How SPEED Appliance is Effective in Torque Control, Space Closure and Sliding Mechanics

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Literature review on torque efficacy of self ligating bracket. How to close space with SPEED brackets? Sliding mechanics with SPEED.
Torque control, torquing moment, self-ligating bracket and torque, torquing moment, Enmasse retraction, space closure, sliding mechanics,

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How SPEED Appliance is Effective in Torque Control, Space Closure and Sliding Mechanics

  1. 1. How SPEED Appliance isEffective in Torque Control Effective Torque Torquing moment Sliding mechanics Enmasse retraction drsylchamberland@biz.videotron.ca
  2. 2. Effective Torque .022 slot • Torque play • Effective torque ! .017 x .022 = 22,3° ! 0° ! .019 x .025 = 10,5° ! 5° ! .021 x .021 = 5° ! 6° ! .021 x .025 = 3,9° ! 7,1° .020 x .025 ! .020 x .025 SW ! 4° ! ! 7°©Dr Sylvain Chamberland
  3. 3. Effective Torque .018 slot • Torque play • Effective torque ! .017 x .022 = 5,4° ! 5,6° ! .017 x .025 = 4,5° ! 6,5° ! .018 x .025 = 2° ! 9°©Dr Sylvain Chamberland
  4. 4. Mc / Mf > 1 • A rectangular arch wire fitting into a rectangular slot can generate the moment of a couple necessary to control root position. ! The wire is twisted (placed into torsion) as it is put into the bracket slot. ! The two points of contact are at the edge of the wire, where it contacts the bracket. • The moment arm therefore is quite small, and forces must be large to generate the necessary MC. • Using the same tooth, a 50 gm net lingual force would generate a 750 gm- mm moment. To balance it by creating an opposite 750 gm-mm moment within a 0.5 mm bracket, a torsional force of 1500 gm is required.©Dr Sylvain ChamberlandDownloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 5 April 2009 03:18 PM) © 2007 Elsevier
  5. 5. • Moment of force, MF1, = F1 X D1 • Moment of couple Mc = F2 X D2 • D1 > D2 • Therefore, to produce moments of equal magnitude, the forces F2 creating the couple must be of greater magnitude than F1©Dr Sylvain Chamberland
  6. 6. • Moment required to torque maxillary incisal segment ! = 3000 -3500 g-mm (Nikolai 1985) ! 1000 g-mm for 2 incisors, 2500 g-mm for 4 incisors (Burstone) ! 2000g-mm ! 20 Nmm • To not overcome the torquing moment of 20 Nmm, the retraction force should be of low magnitude©Dr Sylvain Chamberland
  7. 7. Nmm Torque expression of self-ligating brackets compared with conventional metallic, ceramic, and plastic brackets Morina et al EJO 2008 (30) 233-238 Badawi, et. al. AJODO 2008; 133:721-8 • At 20° of torsion; .019 x .025 w; .022 slot • At 12° & 24°: A-SLB > P-SLB • SPEED = 8 Nmm, torque loss 11° • At 36° of torsion • This is consistant with Badawi study: 24°! 11,8 Nmm • No difference in the torquing moment between P-SLB and A-SLB • One would assume that with a .020 x .25 SW or .021 x .021 x .020 torque would be first expressed at a smaller angle • Higher torquing moment would be generated at smaller angle of twist©Dr Sylvain Chamberland
  8. 8. Comparison of torque expression between SS, TMA and CuNiti in metallic SLB AO 2010 #80; 884-889 In-Ovation-R • At 36°: Mean torque difference within 5% between all brackets when SS was compare with either NiTi or TMA • At 24° Damon 3MX • SS ! 1.5 to 1.8 times the torque of TMA • SS ! 2.5 times the torque of Niti • Speed and In-Ovation-R: Ealier engagement of torque at 5° SPEED • Damon 3Mx: Engagement at 10-12°©Dr Sylvain Chamberland
  9. 9. • At 25° of twist: Mc ! 35Nmm • No statistic " between the 3 Bk • At 20° of twist: Mc ! 21 Nmm Damon Q • More than Morina et al because it is measured at the bk and not at 10 mm away • SPEED brackets that clip did not opened have similar torque curve as Damon and In-Ovation R In-Ovation-R • Conclusion "Bracket deformation occurs above 30° of twist "Likely a significant factor in loss of SPEED NTP torque expression Mechanical effects of 3rd movement in SLB by the measurement of torque expression AJODO 2011;139:e31-e44 for both SLB and Twin conventional Bk©Dr Sylvain Chamberland Dashed line = expressed torque Journal of Dental Biomechanics Vol 2010 (2010), Article ID 397037, 7 pages
  10. 10. Weakness & Bias of this Study Mechanical effects of 3rd movement in SLB by the measurement of torque expression AJODO 2011;139:e31-e44 • Data of SPEED bracket that clips opened are pooled with bracket that did not opened, even if a statistical differences between the 2 sub- SPEED-NTP N = 14 group was established ! "SPEED NTP have similar torque curves as Damon and In-Ovation R" • Plastic deformation of wire or the brackets alone are unknown • Torquing moment behond plastic deformation of the wire is unknown • Torquing moment at yield point of the©Dr Sylvain Chamberland brackets is unknown
  11. 11. Home Made Fancy Study • H1: A 45° or so angle of twist in a .019 X .025 SS wire do not create plastic deformation • H1: REJECTED©Dr Sylvain Chamberland
  12. 12. Home Made Fancy Study • H2: A 45° or so angle of twist do not debond a bracket • H2: REJECTED©Dr Sylvain Chamberland
  13. 13. Home Made Fancy Study • H3: A 45° or so angle of twist create plastic deformation of the bracket • Since bond failure occurred, a fancy lab study is required • To know at which angle and torquing moment bracket deformation occurs, a non deformable material should be used instead of a SS wire©Dr Sylvain Chamberland
  14. 14. Torque play of various SLB
  15. 15. What are the limits of 1/-SN 1/-SN = 72° 1/-SN = 103° 1/-SN = 126° - 31° + 23°©Dr Sylvain Chamberland
  16. 16. • A single force applied at the crown create uncontrolled tipping which improve incisor torque ! The crown move in the opposite direction of the root GR 21-06-10 GR 20-09-10 GR 01-11-10 20x25 nitisw 21x21DW 16x22 neost16SC for 6 weeks !16x22 neost for 6 weeks !20x25 nitisw for 6 weeks !21x21 Dwire©Dr Sylvain Chamberland
  17. 17. 1/-SN = 72° +28° 1/-SN = 100° • 16SC (6 w) !16x22 neost (6 w) !20x25 nitisw (6 w) !21x21 Dwire (6 w) !Stop ABP, bond 6s/ & 7s/, 16x16sent (6 w) ! 20x20neost (6 w) !20x25 niti (6 w) !20x25 SS (6 w) ! 20x25 SS + ART (6 w) • Significant torque increased was obtained in 65 weeks through a progression of at least 5 wires • 28° is below the angle at which bracket deformation could occur©Dr Sylvain Chamberland
  18. 18. Wire progression = torque correction 1/-SN = 82° +14° 1/-SN = 96° •.016SC (6w)!.018SC (6w) !.020x.020NiTi (12w) ! !.020x.025 Niti (12w)!.020x.025 SW (16w)! !.021x.025SS • Torque has improved with engagement of full size archwire Em.Ja. 0909 Em.Ja. 0910©Dr Sylvain Chamberland
  19. 19. MxMd advancement for OSA Em.Ja. 0909 Em.Ja. 0611©Dr Sylvain Chamberland
  20. 20. Maintain torque while retracting 1/-SN = 112° -16° 1/-SN = 96° •.016SC (6w)!.016x.022Niti (8w) ! !.020x.020NiTi (14w) !.019x.025 TMA (10w)! !.021x.021x.020 retmasse SW (12m)! !.021x.021Dwire SS • Maintain low force module while retracting to not overcome Mc generated at the bracket interface • Increased wire cross section to increase stiffness in torsion and reduce torque play • Mx & Md advancement is planned Se.Ma. 0308 Se.Ma. 0810©Dr Sylvain Chamberland
  21. 21. ©Dr Sylvain Chamberland
  22. 22. Maintain initial torque 103° to 104° = maintain • .016SC (12w)!.018SC (16w) !.016x.022NiTi (6w) ! !.020x.025 Niti (6w)!.019x.025 TMA (12w) ! !.020x.025 Niti (6w) ! .020x.025 SW (8w) • 1/1 improved because /1-MP improved • Early engagement of full dimensional archwire helped to maintain adequate torque Ja.Le. 0808 Ja.Le. 0510©Dr Sylvain Chamberland
  23. 23. Ectopic lateral incisor • Early engagement of rectangular wire and 0° torque Bk on lateral incisor was efficient and effective to obtain alignement in the 3rd order plane of space • .020 x.020 Niti!.020x.025Niti! !.020x.025SW • Finishing: .021x.025SS (8 m)©Dr Sylvain Chamberland Lateral incisors Bk prescription: 0°
  24. 24. Assessment of Slot Sizes in Self-ligating Brackets using Electron Microscopy N.B. BHALLA, S.A. GOOD, F. MCDONALD, M. SHERRIFF, A.C.CASH • Aim: to assess the slot dimensions in the 0.022-inch bracket different commercially available self-ligating bracket systems, , in six of an upper left central incisor using electron microscopy , in order to determine the accuracy of manufacturers published dimensions • SmartClip, Clarity SL, SPEED, Damon MX, In-Ovation R, In-Ovation C©Dr Sylvain Chamberland
  25. 25. Assessment of Slot Sizes in Self-ligating Brackets using Electron Microscopy N.B. BHALLA, S.A.GOOD, F.MCDONALD, M.SHERRIFF, A.C.CASH Aust Orthod J 2010, may 26 • Results ! All of the brackets systems measured had slot sizes that were significantly greater than their stated 0.022-inch dimension ! Speed brackets (Strite Industries) were 5.1% larger, and found to be the closest dimensions to those published. ! The largest bracket was the Smartclip bracket (3M) measured to be 14.8% bigger than 0.022 inches©Dr Sylvain Chamberland
  26. 26. • Clinical implication ! Increased slot dimensions reduces the expression of bracket prescription in all three dimensions. ! Dimensional inaccuracies lead to teeth moving by tipping, rather than bodily movement.©Dr Sylvain Chamberland
  27. 27. Orthodontic Bracket Manufacturing Tolerances and Dimensional Differences between SLB Major T et al, J Dental Biomechanics, v 2010 Nominal height=0,559 mm • SPEED: Smaller than nominal height, larger at bottom than the top • In-Ovation: Taper!Smaller at the bottom, larger at the top • Damon: Larger than nominal height©Dr Sylvain Chamberland
  28. 28. Orthodontic Bracket Manufacturing Tolerances and Dimensional Differences between SLB Major T et al, J Dental Biomechanics, v 2010 • Tolerance of slot height of SPEED = 15#m smaller than nominal • Tolerance of slot height of In-Ovation = 15#m smaller at bottom & bigger at the top • Tolerance of slot height of Damon Q = 43#m bigger (oversized) • An oversize/undersize of 15#m means ±2,3° of torque play • An oversize/undersize of 43#m means ±4,7° of torque play and a reduced torque expression (Mc) of 5-10 Nmm • Difference between SPEED and Damon = 15 + 43#m or 7° of torque play©Dr Sylvain Chamberland
  29. 29. • If an .022" slot bracket is actually . TABLE 1 TIPPING DUE TO LOSS OF TORQUE CONTROL* 0235" (~ 7%) Torque Loss 5° 8° 10° Maxillary 1.3mm 2.1mm 2.7mm Mandibular 1.2mm 1.9mm 2.3mm ! An .019 X .025 or an .0215 X .028 archwire will *Lingual change in incisal edge position (incisors of average dimensions). have 5° of wire bracket play beyond that usually anticipated for an .022" slot. • When protracting posterior teeth, SIATKOWSKI, JCO 1999, p 509 ! If the mechanics depend upon moments generated at the incisor brackets with rectangular archwires, the above slot-size errors can induce lingual tipping of the incisors ! Such results are undesirable, to say the least. If the archwires are smaller than their stated sizes, the impact is even worse©Dr Sylvain Chamberland
  30. 30. Phases of treatment Tooth translation Enmasse retraction
  31. 31. Some thoughts about friction LLY • Most study are bench study INIC A R CL ! Test .019 x .025 SS wire or similar C CU VE RO E Nangulation) & wire is pulled at a • Bracket held steady (no NS IT O rate of 10 mm/ Iminute (Stefanos S., Secchi A. et al, AJODO 2010) ND CO • CH SUBracket sliding on a steady wire at a rate of 1 mm/minute (Budd S., Dask J.Tompson B. EJO 2008; Oliver C. Dask J.Tompson B. AO 2011)©Dr Sylvain Chamberland
  32. 32. Change over time in canine retraction: an implant study Parsekian, R, Bushang, P.H., Gandini L.G., Rossouw P.E., Am J Orthod Dentofacial Orthop 2009;136:87-93©Dr Sylvain Chamberland
  33. 33. Rate of tooth movement • 10 mm / minute ! 432 000 mm per month • 1 mm / minute ! 43 200 mm per month • Average of 1,42 mm / month ! 0,00003287 mm per minute©Dr Sylvain Chamberland
  34. 34. Some other thoughts about friction • Findings: ! Passive SLB produce less frictional resistance than Active SLB ! However, this decreased friction may result in decreased control compared with actively ligated systems • All wire tested were rectangular ! activate the clip (active zone)©Dr Sylvain Chamberland
  35. 35. • If bracket held steady (no angulation) ! RS is lower for all SLB than for conventional bracket tied with wire or an elastomeric ligature and lower with passive clip than active • This condition never occurs clinically!©Dr Sylvain Chamberland
  36. 36. • As soon as the corners of the bracket contact the wire (2nd order), binding occurs, and this contribute most of the resistance to sliding • Binding do not appear to be affected by the method of ligation • Same binding and notching could be expected in the 1st order # Heavy forces = more rotation and anchorage loss Yee et al, AJODO 2006; 136:150.e1-150.e9©Dr Sylvain Chamberland
  37. 37. Friction Conclusion • Clinical studies support the view that resistance to sliding has little to do with friction and, instead, is largely a binding-and-release phenomenon that is about the same with conventional and self-ligating brackets. • The limited clinical trial data now available do not support the contention that treatment time is reduced (presumably because of lower friction) with self-ligating brackets Friction and resistance to sliding in orthodontics: a critical review. AJODO 2009; 135:442-7©Dr Sylvain Chamberland
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. • The width of the bracket on a tooth determines the length of the moment arm (half the width of the bracket) for control of mesiodistal root position. • Bracket width also influences the contact angle at which the corner of the bracket meets the arch wire. The wider the bracket, the smaller the contact angle. • In the 1st order, the clip prevent rotation and help reduce the moment arm in that plane©Dr Sylvain Chamberland Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 5 April 2009 03:23 PM) © 2007 Elsevier
  42. 42. Do We Need a Fancy Study to... • Know that .019x.025 TMA (or SS) will generate more Friction (FR) than a smaller wire ? • Know that increased retraction force will cause more tipping of the tooth to retract and therefore Binding (BI) and An.No 310308 Notching (NO) is more likely to Resistance to slide occur?©Dr Sylvain Chamberland
  43. 43. Do We Need Fancy Study to... • Know that .020 SS wire has less friction than .019x.025? An.No 250608 Resistance to slide©Dr Sylvain Chamberland
  44. 44. Do We Need Fancy Study to... • Know that pulling on 1 side and pushing from the other side make it easier to translate teeth over a rounded corner of an anterior arch form? An.No 110309 Resistance to slide©Dr Sylvain Chamberland An.No 081209
  45. 45. Do We Need Fancy Study to... • Know that T loop retraction springs are...frictionless?©Dr Sylvain Chamberland
  46. 46. Re.Ba. 0906 Sliding a single tooth • .021 x .021 x .020 HDG • Elastomeric chain 7-6-5-o-3 Re.Ba. 0107 ! Round wire to reduce Friction ! Lower force to reduce Binding & Notching Re.Ba. 1007 Re.Ba. 0907©Dr Sylvain Chamberland
  47. 47. Sliding a single tooth • .021 x .021 x .020 HDG • Re.Ba. 0906 Compressed coil 22-24 ! Round wire reduced Friction ! Low force reduced Binding & Notching Re.Ba. 0107 • Auxilliary wire .016 • .016 x .022 HA niti Re.Ba. 0907 Re.Ba. 1007©Dr Sylvain Chamberland
  48. 48. • Mx: 021x021x020: #13 is retracted individually • Md: 021x021x020: #46 is protracted + upright spring to increase anchorageEs.Gr1210 • Mx: $ E link: space is opening mesially • Md: New 021x021x020 X 58 mm ! To include 1st premolar ! Increase wire stiffnessEs.Gr0111 • Mx: $ 020 SS wire. ! Class I canine achieved ! Elastomeric chain activated ~ 2 mm for the lateralEs.Gr0311 • Md: $ E link
  49. 49. Rate of tooth movement under heavy and light continuous orthodontic forces Yee J.A., Elekdag-Türk T., Cheng LL, Darendeliler MA, AJODO 2009; 136:150e1-150e9 • Initial tooth mvt benefits from light forces • Heavy forces increased rate of tooth mvt and amount of canine retraction BUT increased anchorage loss and loss of canine rotation control • Maximum anchorage cases benefits from light forces©Dr Sylvain Chamberland
  50. 50. Tipping and translating Am.Bu. 0500 • Distal tipping + rotation Am.Bu. 0800 • T-loop for root uprighting Am.Bu. 1000©Dr Sylvain Chamberland Am.Bu. 0101
  51. 51. Hills DUAL-GEOMETRY Wire™ • Full sized square anterior section fills the slot of optimal torque control ! Torque play = 5°; Effective torque ! 6° • Rounded posterior section is polished to minimize friction ! Estimated torquing moment: ~ 15 Nmm.021 X .021 X .020 • Made of an ultra-high tensile strength stainless steel for optimum stiffness.©Dr Sylvain Chamberland
  52. 52. Hills DUAL-GEOMETRY Wire™ Anterior section - square • Mx: ! 38 mm: to include 4 incisors ! 55 mm: to include canine to canine Posterior section- round • Md: ! 45 mm: to include canine to canine ! 58 mm: 1st premolar to 1st premolar©Dr Sylvain Chamberland
  53. 53. En masse retraction • .021 X .021 X .020 Hills Dual geometry • Cl I module: E-Link E-5 ! Force 100 to 125 g • Reverse curve of Spee ! Moment to counteract tipping ! Posterior toe in or constriction©Dr Sylvain Chamberland Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 3 May 2007 06:18 PM) © 2007 Elsevier
  54. 54. Force system (M/F =10:1) • Translation: ~ 100 g ! To maintain torque control when closing space ! Use low force module©Dr Sylvain Chamberland Downloaded from: Proffit: Contemporary Orthodontics, 4th edition (on 3 May 2005
  55. 55. 01-03• Enmasse space closure ! 021 X 025 SS + oxydoreduction of 05-03 the posterior section distal to 1st premolar• Molar protraction ! Note that flat curve of Spee is 11-03 maintained©Dr Sylvain Chamberland
  56. 56. Enmasse retraction: Anchorage A 08-04 • .021 x .025 SS DG ! Upright spring on /3s ! E5, 75g/side 09-04 ! Protraction of lower 5s • .021 x .021 x .020 HDG $ E-links 5 11-04 ! OJ and Cl I molar relationship is improving $ E-links 5©Dr Sylvain Chamberland
  57. 57. 12-04 • Use cl II to improve molar relationship 01-05 • Upright spring to PM2 • E6 47-P; E5 P-36 03-05©Dr Sylvain Chamberland
  58. 58. Molar protraction 09-04 11-04 12-04 • Time: 8 months • Note space opening between the premolar and the molar 01-05 03-05 04-05©Dr Sylvain Chamberland
  59. 59. Pa.Ge.0803 .021 x .025 SS + oxydoreduction Space close in 5 months Flat curve of Spee is maintained Pa.Ge.1003 Pa.Ge.0104©Dr Sylvain Chamberland
  60. 60. Ka.Sw.200504 • Adult, cl II div 1, missing #36 • Tx plan:_________ Ka.Sw.050804©Dr Sylvain Chamberland
  61. 61. Ka.Sw.300505 at 1 year into tx • Note space opening distal to 46 & 37 Ka.Sw.210905 •©Dr Sylvain Chamberland Once 46 is contacting 44, start protraction of 47
  62. 62. Ka.Sw.191005 • TPA removal, reassessment of Bk position, cl II elastic©Dr Sylvain Chamberland
  63. 63. Ka.Sw.160106 • Duration: 108 weeks Ka Sw Ka.Sw.260606©Dr Sylvain Chamberland
  64. 64. Mc / Mf > 1 Moment / Force • Problem •Solution: M c > MF –Increase moment at the wire/bk ! Loss of incisor torque interface !! wire stiffness ! Mx: reverse curve of spee !RC in Md ! Md: increased curve of spee !AC in Mx –Reduced force level©Dr Sylvain Chamberland
  65. 65. Molar protraction • Enmasse .021 x .021 x .020 • E-links : 7s - hook Fo.Mi 0407 Fo.Mi 0206 Fo.Mi 1208©Dr Sylvain Chamberland
  66. 66. Mi.Fo. 0206 Mi.Fo. 1208©Dr Sylvain Chamberland
  67. 67. Molar protraction • Enmasse .021 x .021 x .020 • E-links : 6s - hook • Uprighting spring 17-15 ! to overcome tipping in the 2nd order Da.Ga.210209 Da.Ga.300910©Dr Sylvain Chamberland
  68. 68. Molar protraction • Such large protraction of the 2nd molar resulted in mesial rotation in the 1st order • Class I force module from the lingual helped to correct rotation in the 1st order while the uprighting spring corrected the tipping in the 2nd order©Dr Sylvain Chamberland Da.Ga. 0109 Da.Ga. 0410 Da.Ga. 0910
  69. 69. 2 nd Molar ProtractionTx initiated: Dec 07 Na.Ru.030809 At 19 m Na.Ru.121010Na.Ru.140907 Na.Ru.261009 At 23 m Na.Ru.121010 At 34 m©Dr Sylvain Chamberland
  70. 70. Enmasse incisor retraction • .017 x .025 ß-Ti mushroom wire • Preactivation bend ! Accentuated curve of Spee ! Anterior step up ! Posterior toe in • Activation ! Pull & cinch©Dr Sylvain Chamberland
  71. 71. Frictionless anterior retraction Bé.-De. Sa 120802 • .017 x .025 TMA mushroom loop Bé.-De. Sa 220902©Dr Sylvain Chamberland
  72. 72. Phases of treatment Finishing
  73. 73. SPEED Wire™ • Torque play on top • Wire is seated at the bottom of the slot •Active • Passively seated • Actively maintained • Torque play ! .020 x .025 ! 4° • Effective torque ! .020 x .025 ! 7° • Spring-Clip activated by "cam" • Archwire and archwire slot action of SPEED archwire in perfect alignment Seating the spring clip 0.01 mm©Dr Sylvain Chamberland created an arc of 5,4 mm at the apex
  74. 74. Other finishing wire D-Wire .020 x .020 SS • Torque play ! .020 x .020 ! 6°to 7° • Effective torque ! .020 x .020 ! 4° to 5° D-Wire • Torque play ! .021 x .021 = 5° • Effective torque .019 x .025 SS or %-Ti .021 x .021 = 6° ! • Torque play ! .019 x .025 = 10.5° • Effective torque ! .019 x .025 = ±9° (for the lower anteriors) ! .019 x .025 = 5° (for upper anteriors)©Dr Sylvain Chamberland
  75. 75. Finishing Ca.Gr.0907 Ca.Gr.1208 Ca.Gr.0309 • Prior to surgery .020 x .025 SW + finishing bend • Root torque achieved Ca.Gr.0907©Dr Sylvain Chamberland Ca.Gr.1208 Ca.Gr.0309
  76. 76. 3 rd order problem Labial root torque Lingual root torque Ev. Ca.0507 Ev. Ca.0309 • Most of my problems encountered in the 3rd order plane of space where caused because I used (from 1998 to 2005) an undersized .019 x .025 archwire (SS or %-Ti)during finishing stage Ev. Ca.0909 • Since I reintroduced .020 X .025 or .021 X .025 archwire, I significantly reduced the needs of torquing©Dr Sylvain Chamberland spring in finishing except for a few particular situations
  77. 77. Torque issue in finishing stage • Engaging a continuous archwire will cause 3rd order discepancy that will need to be address in the finishing stage Da.Pa 0706 Da.Pa 0908. Da.Pa 280109 • .020 x .025SS was engaged in June. Torquing spring were added in september • Adequate alignement of incisorss talon was achieved in January©Dr Sylvain Chamberland
  78. 78. An.No 05-7, tx initiated 0607 • Tx time = 130 weeks • Got it straight + a new born baby An.No 12-09©Dr Sylvain Chamberland
  79. 79. ©Dr Sylvain Chamberland
  80. 80. Ja.Le. 07-8, tx initiated 0808 • Tx time: 92 weeks • Slight residual midline deviation Md deviation Ja.Le. 05-10©Dr Sylvain Chamberland
  81. 81. ©Dr Sylvain Chamberland $ issues explain /8s
  82. 82. 11 y. 4 m. Ta.Po. 09-08, tx initiated 011008 • Tx time: 92.7 weeks Ta.Po. 12-07-10 ©Dr Sylvain Chamberland
  83. 83. 1/ :Torque improved©Dr Sylvain Chamberland
  84. 84. Class III Severe ALD Vi.Lé.02-10-07 • Hopeless #16 (UR 1st molar) • Mx midline deviated to the right©Dr Sylvain Chamberland
  85. 85. • Dentoalveolar Protrusion • Lower lip procumbency©Dr Sylvain Chamberland
  86. 86. Tx planning • Tx goals ! Reduce lip procumbency ! Obtain coincident midline ! Achieve cl I canine ! Achieve cl I molar on the left ! Achieve cl III molar on the right • Extraction: ?©Dr Sylvain Chamberland
  87. 87. Vi.Lé.03-07-08 • Mx:.020 x .020 neost + .016 SC • Md: .021 x .021 x .020 enmasse retract.©Dr Sylvain Chamberland
  88. 88. Vi.Lé. 01-10-08 • At 50 weeks • Mx: .016 X .022 neost; #13 engaged©Dr Sylvain Chamberland
  89. 89. • Reassessment of bracket position ! 14, 13, 12, 11, 22, 23, 24, 33©Dr Sylvain Chamberland
  90. 90. Vi.Lé. 28-01-09 • At 67 weeks • Mx & Md: .019 x.025 Resol, finishing bend©Dr Sylvain Chamberland
  91. 91. Vi.Lé. 23-03-2009 • At 75 weeks • Mx: .019 x .025 resol., finishing bend 21, 12 • Md: .020 x .025 SW, finishing bend 43, 45©Dr Sylvain Chamberland
  92. 92. Vi.Le. 15-06-09 • At 87 weeks or 20 months©Dr Sylvain Chamberland
  93. 93. Vi.Le. 0609©Dr Sylvain Chamberland

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