Scott et 2008 Randomised controlled clinical trial Damon versus conventional ligation No sig difference in pain during initial alignment

Fleming et al 2009 SmartClipTM versus Victory Randomised controlled trial No sig difference in pain during initial alignment More discomfort with SmartClipTM during insertion and removal of 19:25

Pain during alignment Rahman et al SmartClipTM vs Victory prospective RCT No sig difference between either bracket group for either comfort or breakages

Ways of preventing arch wire slewing Cinch back Especially across larger extraction sites

Composite stops Crimpable stop/split tubing Dimpled archwire Place 1-2 fig 8 modules

SmartClip aligning Partial engagement of clips Add ligation Early use of push coil/elastics Great for centreline correction

SmartClip tandem archwire aligning and levelling 014 + 014 NiTi 014 + 016 NiTi 018 + 012 NiTi Or 018ss and 012 NiTi for displaced teeth Excellent levelling Resolves lower incisor crowding

3rd Generation clip

Tandem wires

Tandem .030 HANT .016 HANT .014 HANT

SmartClip aligning and levellingMy Archwire sequence 014 NiTi Tandem 014 +016 NiTi Or 20:20 Neo-sentalloy

19:25 NiTi This is an addition to my normal sequence

19:25 ss (or not if no OB problems or sig space closure)

SmartClip aligning and levellingMy Archwire sequence Finishing 21:25 beta titanium or NiTi upper for extra torque Lower 19:25 braided and seating

Alternatives

20:20 Neo sentalloy instead of tandem 018 ss early archform control/OB Maintain archform with auxillary 012 NiTi

Hybrid wires Response to the difficulty engaging rectangular archwires in 1st generation clip Less torque expression Expensive and unnecessary

Miles PG et al., Angle Orthod 2006 Damon II vs Conventional Damon II no more effective at reducing irregularity during initial stages of treatment (20w)The conventional bracket achieved a lower Ireg Index at 10 and 20w SmartClip vs Conventional SmartClip no more effective at reducing irregularity during initial stages of treatment (20w)

Aust Orthod J 2005

Pandis et al., AJODO 2007 No statistically significant difference between conventional and Damon II appliances in speed of alignment

Scott et al 2008 Damon versus standard ligation RCT 62 subjects No sig difference in alignment Up to 19:25 ss

Efficiency ODwyer et al (in Press) RCT Time taken to reach the working archwires of 19:25 ss No sig difference between Smartclip and Victory, Trainees, same treatment intervals

SmartClip aligning Research isnt showing great benefits! Other efficiencies Specific clinical problems Chairside time overall treatment time

Opening space for impacted teeth Developing an arch form

SmartClip space closure and overjet reduction Case is not fully levelled until 19:25 NiTi then transition to 19:25ss then not a problem Combines nicely with

Increase friction on anchor teeth

micro-implants Twin-block Can use with headgear but no funnelled tubes

FrictionClassical Friction 150 Average Kinetic Friction (cN) 100 0.014" Nickel Titanium 0.016x0.22" Nickel Titanium 50 0.019x0.025" Stainless Steel

0 SmartClip Victory with Victory with Damon 2 Alastiks Stainless Steel Ligature Wires In-Ovation SPEED Time

Average kinetic friction for all archwirebracket combinations

Clarity SL

SmartClip

Victory In-Ovation C Series w/ Module

0g Friction

0g Friction

55g Friction

145g Friction

SmartClip space closure During space closure no rotation off the archwire if using power chain remember to put under the wire to make us of low friction E-links quick and cleaner

Key Perceived advantages with self-ligation Time savings Time to remove and place the archwire Treatment efficiency

In my practiceis it quicker? Arch wire placement quicker Arch wire removal Quicker for round NiTi Same for 19:25 ss

Tooth movement ? quicker but I do leave the patients for 810 weeks and things seem to progress

My efficiency savings Archwires Tandem saves 2nd expensive rectangular NiTi Chairside time Supervision of postgraduates

Wires in and out Nursing chair turnover

Time Study

Time savingBracket type Maijer, JCO 1990 Conventional Activa Archwire removal 192 66 Archwire placement 414 102

Shivapuja, AJODO 1994

Steel ligation Elastomerics Speed Activa Edgelok

180 60 30 45 52

300 80 11 60 40

Time savingBracket type Berger, JCO 2001 Steel ligation Elastomerics Speed Damon SL Time Twinlock Conventional Damon SL Damon 2 Orthos Archwire removal 77.5 23.5 17 27 23 29.5 31.8 15.4 39.8 64.5 Archwire placement 304 80 9 24.5 22 21 68.8 59.4 46.3 98.4

Harradine, Clin Orthod Res 2001 Turnbull, AJODO 2007

Time saving per archwire Berger and Byloff JCO 2001 2-3 minutes per wire

Harradine Clin Ortho Res 2001 Archwire placement/removal: 24 sec per arch

Turnbull and Birnie AJODO 2007 Ligation twice as fast with Damon II Opening 1 sec quicker per bracket

Time saving - Visits Harradine Clin Ortho Res 2001 Reduced from 16 to 12 visits 4 visits saved Reduction in treatment time of 4 months

Eberting et al., Clin Ortho Res 2001 Reduced from 28 to 21 7 visits saved Reduction in treatment time 6 months

SmartClip Finishing Bracket reposition early on in treatment Torque expression Use 21:25 NiTi or Beta titanium Figure 8 or ligature tie to seat archwire

Torque expression Morina et al 2008 Greater Torque loss in Damon 2 and Speed

Badawi 2008 SmartClip, Damon, In-Ovation and Speed Lab study 19:25 ss Active clip generated more torque

In Summary Brief overview of smart-clip Excellent system, easy to adapt to 3rd generation clips have dealt with difficulties Clarity SL aesthetic self-ligation Specific clinical advantages