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Part I-Management of Class II Malocclusion with SPEED Appliance Part I

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SPEED appliance and treatment of class II malocclusion using Forsus, Twin Force Bite corrector. …

SPEED appliance and treatment of class II malocclusion using Forsus, Twin Force Bite corrector.
Class II treatment with impacted canine (canine incluse)

Published in: Health & Medicine

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  • 1. Management of Class II Malocclusion with SPEED Appliance Part I slideshare.net/sylvainchamberland www.sylvainchamberland.com©Dr Sylvain Chamberland
  • 2. Clinical case presentation • Class II div 2 • Class II div 1 • Pendulum Appliance • Forsus • Crossbow appliance and Forsus class II corrector©Dr Sylvain Chamberland
  • 3. Cl II div 2 # 2- Ém. Ma.©Dr Sylvain Chamberland 3
  • 4. • RPE. Distallize 6|6 • Decompensation 1|1, Level Md curve of Spee É.M. 13a10m; 10-03 É.M. 14a3m; 04-04©Dr Sylvain Chamberland
  • 5. É.M. 12-03 É.M. 4-04 É.M. 06-04 É.M. 01-05 É.M. 06-05©Dr Sylvain Chamberland
  • 6. Em. Ma 06-04 • Note hook toward occlusal plane ! Reduce vertical component of distallizing force Em. Ma 11-04©Dr Sylvain Chamberland
  • 7. Em. Ma 01-05 Em. Ma 03-05: Reassessment of bk position Em. Ma 05-05:©Dr Sylvain Chamberland
  • 8. É.M. 06-05 Em. Ma 08-05: É.M. 02-06©Dr Sylvain Chamberland
  • 9. SNA = 79 78 SNB = 73 73,5 ANB= 6 4,6 ABOP = 5 2,4 FMA= 20,4 20,3 ANS-Me=51 56 1/SN = 70 99 1/1 = 175,4 128,6 /1-PM= 86 101,5©Dr Sylvain Chamberland
  • 10. Em. Ma 02-08, • 2 years into retention©Dr Sylvain Chamberland
  • 11. Cl II div 1 # 4- Vi. Ga.©Dr Sylvain Chamberland 11
  • 12. Vi.Ga. 15-04-08 • Cl II div 1 • Bimaxillary protrusion • Mesially rotated 1 molar st©Dr Sylvain Chamberland
  • 13. • Proclined Mx & Md 1/1©Dr Sylvain Chamberland
  • 14. • At 7 months ! .020x.020 neost/ .19x.25 resolv ! Chain 6-5-4 | 4-5-6 + cl II elastic Vi.Ga. 09-12-08 TPA helped to derotate the molars, change the arch form and obtain class I molar relationship©Dr Sylvain Chamberland
  • 15. • At 10 months • Reassessment of bk position 15, 13, 12 Vi.Ga. 19-02-09©Dr Sylvain Chamberland
  • 16. Vi.Ga. 12-05-09 at 13 months • 21x21x20 enmasse ret + Class II elastic at occlusal plane • Class 1 E-links; md: 20x25 nitisw©Dr Sylvain Chamberland Vi.Ga. 25-08-09 at 16 months
  • 17. Note 1st molar derotation Vi.Ga. 25-06-10 tx time: 113 weeks©Dr Sylvain Chamberland
  • 18. Vi.Ga. 25-06-10 at 113 weeks ©Dr Sylvain Chamberland
  • 19. Cl II div 1 # 5- Jo. Si.©Dr Sylvain Chamberland 19
  • 20. • Mesially rotated 1 st molar Jo..Si. 27-02-08©Dr Sylvain Chamberland
  • 21. ©Dr Sylvain Chamberland
  • 22. • Molar derotation with TPA • Class I relationship achieved Jo..Si. 25-11-08©Dr Sylvain Chamberland
  • 23. • At 10 months: Finishing Jo..Si. 28-01-09 • At 13 months: more finishing Jo..Si. 28-03-09©Dr Sylvain Chamberland
  • 24. • Tx duration 15 months (62 w.) Jo..Si. 01-06-09©Dr Sylvain Chamberland
  • 25. ©Dr Sylvain Chamberland
  • 26. ©Dr Sylvain Chamberland
  • 27. Cl II div 1 # 6- Gu. Ma.©Dr Sylvain Chamberland 27
  • 28. • Class II div 1 • Constricted maxilla Gu.Ma. 0707©Dr Sylvain Chamberland
  • 29. • Forsus spring-rod (insertion April 07) ! RPE ! Md + Mx: .019 x .025 SS cinched distal /7’s ! Loops distal /3’s Gu.Ma. 0708©Dr Sylvain Chamberland
  • 30. Tricks • Offset bend©Dr Sylvain Chamberland
  • 31. • At 5 months: removal of RPE and Forsus • Molar distallization 6’s/ • Anterior proclination Gu.Ma. 0908©Dr Sylvain Chamberland
  • 32. • Bone deposition lamina dura©Dr Sylvain Chamberland
  • 33. • Palatoversion de 1/ • Proclination /1 • Lip incompetency©Dr Sylvain Chamberland
  • 34. ©Dr Sylvain Chamberland
  • 35. Gu. Ma 01-09 • Mx: .020 x .025 SW + ART Gu. Ma 04-09©Dr Sylvain Chamberland
  • 36. Gu. Ma 01-09 Gu. Ma 06-09©Dr Sylvain Chamberland
  • 37. Gu. Ma 21-05-09 • Finishing bend 11, 21 • Note expansion of buccal segment Gu. Ma 23-06-09©Dr Sylvain Chamberland
  • 38. • Tx duration: 25 months Gu. Ma 29-09-09©Dr Sylvain Chamberland
  • 39. ©Dr Sylvain Chamberland
  • 40. • Favorable growth occurred • Adverse side effect relapsed • /1 inclination maintained©Dr Sylvain Chamberland
  • 41. • Hes happy!©Dr Sylvain Chamberland
  • 42. 99 weeks into retention Gu.Ma.250811©Dr Sylvain Chamberland
  • 43. Cl II div 1 # 7- Sh. La.©Dr Sylvain Chamberland 43
  • 44. • , 12 a. 5 m. • Cl II div 1 La.Sha 0807©Dr Sylvain Chamberland
  • 45. • Md retrusion, SNB = 5°, ABOP = 6,5 mm • Md dento-alveolar retrusion©Dr Sylvain Chamberland
  • 46. • Post-expansion • Forsus inserted ! Note: La.Sha 1007 ! Occlusal rest on 7’s ! Engaged 17 & 27 on the archwire ! Posterior cinch©Dr Sylvain Chamberland
  • 47. • Labial tipping of lower incisors • Distal drift of 6’s La.Sha 0308©Dr Sylvain Chamberland
  • 48. • Lower buccal segment moved mesially • Upper buccal segments moved distally©Dr Sylvain Chamberland
  • 49. ©Dr Sylvain Chamberland
  • 50. • 5 months: Xbow • Hyrax impingement • Md buccal segment tipped mesially • Cl III molar relationship La.Sha 0308©Dr Sylvain Chamberland
  • 51. • Mx: .019 x .025 resolve • Md: .016 neost, rebond 35 La.Sha 0608©Dr Sylvain Chamberland
  • 52. • 12 months into treatment • Mx: .021 x .021 x .020 SW en masse retraction • Md: .020 x .020 neost La.Sha 0908©Dr Sylvain Chamberland
  • 53. • At 18,8 months • Mx & Md: .020 x .025 SW ! Arch form coordination, torquing & finishing La.Sha 0309©Dr Sylvain Chamberland
  • 54. La.Sha 0309 • Torquing arch ART and finishing bend La.Sha 13-04-09©Dr Sylvain Chamberland
  • 55. La.Sha 13-04-09 • Finishing bend • Note expansion side effect at 1 st molar ! Crown buccal-root lingual cause by intrusive force at the attachment point: Lindauer et al, Semin Orthod 2001;7:207-214.) ! Use a TPA or cut the wire and let it relapse©Dr Sylvain La.Sha 26-05-09 Chamberland
  • 56. La.Sha 26-05-09 • Tx duration = 23 months La.Sha 26-08-09©Dr Sylvain Chamberland
  • 57. ©Dr Sylvain Chamberland
  • 58. • Mx incisors retraction occurred • Torque was maintained ! ART + full dimensional archwire + Speed • Severe lower incisors proclination returned to normal value©Dr Sylvain Chamberland
  • 59. • Shes happy!©Dr Sylvain Chamberland
  • 60. La.Sha 0807 • 82 weeks into retention La.Sha 22-03-11©Dr Sylvain Chamberland
  • 61. Cl II div 1 # 8- M.-P. Ga.©Dr Sylvain Chamberland 61
  • 62. Ma-Pi.Ga.0508 11y 5 m • Cl II div 1 • Proclined 1/ • Retroclined /1 • Impacted 23©Dr Sylvain Chamberland
  • 63. Ma-Pi.Ga.0508 ©Dr Sylvain Chamberland
  • 64. Tx plan • Goals ! Retract 1/ ! Procline /1 ! Achieve cl I molar and canine • Tx mechanics:....?©Dr Sylvain Chamberland
  • 65. • 5 months into treatment: RPE + Forsus Xbow removed Ma-Pi.Ga.1108 • /1 proclined • 1/ retroclined • 6/ distalized • #23 is erupting (through mucosa!!!)©Dr Sylvain Chamberland
  • 66. • Delayed eruption of #35 & 45 is expected • Pr: exo #75 & #85 Ma-Pi.Ga.1108©Dr Sylvain Chamberland
  • 67. Ma-Pi.Ga.0109 Ma-Pi.Ga.0409 • Lack of keratinized gingiva #23 buccal • At 12 months: class I relationship is achieved Ma-Pi.Ga.0609©Dr Sylvain Chamberland
  • 68. At 14 months • Reassessment of brackets position ! #12 & #22 to be rebonded Ma-Pi.Ga.0609©Dr Sylvain Chamberland
  • 69. Ma-Pi.Ga.0910 • Tx time = 119 weeks • Narrow band of keratinized gingiva is noted #23 buccal©Dr Sylvain Chamberland
  • 70. Ma-Pi.Ga.0910©Dr Sylvain Chamberland
  • 71. • Growth expressed vertically • Mandibular dentition mesialized • Shes happy©Dr Sylvain Chamberland
  • 72. Cl II div 1 # 9- Al. Du.©Dr Sylvain Chamberland 72
  • 73. Al.Du.0608 • Cl II div 1 • Severe ALD • Impacted 23©Dr Sylvain Chamberland
  • 74. Al.Du.0608©Dr Sylvain Chamberland
  • 75. Tx Planning • Goals ! Achieve cl I molar relationship ! Obtain intra-arch symmetry ! Maintain /1-MP AP-wise ! Retract 1/©Dr Sylvain Chamberland
  • 76. • Voussure vestibulaire • Incision Al.Du.0209 Al.Du.0109©Dr Sylvain Chamberland
  • 77. • Incision sulculaire et sommet de la crête • Incision de relâche au distal ! Préserver tissu kératinisé©Dr Sylvain Chamberland
  • 78. • Rugine pour ! Décoller lambeau périosté • Farabeuf ! Relèvement du lambeau©Dr Sylvain Chamberland
  • 79. • Canine exposée • Enlèvement du sac folliculaire©Dr Sylvain Chamberland
  • 80. • Mordançage ! Self etching primer (ESPE) • Collage du bouton ! Transbond XT©Dr Sylvain Chamberland
  • 81. • Ligature métallique • Activation sur l’arc©Dr Sylvain Chamberland
  • 82. • Fermeture du lambeau Merci au Dr Michel Fortin©Dr Sylvain Chamberland
  • 83. • Guérison à 14 jours post op ! Absence de cicatrice Du.Al. 18-02-09 ! Réactivation de fil de traction©Dr Sylvain Chamberland
  • 84. • Guérison ~ 2 mois ! Excellente bande de gencive kératinisée Du.Al. 01-04-09 ! Absence de cicatrice visible Du.Al. 05-07-10©Dr Sylvain Chamberland
  • 85. Al.Du.0209 Al.Du.0409 Al.Du.0509©Dr Sylvain Chamberland
  • 86. Al.Du.0809 • Note Class I E-links module • Note iatrogenic cant of the occlusal plane • Forsus modules = 4 months Al.Du.1209©Dr Sylvain Chamberland
  • 87. Al.Du.0710 • Tx time = 104 weeks • Arch symmetry achieved • Class I molar and canine relationship©Dr Sylvain Chamberland
  • 88. ©Dr Sylvain Chamberland
  • 89. • 1/-MP maintained • /6 protracted • 1/-SN retracted, maintain torque©Dr Sylvain Chamberland

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