1-0_Benefits-SPEED_Appliance_sylvainchamberland_orthodontiste_quebec

Maximizing Performance and
Efﬁciency with the SPEED
Appliance
Philadelphia
2010
Dr Sylvain Chamberland
slideshare.net/sylvainchamberland

Fr.La. 0602 68! weeks Fr.La. 1003

69 weeks

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

66" weeks
He.Pe. 0608 He.Pe. 0909

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

©Dr Sylvain Chamberland

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 Control
Rotation 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).

Modern Self-ligating Brackets
• Lotus
«Compare to Damon»
• Carriere LX
Ortho Technology

• Damon MX • Smartclip™
Damon Q

• Discovery™
• Vision LP
American Ortho
Dentauraum

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

• In-Ovation R
• SPEED
-Point attachment
• In-ovation C
-twin design
-NiTi spring clip

• Time 3
American Ortho

• Quick 2.0 • Nexus
Forestadent Ormco

Do We Need Fancy
Advertisement ...

• To know that this....
...is not Self-Ligating Bracket

Damon Sequel
• 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

3MX Q C

Meanwhile

• Several improvement, same bracket design


SPEED System Timeline TM

1970 - Concept
1970 - Prototype
1975 - Clinical Trial
1980 - AJO Report
1980 - Commercial Launch 20 years
1980 - SPEED Wire
1980 - F Hooks 30 years
1983 - .022 Slot
1983 - Straightwire Rx
1983 - Buccal Molar Tubes
1983 – Archwire Gripping Hooks
1985 – Spring Protector Slot
1991 – Mushroom Hooks
1993 – Micro-Retentive Mesh
1995 – Supercable
1998 – Superelastic Spring Clip
1998 – Labial Window
1999 – Mx Incisor Torque Rails
1999 – Mx Incisor Mini Hooks
2000 – D Wire
2001 – Medium Torque Rx
2003 – ER Mx Molar Pads
2003 – Dual Geometry Wire
2007 – Zero Offset Md Incisor
2007 – Spring Protector Rails
2008 – SPEED Rhomboid

600 cases

1970 1980 1990 2000

Evolution of the SPEED Appliance

The SPEED modiﬁcations that
have had the greatest impact
on my clinical efﬁciency


SPEED Appliance Development Timeline

1998 - SPEED Labial Window!

Labial Window Opening Technique

• 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.*

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

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

•
Greater precision in tooth control


1999 - SPEED Full Slot! Design

With

•
“Torquing Rails”
“Torquing Rails”
•
• Into upper anterior
bracket body
• Enhance torque Without
expression with full size “Torquing Rails”

archwires.


2007 - SPEED Spring Protector Rails!
Old Design Protector Rail Design
Central Incisor Central Incisor

Illustration of SPEED Protector Rail brackets.
Note incisal extensions of bracket body intended
to inhibit transmission of occlusal forces to
SPEED Spring Clip.

SPEED


2008-SPEED Rhomboid Design

• Angulated for easy bracket placement
• Precise Visual References
• Narrow SE spring clip


Introduction to SPEED
Micro-Retentive SPEED
Mesh™ Mushroom Hook™
Bonding Base for Elastomerics

Fully
Pre-Adjusted Bracket Body
.018" or .022" Slot
Escape-Proof
Horizontal Spring Clip
.016
Auxiliary 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

©Dr Sylvain Chamberland For heavy wire

How does the SPEED Appliance Work?

SPEED envelope of action: PASSIVE ZONE

SPEED spring clip
SPEED spring clip SPEED spring clip
holding archwire in fully
activated by archwire seating archwire
seated position


How does the SPEED Appliance Work?

SPEED envelope of action: ACTIVE ZONE

SPEED spring clip
SPEED spring clip SPEED spring clip
holding archwire in fully
activated by archwire seating archwire
seated position


How does the SPEED Appliance Differ?

• At the very least, SPEED is
! Much smaller

! Point attachment



• Choosing Between
Choosing between low friction or full control
Low Friction or Full
Control

Undersized wire Full sized wire
Low friction - Poor control Full control - High friction



• SPEED offers both low friction AND full control

SPEED spring clip Archwire fully seated by
Activated by archwire 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 Torque play: ± 5° for .020 x .025 wire in .022 slot

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

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

• 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

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

• 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


Neat beneﬁts of the SPEED Bracket 2

•Auxiliary archwire slot
•To consolidate a segment
•For segmental mechanics
•Ligature wire
•016 NiTi, Supercable™, SS
•.016 x .016 S
•.017 NiTi auxiliary spring


Unique beneﬁts of the SPEED Bracket

•Escape-proof spring clip (no ligation decay)

•Increased inter-bracket distance
Cl.Tur. 0209

• More springiness


Easier ﬁnishing than ceramic
bracket
• Control 1st order rotation
• Control 3rd order

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

!Precise Bracket position

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


Do We Need Fancy Study
to...

• Know that wire ligature takes
time to do and remove


to...

• Know that elastomeric ligature
takes less time to place and
remove than wire ligature but...
• ...most likely more than open
and close SLB


The Clinical Efﬁciency of Self-Ligating Brackets
Bimaxillary ligation time (min)
(Second bicuspid - Second bicuspid)

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

Source: JCO May 2001 - Berger, Byloff

Bond Strength - Lab
The influence of orthodontic bracket base design on shear bond strength

Study Findings - Bond strength after 24 hours
• Despite it’s smaller base size, the
SPEED appliance demonstrated
statistically significant superior
Shear Bond Strength than 4 of the
10,0
9.73
5 brackets tested.

•
8.05
No statistically significant
7,5
difference in SBS between the
Mean SBS
(MPa)
5.25
4.47
SPEED appliance and the Time
5,0 bracket.

2,5
2.20
• Cleaning, sandblasting, and
rebonding the SPEED appliance
0
did not result in a statistically
Time SPEED Ormco GAC American significant reduction in SBS
Bracket Type

Source: AJODO - Volume 124, Number 1

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
©Dr Sylvain Chamberland 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 FRICTION
Will be discussed later

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.


to...

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


to...

• Know that poor oral hygiene is
independent of bracket systems
• It's a behavioral issue


to...
• 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?

This patient brushes his teeth This patient doesn’t!


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