SPEED Bracket Placement Guide v2012

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Third edition of the Speed bracket placement guide.

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  • SPEED Bracket Placement Guide v2012

    1. 1. SPEED Bracket Placement Guide 3 rd edition 2012 ©Sylvain Chamberland http://www.slideshare.net/sylvainchamberland
    2. 2. Bracket Placement Key Points©Dr Sylvain Chamberland
    3. 3. Bracket Placement Key Points • Rounded portion of the spring clip faces occlusally in both arches • Mesial and distal edges of the bonding pads ➜ parallel to the long axis of the middle lobe of each tooth.©Dr Sylvain Chamberland
    4. 4. Bracket Placement Key Points SPEED Rhomboid • Narrow SE Spring clip • Horizontal Positioning ✦ Mesial and distal edges of the SPEED bonding base / spring clip / bracket body. • Vertical Positioning ✦ Archwire slot / occlusal edge of the bonding pad and the bracket body©Dr Sylvain Chamberland
    5. 5. Bracket Placement Key Points • Not necessary to angulate bracket slots into extraction sites or to use special extraction brackets. • Spring clip on the arch wire • Rounded portion of the spring clip faces occlusally continuously maintains excellent root parallelism as spaces are closed.©Dr Sylvain Chamberland
    6. 6. Bonding SPEED Attachments • Incisor brackets ✦ Forcing excess adhesive to exude toward the gingival reduces the risk of clogging the spring clips on these brackets with miniaturized pads. • Posterior brackets ✦ Larger bonding pads = not a problem ✦ Excess adhesive may be forced toward the occlusal. ✦ Less residual flash removal at the©Dr Sylvain Chamberland gingival.
    7. 7. Bonding SPEED Attachments • Care must be taken during bonding to avoid clogging the gingival end of the bracket / spring slot. • If some composite is inadvertently squeezed over the gingival edge of a bonding base and into a spring slot, immediately wipe it out with the tip of a sharp explorer.©Dr Sylvain Chamberland
    8. 8. Bonding Set Up • Cheek retractor ✦ #0118-HA - Adult High Heat Sterilizable Cheek Retractor #0118-HC - Child Hight Heat Sterilizable Cheek Retractor #0118-NA Nola Dry Field Kit Adult #0118-NC Nola Dry Field Kit Child Ortho-Pli corp • Saliva ejector©Dr Sylvain Chamberland
    9. 9. Bonding Set Up • Bracket placement trays ✦ 20-050-99 (GAC) ✦ 740-0076 (Ormco) • Graduated perio probe ✦ Hu-Friedy: XP23/OW6 • Self-locking pliers ✦ #0152 Cotton Plier, self locking (Ortho-Pli) • Boone gauge ✦ #BBG4 - Boone Bracket Positioning Gauge (Ortho-Pli)©Dr Sylvain Chamberland
    10. 10. Bonding Technique Key Points • Hold the bracket with • Wipe into the bonding paste self-locking plier©Dr Sylvain Chamberland
    11. 11. Bonding Technique Key Points • Place the bracket©Dr Sylvain Chamberland
    12. 12. Bonding Technique Key Points • Place the bracket©Dr Sylvain Chamberland
    13. 13. Bonding Technique Key Points • Place the bracket • Push to exude excess bonding paste and obtain close contact©Dr Sylvain Chamberland
    14. 14. Bonding Technique Key Points Measure height©Dr Sylvain Chamberland
    15. 15. Bonding Technique Key Points Measure height Assess long axis©Dr Sylvain Chamberland
    16. 16. Bonding Technique Key Points Measure height Assess long axis Remove flash Note: Position of the bracket on tooth #22 is not adequate. Instructing the photographer while positioning the bracket was distracting. The bracket was repositioned...off camera.©Dr Sylvain Chamberland
    17. 17. SPEED System • Straight wire appliance ✦ Long axis (facial axis) of clinical crown ✦ Facial axis point: maximal buccal convexity©Dr Sylvain Chamberland
    18. 18. • Andrews’s plane ✦ Plane of the bracket’s slot©Dr Sylvain Chamberland
    19. 19. • Mandibular arch ✦ Average tip (2nd order) ✦ Average torque (3rd order) ✓ Molar crown = -30° ✓ Incisors = -1° ✦ Roth prescription©Dr Sylvain Chamberland
    20. 20. • Maxillary arch ✦ Average tip (2nd order) ✦ Average torque (3rd order) ✓ Incisors = 7° ✦ Roth prescription©Dr Sylvain Chamberland
    21. 21. • Long axis©Dr Sylvain Chamberland
    22. 22. • Long axis©Dr Sylvain Chamberland
    23. 23. • C • Maxillary incisors ✦ Locate the long axis from the lingual view©Dr Sylvain Chamberland
    24. 24. Archwire plane selection • Anteriors ✦ 4 to 4,5 mm from incisal edge ✦ May vary with shorter or longer crown©Dr Sylvain Chamberland
    25. 25. Archwire plane selection • Far enough gingivally to avoid occlusal contact ✦ 4 to 4,5 mm in most situation ✦ 5 mm or more may prevent leveling the curve of Spee©Dr Sylvain Chamberland
    26. 26. Archwire plane selection • Far enough gingivally to avoid occlusal contact ✦ 4 to 4,5 mm in most situation ✦ 5 mm or more may prevent • Maximum buccal convexity leveling the curve of Spee • 4,5 mm is better to avoid unwanted upper incisal contact©Dr Sylvain Chamberland
    27. 27. ✦ Long axis located from the lingual view©Dr Sylvain Chamberland
    28. 28. • Long axis assessed by the lingual • MD placement: ✦ middle lobe prominence©Dr Sylvain Chamberland
    29. 29. ©Dr Sylvain Chamberland
    30. 30. • Placement of 2nd molar occlusally reduce the likelihood of extrusion©Dr Sylvain Chamberland
    31. 31. • Placement of 2nd molar occlusally reduce the likelihood of extrusion • Reflection lines on the labial aid to slot alignment©Dr Sylvain Chamberland
    32. 32. Mx central incisors • Bracket body centred on the facial surface of the tooth • Rhomboid angulated design provides better visual references to match the 4 to 4,5 long axis of the bracket with the long axis of the tooth • Long axis of the tooth bisect middle lobe and the centre of the talon©Dr Sylvain Chamberland
    33. 33. How to measure? • Boone Gauge ✦ From slot to incisal edge 4 to 4,5 • Perio probe ✦ From bracket base to incisal edge©Dr Sylvain Chamberland
    34. 34. Bracket Placement Tips • Direct view may differ from mirror view • Assess long axis using both direct view and mirror view©Dr Sylvain Chamberland
    35. 35. Mx Lateral Incisors • ~ 0,5 mm shorter than the central • Bracket body centred on the facial surface of the tooth • Rhomboid design facilitates precise bracket placement©Dr Sylvain Chamberland
    36. 36. Caution: Incisal Wear & Lateral Incisors • Bracket slot ✦ Not necessarily parallel to incisal edge because of incisal wear©Dr Sylvain Chamberland
    37. 37. Mx Canines • ~ 0,5 mm longer than the central incisor • Mesial and distal edges parallel to long axis • Compound contoured design of the bonding pad seat the bracket on the greatest contour of the middle lobe©Dr Sylvain Chamberland
    38. 38. Mini Bracket for Canine©Dr Sylvain Chamberland
    39. 39. Bracket long axis = Parallel lingual long axis©Dr Sylvain Chamberland
    40. 40. Mx 1st Premolars • At its maximal height of labial convexity 5 • Mesial and distal edges parallel to long axis • Centre with the middle lobe©Dr Sylvain Chamberland
    41. 41. Mx 2nd Premolars • At its maximal height of labial convexity • Mesial and distal edges parallel to long axis • Occlusal edge of the bonding pad parallel to the ridge line • Centre with the middle lobe©Dr Sylvain Chamberland
    42. 42. Mx 2nd Premolars • Larger mesh pad • Occlusal offset • Easier placement for partially erupted tooth • Difficult to align mesh pad with Pm1 and M1©Dr Sylvain Chamberland
    43. 43. Mx 1st & 2 nd Molars • At 3 to 3,5 mm or at its maximal convexity • Bk positioned with MB cusp tip • Occlusal edge parallel to the ridge line if cusp tips are not worn • Distal cusp longer than mesial cusp • Middle groove aid to locate the long axis©Dr Sylvain Chamberland
    44. 44. Marginal Ridges • Marginal ridges aid to assess bracket position and height • The mirror occlusal view show the bracket centred with middle lobe or mesiobuccal cusp tip • Mx 2ndmolar is oriented distally when emerging©Dr Sylvain Chamberland
    45. 45. Marginal Ridges Same remarks as the previous slide©Dr Sylvain Chamberland
    46. 46. Md Central & Lateral Incisors Rhomboid • Central & Lateral: At 4,5 from incisal edges • Central & Lateral: Centred with the middle lobe M-D • Long axis located from the lingual• 4,5 mm is recommended if one wants to avoid unwanted upper incisal contact©Dr Sylvain Chamberland
    47. 47. Lower Anteriors • View from operator chair ✦ Long axis assess from lingual ✦ Note minimal paste thickness between bracket base and tooth surface ✦ Bracket centred with the middle lobe©Dr Sylvain Chamberland
    48. 48. Lower Canines & Lateral Incisors • View for operator chair ✦ Canine bracket centred with cusp tip ✦ Lateral centred with middle lobe©Dr Sylvain Chamberland
    49. 49. Md Canine Rhomboid • Slot at 4,5 to 5 mm from cusp tip • Centre on the middle lobe • Long axis located from the lingual©Dr Sylvain Chamberland
    50. 50. Canine_Occlusal View • Bracket centred with cusp tip©Dr Sylvain Chamberland
    51. 51. Md 1st Premolars • At its maximal height of convexity • Centred with cusp tip©Dr Sylvain Chamberland
    52. 52. Md 2nd Premolars • At its maximal height of convexity • Centred with cusp tip • Longer mesh pad occlusal may cause placement too gingival • Concentrate on the bracket slot and the height of convexity©Dr Sylvain Chamberland
    53. 53. Assessment of Pracket Position • After direct bonding ✦ Reassessment of bracket position to pick any discrepancy ✦ Note parallelism with marginal ridges©Dr Sylvain Chamberland
    54. 54. Assessment of Bracket Position • After direct bonding ✦ Same remarks as previous slide ✦ Mirror viewed are use to do these assessments©Dr Sylvain Chamberland
    55. 55. Md 1st Molars • At its maximal height of convexity • Indent on the bonding pad centred opposite buccal groove • Indent is off centre mesiodistaly • Slot parallel to marginal ridges©Dr Sylvain Chamberland
    56. 56. Md 1st Molars • SPEED Convertible Tube ✦ Align indent with buccal groove ✦ Parallel to occlusal Clip closed Clip open©Dr Sylvain Chamberland
    57. 57. Md 1 Molars st Double tube • Double Tube may lead to a too occlusal placement • If one place a Single Tube the same manner (too occlusal), antogonist occlusion may cause indent into the tube©Dr Sylvain Chamberland
    58. 58. Md 1 Molars st Double tube • Wire engaged in the auxiliary tube by error • Extrusion occurred • Single tube rebounded at maximal convexity: wire is straight©Dr Sylvain Chamberland
    59. 59. • Press brackets firmly • Centre the bracket on the middle lobe ✦ MD slot axis tangent to MD lobe curvature • Molar bk are placed on the MB cusp Large base U6 ERX For 2nd premolar extraction case©Dr Sylvain Chamberland
    60. 60. • Press brackets firmly • Centre the bracket on the middle lobe ✦ MD slot axis tangent to MD lobe curvature • Molar bk are placed on the MB cusp Large base U6 ERX For 2nd premolar extraction case©Dr Sylvain Chamberland
    61. 61. • Placement on MB • ER bk rotate 1st • ERX bk will rotate cusp help achieve molar distally 1st molar mesially molar derotation©Dr Sylvain Chamberland An.No. 12-08
    62. 62. • Placement on MB • ER bk rotate 1st • ERX bk will rotate cusp help achieve molar distally 1st molar mesially molar derotation©Dr Sylvain Chamberland An.No. 12-08
    63. 63. At least 10° offset Cl.Tu.0507©Dr Sylvain Chamberland
    64. 64. At least 10° offset Cl.Tu.0507©Dr Sylvain Chamberland
    65. 65. At least 10° offset Cl.Tu.0507 Cl.Tu.0209 • Derotation of the 1st molar helped: ✦ To gain arch length ✦ To achieve class I relationship©Dr Sylvain Chamberland
    66. 66. To Maintain Molar Rotation • Use Bk ERX©Dr Sylvain Chamberland
    67. 67. To Maintain Molar Rotation • Place regular bk at the middle grove©Dr Sylvain Chamberland
    68. 68. ©Dr Sylvain Chamberland
    69. 69. • Reflection lines on the labial aid to slot alignment©Dr Sylvain Chamberland
    70. 70. • Reflection lines on the labial aid to slot alignment • Speed mini-tubes for 2 nd molar©Dr Sylvain Chamberland
    71. 71. • Molar tube ✦ Indent off-centre to the distal©Dr Sylvain Chamberland
    72. 72. Reassessment of Bracket Positions Off centred Re-centred • A non ideal bracket placement due to initial crowding should be corrected after alignment • Rotation wedge is of no help and cumbersome©Dr Sylvain Chamberland
    73. 73. Bracket Placement Error • Note Bk #23 too distal ✦ Mesial rotation not corrected • Bk #13 centred with cusp tip ✦ Rotation is corrected©Dr Sylvain Chamberland
    74. 74. Bracket Placement Error • Rebond #23 ✦ Note derotation©Dr Sylvain Chamberland
    75. 75. Bracket Placement Error • Bracket inclined too distally ✦ Need to be rebonded©Dr Sylvain Chamberland
    76. 76. Bracket Placement Error • Upper left canine ✦ Bk long axis incline to distally ✦ Bk not at maximal convexity • Bracket was rebonded©Dr Sylvain Chamberland
    77. 77. Bracket Placement Error • Upper left canine ✦ Bk long axis incline to distally ✦ Bk not at maximal convexity • Bracket was rebonded©Dr Sylvain Chamberland
    78. 78. Bracket Placement Tips • Bk on the 2 nd molar should be placed slightly more occlusally ✦ To avoid unwanted extrusion during treatment©Dr Sylvain Chamberland
    79. 79. Bracket Placement Tips • Note composite on #42 to avoid occlusal contact • Clinical view reproduce model set up©Dr Sylvain Chamberland
    80. 80. Bracket Placement Tips • Self-uprighting of 43 is anticipated after extraction of lower right premolar • Labial tipping of 42 is expected©Dr Sylvain Chamberland
    81. 81. Bracket Placement Tips • Clinical view reproduce model set up©Dr Sylvain Chamberland
    82. 82. Bracket Placement Error El.Jo.100309 Adhesive thickness distally under the mesh pad create distal rotation and uneven contact point with the canine©Dr Sylvain Chamberland
    83. 83. Bracket Placement Error El.Jo.100309 Adhesive thickness distally under the mesh Bracket on the lower right central is bonded too pad create distal rotation and uneven mesially and create a distal rotation and uneven contact point with the canine contact point with the lateral©Dr Sylvain Chamberland
    84. 84. Bracket Placement Error El.Jo.100309 Adhesive thickness distally under the mesh Bracket on the lower right central is bonded too pad create distal rotation and uneven mesially and create a distal rotation and uneven contact point with the canine contact point with the lateral El.Jo.240409 Rebonded bracket help to achieve better alignment of the contact points©Dr Sylvain Chamberland
    85. 85. Bracket Placement Error El.Jo.100309 Adhesive thickness distally under the mesh Bracket on the lower right central is bonded too pad create distal rotation and uneven mesially and create a distal rotation and uneven contact point with the canine contact point with the lateral El.Jo.240409 El.Jo.130709 Rebonded bracket help to achieve better 3rd order (torque) is needed to improved alignment of the contact points aligment of the incisal edges and the talon©Dr Sylvain Chamberland
    86. 86. Bracket Placement Error • 2 nd order error ✦ The bracket is inclined distal to the long axis of the lateral Mi.Pi 270809 ✦ Rebonded to the long axis©Dr Sylvain Chamberland
    87. 87. Bracket Placement Error • 2 nd order error ✦ The bracket is inclined distal to the long axis of the lateral Mi.Pi 270809 ✦ Rebonded to the long axis©Dr Sylvain Chamberland
    88. 88. Bracket Placement Error • 2 nd order error ✦ The bracket is inclined distal to the long axis of the lateral Mi.Pi 270809 ✦ Rebonded to the long axis©Dr Sylvain Chamberland
    89. 89. Bracket Placement Error • 2 nd order error ✦ The bracket is inclined distal to the long axis of the lateral Mi.Pi 270809 ✦ Rebonded to the long axis©Dr Sylvain Chamberland
    90. 90. Bracket Placement Error • Bk error #35 • Solution ✦ Slightly too distal ✦ Re-position the bracket ✓ Mesial rotation occured ✦ Do an offset bend ✦ Rotation wedge is not an option©Dr Sylvain Chamberland
    91. 91. Precise Bracket Position • Carefull and precise bracket positioning is essential to achieve perfect alignment in the 3 planes of space • A misplaced bracket can never help achieve perfect alignment©Dr Sylvain Chamberland

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