4 Bi Extraction: A Flawed Assertion – Historical Review of Literature

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by Hamid Nassery, D.M.D., Miami Beach, Florida – OC GNM Trained

The very foundation of the 4 bicuspid extraction concept is based on a very flawed assertion by P. R. Begg’s in 1954, that advocated the low incidence of malocclusion in primitive dentition was due to gritty diets causing interproximal attrition.  Begg suggested that this interproximal tooth size width deficit amounted to a pre-molar width in each quadrant. Of course, we now know the lack of malocclusion had more to do with less polution and better upper airway clearance.

http://www.journals.elsevierhealth.com/periodicals/ajorth/article/0002-9416(54)90103-7

Begg’s research has been amply refuted in the literature, no less with his own results; both crowding and attrition increased with age.  Pre-molar extraction does not result in more stability.  Little’s study in 1981 showed less than 30% of cases 10 years  post treatment maintained anterior alignment.  (Think about this for a minute.  Would any other medical/dental procedure with such success rate endure for this long in any segment of the health profession)?

http://www.ncbi.nlm.nih.gov/pubmed/6945805

But there exists another concept which our orthodontic programs should emphasize and that is the subject of occlusion or rather the causes of mal-occlusion. In his 1963 manifesto, Graber writes “Whenever there is a struggle between muscle and bone, bone yields” .

http://deepblue.lib.umich.edu/handle/2027.42/32220

In their 2005 paper Pepicelli et al, said,  “It is well accepted that the position and function of the facial and mandibular muscles are critical influences on alignment and stability”.  The literature weighs heavily on the fact that muscle function and posture are the most significant causes of mal-occlusion.

http://www.ncbi.nlm.nih.gov/pubmed/16360920

“Nature is not telling us we need less teeth but rather it is telling us if you mess with me, I mess with you”.

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Brief Background of  Dr. Percy Raymond Begg (An orthodontist, researcher, authority and a respected text book orthodontic author and resource to the dental profession).

  • Born in Western Australia on Oct. 13, 1898.
  • Earned his dental degree (B.D.Sc and L.D.S.) in Melbourne 1923.
  • Strong desire to study Orthodontics.
  • Studied with Dr. Edward H.Angle, at the Angle School of Orthodontia, Pasadena, California, (1924-1925).
  • Returned to Australia in 1925.
  • Appointed lecturer in orthodontia in 1926 and started private practice.
  • Treated non-extraction, expansion edgewise for two years.
  • Began re-treating with pre-molar extraction in 1928 using 0.020 round gold wire in 1929.
  • DDSc awarded by the University of Adelaide.
  • The Begg technique was evolving and in the early 1940’s he met Arthur J. Wilcock (University of Melbourne), who developed high tensile stainless steel wire.
  • 1954 published “Stone Age Man’s Dentition”.
  • 1956 Published treatment with the Begg technique.
  • 1960 Presented the Begg treatment to the American Assoc. Ortho.
  • The technique rapidly developed and the stage system was introduced for teaching.
  • 1963 retired.
  • 1964 permanent display established at Smithsonian.
  • 1965 Published the Begg technique text.. later published in Spanish, French, Italian, and Japanese.
  • 1981 Passed away.
  • Permanent memorial at the Adelaide Dental Hospital.
  • Named as one of 200 significant Australians in the Bi-centennial celebrations in 1988.
  • 2001 the Begg technique was named one the top 100 Australian inventions of the 20th Century.

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