THE EDITOR'S CORNER
The Begg theory of attritional occlusion should be separated from the practice of Begg orthodontic treatment.
Dr. P. R. Begg is an excellent clinical orthodontist and an outstanding anthropologist. Though his studies of the dentition of Stone Age man, he evolved a concept of attritional occlusion which is as good an explanation as we have of the mechanism by which attrition of the teeth by a primitive diet, as a compensatory mechanism to mesial and occlusal migration of teeth, resulted in fewer malocclusions in Stone Age man than we see in modern civilized man whose diet is non-attritional.
In his role as clinical orthodontist, Dr. Begg evolved his technique of differential force using light wires and light elastics, which has become one of the standard techniques in our specialty. He has had as much impact on orthodontic thought and treatment as any individual in our history. Most men don't have one great idea in their lifetime. Dr. Begg had two. However, if Dr. Begg had been two men, I wonder whether we would have experienced the marriage of these two ideas.
In the rationale of Begg treatment usually seen in the literature, reduction of tooth structure by extraction (and stripping) is prescribed as the modern substitute for attrition, with the suggestion that more tooth structure than necessary should be removed to account for future non-attrition. When the theory is applied to treatment, it states that distal movement of posterior teeth is contrary to the laws of nature and is doomed to relapse; that extraoral anchorage must never be used.
It is possible to accept the theory of attritional occlusion in primitive man and the Begg orthodontic treatment technique in modern man without unifying the two. Many Begg practitioners have already drawn the line between them. Many are using extraoral appliances to reinforce anchorage and to achieve Class II correction, especially in early treatment cases. We have been treating with headgear for years without observing constant relapse. Myriads of Class II relationships have been corrected in early treatment using extraoral appliances. More headgears than that have been used to reinforce anchorage in full banded mechanics. Modern orthodontics is not an anchorage-losing proposition to simulate mesial migration and attrition .
Extraction of permanent teeth to achieve orthodontic treatment goals is well established. The trend among Begg practitioners, as among all orthodontists, is toward a better understanding of treatment goals, a better understanding of treatment mechanics, and a reduction in permanent tooth extraction. The rationale for extraction in orthodontics is not to simulate an attritional occlusion model nor to anticipate future non-attrition.
The more successful orthodontic techniques, including Begg, are zeroing in on a similar set of treatment goals and mechanical principles for achieving them, however varied their hardware or sequence of steps may be. Orthodontic treatment is largely concerned with the correction of a problem of occlusion which presents. The variables in it are the mechanical ability of the operator, the mechanical ability of the appliance, the correctness of the diagnosis, patient cooperation and growth. Some other science may try to do for the dentition of man what Dr. Begg says attrition accomplished for Stone Age man. To Dr. Begg, the attritional occlusion is the normal occlusion for man--with no overbite, with reduced arch length, with elimination of tooth cusps, with an edge-to-edge bite, with no centric occlusion. This may be correct, but it is not the occlusion that we have to work with. Dr. Begg readily points this out and says that he would not suggest trying to convert our patients' occlusions to resemble that of Stone Age man. So, why the marriage of the theory and the technique? Why deprive oneself of a useful appliance and treatment concept in the name of orthodoxy?
Bad as "textbook normal" may be when, compared to attritional occlusion, it is the one that we have to treat and we cannot treat it in terms of another occlusion. Dr. Begg's theory of attritional occlusion is not negated by separating it from orthodontic treatment of modern dentitions. As a matter of fact, one of the most important contributions of the Begg theory of attritional occlusion should be to give us an understanding of the imperfection of our occlusal model and of the limitations that this imposes on orthodontic treatment.
