Beruflich Dokumente
Kultur Dokumente
Volume
71, Number
1, January,
ORIGINAL
1977
ARTICLES
Many
D.D.S.
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.
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
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
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.
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
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
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
Volunze
Number
DifSerentinl
71
1
force method
13
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
14
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.
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.
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
Stage
dentition
appliance
by
means
therapy
of
is
3 0bjectitqe.s
Vozunze
Number
71
1
Di#erential
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
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.
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.
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-
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.
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
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
Am. J. Orthocl.
,Jnnunry
1977
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
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
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
30
AWL. J. O&hod.
January
1977
Diferential
force
method
31
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.
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.
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.
Differential
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.
36
Am. J. Orthod.
JamuarU
19 7 7
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
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.)
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
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.
REFERENCES
1. Begg,
P. R.: Progress
report
of observations
on attrition
of the teeth in its relation
to
and tooth decay, Aust.
5. Dent. 42: 3X-320,
1938.
Begg,
P. R.: Stone Age mans
dentition,
AM. J. ORTHOD. 40: 298-312,
373-383,
462-475,
517-531,
1954.
Begg, P. R.: Differential
force in orthodontic
treatment,
AM. J. ORTHOD. 42: 481-510,
1956.
Kesling,
H. D.: Have
recent
technical
advances
in orthodontics
made possible
successful
treatment
for more people8
Dent.
Clin. North
Am., pp. 821-829,
November,
1960. W. B.
Saunders
Company,
Philadelphia.
Begg, P. R.: Light
arch wire technique,
AM. J. ORTHOD. 47: 30-48, 1961.
Kesling,
P. C. (editor)
: Begg J. Orthod.
Theory
and Treatment,
July,
1962; April,
1963;
September,
1964; January,
1968; June, 1969.
Begg,
P. R., and Kesling,
P. C.: Begg
Orthodontic
Theory
and Technique,
ed. 1, Philadelphia,
1965, W. B. Saunders
Company,
pp. 5-51.
Begg,
P. R., and Kesling,
P. C.: Begg
Orthodontic
Theory
and Technique,
ed. 2, Philadelphia,
1971, W. B. Saunders
Company,
pp. l-57.
Enoki,
K.:
Begg
light wire technique,
Jap. Dent.
Rev., pp. l-27, January,
1964.
Motohashi,
K., Ohno,
T., Shimizu,
K., Shimoyama,
K., Yamamoto,
Y., and Ohtsuka,
E.:
Eight
teeth
extraction
cases treated
wit,h the Begg
technique,
.J. Jap. Orthod.
Sot. 32:
321-343,
1973.
Begg, P. R.: Some aspects
of the etiology
of malocclusion
of the teeth, unpublished
thesis
presented
by P. R. Begg to University
of Adelaide,
1935.
Payne,
G. S.: The effect of intermaxillary
elastic
force on the temporomandibular
articulation in the growing
macaque
monkey,
Am J. ORTHOD. 60: 491-504,
1971.
Cooperman,
H. N.: HIP plane of occlusion
in oral diagnosis,
Dent. Survey
51: 60, 62, 1975.
pyorrhea
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Dr.
Dr.
Begg:
Kesling:
North
Terrace
Orthodontic
(5000)
Center
(46391)