1-0_Benefits-SPEED_Appliance_sylvainchamberland_orthodontiste_quebec

Maximizing Performance and Efficiency with the SPEED

AppliancePhiladelphia

2010Dr Sylvain Chamberland

slideshare.net/sylvainchamberland

©Dr Sylvain Chamberland

• Before we can get there, we need to understand the SPEED basics

Fr.La. 0602 Fr.La. 1003

An.Ju.Cl. 0807 An.Ju.Cl. 1208

68! weeks

69 weeks

He.Pe. 0608 He.Pe. 0909

66" weeks


The SPEED Appliance - 1980

• Invented: Dr. G.H. Hanson. Manufactured: Aerospace Manufacturer Strite Industries.

• Introduced to market in 1980 after 5 years of clinical development and 400 completed treatments.

• Highly flexible outer wall (Spring-Clip) capable of deflecting in all three spatial planes when contacted by the archwire.

• The first S-L design to provide the combined benefits of low friction, and the essential component of exceptional tooth control.

• The 1st commercially successful Self-Ligating appliance.


SPEED’s Unique Mode of Action

A New Paradigm - Exceptional ControlRotation Tip Torque

• SPEED’s Spring-Clip stores energy once deflected by the archwire.

• Gradual release of this stored energy ! corrective tooth movement in all three planes of space.

• Unprecedented level of control + Constant corrective action that will not degrade over time (unlike traditional ligatures).

• Elimination of elastomeric ties reduces frictional resistance by as much as 90% (Berger AJODO, 1990).

• Lotus«Compare to Damon»Ortho Technology

• Damon MXDamon Q

• Vision LPAmerican Ortho

• Carriere LX

• Smartclip™

• Discovery™Dentauraum

Modern Self-ligating Brackets

• In-Ovation R

• In-ovation C-twin design

• Time 3American Ortho

• Quick 2.0Forestadent

• SPEED-Point attachment-NiTi spring clip

• NexusOrmco

Modern Self-ligating BracketsPassive in the leveling and alignment stages and active during major mechanics and finishing

Do We Need Fancy Advertisement ...

• To know that this....

...is not Self-Ligating Bracket


• Large twin design, rigid clip, high profile

• Several generations of the Damon bracket have already been released

• Clinical efficiency remains to be seen

• Passive system: 4 solid walls

• Only the name Damon has not changed for obvious marketing issue

Damon Sequel

Q3MX C


Meanwhile

• Several improvement, same bracket design


SPEED SystemTM Timeline

Evolution of the SPEED Appliance

1970 1980 1990 2000

1970 - Concept1970 - Prototype1975 - Clinical Trial1980 - AJO Report1980 - Commercial Launch1980 - SPEED Wire1980 - F Hooks1983 - .022 Slot1983 - Straightwire Rx1983 - Buccal Molar Tubes1983 – Archwire Gripping Hooks1985 – Spring Protector Slot1991 – Mushroom Hooks1993 – Micro-Retentive Mesh1995 – Supercable1998 – Superelastic Spring Clip1998 – Labial Window1999 – Mx Incisor Torque Rails1999 – Mx Incisor Mini Hooks2000 – D Wire2001 – Medium Torque Rx2003 – ER Mx Molar Pads2003 – Dual Geometry Wire2007 – Zero Offset Md Incisor2007 – Spring Protector Rails2008 – SPEED Rhomboid

20 years

30 years

600 cases


The SPEED modifications that have had the greatest impact

on my clinical efficiency


SPEED Appliance Development Timeline

1998 - SPEED Labial Window!

• Short learning curve for staff

• Small window in Spring-Clip ! accept the tip of a SPEED opening instrument or generic scaler.

• Dramatically increased the simplicity and speed of opening the appliance.

• Archwire changes 4x faster than traditionally ligated appliances.*

* Berger, J. and Byloff, F.: The Clinical Efficiency of Self Ligated Brackets, J. Clin. Orthod. 35:304-308, 2001

Labial Window Opening Technique


Super-elastic spring clip

• Clip is 400% more elastic than Stainless Steel

! Resilient Spring Clip entraps the wire

• Spring Clip and archwire cooperate

! Mutual action extends appliance activation

• Extremely light force delivery

• Greater precision in tooth control

• SPEED Super-Elastic eliminates the possibility of damage in all but the most severe instances of abuse



1999 - SPEED Full Slot! Design

•• “Torquing Rails”

• Into upper anterior bracket body

• Enhance torque expression with full size archwires.

With“Torquing Rails”

Without“Torquing Rails”


2007 - SPEED Spring Protector Rails!

SPEED

Illustration of SPEED Protector Rail brackets. Note incisal extensions of bracket body intended

to inhibit transmission of occlusal forces to SPEED Spring Clip.

Protector Rail DesignOld DesignCentral IncisorCentral Incisor



2008-SPEED Rhomboid Design

• Angulated for easy bracket placement

• Precise Visual References

• Narrow SE spring clip



Introduction to SPEEDMicro-Retentive

Mesh™Bonding Base

SPEEDMushroom Hook™

for Elastomerics

FullyPre-Adjusted Bracket Body

.018" or .022" SlotEscape-ProofSpring ClipHorizontal

.016Auxiliary Slot


How to open Speed

• From SPEED labial window

• From the gingival


How to close SPEED

• Most of the time

! Easily closed with gloved hands

• Closing instrument

! To engage large or heavy wire


Closing SPEED

• Wire not properly engaged

• Pay attention!

Use this

For heavy wire


How does the SPEED Appliance Work?

SPEED envelope of action: PASSIVE ZONE

SPEED spring clip activated by archwire

SPEED spring clip seating archwire

SPEED spring clip holding archwire in fully

seated position


How does the SPEED Appliance Work?

SPEED envelope of action: ACTIVE ZONE

SPEED spring clip activated by archwire

SPEED spring clip seating archwire

SPEED spring clip holding archwire in fully

seated position


How does the SPEED Appliance Differ?

• At the very least, SPEED is

! Much smaller

! Point attachment


Choosing BetweenLow Friction or Full

Control


• Choosing between low friction or full control

Undersized wireLow friction - Poor control

Full sized wireFull control - High friction


• SPEED offers both low friction AND full control


SPEED spring clipActivated by archwire

Archwire fully seated by SPEED spring clip


Better torque control• Active spring clip seat the wire into the slot

• Passive clip can't seat the wire unless filling the slot

! Therefore, torque is dependant of the wire play and the torsional moment (N-mm) created by its relationship to the bracket slot

! Torsional moment is related to wire stiffness in torsion " Bigger wire = Bigger moment

! Use of pretorqued wire is an implicit admission that the bracket can’t achieve torque Torque play: ± 10,5° for .019 x .025 wire in .022 slot

Koziowski, CI v 16, #1, 2008, p.25

Torque play: ± 5° for .020 x .025 wire in .022 slot


SPEED Paradigm!So many advantages!

" No tie wing.

" No ligature tie.

" Miniaturized.

" Better control in the 3 planes of space

!SPEED was thinking of self-ligation 30 years ago

!SPEED = Ahead of its time? Revolutionary?

!The 1st active SLB


Why my patients prefer SPEED brackets?

• The smallest bracket on the market = SPEED


Proposed Core Advantages of Self-Ligating brackets

• Faster ligation = Less chair time

! Save up to 10 minutes for replacement of a wire

• Ligation stability - Secure archwire engagement

• Low friction??

! Ligature ties and elastomeric ties may cause friction

! Resistance to slide if affected by bending and notching

! Passive zone = low friction

! Active zone = higher friction

Eliasdes T., Pandis N., Self-Ligation in Orthodontics,2009, Wiley-Blackewell


Proposed Core Advantages of Self-Ligating brackets

• Practice builder

! Promote the smallest SLB = SPEED

• Assistance to good oral hygiene??

• More comfortable treatment??

! Initial .016 Supercable wire will more likely cause less pain than a solid .016 niti wire

! Differences in design of SLB have important consequences

! SmartClip: marked increase discomfort when removing and engaging wire

! Damon2: low discomfort initially, but higher discomfort at later stage


Benefits of a Self-Ligating Bracket System for a Patient

• Minimal initial discomfort

! Light, continuous forces if used with Supercable™

• Better oral hygiene, minimal tissue lacerations, if any

• Shorter office visits !less chair time

• Longer interval between visits


Do you think self ligating brackets will replace conventional brackets in the future?

• "In the near future, yes, they will, to some degree, replace conventional brackets." ... "I am extremely surprised to see that ligation brackets are still so much in use. Clinical advantages of the self-ligating brackets are not limited to saving chairside time; they also produce less wire-to-bracket friction, require less stock in the practice and if used efficiently they may increased the practice production by 15% to 30%."

VIP interview: Dr Ali Darendeliler, WJO v10, #1, 2009


Self-ligating bracket claims

• SLB do not grow buccal alveolar bone! Cevidanes L, Treccani M, Myrda A, Melsen B. Transversal expansion and SLB brackets: A CBCT study

! Paventy A. Facial alveolar bone evaluation with CBCT in non extraction treatment using the Damon system: a prospective clinical trial [thesis] Norman, Okla: U of Oklahoma; 2008

• Lateral expansion of the dental arch by SLB

! Can not be compared to RME

! Not more stable

Ask us, AJODO 2010, 138, #2, 128-131



• SLB more efficient and more effective than conventional edgwise bracket systems in treating malocclusion

! Current evidence does not indicate differences for treatment time, rate of alignment, rate of space closure, final arch dimension or occlusal outcomes

! Neither for : reduced friction between archwire and bracket, reduced clinical forces, patient pain, more hygienic

Ask us, AJODO 2010, 138, #2, 128-131



• 2 assertions supported

! Reduced chair time

! Control of mandibular incisor inclination

Ask us, AJODO 2010, 138, #2, 128-131


•Auxiliary archwire slot

•To consolidate a segment

•For segmental mechanics

•Ligature wire

•016 NiTi, Supercable™, SS

•.016 x .016 S

•.017 NiTi auxiliary spring

Neat benefits of the SPEED Bracket 2


Unique benefits of the SPEED Bracket

Cl.Tur. 0209

•Escape-proof spring clip (no ligation decay)

•Increased inter-bracket distance

• More springiness


Easier finishing than ceramic bracket

May 02/03 May 02/03 Aug. 02/03

• Control 1st order rotation

• Control 3rd order

!Precise Bracket position


What does the scientific literature have to say about the benefits of

SPEED?

CLINICAL EFFICIENCY


Do We Need Fancy Study to...

• Know that wire ligature takes time to do and remove



• Know that elastomeric ligature takes less time to place and remove than wire ligature but...

• ...most likely more than open and close SLB


Ligation Method Remove / Open Retie / Close Total Time

Steel Tie 2.83 9.53 12.36

Elastomeric Ring 1.05 2.53 3.58

Damon I 0.88 0.88 1.76

TwinLock 0.61 0.56 1.17

Time 0.80 0.71 1.51

SPEED 0.55 0.30 0.85

Bimaxillary ligation time (min)(Second bicuspid - Second bicuspid)

Source: JCO May 2001 - Berger, Byloff

The Clinical Efficiency of Self-Ligating Brackets

Bond Strength


Bond Strength - Lab

Source: AJODO - Volume 124, Number 1

Study Findings - Bond strength after 24 hours

0

2,5

5,0

7,5

10,0

Time SPEED Ormco GAC American

Mean SBS(MPa)

Bracket Type

9.73

8.05

5.25

4.47

2.20

The influence of orthodontic bracket base design on shear bond strength

• Despite it’s smaller base size, the SPEED appliance demonstrated statistically significant superior Shear Bond Strength than 4 of the 5 brackets tested.

• No statistically significant difference in SBS between the SPEED appliance and the Time bracket.

• Cleaning, sandblasting, and rebonding the SPEED appliance did not result in a statistically significant reduction in SBS


Control - Spring Clip Resiliency

• Niti spring clip do not loose stiffness

• Results! No difference was found between “as

received” and “used” brackets in the SPEED Group.

! The In Ovation group showed extensive “relaxation” (50% decrease in stiffness) after use.

! Neither group showed signs of permanent deformation.

Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets

AJODO 2007; 132: 834-7


Aging of the Spring Clip

• Performance and aging depend on the alloy composition of the Spring Clip

• Clinical relevance

! Inability of the relaxed clip to apply forces due to aging

! Inadequate engagement of the wire into the bracket slot may arise in the last stages of treatment when rectangular wires are inserted

! Undesirerable outcome on associated mechanotherapeutical schemes

LOW FRICTIONWill be discussed later

HYGIENE


Plaque retention by self-ligating vs elastomeric orthodontic brackets: Quantitative comparison of oral bacteria and detection

with adenosine triphosphate-driven bioluminescence(Am J Orthod Dentofacial Orthop 2009;135:426.e1–426.e9)

• Methods: Patients (ages, 11-17 years) were bonded with SL and E brackets in 14 maxillary and 12 mandibular arches by using a split-mouth design.

! Recall visits were at 1 and 5 weeks after bonding.

• Editor's summary:

! The findings indicate that self-ligating appliances might promote reduced retention of bacteria, including streptococci, than appliances with elastomeric ligation.

! Of course, you must assume that this advantage would be lost by placing elastomeres over the self-ligating brackets.



• Know that plaque accumulation and gum swelling are related to...poor oral hygiene



• Know that poor oral hygiene is independent of bracket systems

• It's a behavioral issue



• Know that poor oral hygiene may lead to white spot lesion

• WSL is not related to bracket systems

• One should focus on reducing potential damage

! Fluoride rinses, varnishes, sealants & frequent cleanings


HYGIENE

This patient brushes his teeth This patient doesn’t!

• What is the difference between these 2 patients?

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