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

Initial Alignment with SPEED
Appliance
Speed Technique Course
2011

slideshare.net/sylvainchamberland
www.sylvainchamberland.com

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

Force level
• How much force is necessary to align the anteriors?

• What would be your 1st wire?

Pi.Har.Mar.0601


Unloading value


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)


.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.


What does the literature say
about the other systems?

• 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)


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

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.


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


Phase of treatment

• Phase 1: Initial alignment

• Phase 2: Arch levelling

• Phase 3: Tooth translation & retraction

• Phase 4: Finishing


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™


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

Pl. Is. 16Sent 0910

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

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

! #13 not engaged ! Bonded occlusal stop #42

An.No. 06-07

• .016 Supercable™

! Self uprighting

An.No. 08-07

©Dr Sylvain Chamberland ! Self uprighting

An.No. 06-07

• Mx: Open coil to initiate midline correction

• Md: Note self uprighting of 43 + labial tipping of 42

An.No. 08-07

• 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


Individual canine retraction

• Mechanotherapy
D.M.

! TPA

! .017 x .025 TMA T loop
D.M. After 6 weeks of retraction


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


• At 6 months


! +
Ja.Le 0708

! At 6 months:

! Same wire left in place +EC 23-24
for derotation of 23
Ja.Le 0209 Ja.Le 0309 at 7 months


Ja.Le 0708 Ja.Le 1108 Ja.Le 0209

• At 6 months


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

•
At 7,9 months: Mx: .016 x .022 HA niti

• 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

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


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


Application of SPEED split stops

• Wiengart plier

• Ligature director

• Miniature pin and ligature cutter

• Flush distal end cutter


Tricks & tips


Tricks & tips
• Pull & hold the wire with the fork


Tricks & tips

• Crimp the stop with the plier
while pushing the wire in the
opposite direction of the plier


Tricks & tips

• 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


Uncontrolled tipping
3 rd order view


3 rd order view
• Crown
! Lingual vector 1|1

! Labial vector 2|2


3 rd order view
• Crown !Root

! Lingual vector 1|1 –Labial root tip 1|1
–Lingual root tip 2|2
! Labial vector 2|2


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

DM 04-03 DM 10-06

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.1104
Ma.Br.1005

TABLE 1
TIPPING DUE TO LOSS

3 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

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

I’m seriously thinking having
braces


Forces & Moments

Asymmetric V

Forces & Moments

Asymmetric V
Bigger moment on 42 and 31
2 small opposite moments on 41 cancels
2 lingual forces add up

Forces & Moments

Asymmetric 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

Solution
Cl.Be 090109

Cl.Be 130509 Cl.Be 080709 Cl.Be 190809

It tooks 7 months...

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

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
Ka.Ri.20x20neost

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

© 2007 Elsevier

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

An.No. 08-07

• At 10,5 months: 019 x 025 Resol

! Torque

An.No. 03-08


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

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


At 22,8 months

An.No. 11-03-09

• Mx: .020 SS, EC 11-27, coil 12-13


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
x .025 nitisw, EC 34-o-36-37

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


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

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

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