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- 1. SPEED Bracket Placement Guide 3rdedition 2012 ©Sylvain Chamberland http://www.slideshare.net/sylvainchamberland
- 2. ©Dr Sylvain Chamberland -BCJBM -JOHVBM (JOHJWBM 0DDMVTBM %JTUBM .FTJBM BracketPlacement Key Points
- 3. ©Dr Sylvain Chamberland •Rounded portion of the spring clip faces occlusally in both arches • Mesial and distal edges of the bonding pads ➜ parallel to the long axis of the middle lobe of each tooth. Bracket Placement Key Points
- 4. ©Dr Sylvain Chamberland BracketPlacement Key Points SPEED Rhomboid • Narrow SE Spring clip • Horizontal Positioning ✦ Mesial and distal edges of the SPEED bonding base / spring clip / bracket body. • Vertical Positioning ✦ Archwire slot / occlusal edge of the bonding pad and the bracket body
- 5. ©Dr Sylvain Chamberland BracketPlacement Key Points • Not necessary to angulate bracket slots into extraction sites or to use special extraction brackets. • Spring clip on the arch wire continuously maintains excellent root parallelism as spaces are closed. • Rounded portion of the spring clip faces occlusally
- 6. ©Dr Sylvain Chamberland BondingSPEED Attachments • Incisor brackets ✦ Forcing excess adhesive to exude toward the gingival reduces the risk of clogging the spring clips on these brackets with miniaturized pads. • Posterior brackets ✦ Larger bonding pads = not a problem ✦ Excess adhesive may be forced toward the occlusal. ✦ Less residual flash removal at the gingival.
- 7. ©Dr Sylvain Chamberland BondingSPEED Attachments • Care must be taken during bonding to avoid clogging the gingival end of the bracket / spring slot. • If some composite is inadvertently squeezed over the gingival edge of a bonding base and into a spring slot, immediately wipe it out with the tip of a sharp explorer.
- 8. ©Dr Sylvain Chamberland BondingSet Up • Cheek retractor ✦ #0118-HA - Adult High Heat Sterilizable Cheek Retractor #0118-HC - Child Hight Heat Sterilizable Cheek Retractor #0118-NA Nola Dry Field Kit Adult #0118-NC Nola Dry Field Kit Child Ortho-Pli corp • Saliva ejector
- 9. ©Dr Sylvain Chamberland BondingSet Up • Bracket placement trays ✦ 20-050-99 (GAC) ✦ 740-0076 (Ormco) • Graduated perio probe ✦ Hu-Friedy: XP23/OW6 • Self-locking pliers ✦ #0152 Cotton Plier, self locking (Ortho-Pli) • Boone gauge ✦ #BBG4 - Boone Bracket Positioning Gauge (Ortho-Pli)
- 10. ©Dr Sylvain Chamberland BondingTechnique Key Points • Wipe into the bonding paste • Hold the bracket with self-locking plier
- 11. ©Dr Sylvain Chamberland BondingTechnique Key Points • Place the bracket
- 12. ©Dr Sylvain Chamberland BondingTechnique Key Points • Place the bracket
- 13. ©Dr Sylvain Chamberland BondingTechnique Key Points • Place the bracket • Push to exude excess bonding paste and obtain close contact
- 14. ©Dr Sylvain Chamberland BondingTechnique Key Points Measure height
- 15. ©Dr Sylvain Chamberland BondingTechnique Key Points Measure height Assess long axis
- 16. ©Dr Sylvain Chamberland BondingTechnique Key Points Measure height Assess long axis Remove flash Note: Position of the bracket on tooth #22 is not adequate. Instructing the photographer while positioning the bracket was distracting.The bracket was repositioned...off camera.
- 17. ©Dr Sylvain Chamberland SPEEDSystem • Straight wire appliance ✦ Long axis (facial axis) of clinical crown ✦ Facial axis point: maximal buccal convexity
- 18. ©Dr Sylvain Chamberland •Andrews’s plane ✦ Plane of the bracket’s slot
- 19. ©Dr Sylvain Chamberland •Mandibular arch ✦ Average tip (2nd order) ✦ Average torque (3rd order) ✓ Molar crown = -30° ✓ Incisors = -1° ✦ Roth prescription
- 20. ©Dr Sylvain Chamberland •Maxillary arch ✦ Average tip (2nd order) ✦ Average torque (3rd order) ✓ Incisors = 7° ✦ Roth prescription
- 21. ©Dr Sylvain Chamberland •Long axis
- 22. ©Dr Sylvain Chamberland •Long axis
- 23. ©Dr Sylvain Chamberland •C • Maxillary incisors ✦ Locate the long axis from the lingual view
- 24. ©Dr Sylvain Chamberland •Anteriors ✦ 4 to 4,5 mm from incisal edge ✦ May vary with shorter or longer crown Archwire plane selection
- 25. ©Dr Sylvain Chamberland •Far enough gingivally to avoid occlusal contact ✦ 4 to 4,5 mm in most situation ✦ 5 mm or more may prevent leveling the curve of Spee Archwire plane selection
- 26. ©Dr Sylvain Chamberland •Far enough gingivally to avoid occlusal contact ✦ 4 to 4,5 mm in most situation ✦ 5 mm or more may prevent leveling the curve of Spee Archwire plane selection • Maximum buccal convexity • 4,5 mm is better to avoid unwanted upper incisal contact
- 27. ©Dr Sylvain Chamberland ✦Long axis located from the lingual view
- 28. ©Dr Sylvain Chamberland •Long axis assessed by the lingual • MD placement: ✦ middle lobe prominence
- 29.
- 30. ©Dr Sylvain Chamberland •Placement of 2nd molar occlusally reduce the likelihood of extrusion
- 31. ©Dr Sylvain Chamberland •Placement of 2nd molar occlusally reduce the likelihood of extrusion • Reflection lines on the labial aid to slot alignment
- 32. ©Dr Sylvain Chamberland •Bracket body centred on the facial surface of the tooth • Rhomboid angulated design provides better visual references to match the long axis of the bracket with the long axis of the tooth • Long axis of the tooth bisect middle lobe and the centre of the talon Mx central incisors 4 to 4,5
- 33. ©Dr Sylvain Chamberland Howto measure? • Boone Gauge ✦ From slot to incisal edge • Perio probe ✦ From bracket base to incisal edge 4 to 4,5
- 34. ©Dr Sylvain Chamberland BracketPlacement Tips • Direct view may differ from mirror view • Assess long axis using both direct view and mirror view
- 35. ©Dr Sylvain Chamberland MxLateral Incisors • ~ 0,5 mm shorter than the central • Bracket body centred on the facial surface of the tooth • Rhomboid design facilitates precise bracket placement
- 36. ©Dr Sylvain Chamberland •Bracket slot ✦ Not necessarily parallel to incisal edge because of incisal wear Caution: Incisal Wear & Lateral Incisors
- 37. ©Dr Sylvain Chamberland MxCanines • ~ 0,5 mm longer than the central incisor • Mesial and distal edges parallel to long axis • Compound contoured design of the bonding pad seat the bracket on the greatest contour of the middle lobe
- 38. ©Dr Sylvain Chamberland MiniBracket for Canine
- 39. ©Dr Sylvain Chamberland Bracketlong axis = Parallel lingual long axis
- 40. ©Dr Sylvain Chamberland Mx1st Premolars • At its maximal height of labial convexity • Mesial and distal edges parallel to long axis • Centre with the middle lobe 5
- 41. ©Dr Sylvain Chamberland Mx2nd Premolars • At its maximal height of labial convexity • Mesial and distal edges parallel to long axis • Occlusal edge of the bonding pad parallel to the ridge line • Centre with the middle lobe
- 42. ©Dr Sylvain Chamberland Mx2nd Premolars • Larger mesh pad • Occlusal offset • Easier placement for partially erupted tooth • Difficult to align mesh pad with Pm1 and M1
- 43. ©Dr Sylvain Chamberland Mx1st & 2nd Molars • At 3 to 3,5 mm or at its maximal convexity • Bk positioned with MB cusp tip • Occlusal edge parallel to the ridge line if cusp tips are not worn • Distal cusp longer than mesial cusp • Middle groove aid to locate the long axis
- 44. ©Dr Sylvain Chamberland •Marginal ridges aid to assess bracket position and height • The mirror occlusal view show the bracket centred with middle lobe or mesiobuccal cusp tip • Mx 2nd molar is oriented distally when emerging Marginal Ridges
- 45. ©Dr Sylvain Chamberland MarginalRidges Same remarks as the previous slide
- 46. ©Dr Sylvain Chamberland MdCentral & Lateral Incisors Rhomboid • 4,5 mm is recommended if one wants to avoid unwanted upper incisal contact • Central & Lateral:At 4,5 from incisal edges • Central & Lateral: Centred with the middle lobe M-D • Long axis located from the lingual
- 47. ©Dr Sylvain Chamberland LowerAnteriors • View from operator chair ✦ Long axis assess from lingual ✦ Note minimal paste thickness between bracket base and tooth surface ✦ Bracket centred with the middle lobe
- 48. ©Dr Sylvain Chamberland LowerCanines & Lateral Incisors • View for operator chair ✦ Canine bracket centred with cusp tip ✦ Lateral centred with middle lobe
- 49. ©Dr Sylvain Chamberland MdCanine Rhomboid • Slot at 4,5 to 5 mm from cusp tip • Centre on the middle lobe • Long axis located from the lingual
- 50. ©Dr Sylvain Chamberland Canine_OcclusalView •Bracket centred with cusp tip
- 51. ©Dr Sylvain Chamberland Md1st Premolars • At its maximal height of convexity • Centred with cusp tip
- 52. ©Dr Sylvain Chamberland Md2nd Premolars • At its maximal height of convexity • Centred with cusp tip • Longer mesh pad occlusal may cause placement too gingival • Concentrate on the bracket slot and the height of convexity
- 53. ©Dr Sylvain Chamberland Assessmentof Pracket Position • After direct bonding ✦ Reassessment of bracket position to pick any discrepancy ✦ Note parallelism with marginal ridges
- 54. ©Dr Sylvain Chamberland Assessmentof Bracket Position • After direct bonding ✦ Same remarks as previous slide ✦ Mirror viewed are use to do these assessments
- 55. ©Dr Sylvain Chamberland Md1st Molars • At its maximal height of convexity • Indent on the bonding pad centred opposite buccal groove • Indent is off centre mesiodistaly • Slot parallel to marginal ridges
- 56. ©Dr Sylvain Chamberland Md1st Molars • SPEED Convertible Tube ✦ Align indent with buccal groove ✦ Parallel to occlusal Clip closed Clip open
- 57. ©Dr Sylvain Chamberland Md1st Molars Double tube • Double Tube may lead to a too occlusal placement • If one place a Single Tube the same manner (too occlusal), antogonist occlusion may cause indent into the tube
- 58. ©Dr Sylvain Chamberland Md1st Molars Double tube • Wire engaged in the auxiliary tube by error • Extrusion occurred • Single tube rebounded at maximal convexity: wire is straight
- 59. ©Dr Sylvain Chamberland •Press brackets firmly • Centre the bracket on the middle lobe ✦ MD slot axis tangent to MD lobe curvature • Molar bk are placed on the MB cusp Large base U6 ERX For 2nd premolar extraction case
- 60. ©Dr Sylvain Chamberland •Press brackets firmly • Centre the bracket on the middle lobe ✦ MD slot axis tangent to MD lobe curvature • Molar bk are placed on the MB cusp Large base U6 ERX For 2nd premolar extraction case
- 61. ©Dr Sylvain ChamberlandAn.No. 12-08 • ERX bk will rotate 1st molar mesially • Placement on MB cusp help achieve molar derotation • ER bk rotate 1st molar distally
- 62. ©Dr Sylvain ChamberlandAn.No. 12-08 • ERX bk will rotate 1st molar mesially • Placement on MB cusp help achieve molar derotation • ER bk rotate 1st molar distally
- 63. ©Dr Sylvain Chamberland Cl.Tu.0507 Atleast 10° offset
- 64. ©Dr Sylvain Chamberland Cl.Tu.0507 Atleast 10° offset
- 65. ©Dr Sylvain Chamberland •Derotation of the 1st molar helped: ✦ To gain arch length ✦ To achieve class I relationship Cl.Tu.0507 Cl.Tu.0209 At least 10° offset
- 66. ©Dr Sylvain Chamberland •Use Bk ERX To Maintain Molar Rotation
- 67. ©Dr Sylvain Chamberland •Place regular bk at the middle grove To Maintain Molar Rotation
- 68.
- 69. ©Dr Sylvain Chamberland •Reflection lines on the labial aid to slot alignment
- 70. ©Dr Sylvain Chamberland •Reflection lines on the labial aid to slot alignment • Speed mini-tubes for 2nd molar
- 71. ©Dr Sylvain Chamberland •Molar tube ✦ Indent off-centre to the distal
- 72. ©Dr Sylvain Chamberland Reassessmentof Bracket Positions • A non ideal bracket placement due to initial crowding should be corrected after alignment • Rotation wedge is of no help and cumbersome Off centred Re-centred
- 73. ©Dr Sylvain Chamberland BracketPlacement Error • Note Bk #23 too distal ✦ Mesial rotation not corrected • Bk #13 centred with cusp tip ✦ Rotation is corrected
- 74. ©Dr Sylvain Chamberland •Rebond #23 ✦ Note derotation Bracket Placement Error
- 75. ©Dr Sylvain Chamberland BracketPlacement Error • Bracket inclined too distally ✦ Need to be rebonded
- 76. ©Dr Sylvain Chamberland BracketPlacement Error • Upper left canine ✦ Bk long axis incline to distally ✦ Bk not at maximal convexity • Bracket was rebonded
- 77. ©Dr Sylvain Chamberland BracketPlacement Error • Upper left canine ✦ Bk long axis incline to distally ✦ Bk not at maximal convexity • Bracket was rebonded
- 78. ©Dr Sylvain Chamberland •Bk on the 2nd molar should be placed slightly more occlusally ✦ To avoid unwanted extrusion during treatment Bracket Placement Tips
- 79. ©Dr Sylvain Chamberland •Note composite on #42 to avoid occlusal contact • Clinical view reproduce model set up Bracket Placement Tips
- 80. ©Dr Sylvain Chamberland •Self-uprighting of 43 is anticipated after extraction of lower right premolar • Labial tipping of 42 is expected Bracket Placement Tips
- 81. ©Dr Sylvain Chamberland •Clinical view reproduce model set up Bracket Placement Tips
- 82. ©Dr Sylvain Chamberland BracketPlacement Error El.Jo.100309 Adhesive thickness distally under the mesh pad create distal rotation and uneven contact point with the canine
- 83. ©Dr Sylvain Chamberland BracketPlacement Error El.Jo.100309 Adhesive thickness distally under the mesh pad create distal rotation and uneven contact point with the canine Bracket on the lower right central is bonded too mesially and create a distal rotation and uneven contact point with the lateral
- 84. ©Dr Sylvain Chamberland BracketPlacement Error El.Jo.100309 Adhesive thickness distally under the mesh pad create distal rotation and uneven contact point with the canine Bracket on the lower right central is bonded too mesially and create a distal rotation and uneven contact point with the lateral El.Jo.240409 Rebonded bracket help to achieve better alignment of the contact points
- 85. ©Dr Sylvain Chamberland BracketPlacement Error El.Jo.100309 Adhesive thickness distally under the mesh pad create distal rotation and uneven contact point with the canine Bracket on the lower right central is bonded too mesially and create a distal rotation and uneven contact point with the lateral El.Jo.240409 Rebonded bracket help to achieve better alignment of the contact points El.Jo.130709 3rd order (torque) is needed to improved aligment of the incisal edges and the talon
- 86. ©Dr Sylvain Chamberland BracketPlacement Error • 2nd order error ✦ The bracket is inclined distal to the long axis of the lateral ✦ Rebonded to the long axis Mi.Pi 270809
- 87. ©Dr Sylvain Chamberland BracketPlacement Error • 2nd order error ✦ The bracket is inclined distal to the long axis of the lateral ✦ Rebonded to the long axis Mi.Pi 270809
- 88. ©Dr Sylvain Chamberland BracketPlacement Error • 2nd order error ✦ The bracket is inclined distal to the long axis of the lateral ✦ Rebonded to the long axis Mi.Pi 270809
- 89. ©Dr Sylvain Chamberland BracketPlacement Error • 2nd order error ✦ The bracket is inclined distal to the long axis of the lateral ✦ Rebonded to the long axis Mi.Pi 270809
- 90. ©Dr Sylvain Chamberland •Bk error #35 ✦ Slightly too distal ✓ Mesial rotation occured • Solution ✦ Re-position the bracket ✦ Do an offset bend ✦ Rotation wedge is not an option Bracket Placement Error
- 91. ©Dr Sylvain Chamberland PreciseBracket Position • Carefull and precise bracket positioning is essential to achieve perfect alignment in the 3 planes of space • A misplaced bracket can never help achieve perfect alignment