benefits of speed bracket_getting to know the speed appliance

Getting to Know the SPEED Appliance

UNC2011Dr Sylvain Chamberland

slideshare.net/sylvainchamberlandwww.sylvainchamberland.com

©Dr Sylvain Chamberland

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68! weeks

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68! weeks

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Fr.La. 0602 Fr.La. 1003

An.Ju.Cl. 0807

68! weeks

69 weeks

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Fr.La. 0602 Fr.La. 1003

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68! weeks

69 weeks

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Fr.La. 0602 Fr.La. 1003


68! weeks

69 weeks

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66" weeks


Fr.La. 0602 Fr.La. 1003


68! weeks

69 weeks

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66" weeks


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

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68! weeks

69 weeks

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66" weeks


The SPEED Appliance - 1980

• Invented: Dr. G.H. Hanson.

• Manufactured: Strite Industries.

• Introduced to market in 1980 after 5 years of clinical development.

• The 1st commercially successful Self-Ligating appliance.


SPEED’s Unique Mode of Action

A New Paradigm - Exceptional ControlRotation Tip Torque


SPEED’s Unique Mode of Action

A New Paradigm - Exceptional ControlRotation Tip Torque

• Spring-Clip activated once deflected by the archwire.

• Gradual homing position ! corrective tooth movement in all 3 planes of space.

• Constant corrective action ! ligation stability.

• No elastomeric ties = " frictional resistance.

• 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 3 & EmpowerAmerican 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....


• 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


1980 SPEED

ThereforeActive Self Ligation’s Rise

In the beginning, in the end and all along the way, it’s been SPEED


1980 SPEED InOvation BioQuick

EmPower Nexus

ThereforeActive Self Ligation’s Rise

SPEED

In the beginning, in the end and all along the way, it’s been SPEED


SPEED Convertible Tube

• Re-Convertible form start to finish

Insert Press Rotate



• Self-ligating re-convertible tube

• Nicket-Titanium Microlatch entraps and securely holds the archwire

! Greater buccal force # Greater resistance to opening

• Repeatedly convertible for unlimited archwire engagements



• Lowest profile convertible tube

SPEED Convertible Tube In-Ovation SL Tube Damon SL Tube


How to open Speed


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!


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 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



SPEED envelope of action: ACTIVE ZONE



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? • Choosing between low friction or full control

Undersized wireLow friction - Poor control

Full sized wireFull control - High friction


How does the SPEED Appliance Differ?


• SPEED offers both low friction AND full control

How does the SPEED Appliance Differ?

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


How to market SPEED bracket?



• Do your want one of these big chunky ceramic bracket?




• Do you want this other regular bracket with colored elastics that accumulated bacterial plaque, are difficult to clean and that the color will look dirty quickly?





• Do you want one of those big SLB?





• Do you want one of those big SLB?

• Or do you prefer this tiny mini braket?


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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?


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

Yes!


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???

! This last affirmation don't seem to be supported by recent study

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


Neat benefits of the SPEED Bracket

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•Escape-proof spring clip (no ligation decay)

•Increased inter-bracket distance

• More springiness


The SPEED modifications that have had the greatest impact

on my clinical efficiency


Super-elastic spring clip• Clip is 400% more elastic than SS

! No difference between “as received” and “used” brackets in the SPEED Group

! Range of activation did not change

! No permanent deformation

• Spring Clip deliver 1,2 N per mm of activation

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

1,61,2

0,6

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


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...



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

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

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


Bond Strength - Lab



0

2,5

5,0

7,5

10,0


Mean SBS(MPa)

Bracket Type

9.73

8.05

5.25

4.47

2.20


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


Bond Strength - Lab



0

2,5

5,0

7,5

10,0


Mean SBS(MPa)

Bracket Type

9.73

8.05

5.25

4.47

2.20



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


Bond Strength - Lab



0

2,5

5,0

7,5

10,0


Mean SBS(MPa)

Bracket Type

9.73

8.05

5.25

4.47

2.20



• 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

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

• What is the difference between these 2 patients?


HYGIENE

This patient brushes his teeth This patient doesn’t!

• What is the difference between these 2 patients?


• Next!


Ligature derived force

• Depends on ligation mode

! Can be smaller in SLB or greater in conventional systems

• Shear force increase linearly with wire deflection relative to the bracket slot

• Friction resistance is proportional to the grade of the wire securing elements rigidity and to the extent of wire deflection

• Correlation between passive clip design and wire surface scratching

Reznikov, N et al, Measurement of friction forces between stainless steel wires and reduced-friction self-ligating brackets, AJODO 2010; 138:330-8


• Some clip flexibility might provide a considerable benefit during the working stage of the orthodontic treatment, when residual malalignment of the teeth still persists.

• Either an active clip or an elastomeric module can absorb minor, clinically undiscernible tooth irregularities and does not hinder sliding mechanics.

• In contrast, a passive clip demands ideal alignment of the teeth subjected to a retraction force.

Reznikov, N et al, Measurement of friction forces between stainless steel wires and reduced-friction self-ligating brackets, AJODO 2010; 138:330-8


Therefore

• Swinging the teeth on a very small wire

• Few if any friction is involved:

! Passive zone

! No binding

! No notching

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