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

Initial Alignment with SPEED ApplianceSpeed Technique Course

2011

slideshare.net/sylvainchamberlandwww.sylvainchamberland.com

©Dr Sylvain Chamberland

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


• How much force is necessary to align the anteriors?

• What would be your 1st wire?

Force level

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 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.

Torsional superelasticity of NiTi archwiresBolender Y et al, Angle Orthod. 2010;80:1100–1109.

.017 X .025 NiTi

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


• 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.

Root resorption with conventional and self-ligating brackets

UPDATE Date Added: 27 January 2009 (Proffit, Contemporary Orthodontics, 4 ed)

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

! Light force (25 g)

! = 3,49-fold greater than control

! Heavy force (225 g)

! = 11,59-fold greater than control (p < .001)

! Heavy force = 3,31-fold greater total resorption than light force (p < .001)

! Difference betwween light force vs control: NS

D

Mean volume of resorption per Group

11.59 x

3.31 x

194.58

3.49 x

58.69

16.77

NS

conrtrol light heavy

3

2

1

0

X 106

µm3

Comparison of volumetric analysis of resorption craters between regions

p = 0.000


Phase of treatment

• Phase 1: Initial alignment

• Phase 2: Arch levelling

• Phase 3: Tooth translation & retraction

• Phase 4: Finishing

Phase 1

Initial alignment


Initial alignment

• Severe malalignment

! .016 Supercable™ for 6 weeks to 18 weeks or even more up to 6 months

! May be replaced after 6 or 12 weeks to avoid breakage, .018 Supercable™

J-A.Dr. .016SC 090910

Passive zone


Initial alignment

• Moderate malalignment

! .018 Supercable™ for 6 weeks to 18 weeks

! .016 HA niti or .016 x .022 HA niti

Ka. La. 18SC 150910 Passive zone

Pl. Is. 16Sent 0910


• .016 Supercable™ for 5 months

• Let it cook25-06-02

02-12-02

Working in passive zone

Graber, Orthodontics current principles & technique, 4e ed. p726

09-09-02 02-12-02


• Wire extend distally as alignment occurs

7 w 11 wJu.De.#2 0605 Ju.De.#2 0805 Ju.De.#2 0905

Working in passive zone


• .016 Supercable™

! Self uprighting

An.No. 06-07

! #13 not engaged ! Bonded occlusal stop #42

An.No. 08-07

! Self uprighting


• Mx: Open coil to initiate midline correction

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

An.No. 06-07

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. Pa1108 at 18 weeksPa.-Ge. Pa. 0708 Pa.-Ge. Pa.1008 at 12 weeks


• Mechanotherapy

! TPA

! .017 x .025 TMA T loop

Individual canine retraction

D.M.

D.M. After 6 weeks of retraction


• At 6 months

! .016 SC for 17,7 weeks

! +

! .018 SC for 8 weeks

Ja.Le 0708

Ja.Le 0209

Let it cook

Ja.Le 0309 at 7 months


• At 6 months


! +


! At 6 months:

! Same wire left in place +EC 23-24 for derotation of 23

Ja.Le 0708

Ja.Le 0209 Ja.Le 0309 at 7 months


• At 6 months



! 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

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

Ja.Le 0309 at 31,7 w / 7,9 m


• Mx: Segmented .016 SC 12-23; 13 and 42 not engagedMd: .016 SC 34-44, active coil 43-41

• 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

• At 21 w: .016 HA NiTi / .016 x .022 HA NiTi

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. 1008 Ta.Po. -080109 11 w Ta.Po. -260209 21 w

Ta.Po. -080109 11 w Ta.Po. -260209 21 w


• Wiengart plier

• Ligature director

• Miniature pin and ligature cutter

• Flush distal end cutter

Application of SPEED split stops


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

Tricks & tips


Uncontrolled tipping3rd order view



• Crown

! Lingual vector 1|1

! Labial vector 2|2



• Crown

! Lingual vector 1|1

! Labial vector 2|2

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


Solution• Elgiloy Anterior torquing spring

• Reduced torque 2|2

DM 04-03 DM 10-06

> 3 years after tx

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

3rd order

• Extraction of #14 was delayed

• No space was available to align #12

• Uncontrolled tipping occurred #11 and 12

Ma.Br.0804

Ma.Br.0904

Ma.Br.1104Ma.Br.1005

3rd order

• Forces applied buccal to Cres

• Once the 6 anteriors teeth are engaged the roots are all over the place in the 3rd order

Ma.Br.0605

Ma.Br.0605

Ma.Br.1005

TABLE 1TIPPING DUE TO LOSSOF TORQUE CONTROL*

Torque Loss5° 8° 10°

Maxillary 1.3mm 2.1mm 2.7mmMandibular 1.2mm 1.9mm 2.3mm

*Lingual change in incisal edge position (incisors of average dimensions).

Torquing while finishing

• Finish with full size archwire

• Let it cook

Ma.Br.0407 Ma.Br.0607 Ma.Br.0508

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

Supercable™

Hands on


I’m seriously thinking having braces

Forces & Moments

Asymmetric V

Forces & Moments

Asymmetric VBigger moment on 42 and 312 small opposite moments on 41 cancels2 lingual forces add up

Forces & Moments

Asymmetric VBigger moment on 42 and 312 small opposite moments on 41 cancels2 lingual forces add up2 labial forces apply to 43 and 32

Forces & Moments

Solution

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

Cl.Be 090109

It tooks 7 months...


A smarter approach

• 018 SC + coil, 4 months

• .016 x .022 neost + coil

• .020 x .020 neost + .016 aux. SC

Se.Le.07-10-09 Se.Le.23-11-09

Se.Le.15-01-10

Phase 2

Arch levelling


• Once initial alignment is achieved, rectangular HA Niti wire is used to level and align in the 3 planes of space

! .016 x .022 or .020 x .020 HA Niti

! .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

Arch levelling

Ka.La.16x22neost

Ka.Ri.20x20neost

Active Zone

Active Zone


• Rectangular wire

• Force system

! Controlled tipping

! Force + moment

" (M/F =7:1)

! 2nd & 3rd order

© 2007 Elsevier

Arch levelling

Nanda: Biomechanics and esthetic strategies in clinical orthodontics, Elsevier|Saunders 2005


• 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. 08-07

An.No. 03-08


• At 10,5 months: 019 x 025 Resol

An.No. 08-07

An.No. 03-08

! Torque


• 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. 03-08

An.No. 06-08


• Mx: .018 x .025 SS,

! EC 22-27,

! Open coil 13-12

• Md: .020 x .025 SW

An.No. 28-01-09

At 21 months


• Mx: .020 SS, EC 11-27, coil 12-13

An.No. 11-03-09

At 22,8 months


• Mx + Md: .020 x .025 nitisw

• Mx: 19x25 resol, root spring + EC 14-16, 24-26; Md: .020 x .025 nitisw, EC 34-o-36-37

Ja.Le. 15-05-09, 39 w

Ja.Le. 17-08-09, 53 w


• Mx: .020 x .025 nitisw, EC 17-16-14 & 24-26

• Md: .020 x .025 sw, EC 31 to 36

Ja.Le. 21-09-09, 58 w


• Mx: .020 x .020 neosent / Md: .016 x .022 neost

• Mx: .020 x .025 niti SW / Md: .020 x .020 neost + cl II 23/36

Ta. Po. 09-04-09

Ta. Po. 21-05-09


• 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

• At 53 w: Mx: .020 x .025 SW, EC 23-25-26 / Md: .020 x .025 SW, elastomeric chain 36 to 46

Ta. Po. 07-10-09

Ta. Po. 02-07-09, 39 weeks

.020 x .025 Niti

Hands on

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

Health & Medicine

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