Benefits of SPEED bracket_Getting to Know the SPEED Appliance
 

Benefits of SPEED bracket_Getting to Know the SPEED Appliance

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This document is an updated version of the previous version of Intro_ Benefits of SPEED brackets.

This document is an updated version of the previous version of Intro_ Benefits of SPEED brackets.

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Benefits of SPEED bracket_Getting to Know the SPEED Appliance Benefits of SPEED bracket_Getting to Know the SPEED Appliance Presentation Transcript

  • Getting to Know the SPEED Appliance UNC2011 Dr Sylvain Chamberland slideshare.net/sylvainchamberland www.sylvainchamberland.com
  • Fr.La. 0602 An.Ju.Cl. 0807 He.Pe. 0608©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks An.Ju.Cl. 0807 He.Pe. 0608©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks Fr.La. 1003 An.Ju.Cl. 0807 He.Pe. 0608©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks Fr.La. 1003 69 weeks An.Ju.Cl. 0807 He.Pe. 0608©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks Fr.La. 1003 69 weeks An.Ju.Cl. 0807 An.Ju.Cl. 1208 He.Pe. 0608©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks Fr.La. 1003 69 weeks An.Ju.Cl. 0807 An.Ju.Cl. 1208 66" weeks He.Pe. 0608©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks Fr.La. 1003 69 weeks An.Ju.Cl. 0807 An.Ju.Cl. 1208 66" weeks He.Pe. 0608 He.Pe. 0909©Dr Sylvain Chamberland
  • Fr.La. 0602 68! weeks Fr.La. 1003 69 weeks An.Ju.Cl. 0807 An.Ju.Cl. 1208 66" weeks He.Pe. 0608 He.Pe. 0909 • Before we can get there, we need to understand the SPEED basics©Dr Sylvain Chamberland
  • The SPEED Appliance - 1980 • Invented: Dr. G.H. Hanson. • Manufactured: Strite Industries. • Introduced to market in 1980 after 5 years of clinical development. • The 1st commercially successful Self-Ligating appliance.©Dr Sylvain Chamberland
  • The SPEED Appliance - 1980 • Invented: Dr. G.H. Hanson. • Manufactured: Strite Industries. • Introduced to market in 1980 after 5 years of clinical development. • The 1st commercially successful Self-Ligating appliance.©Dr Sylvain Chamberland
  • SPEED’s Unique Mode of Action A New Paradigm - Exceptional Control Rotation Tip Torque©Dr Sylvain Chamberland
  • SPEED’s Unique Mode of Action A New Paradigm - Exceptional Control Rotation Tip Torque • Spring-Clip activated once deflected by the archwire. • Gradual homing position ! corrective tooth movement in all 3 planes of space. • Constant corrective action ! ligation stability. • No elastomeric ties = " frictional resistance.©Dr Sylvain Chamberland
  • Modern Self-ligating Brackets• Lotus «Compare to Damon» • Carriere LX Ortho Technology• Damon MX • Smartclip™ Damon Q • Discovery™• Vision LP American Ortho Dentauraum
  • Modern Self-ligating Brackets Passive in the leveling and alignment stages and active during major mechanics and finishing• In-Ovation R • SPEED -Point attachment• In-ovation C -twin design -NiTi spring clip• Time 3 & Empower American Ortho• Quick 2.0 • Nexus Forestadent Ormco
  • Do We Need Fancy Advertisement ...
  • Do We Need Fancy Advertisement ...• To know that this....
  • Do We Need Fancy Advertisement ...• To know that this.... ...is not Self-Ligating Bracket
  • Damon Sequel • Large twin design, rigid clip, high profile • Several generations of the Damon bracket have already been released • Clinical efficiency remains to be seen • Passive system: 4 solid walls • Only the name Damon has not changed for obvious marketing issue 3MX Q C©Dr Sylvain Chamberland
  • Damon Sequel • Large twin design, rigid clip, high profile • Several generations of the Damon bracket have already been released • Clinical efficiency remains to be seen • Passive system: 4 solid walls • Only the name Damon has not changed for obvious marketing issue 3MX Q C©Dr Sylvain Chamberland
  • Meanwhile • Several improvement, same bracket design©Dr Sylvain Chamberland
  • Meanwhile • Several improvement, same bracket design©Dr Sylvain Chamberland
  • Therefore Active Self Ligation’s Rise 1980 SPEED In the beginning, in the end and all along the way, it’s been SPEED©Dr Sylvain Chamberland
  • Therefore Active Self Ligation’s Rise 1980 SPEED InOvation BioQuick EmPower Nexus SPEED In the beginning, in the end and all along the way, it’s been SPEED©Dr Sylvain Chamberland
  • SPEED Convertible Tube • Re-Convertible form start to finish Insert Press Rotate©Dr Sylvain Chamberland
  • SPEED Convertible Tube • Self-ligating re-convertible tube • Nicket-Titanium Microlatch entraps and securely holds the archwire ! Greater buccal force # Greater resistance to opening • Repeatedly convertible for unlimited archwire engagements©Dr Sylvain Chamberland
  • SPEED Convertible Tube • Lowest profile convertible tubeSPEED Convertible Tube In-Ovation SL Tube Damon SL Tube©Dr Sylvain Chamberland
  • ©Dr Sylvain Chamberland
  • How to open Speed©Dr Sylvain Chamberland
  • How to open Speed • From SPEED labial window • From the gingival©Dr Sylvain Chamberland
  • How to close SPEED • Most of the time ! Easily closed with gloved hands • Closing instrument ! To engage large or heavy wire©Dr Sylvain Chamberland
  • Closing SPEED • Wire not properly engaged • Pay attention!©Dr Sylvain Chamberland
  • Closing SPEED • Wire not properly engaged • Pay attention! Use this©Dr Sylvain Chamberland For heavy wire
  • How does the SPEED Appliance Work? SPEED envelope of action: PASSIVE ZONE©Dr Sylvain Chamberland
  • How does the SPEED Appliance Work? SPEED envelope of action: PASSIVE ZONE SPEED spring clip SPEED spring clip SPEED spring clip holding archwire in fullyactivated by archwire seating archwire seated position ©Dr Sylvain Chamberland
  • How does the SPEED Appliance Work? SPEED envelope of action: ACTIVE ZONE©Dr Sylvain Chamberland
  • How does the SPEED Appliance Work? SPEED envelope of action: ACTIVE ZONE SPEED spring clip SPEED spring clip SPEED spring clip holding archwire in fullyactivated by archwire seating archwire seated position ©Dr Sylvain Chamberland
  • How does the SPEED Appliance Differ?• Choosing between low friction or full control Undersized wire Full sized wire Low friction - Poor control Full control - High friction
  • How does the SPEED Appliance Differ?• Choosing between low friction or full control Undersized wire Full sized wire Low friction - Poor control Full control - High friction
  • How does the SPEED Appliance Differ?©Dr Sylvain Chamberland
  • How does the SPEED Appliance Differ? • SPEED offers both low friction AND full control SPEED spring clip Archwire fully seated by Activated by archwire SPEED spring clip©Dr Sylvain Chamberland
  • Better torque control • Active spring clip seat the wire into the slot • Passive clip cant seat the wire unless filling the slot ! Therefore, torque is dependant of the wire play and the torsional moment (N-mm) created by its Torque play: ± 5° for .020 x .025 wire in .022 slot relationship to the bracket slot ! Torsional moment is related to wire stiffness in torsion $ Bigger wire = Bigger moment ! Use of pretorqued wire is an implicit admission that the bracket can’t achieve torque Torque play: ± 10,5° for .019 x .025 wire in .022 slot Koziowski, CI v 16, #1, 2008, p.25©Dr Sylvain Chamberland
  • SPEED Paradigm !So many advantages! " No tie wing. " No ligature tie. " Miniaturized. " Better control in the 3 planes of space !SPEED was thinking of self-ligation 30 years ago !SPEED = Ahead of its time? Revolutionary? !The 1st active SLB©Dr Sylvain Chamberland
  • Why my patients prefer SPEED brackets? • The smallest bracket on the market = SPEED©Dr Sylvain Chamberland
  • How to market SPEED bracket?©Dr Sylvain Chamberland
  • How to market SPEED bracket?©Dr Sylvain Chamberland
  • How to market SPEED bracket? • Do your want one of these big chunky ceramic bracket?©Dr Sylvain Chamberland
  • How to market SPEED bracket? • Do your want one of these big chunky ceramic bracket? • Do you want this other regular bracket with colored elastics that accumulated bacterial plaque, are difficult to clean and that the color will look dirty quickly?©Dr Sylvain Chamberland
  • How to market SPEED bracket? • Do your want one of these big chunky ceramic bracket? • Do you want this other regular bracket with colored elastics that accumulated bacterial plaque, are difficult to clean and that the color will look dirty quickly? • Do you want one of those big SLB?©Dr Sylvain Chamberland
  • How to market SPEED bracket? • Do your want one of these big chunky ceramic bracket? • Do you want this other regular bracket with colored elastics that accumulated bacterial plaque, are difficult to clean and that the color will look dirty quickly? • Do you want one of those big SLB? • Or do you prefer this tiny mini braket?©Dr Sylvain Chamberland
  • ©Dr Sylvain Chamberland !! ! " # $ % &! &" &# &$ ( )) *+ ,- . /0 +" G.H<I+J33K L@.MI<+J33K 1! -AN2/@+J33"K *2 3 45 +6 7 95 8 :; 2< .4 5+ = )3 >4 ? @A 95 :; 2< .4 5+ B B2 "#$%&() AA. @A @ > . A.< 7 .5 .<? .5 BC 2A .<D +E ,- ./F C@ 2A BC 2 A.< D+ E
  • &$ G.H<I+J33K L@.MI<+J33K -AN2/@+J33"K &# &" &! % !! $ # " ! *+ 8 = @A B .5 E D+ 7 5+ 5+ .<? )) ? <.4 +6 .4 A.< >4 ( 45 .5 2< 2 2 )3 7 :; :; BC 3 *2 95 95 "#$%&()©Dr Sylvain Chamberland
  • Proposed Core Advantages of Self-Ligating brackets Eliasdes T., Pandis N., Self-Ligation in Orthodontics,2009, Wiley-Blackewell • Faster ligation = Less chair time ! Save up to 10 minutes for replacement of a wire • Ligation stability - Secure archwire engagement • Low friction?? ! Ligature ties and elastomeric ties may cause friction ! Resistance to slide if affected by bending and notching ! Passive zone = low friction ! Active zone = higher friction©Dr Sylvain Chamberland
  • Proposed Core Advantages of Self-Ligating brackets • Practice builder ! Promote the smallest SLB = SPEED • Assistance to good oral hygiene?? • More comfortable treatment?? ! Initial .016 Supercable wire will more likely cause less pain than a solid .016 niti wire ! Differences in design of SLB have important consequences ! SmartClip: marked increase discomfort when removing and engaging wire ! Damon2: low discomfort initially, but higher discomfort at later stage©Dr Sylvain Chamberland
  • Benefits of a Self-Ligating Bracket System for a Patient • Minimal initial discomfort ! Light, continuous forces if used with Supercable™ • Better oral hygiene, minimal tissue lacerations, if any • Shorter office visits !less chair time • Longer interval between visits©Dr Sylvain Chamberland
  • Do you think self ligating brackets will replace conventional brackets in the future?©Dr Sylvain Chamberland
  • Do you think self ligating brackets will replace conventional brackets in the future? • "In the near future, yes, they will, to some degree, replace conventional brackets." ... "I am extremely surprised to see Ye s! that ligation brackets are still so much in use. Clinical advantages of the self-ligating brackets are not limited to saving chairside time; they also produce less wire-to-bracket friction, require less stock in the practice and if used efficiently they may increased the practice production by 15% to 30%." VIP interview: Dr Ali Darendeliler, WJO v10, #1, 2009©Dr Sylvain Chamberland
  • Self-ligating bracket claims Ask us, AJODO 2010, 138, #2, 128-131 • SLB do not grow buccal alveolar bone ! Cevidanes L, Treccani M, Myrda A, Melsen B. Transversal expansion and SLB brackets: A CBCT study ! Paventy A. Facial alveolar bone evaluation with CBCT in non extraction treatment using the Damon system: a prospective clinical trial [thesis] Norman, Okla: U of Oklahoma; 2008 • Lateral expansion of the dental arch by SLB ! Can not be compared to RME ! Not more stable©Dr Sylvain Chamberland
  • Self-ligating bracket claims Ask us, AJODO 2010, 138, #2, 128-131 • SLB more efficient and more effective than conventional edgwise bracket systems in treating malocclusion ! Current evidence does not indicate differences for treatment time, rate of alignment, rate of space closure, final arch dimension or occlusal outcomes ! Neither for : reduced friction between archwire and bracket, reduced clinical forces, patient pain, more hygienic©Dr Sylvain Chamberland
  • Self-ligating bracket claims Ask us, AJODO 2010, 138, #2, 128-131 • 2 assertions supported ! Reduced chair time ! Control of mandibular incisor inclination??? ! This last affirmation dont seem to be supported by recent study©Dr Sylvain Chamberland
  • Neat benefits of the SPEED Bracket •Auxiliary archwire slot •To consolidate a segment •For segmental mechanics •Ligature wire •016 NiTi, Supercable™, SS •.016 x .016 S •.017 NiTi auxiliary spring©Dr Sylvain Chamberland
  • Neat benefits of the SPEED Bracket •Escape-proof spring clip (no ligation decay) •Increased inter-bracket distance Cl.Tur. 0209 • More springiness©Dr Sylvain Chamberland
  • The SPEED modifications that have had the greatest impact on my clinical efficiency©Dr Sylvain Chamberland
  • Super-elastic spring clip • Clip is 400% more elastic than SS ! No difference between “as received” and “used” brackets in the SPEED Group ! Range of activation did not change 1,6 ! No permanent deformation 1,2 0,6 • Spring Clip deliver 1,2 N per mm of activation • Performance and aging depend on the alloy composition of the Spring Clip©Dr Sylvain Chamberland Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets AJODO 2007; 132: 834-7
  • Aging of the Spring Clip • Performance and aging depend on the alloy composition of the Spring Clip • Clinical relevance ! Inability of the relaxed clip to apply forces due to aging ! Inadequate engagement of the wire into the bracket slot may arise in the last stages of treatment when rectangular wires are inserted ! Undesirerable outcome on associated mechanotherapeutical schemes©Dr Sylvain Chamberland
  • What does the scientific literature have to say about the benefits of SPEED?©Dr Sylvain Chamberland
  • CLINICAL EFFICIENCY
  • Do We Need Fancy Study to... • Know that wire ligature takes time to do and remove©Dr Sylvain Chamberland
  • Do We Need Fancy Study to...©Dr Sylvain Chamberland
  • Do We Need Fancy Study to... • Know that elastomeric ligature takes less time to place and remove than wire ligature but...©Dr Sylvain Chamberland
  • Do We Need Fancy Study to... • Know that elastomeric ligature takes less time to place and remove than wire ligature but... • ...most likely more than open and close SLB©Dr Sylvain Chamberland
  • Bond Strength
  • Bond Strength - Lab The influence of orthodontic bracket base design on shear bond strength Study Findings - Bond strength after 24 hours 9.73 10,0 8.05 7,5 Mean SBS 5.25 (MPa) 4.47 5,0 2.20 2,5 0 Time SPEED Ormco GAC American Bracket Type Source: AJODO - Volume 124, Number 1©Dr Sylvain Chamberland
  • Bond Strength - Lab The influence of orthodontic bracket base design on shear bond strength Study Findings - Bond strength after 24 hours • Despite it’s smaller base size, the SPEED appliance demonstrated statistically significant superior Shear Bond Strength than 4 of the 10,0 9.73 5 brackets tested. 8.05 7,5 Mean SBS 5.25 (MPa) 4.47 5,0 2.20 2,5 0 Time SPEED Ormco GAC American Bracket Type Source: AJODO - Volume 124, Number 1©Dr Sylvain Chamberland
  • Bond Strength - Lab The influence of orthodontic bracket base design on shear bond strength Study Findings - Bond strength after 24 hours • Despite it’s smaller base size, the SPEED appliance demonstrated statistically significant superior Shear Bond Strength than 4 of the 10,0 9.73 5 brackets tested. • 8.05 No statistically significant 7,5 difference in SBS between the Mean SBS (MPa) 5.25 4.47 SPEED appliance and the Time 5,0 bracket. 2.20 2,5 0 Time SPEED Ormco GAC American Bracket Type Source: AJODO - Volume 124, Number 1©Dr Sylvain Chamberland
  • Bond Strength - Lab The influence of orthodontic bracket base design on shear bond strength Study Findings - Bond strength after 24 hours • Despite it’s smaller base size, the SPEED appliance demonstrated statistically significant superior Shear Bond Strength than 4 of the 10,0 9.73 5 brackets tested. • 8.05 No statistically significant 7,5 difference in SBS between the Mean SBS (MPa) 5.25 4.47 SPEED appliance and the Time 5,0 bracket. 2,5 2.20 • Cleaning, sandblasting, and rebonding the SPEED appliance 0 did not result in a statistically Time SPEED Ormco GAC American significant reduction in SBS Bracket Type Source: AJODO - Volume 124, Number 1©Dr Sylvain Chamberland
  • LOW FRICTION Will be discussed later
  • HYGIENE
  • Plaque retention by self-ligating vs elastomeric orthodontic brackets: Quantitative comparison of oral bacteria and detection with adenosine triphosphate-driven bioluminescence (Am J Orthod Dentofacial Orthop 2009;135:426.e1–426.e9) • Methods: Patients (ages, 11-17 years) were bonded with SL and E brackets in 14 maxillary and 12 mandibular arches by using a split-mouth design. ! Recall visits were at 1 and 5 weeks after bonding. • Editors summary: ! The findings indicate that self-ligating appliances might promote reduced retention of bacteria, including streptococci, than appliances with elastomeric ligation. ! Of course, you must assume that this advantage would be lost by placing elastomeres over the self-ligating brackets.©Dr Sylvain Chamberland
  • Do We Need Fancy Study to... • Know that plaque accumulation and gum swelling are related to...poor oral hygiene©Dr Sylvain Chamberland
  • Do We Need Fancy Study to... • Know that poor oral hygiene is independent of bracket systems • Its a behavioral issue©Dr Sylvain Chamberland
  • Do We Need Fancy Study to... • Know that poor oral hygiene may lead to white spot lesion • WSL is not related to bracket systems • One should focus on reducing potential damage ! Fluoride rinses, varnishes, sealants & frequent cleanings©Dr Sylvain Chamberland
  • HYGIENE • What is the difference between these 2 patients?©Dr Sylvain Chamberland
  • HYGIENE • What is the difference between these 2 patients? This patient brushes his teeth This patient doesn’t!©Dr Sylvain Chamberland
  • • Next!©Dr Sylvain Chamberland
  • Ligature derived force Reznikov, N et al, Measurement of friction forces between stainless steel wires and reduced-friction self-ligating brackets, AJODO 2010; 138:330-8 • Depends on ligation mode ! Can be smaller in SLB or greater in conventional systems • Shear force increase linearly with wire deflection relative to the bracket slot • Friction resistance is proportional to the grade of the wire securing elements rigidity and to the extent of wire deflection • Correlation between passive clip design and wire surface scratching©Dr Sylvain Chamberland
  • Reznikov, N et al, Measurement of friction forces between stainless steel wires and reduced-friction self-ligating brackets, AJODO 2010; 138:330-8 • Some clip flexibility might provide a considerable benefit during the working stage of the orthodontic treatment, when residual malalignment of the teeth still persists. • Either an active clip or an elastomeric module can absorb minor, clinically undiscernible tooth irregularities and does not hinder sliding mechanics. • In contrast, a passive clip demands ideal alignment of the teeth subjected to a retraction force.©Dr Sylvain Chamberland
  • Therefore Wi.Be.290609 Wi.Be.120809 Wi.Be.250909 • Swinging the teeth on a very small wire • Few if any friction is involved: ! Passive zone ! No binding ! No notching Wi.Be.131109 Wi.Be.100510©Dr Sylvain Chamberland