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Initial alignment and arch leveling with SPEED Appliance, 2nd edition

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How to align and level teeht with SPEED brackets? What is the recommended archwire progression? Biomechanics tips and tricks with SPEED. How to avoid problem in the 3rd order plane of space.

How to align and level teeht with SPEED brackets? What is the recommended archwire progression? Biomechanics tips and tricks with SPEED. How to avoid problem in the 3rd order plane of space.


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  • Merci pour votre encouragement,
    SI vous avez des questions spécifiques, n'hésitez pas à demander. Vous pouvez poser vos questions sur ce site ou encore sur mon site web www.sylvainchamberland.com
    Thank you,
    If you have any technical question, you ask ask via this site or via my website www.sylvainchamberland.com
    Recevez mes salutations distinguées
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  • 1. Initial Alignment with SPEED Appliance Speed Technique Course 2011 slideshare.net/sylvainchamberland www.sylvainchamberland.com
  • 2. Force level • "It appeared that no evidence about optimal force level in orthodontics could be extracted from literature" ! Optimum force magnitude for orthodontic tooth movement: a systematic literature review, Ren et al., AO 2003©Dr Sylvain Chamberland
  • 3. Force level • How much force is necessary to align the anteriors? • What would be your 1st wire? Pi.Har.Mar.0601©Dr Sylvain Chamberland
  • 4. Force level • How much force is necessary to align the anteriors? • What would be your 1st wire? Pi.Har.Mar.0601©Dr Sylvain Chamberland
  • 5. Unloading value©Dr Sylvain Chamberland
  • 6. Unloading value • Supercable™ ! ! Extremely low unloading forces regardless of wire diameter (.55 g for .016 / 105 g for .020). ! Lower unloading forces than Traditional Nickel Titanium. • Damon Optimal Force CuNiTi arch wires ! ! Very high unloading forces despite their small diameter (161 g for .013 / 234 g for .014)©Dr Sylvain Chamberland
  • 7. ©Dr Sylvain Chamberland
  • 8. ©Dr Sylvain Chamberland
  • 9. .017 X .025 NiTi Torsional superelasticity of NiTi archwires Bolender Y et al, Angle Orthod. 2010;80:1100–1109. • .017 X .025 neosentalloy 100g ! Most NiTi archwires did not display any superelasticity in torsion at average oral temperature. ! Copper NiTi 35°C and 40°C were the only superelastic wires at 35°C.©Dr Sylvain Chamberland
  • 10. What does the literature say about the other systems?
  • 11. • Damon3™ SLB are no more efficient than conventional ligated pre-adjusted brackets (Synthesis™) during tooth alignment. Alignment efficiency of Damon3™ self-ligating and conventional orthodontic bracket systems: a RCT trial (AJODO, 2008; 134: 470.e1-470.e8) • Damon 3™ SLB does not reduce overall treatment time, total number of visit, or result in a better occlusal outcome when compared with conventional ligated pre-adjusted brackets (Synthesis™) in the treatment of extraction patients with crowding. Duration of treatment and occlusal outcome using Damon3 self-ligated and conventional orthodontic bracket systems in extraction patients: A prospective RCT (AJODO 2011;139:e111-e116) • SmartClip vs Victory: Bracket type did not influence the duration of treatment or the number of visits or occlusal outcome (PAR score). RCT of orthodontic treatment efficiency with SLB and conventional fixed orthodontic appliances (AJODO 2010;137:738-42)©Dr Sylvain Chamberland
  • 12. Claim: Incisor position & dental transverse changes • Damon 3 Mx ! Md incisors advance significantly to alleviate crowding !contradict lip bumper theory ! Posttreatment /1 inclination: no difference D3 MX vs conventional bk ! Mx & Md intercanine, interpremolar and intermolar " sig. with D3 Mx Vajaria et al, Evaluation of incisor position and dental transverse dimensional changes using the Damon system, AO 2011;81:647-652 ! Same conclusion in : Pandis et al EJO 2010;32:248-253, D2 vs Microarch GAC©Dr Sylvain Chamberland
  • 13. UPDATE Date Added: 27 January 2009(Proffit, Contemporary Orthodontics, 4 ed) Root resorption with conventional and self-ligating brackets • Multivariate regression analysis showed that treatment duration independent from appliance type was a significant predictor of apical resorption. For the entire sample, the median decrease in incisor root length was 1.05 mm, with a range from 5%-95% of the sample of 0.18-3.06 mm. The difference between appliance types was not statistically significant, but after accounting for treatment duration, there was a trend toward slightly greater resorption (0.37 mm average) with the Damon brackets (P = . 06). • The data do not support the claim of less root resorption with rigid-clip self-ligating brackets. Pandis N, Nasika M, Polychronopoulou A, et al: External apical root resorption in patients treated with conventional and self-ligating brackets. Am J Orthod Dentofac Orthop 134(5):646-651, 2008.©Dr Sylvain Chamberland
  • 14. Volumetric analysis of root resorption crater after application of light and heavy orthodontic forces Chan E, Darendeliler A, AJODO 2005; 127: 186-95 • Mean volume of resorption crater Mean volume of resorption per Group 3 11.59 x 3.31 x ! Light force (25 g) 194.58 2 ! = 3,49-fold greater than control X 106 µm 3 3.49 x NS 1 58.69 ! Heavy force (225 g) 16.77 0 p = 0.000 conrtrol light heavy ! = 11,59-fold greater than control (p < .001) D Comparison of volumetric analysis of resorption craters between regions ! Heavy force = 3,31-fold greater total resorption than light force (p < .001) ! Difference betwween light force vs control: NS©Dr Sylvain Chamberland
  • 15. Phase of treatment • Phase 1: Initial alignment • Phase 2: Arch levelling • Phase 3: Tooth translation & retraction • Phase 4: Finishing©Dr Sylvain Chamberland
  • 16. Phase 1Initial alignment
  • 17. Initial alignment • Severe malalignment J-A.Dr. .016SC 090910 ! .016 Supercable™ for 6 weeks to 18 Passive zone weeks or even more up to 6 months ! May be replaced after 6 or 12 weeks to avoid breakage, .018 Supercable™©Dr Sylvain Chamberland
  • 18. Initial alignment • Moderate malalignment ! .018 Supercable™ for 6 weeks to 18 weeks ! .016 HA niti or .016 x .022 HA Passive zone Ka. La. 18SC 150910 niti©Dr Sylvain Chamberland Pl. Is. 16Sent 0910
  • 19. Working in passive zone • .016 Supercable™ for 5 months • Let it cook 25-06-02 02-12-02 09-09-02 02-12-02©Dr Sylvain Chamberland Graber, Orthodontics current principles & technique, 4e ed. p726
  • 20. Working in passive zone • Wire extend distally as alignment occurs 7w 11 w Ju.De.#2 0605 Ju.De.#2 0805 Ju.De.#2 0905©Dr Sylvain Chamberland
  • 21. ! #13 not engaged ! Bonded occlusal stop #42 An.No. 06-07 • .016 Supercable™ ! Self uprighting An.No. 08-07©Dr Sylvain Chamberland ! Self uprighting
  • 22. An.No. 06-07 • Mx: Open coil to initiate midline correction • Md: Note self uprighting of 43 + labial tipping of 42©Dr Sylvain Chamberland An.No. 08-07
  • 23. • Main arch: .016 neost ! Auxiliary wire: .016 Supercable™ • To minimize labial tipping of the lateral incisors and lingual tipping of maxillary incisors Pa.-Ge. Pa. 0708 Pa.-Ge. Pa.1008 at 12 weeks Pa.-Ge. Pa1108 at 18 weeks©Dr Sylvain Chamberland
  • 24. Individual canine retraction • Mechanotherapy D.M. ! TPA ! .017 x .025 TMA T loop D.M. After 6 weeks of retraction©Dr Sylvain Chamberland
  • 25. Let it cook • At 6 months ! .016 SC for 17,7 weeks Ja.Le 0708 ! + Ja.Le 0309 at 7 months ! .018 SC for 8 weeks Ja.Le 0209©Dr Sylvain Chamberland
  • 26. • At 6 months ! .016 SC for 11,7 weeks ! + Ja.Le 0708 ! .018 SC for 14 weeks ! At 6 months: ! Same wire left in place +EC 23-24 for derotation of 23 Ja.Le 0209 Ja.Le 0309 at 7 months©Dr Sylvain Chamberland
  • 27. Ja.Le 0708 Ja.Le 1108 Ja.Le 0209 • At 6 months ! .016 SC for 11,7 weeks ! .018 SC for 14 weeks Ja.Le 0309 at 31,7 w / 7,9 m ! At 6 months (22,7 w): ! Same wire left in place +EC 23-24 for derotation of 23 •©Dr Sylvain Chamberland At 7,9 months: Mx: .016 x .022 HA niti
  • 28. • Mx: Segmented .016 SC 12-23; 13 and 42 not engaged Md: .016 SC 34-44, active coil 43-41 Ta.Po. 1008 • At 6 w: continuous arch wire .016 SC, active coil 15-12 & 43-41 • At 11 w: .016 SC / .016 HA NiTi; 13 and 42 were engaged Ta.Po. -080109 11 w • At 21 w: .016 HA NiTi / .016 x .022 HA NiTi Ta.Po. -260209©Dr Sylvain Chamberland 21 w
  • 29. Ta.Po. 1008 Ta.Po. -080109 11 w Ta.Po. -260209 21 w Ta.Po. 1008 Ta.Po. -080109 11 w Ta.Po. -260209 21 w©Dr Sylvain Chamberland
  • 30. Ta.Po. 1008 Ta.Po. -080109 11 w Ta.Po. -260209 21 w • Midline correction is achieved Ta.Po. -080109 11 w Ta.Po. -260209 21 w©Dr Sylvain Chamberland
  • 31. Application of SPEED split stops • Wiengart plier • Ligature director • Miniature pin and ligature cutter • Flush distal end cutter©Dr Sylvain Chamberland
  • 32. Tricks & tips©Dr Sylvain Chamberland
  • 33. Tricks & tips • Pull & hold the wire with the fork©Dr Sylvain Chamberland
  • 34. Tricks & tips • Pull & hold the wire with the fork • Crimp the stop with the plier while pushing the wire in the opposite direction of the plier©Dr Sylvain Chamberland
  • 35. Tricks & tips • Pull & hold the wire with the fork • Crimp the stop with the plier while pushing the wire in the opposite direction of the plier • Use the mini ligature cutter and the ligature director to hold the wire while cutting©Dr Sylvain Chamberland
  • 36. Uncontrolled tipping 3 rd order view©Dr Sylvain Chamberland
  • 37. Uncontrolled tipping 3 rd order view • Crown ! Lingual vector 1|1 ! Labial vector 2|2©Dr Sylvain Chamberland
  • 38. Uncontrolled tipping 3 rd order view • Crown !Root ! Lingual vector 1|1 –Labial root tip 1|1 –Lingual root tip 2|2 ! Labial vector 2|2©Dr Sylvain Chamberland
  • 39. Solution WARNING: During that period, I was using • Elgiloy Anterior torquing spring .019 x .025 SS wire. I would have avoid many • Reduced torque 2|2 torquing problem if i had used .020 x.025 SS or .021 x.025 SS > 3 years after tx©Dr Sylvain Chamberland DM 04-03 DM 10-06
  • 40. 3rd order • Extraction of #14 was delayed Ma.Br.0804 • No space was available to align #12 • Uncontrolled tipping occurred #11 and 12 Ma.Br.0904 Ma.Br.1104Ma.Br.1005
  • 41. TABLE 1 TIPPING DUE TO LOSS3 rd order OF TORQUE CONTROL* Torque Loss 5° 8° 10° Maxillary 1.3mm 2.1mm 2.7mm Mandibular 1.2mm 1.9mm 2.3mm *Lingual change in incisal edge position (incisors of average dimensions). Ma.Br.0605• Forces applied buccal to Cres• Once the 6 anteriors teeth are Ma.Br.0605 engaged the roots are all over the place in the 3rd order Ma.Br.1005
  • 42. Torquing while finishing• Finish with Ma.Br.0407 Ma.Br.0607 Ma.Br.0508 full size archwire• Let it cook WARNING: During that period, I was using .019 x .025 SS wire. I would have avoid many torquing problem if i had used .020 x.025 SS or .021 x.025 SS
  • 43. Hands on Supercable™
  • 44. I’m seriously thinking having braces©Dr Sylvain Chamberland
  • 45. Forces & Moments
  • 46. Forces & Moments
  • 47. Forces & Moments
  • 48. Forces & MomentsAsymmetric V
  • 49. Forces & MomentsAsymmetric V
  • 50. Forces & MomentsAsymmetric V
  • 51. Forces & MomentsAsymmetric V Bigger moment on 42 and 31 2 small opposite moments on 41 cancels 2 lingual forces add up
  • 52. Forces & MomentsAsymmetric V Bigger moment on 42 and 31 2 small opposite moments on 41 cancels 2 lingual forces add up 2 labial forces apply to 43 and 32
  • 53. SolutionCl.Be 090109Cl.Be 130509 Cl.Be 080709 Cl.Be 190809 It tooks 7 months...
  • 54. A smarter approach Se.Le.07-10-09 Se.Le.23-11-09 • 018 SC + coil, 4 months • .016 x .022 neost + coil • .020 x .020 neost + .016 aux. SC Se.Le.15-01-10©Dr Sylvain Chamberland
  • 55. Phase 2Arch levelling
  • 56. Arch levelling Active Zone • Once initial alignment is achieved, rectangular HA Niti wire is used to level and align in the 3 planes of space Ka.La.16x22neost ! .016 x .022 or .020 x .020 HA Niti Active Zone ! .017 x .022 or .020 x .025 NiTi Speedwire™ ! .020 x .025 SS Speedwire™ • Reassessment of bracket position should be done at this stage before engaging stainless steel wire©Dr Sylvain Chamberland Ka.Ri.20x20neost
  • 57. Arch levelling • Rectangular wire • Force system ! Controlled tipping ! Force + moment Nanda: Biomechanics and esthetic strategies in clinical orthodontics, Elsevier|Saunders 2005 " (M/F =7:1) ! 2nd & 3rd order©Dr Sylvain Chamberland © 2007 Elsevier
  • 58. An.No. 08-07 • At 18 weeks, Mx #13 was engaged using a main arch .016 x . 022 + auxiliary .016 SC; Md: .016 HA Niti • At 10,5 months, Mx: .019 x .025 resolve + EC 23-o-25-26-27 Md: .019 x .025 resolve + EC 46 to 35 An.No. 03-08©Dr Sylvain Chamberland
  • 59. An.No. 08-07 • At 10,5 months: 019 x 025 Resol ! Torque An.No. 03-08©Dr Sylvain Chamberland
  • 60. An.No. 03-08 • At 11 months: Mx: .021x .021x .020 Dual geometry + EC + Cl II elastic 23/36. Md: reverse curve of Spee, EC 46-35 • At 12 months: Mx: ! EC 23-27 + CL II. Md: EC 36-46 An.No. 06-08©Dr Sylvain Chamberland
  • 61. At 21 months An.No. 28-01-09 • Mx: .018 x .025 SS, ! EC 22-27, ! Open coil 13-12 • Md: .020 x .025 SW©Dr Sylvain Chamberland
  • 62. At 22,8 months An.No. 11-03-09 • Mx: .020 SS, EC 11-27, coil 12-13©Dr Sylvain Chamberland
  • 63. Ja.Le. 15-05-09, 39 w • Mx + Md: .020 x .025 nitisw Ja.Le. 17-08-09, 53 w • Mx: 19x25 resol, root spring + EC 14-16, 24-26; Md: .020©Dr Sylvain Chamberland x .025 nitisw, EC 34-o-36-37
  • 64. Ja.Le. 21-09-09, 58 w • Mx: .020 x .025 nitisw, EC 17-16-14 & 24-26 • Md: .020 x .025 sw, EC 31 to 36©Dr Sylvain Chamberland
  • 65. Ta. Po. 09-04-09 • Mx: .020 x .020 neosent / Md: .016 x .022 neost Ta. Po. 21-05-09 • Mx: .020 x .025 niti SW / Md: .020 x .020 neost + cl II 23/36©Dr Sylvain Chamberland
  • 66. Ta. Po. 02-07-09, 39 weeks • Mx: .020 x .025 SW open coil 13-12, elastomeric chain 23-o-25-26 / Md: .020 x .025 niti SW, EC 33-34-o-36 Ta. Po. 07-10-09 • At 53 w: Mx: .020 x .025 SW, EC 23-25-26 / Md: .020 x . 025 SW, elastomeric chain 36 to 46©Dr Sylvain Chamberland
  • 67. Hands on .020 x .025 Niti

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