacteria.

triangles

papilla.
Surg.,

man
disease.

A, Free

gingival
Oral

comparison*

primitive

periodontal

Maturity

from
The
the

B, Level
of

changes

his

to
crude

at

show

relative
of
gingival

kept

space
sizes,

soft-tissue
trough.

at

different
how

food

interproximal

margin.
Height

the
man

represent
B,

37

MAN

A m:,escel,m

m 4

Fig.

PRIMITIVE

force method

was
different

attachment
(From

ages

of

primitive
the

gingival

kept
ages,
Begg,

of
tooth.
P.

teeth

and

remained

free

(A

trough

small
to

the

man
by

interproximal

the

interproximal

to

B)

C, Interproximal
R.:

Am.

J.

Orthod.

1945.)

Civilized mans dentition is pathogenic. It contracts diseases, dental caries,

and periodontitis in the stagnation regions protected by plaque. The sites of these
stagnation regions (namely, proximal surfaces and occlusal pits and fissures)
were pointed out by G. V. Black.
Because of their lack of knowledge of Stone Age attritional occlusion, univer..
sity dental research workers are not aware that plaque formation is caused by the
absence of abrasive and cleansing properties in civilized mans food. When they
realize this true cause of plaque, it should be useful to them in discovering means
to prevent both dental caries and periodontal disease.
In Stone Age man proximal attrition wore away the contact points of his
teeth and turned them into flat, continually enlarging contact surfaces. The process of mesial migration kept his teeth in proximal contact as their mesiodistal
widths were being continually reduced. Consequently, the interdental space remained small and frequently became smaller as the teeth continually erupted.
In civilized man the triangular interproximal
space, as portrayed in Fig. 29,
becomes gradually larger with age in the absence of tooth attrition. The apex of
this space is the point of contact of the neighboring teeth, and the walls of the
neighboring teeth comprise the two sides. The base is defined by the transseptal
fibers.
This pyramidical interproximal
space continually enlarges in civilized man
as the teeth erupt and the transseptal fibers move toward the necks of the teeth.
The interdental
papilla continues to proliferate ; however, the space finally becomes so large that the papilla can no longer fill it.
This unnatural interdental space in civilized man, continually increasing in

Am. J. Orthod.
January
1977

size, is a stagnation region where plaque forms and is protected from dislodgmcnt
by sheltering of the walls of the teeth and the papilla.
Reduction of the mesiodistal widths of adults teeth can eliminate existing
interproximal
periodontitis.
Simultaneously,
small areas of recurrent dental
caries at the gingival margins of proximal fillings are eliminated. Mention of
this ability to prevent caries and periodontal disease by simulating tooth attrition
has been made here to draw to the attention of the dental profession as a whole
the fact that advances can and must be made in other branches of dentistry
through the application of knowledge gained from studying Stone Age attrition.
For instance, proximal fillings should have flat contact surfaces. Original tooth
widths should not be increased by restorations, as this may cause periodontitis,
interproximal caries, and increased tooth crowding.
Fixed bridgework is limited in the number of years of service because its
mesiodistal length is not continually reduced and the abutment teeth cannot
migrate mesially at different rates. Normally the posterior teeth must migrate
farther and, therefore, travel at a greater rate than the anterior teeth. Also, because of continual tooth eruption, the entire bridge moves occlusally and the abutment teeth develop unfavorable clinical crown/root ratios. This results in reduced
alveolar support and the teeth become more susceptible to occlusal and lateral
stresses. Therefore, the abutment, teet,h become mobile and the bridge, as well as
the supporting teeth, must be removed to avoid accelerated alveolar loss from
periodontal disease and ultimate exfoliation.
Simulation of attritional occlusions relatively flat occlusal plant and cdge-toedge anterior tooth relationships would add greatly to complete denture stability.
Flat occlusal surfaces with relatively sharp edges have long ago proved to be the
most efficient masticatory apparatus.
Unworn cusps and fossae have no more place in artificial dentures than they
do in the natural adult dentition. The lateral forces created by cusps are unnecessary and may actually bc a contributing
cause of denture instability.
A recent article indicates that progressive minds in other branches of dentistry are beginning to examine attrit,ional occlusion as a guide to both diagnosis
and treatment planning. Drs. H. 3. Cooperman and 8. B. Willard studied the attritional planes of occlusion of Eskimos, Australian aborigines, Mexican Indians,
Zulus, and Europeans. They noted the reduction in the curve of Spee, the absence
of cusps,
the loss of incisal edges and anterior overbite, and the forward position
of the mandible. On the basis of this study, they have outlined a method to determine the correct (attritional)
occlusal plane for each patient from landmarks
on an upper model. They believe that the use of this plane can aid in diagnosis,
increase stability, and simplify denture construction and oral reconstruction.
Summary

Knowing how to execute differential

force treatment with the proper appliances gives the orthodontist a great advantage, and treatment of any type of
malocclusion, including mutilated cases and those not requiring reduction of tooth
substance, becomes simple.
In order to derive such benefits from the differential force technique, one

Volume
Number

71

Differentin

force method

39

must use it exclusively and not attempt the simultaneous use of other methods,
which leads to confusion in both diagnosis and appliance design. It is absolutely
necessary to use the cold-drawn, heat-treated, highly
resilient wire as produced
especially for this method by A. J. Wilcock of Australia. Failures are caused by
the use of other wire.
The knowledge gained from the study of Stone Age attritional occlusion must
be applied as much as is possible during orthodontic treatment. It will affect the
diagnosis, amount and method of tooth mass reduction (if indicated), and final
positions of teeth for maximum stability and esthetics. To date the differential
force method is the only orthodontic technique that was developed to fit the true
biologic requirements of man.
The practice of the other branches of dentistry must also be related as nearly
as possible to the principles found in the natural evolutionary development of
mans dentition, as found in his Stone Age attritional occlusion. To date we have,
in orthodontics, the light wire differential force treat,ment method which is in
accordance with this principle. The future must bring similar changes in many
other branches of dentistry and, it is hoped, even more in orthodontics.
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P. R.: Progress
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Kesling,
H. D.: Have
recent
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successful
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Begg,
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Orthodontic
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Begg,
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Begg, P. R.: Some aspects
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Payne,
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pyorrhea
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11.
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Dr.
Dr.

Begg:
Kesling:

North
Terrace
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