Commonly asked questions about Self-Ligation and the SPEED APPLIANCE SPEED System™
Get up to SPEED on SPEED! Visit our website and then give SPEED a try! www.speedsystem.com The SPEED System™ Web Site Find out the latest Product News and technique Information at this exciting web site! Movement of the SPEED bracket’s components have been animated for easy understanding. For more information about the many benefits of the SPEED self-ligating design and what it can do for your practice, contact us today! Spring into SPEED Introductory Package If you are looking to evaluate the SPEED appliance, may we suggest our “Spring into SPEED” Introductory Package? This specially priced package has been uniquely formulated for the first time user and provides enough supplies to fully evaluate the system. SAVE OVER OFF THE LIST PRICE 50% If you are looking to evaluate the SPEED appliance, may we suggest our “Spring into SPEED” Introductory Package? This specially priced package has been uniquely formulated for the first time user and provides enough supplies to fully evaluate the system. Spring into SPEED Introductory Package • 20 - .016 SPEED Supercable™ • 20 - .018 SPEED Supercable™ • 100 SPEED Split Stops™ • 10 Hills Dual-Geometry Wire™ (U) • 10 Hills Dual-Geometry Wire™ (L) • 10 SPEED Wire™ (U) • 10 SPEED Wire™ (L) • 1 SPEED Opening Instrument 10 Cases 7-7 with Free Auxiliaries or 15 Cases 5-5 with Free Auxiliaries SPEED Introductory Kit Includes: Free Auxiliaries *Included “Free of Charge” with your first 5 Introductory Packages: • 1 SPEED Instruction Manual • 1 SPEED Instructional DVD • 1 SPEED Study Model • Various Patient Consultation Material SPEED System™ Orthodontics HESPELER ORTHODONTICS LIMITED 298 Shepherd Avenue Cambridge Ontario N3C 1V1 Canada Tel:1-800-26-SPEED 1-519-658-2925 Fax:1-519-658-6925 www.speedsystem.com
SELF LIGATION www.speedsystem.com Table of Contents IsSelf-LigationNew?...................................1 WhatareActiveSelf-LigatingBrackets?. . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WhatarePassiveSelf-LigatingBrackets?. . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WhatistheSPEEDAppliance?...............................4 HowdoIopentheSPEEDAppliance?. . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Do I need a special instrument to open the SPEED Appliance? . . . . . . . . . . . . . . . . . 5 HowdoIclosetheSPEEDAppliance? . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 WillSelf-Ligationsavechairtime?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 HowdoestheSPEEDAppliancework?...........................7 How does this mode of action differ from that of other appliances? . . . . . . . . . . . . . . . 8 How does the SPEED Appliance provide rotational control? . . . . . . . . . . . . . . . . . . 9 How does the SPEED Appliance control axial inclination? . . . . . . . . . . . . . . . . . . . 10 How is torque control achieved with the SPEED Appliance? . . . . . . . . . . . . . . . . . . 11 How does the SPEED Appliance reduce friction? . . . . . . . . . . . . . . . . . . . . . . 12 What force levels are most effective when using the SPEED System™? . . . . . . . . . . . . . 12 Will the Spring Clips hold up over the course of treatment? . . . . . . . . . . . . . . . . . . 13 CanIuseSPEEDbracketsas"bite-shelves"? . . . . . . . . . . . . . . . . . . . . . . . . 13 Is the SPEED Appliance fully pre-adjusted? . . . . . . . . . . . . . . . . . . . . . . . . . 14 What governs the labial-lingual relationship of the dental arch form? . . . . . . . . . . . . . . 14 Are special extraction-series brackets required with SPEED? . . . . . . . . . . . . . . . . . . 14 What type of auxiliaries can be used with the SPEED Appliance? . . . . . . . . . . . . . . . . 15 How can the auxiliary slot be used as a secondary archwire slot? . . . . . . . . . . . . . . . 15 Will I experience more bond failures with SPEED’s mini-bases? . . . . . . . . . . . . . . . . 16 Will the Hygiene of my patients improve with SPEED? . . . . . . . . . . . . . . . . . . . . 16 What wires have been specially designed for use with SPEED? . . . . . . . . . . . . . . . . 17 HowdoIgetstartedwithTheSPEEDSystem? . . . . . . . . . . . . . . . . . . . . . . . 18 BehindTheSPEEDSystem................................19 TreatmentwiththeSPEEDAppliance . . . . . . . . . . . . . . . . . . . . . . . . . 20-34 AdditionalReading.................................35-36
SELF LIGATION www.speedsystem.com Is Self-Ligation New? Self-Ligating orthodontic appliances have been in existence since the 1930's. Various designs were available on a limited "prototype only", basis between the 1930's and the 1970's. Most designs were never made available commercially due to difficulties in manufacturing and the increased emphasis, put by the profession, on the development of the conventional "tiewing" bracket. In the early 1970's, a self-ligating bracket was made available on a widespread commercial basis. This, along with other designs, prompted increased interest in ligature-less designs. Interest that continues to grow today. The following is a short historical overview. The Ford Bracket - 1933 (Passive) Design Characteristics Circular ring rotated to create rigid outer wall that retained archwire in archwire slot. Ligating member incapable of cooperating with the archwire in corrective tooth movement. Clinical Acceptance This design never gained widespread clinical acceptance. The Boyd Bracket - 1933 (Passive) Design Characteristics “U” shaped member formed a rigid outer wall that retained archwire in archwire slot. Ligating member incapable of cooperating with the archwire in corrective tooth movement. Clinical Acceptance This design never gained widespread clinical acceptance. Edgelok - 1972 (Passive) Design Characteristics Dome shaped component formed a rigid outer wall that retained archwire in archwire slot. Ligating member incapable of cooperating with the archwire in corrective tooth movement. Clinical Acceptance This design was the first self-ligating design to be offered on a widespread commercial basis. After gaining limited acceptance in the mid-1970’s, production of this design was abandoned. The bracket was eventually taken off the market. SPEED - 1980 (Active) Design Characteristics Curved flexible component forms an elastic outer wall that retains archwire in archwire slot. "Super-Elastic Nickel-titanium" ligating member capable of cooperating with the archwire in precise corrective tooth movement. Clinical Acceptance This design was the first self-ligating design to gain widespread clinical acceptance. To date this is the most widely used self-ligating design and interest in this design continues to grow. 1 Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open
SELF LIGATION www.speedsystem.com 2 Activa - 1986 (Passive) Design Characteristics Rotating circular component formed a rigid outer wall that retained archwire in archwire slot. Ligating member incapable of cooperating with the archwire to facilitate corrective tooth movement. Vertical slot for auxiliaries. Clinical Acceptance Heavy promotion by the manufacturer in the 1980's resulted in this design receiving much attention. Initial interest in this design was widespread, but its use was limited by its bulky design and poor clinical performance. The bracket was eventually taken off the market. Smart Clip - 2004 (Passive) Design Characteristics Flexible Nickel Titanium "c" clips which flex open to permit both archwire insertion and archwire removal. The clips also serve to retain the archwire in the archwire slot. Clinical Acceptance Clinical use of this design is growing as interest in selfligating designs increases. InOvation R, C - 2000 (Active) Design Characteristics Curved flexible component forms a flexible outer wall that retains archwire in archwire slot. "Elgiloy" ligating member capable of cooperating with the archwire in corrective tooth movement. This design features "tiewings". Clinical Acceptance Clinical use of this design is growing as interest in selfligating designs increases. Damon I, II, III, MX, Q - 1997 (Passive) Design Characteristics Flat rectangular component forms a rigid outer wall that retains archwire in archwire slot. Ligating member incapable of cooperating with the archwire in corrective tooth movement. This design features "tie-wings". Clinical Acceptance The various Damon designs are all very similar in clinical performance. Clinical use of this design is growing as interest in self-ligating designs increases. Mobil Lock - 1980 (Passive) Design Characteristics Circular component of variable thickness formed a rigid outer wall that retained archwire in archwire slot. Ligating member incapable of cooperating with the archwire to facilitate corrective tooth movement. Ligating member able to “lock” the bracket to the archwire. Clinical Acceptance Based on the design of a movable/re-usable archwire hook. After gaining very limited clinical acceptance in the early-1980’s, this design was virtually abandoned by the manufacturer. Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open
SELF LIGATION www.speedsystem.com What are Active Self-Ligating Brackets? 3 Active self-ligating brackets contain a flexible, moveable component which entraps the archwire. This flexible component can also cooperate with the archwire in precise corrective tooth movement. Active self-ligating brackets offer the dual advantage of low friction and precise control. Low friction is ensured by the "metal to metal" contact between the bracket components and the archwire. It can be argued that friction is minimized further with initial undersized wires. Undersized archwires are free to migrate either mesially or distally within the slot during initial alignment. Later in treatment, when larger sized wires are used, the elasticity possessed by the flexible component ensures that contact points are constantly "freed up" thereby minimizing frictional binding during tooth translation. Precise control in all three planes of space is ensured by the unique interaction between the archwire and the active component of the bracket. Active self-ligating brackets possess the unique ability to re-orient themselves and their accompanying tooth relative to the archwire when corrective tooth movement is required. Active self-ligating brackets employ a flexible component to entrap the archwire. Passive self-ligating brackets employ a rigid component to entrap the archwire. Active self-ligating brackets can cooperate with the archwire in corrective tooth movement. Passive self-ligating brackets are limited in their tooth control by the difference in size between the archwire and the archwire slot. What are Passive Self-Ligating Brackets? Passive self-ligating brackets contain a rigid moveable component which simply entraps the archwire. Passive self-ligating brackets are not new and early designs include the Boyd (1933), Ford (1933), Edgelok (1972), Mobil Lock (1980), Activa (1986) etc. None of these designs enjoyed clinical or commercial success due to their limited tooth control and bulky design. Modern passive self-ligating bracket designs are subject to the same design, and therefore performance constraints, as earlier models. Tooth control is ultimately determined by the difference in dimensions between archwire and archwire slot. This results in a "race to fill the slot" which can result in the application of excessive clinical forces, especially upon archwire engagement. Even with so called "full sized wires" tooth control is limited as an archwire can never completely fill the archwire slot. Passive self-ligating brackets offer reduced friction, as do active self-ligating brackets, mainly through the elimination of elastomeric ligatures. It is questionable though whether the passive design differs significantly from the active design from a frictional standpoint in the clinical environment. Clinicians who have utilized both designs report no noticeable difference in the forces required to translate teeth along a given archwire.
SELF LIGATION www.speedsystem.com 4 What is the SPEED Appliance? Archwire Slot Open Archwire Slot Closed The SPEED Appliance employs a Super-Elastic Nickel Titanium Spring Clip to entrap the archwire. This eliminates the need for ligature ties. The Spring Clip snaps open to allow for archwire insertion and snaps closed to entrap the archwire. By eliminating ligature ties, the appliance reduces chairtime thus maximizing clinical efficiency. SPEED Appliance landmarks include an edgewise archwire slot available in either .018 or .022, a miniaturized SPEED Mushroom Hook™ which can be used for a variety of applications, an .016 square auxiliary slot which may house a variety of auxiliaries including preformed SPEED (elastic) Hooks, and a colour code identification mark. SPEED is a totally pre-adjusted appliance with built-in Torque, Tip and In-Out. Various prescriptions are available to suit individual preferences. The SPEED Appliance is a miniaturized self-ligating appliance which offers overlapping benefits to both patients and clinicians. Patients enjoy the benefits of improved hygiene, aesthetics and comfort while clinicians benefit from time savings in self-ligation and precision in tooth movement due to the action of SPEED’s Super Elastic Spring Clip. “Escape-Proof” Super-Elastic Spring Clip Archwire Slot (.018 or .022) Opening Instrument Access Slot SPEED Mushroom Hook™ for Elastomerics In-Out Adaptor .016” Horizontal Auxiliary Slot Labial (Buccal) Occlusal Gingival Lingual Micro-Retentive Mesh™ Bonding Base Labial Window™
SELF LIGATION www.speedsystem.com How do I open the SPEED Appliance? Do I need a special instrument to open the SPEED Appliance? There are two ways to move the SPEED Spring Clip into the "Slot Open" position. Opening the bracket requires no special instruments or complicated techniques and may be accomplished using a SPEED opening instrument or by using a scaler. The opening force is very light: approximately 300 gms when using the Labial Window. Opening from the Labial Opening from the Gingival No. Opening the SPEED Appliance is accomplished with either the SPEED opening instrument, a U-15 scaler or by using one prong of a ligature director. Many clinicians find that they require less instruments when working with the appliance. This reduces the amount of instruments that have to be sterilized. Archwire Slot Closed Archwire Slot Open Archwire Slot Closed Archwire Slot Open Simply insert the tip of an explorer into SPEED’s Labial Window™ and apply a light occlusal force. SPEED brackets can still be opened from the gingival if desired. Simply apply a light occlusally directed sliding force to the indent in the Spring Clip edge. This indent is centrally located in the instrument access slot on the gingival of the bracket body. 5
SELF LIGATION www.speedsystem.com How do I close the SPEED Appliance? Will Self-Ligation save chairtime?* With a light gingivally directed force, slide the Spring Clip into its slot closed position. Yes! The self-ligating SPEED appliance saves approximately 3 to 4 minutes of chairtime per archwire change. Many SPEED users have reduced the time allotted for an arch change. Some by up to 10 minutes per patient. Archwire Slot Open Archwire Slot Closed VS Closing the Spring Clip is as simple as opening and can be accomplished with a finger or thumbnail; no special instrument is required. With a light gingivally directed force, slide the Spring Clip into its slot closed position. This is especially easy with gloves and eliminates the danger of lacerations due to ligature ties. 6 SPEED Twin *The Clinical Efficiency of Self-Ligated Brackets Berger J.L., Byloff F.K. - J. Clin. Orthod. 2001; 35:(5):304-308
SELF LIGATION www.speedsystem.com 7 The SPEED Appliance employs a Super-Elastic Spring Clip to entrap and interact with the archwire. Unlike elastomeric ligatures the Spring Clip provides a constant corrective force that will not degrade with time. The mutual action of the SPEED Spring Clip and archwire extends the range of appliance activation, reducing both patient visits and treatment duration. SPEED provides patients and clinicians with the ultimate in 3-Dimensional control. The SPEED Spring Clip is activated upon archwire engagement. Once deflected by the wire, the SPEED Spring Clip provides the corrective forces which ensure “full” tip, torque and rotational control. This occurs through the corrective reorientation of the bracket and accompanying tooth. Any subsequent deviation from the ideal is corrected through the reactivation of SPEED's unique energy-storing Spring Clip. SPEED Spring Clip activated by archwire SPEED Spring Clip expressing stored energy Precise tooth positioning complete The SPEED Envelope of Action Note: • The dent in his left index finger • The torsional deflection of the spring • The alignment of the band with the archwire after release • How far the band has moved away from his thumb. These kinematics have considerable clinical significance. How does the SPEED Appliance work? This experiment by Dr. Hanson in 1970 revealed that a relatively primitive and largely hand-made SPEED bracket prototype could propel itself through an arc of 30° relative to a rigid wire.
SELF LIGATION www.speedsystem.com How does this mode of action differ from that of other appliances? SPEED Spring Clip activated by archwire SPEED provides precise corrective tooth control Conventional Twin edgewise brackets are passive in their mode of action. Unable to independently affect and control tooth movement, they rely on ligatures to secure them to the archwire. These appliances are wholly dependent on the archwire for their control. The inherent limitations imposed by this “ligature” to “archwire” relationship ultimately compromise the treatment and clinical efficiency of the appliance. Conventional “tie-wing” appliances depend on biodegradable elastomeric ligatures for their control. This design suffers from inherent limitations. Undersized wires used during initial alignment, and later in treatment to reduce friction during tooth translation, are free to roam in the archwire slot; control is therefore sacrificed. Attempting to maximize control through the use of full size wires increases friction thereby inhibiting treatment progress. The above visual, taken from Dr. Hanson’s 1983 Great Lakes Society presentation, shows how elastomeric donuts degrade during a single treatment appointment. Undersized Wire Reduced Friction - Poor Control Full Sized Wire Full Control - High Friction The SPEED Appliance provides clinicians with a predictably low frictional drag while maintaining the ultimate in 3-dimensional tooth control. By employing a resilient Super-Elastic Spring Clip to entrap and interact with the archwire, SPEED ensures a friction reduced “metal to metal” sliding contact while providing the ultimate in 3-dimensional control. This unique feature is synergistically enhanced by the appliance’s uniquely configured slot design and highly polished finish. 8
SELF LIGATION www.speedsystem.com 9 How does the SPEED Appliance provide rotational control? When rotational correction is required, SPEED’s Spring Clip is activated upon archwire engagement. Once deflected elastically by the archwire, the Spring Clip provides corrective forces which ensure “full” rotational control. Any subsequent deviation from this ideal is corrected through the re-activation of SPEED’s unique homing action. Side View (Spring Clip Activated) These first-generation SPEED brackets did not have the escape-proof feature which has been incorporated into the design of subsequent generations. Nonetheless, they provided dramatic evidence of their ability to rotate teeth. As observed in the band experiment shown previously (page 7), the bicuspid (above right) has advanced much as the spoke of a locomotive drivewheel advances when it rolls along a rail. However, at this stage, the frictional forces associated with the archwire/ bracket coupling have diminished to near zero so that stretched transeptal fibers can now tow the bicuspids distally into the newly formed spaces if stops are not applied. Spring Clip Activated Top View (Sectioned) Archwire Bracket Spring Clip Corrective Force Ideal Tooth Position Side View (Spring Clip in Home-Position)
SELF LIGATION www.speedsystem.com How does the SPEED Appliance control axial inclination? SPEED brackets are individually designed with a specific degree of built-in angulation to produce root positioning with the long axis of the root in a distal relationship to the crown. When second order (tip) control is required, SPEED’s Spring Clip is activated upon archwire engagement. The labial deflection of the Spring Clip remains until corrective tooth movement has occurred. Any subsequent deviation from this ideal is corrected through the reactivation of SPEED’s unique Spring Clip. The SPEED mechanism shown here has rotated itself clockwise to eliminate the gap (arrow) between the mesial end of its slot and the wire. Its Spring Clip works relentlessly to establish and maintain continuous contact between the entire mesio-distal length of its slot and the wire. During bodily translation, the retraction force will tend to dominate, causing tipping about a centre of rotation near the middle of the root. Such tipping results in a labial deflection of the SPEED Spring Clip. The energy stored by this elastic deflection of the spring is used later to upright the tooth once the retraction force ceases to dominate. 10
SELF LIGATION www.speedsystem.com How is torque control achieved with the SPEED Appliance?* SPEED's edgewise slot will accommodate square, rectangular, or SPEED shaped archwires for full torque control. SPEED shaped nickel titanium and stainless steel archwires feature a round-rectangular profile. The unique shape of this archwire enhances cooperation between SPEED brackets and archwire ensuring full expression of built-in torque. Additionally, the recently added “Torquing Rails” on the Upper Anterior attachments help ensure full expression of built-in torque in this area of the arch where torquing is most difficult and most critical. Later the Spring Clip and bracket combination has re-oriented the tooth so that the archwire slot is parallel with the occlusal edge of the archwire slot. The illustration above shows the Spring Clip deflected labially indicating that there is a torque discrepancy between the wire and the bracket. 11 Torquing rails further enhance torque control on upper anteriors. *Torque expression of self-ligating brackets Badawi H.M., et al. - Am. J. Orthod. Dentofacial Orthop 2008; 133:(5):721-728 *A recent study, published in the AJODO, has illustrated that Active Self-Ligating Appliances provide superior torque control to Passive Self-Ligating appliances, “as a direct result of their active clip”. Torquing Action with Rectangular Wire Torquing Action with SPEED Wire™
SELF LIGATION www.speedsystem.com How does the SPEED Appliance reduce friction? What force levels are most effective when using the SPEED System™? This space was opened with 15 grams of force. No tipping occurred. Light force levels are ideal for use with the SPEED System™. This is true when selecting any type of force application (i.e. archwires, elastomerics, auxiliaries, etc.) The efficiency of such light force levels can be maximized by allowing archwires 8 to 10 weeks to express themselves. Upper and lower archwire changes can be alternated at 5 or 6 week intervals. The synergistic effect of utilizing threshold forces with an appliance that imparts low frictional resistance results in minimal stress transmitted to the supporting tissues. This is verified by an absence of root blunting in post-treatment radiographs. SPEED Spring Clip activated by archwire The SPEED Appliance provides clinicians with predictably low frictional drag while maintaining the ultimate in 3-dimensional tooth control. Laboratory studies have supported the clinical observation that SPEED, like all self-ligating brackets, imparts little friction when translated along an archwire. By employing a resilient Super-Elastic Spring Clip to entrap and interact with the archwire, SPEED ensures a friction reduced ”metal to metal” sliding contact while providing the ultimate in 3-dimensional control. 12 SPEED’s super-elastic Spring Clip and highly polished slot ensure predictable and light frictional resistance Grams Conventional Twin I Conventional Twin II Damon SPEED 0 30 60 90 120 150 146.9 g 78.4 g 15.5 g 15.9 g 1998 EJO Friction Study B. Melsen et al (.018 SS archwire in .022 slot)
SELF LIGATION www.speedsystem.com 13 Will the Spring Clips hold up over the course of treatment?* Yes! The SPEED appliance has numerous design features which have been engineered to ensure that the Spring Clip will withstand the rigors of orthodontic treatment. SPEED’s Spring-Clip will not fatigue or plastically deform under normal treatment conditions. *A recent study, published in the AJODO, illustrated that the SPEED Nickel Titanium Spring Clip experiences no loss of resiliency during treatment, while the Spring Clips used by SPEED “Imitators” can lose up to 50% of their elasticity during treatment. The occlusal tip of the Spring Clip has its own protector slot which prevents both escape and deformation of the spring under severe transient forces. *Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets Pandis N., et al. - Am. J. Orthod. Dentofacial Orthop 2007; 132:(6):834-837 When closed, the gingival portion of the Spring Clip is supported by the bracket body so it cannot be damaged by mastication forces. Mistakenly leaving lower attachments directly in the occlusion can result in damage to the spring clip. In deep bite cases, bite shelves may be employed to prevent occlusal contact between the upper dentition and lower attachments. They can be removed once posterior extrusion occurs. Can I use SPEED Brackets as "bite shelves"? At first glance, SPEED brackets might look like tempting “bite shelves”, especially for “deep bite” cases, however, SPEED brackets are not designed to be and should never be left directly in the occlusion. Permitting this to occur creates a risk of damage to the patient’s dentition and/or the Spring Clip. If the potential exists for the upper dentition to occlude on the lower SPEED attachments, there are at least 4 possible options at the disposal of the clinician: 1. Postpone bonding the lower attachments - procline upper anteriors 2. Employ a removable bite plate 3. Bite shelf bonded to upper anterior teeth 4. Bite shelf bonded to lower posterior teeth Normal Spring Broken Spring
SELF LIGATION www.speedsystem.com Is the SPEED Appliance fully pre-adjusted? Yes! SPEED is a fully pre-adjusted appliance. The appliance is available in both .018 and .022 slot sizes. Standard Tip angles are built into every SPEED attachment. Each SPEED bracket has a specific base adaptor which provides its corresponding tooth with both an angular and translational offset. SPEED is available in 4 popular Torque prescriptions: • The Hanson prescription • The Regular Torque or Roth* prescription • The Medium Torque or MBT** prescription • The High Torque or Bio-Progressive prescription Labial-lingual relationships are controlled by the combined effect of the anatomically contoured bonding pad (base) and the presence, or absence, of an in-out adaptor. Bonding pads are contoured mesio-distally and occluso-gingivally for the best possible fit to their corresponding tooth surface. In-out adaptors are incorporated into the lateral incisor and bicuspid brackets. This control of individual bracket thickness ensures an ideal arch form. Upper Canine Bracket without in-out adaptor Upper 2nd Bicuspid Bracket with in-out adaptor No! It is not necessary to angulate bracket slots into extraction sites or to use special extraction series brackets. Excellent root parallelism is maintained during extraction space closure without changing bracket angulation from the ideal. This is due to the unique homing action of the Spring Clip in restoring a close fit between the archwire and the entire length of the occlusal wall of the archwire slot after even the smallest amount of crown tipping. What governs the labial-lingual relationship of the dental arch form? Are special extraction-series brackets required with SPEED? Spring Clip Bracket Body In-Out Adaptor Pad SPEED was first to offer both an angular and translational offset. The result – a more smoothly contoured finishing arch. (* Does not imply endorsement. ** MBT is a trademark of 3M/Unitek.) 14
SELF LIGATION www.speedsystem.com 15 What type of auxiliaries can be used with the SPEED appliance? The SPEED appliance has been designed with a horizontal .016 square auxiliary slot which can house auxiliary archwires or may accommodate a variety of square wire SPEED Hooks. Many clinicians using the SPEED appliance utilize the auxiliary slot for auxiliary arches, rotation sectionals and even to ligate through. In addition to the Mushroom Hook™, SPEED Hooks are available in several configurations and can be inserted into the auxiliary slot of any bracket. These provide the clinician with unlimited versatility in using intra-oral elastics. How can the auxiliary slot be used as a secondary archwire slot? The above photos show how SPEED Inventor, Dr. G. H. Hanson has used a Nickel Titanium .016 Supercable sectional threaded through the auxiliary slot of the central, lateral and canine SPEED brackets to affect lateral incisor correction. This technique is routinely used by SPEED users with remarkable results. SPEED’s unique .016” x .016” auxiliary slot offers added versatility to users. The auxiliary slot is often used to house .016” round or rectangular sectional or secondary archwires. Rigid stainless steel archwires may be used to stabilize the arch, through the main slot, while a sectional archwire through the auxiliary slot is used to resolve such problems as impacted canines or lingually displaced teeth. April 13, 1995 June 7, 1995 SPEED’s unique .016” x .016” horizontal auxiliary slot can accommodate: • Auxiliary Hooks • Ligature Ties • Auxiliary Sectionals and Archwires The SPEED Auxiliary Slot .016” .016”
SELF LIGATION www.speedsystem.com Will I experience more bond failures with SPEED’s mini-bases? Will the Hygiene of my patients improve with SPEED? No! SPEED’s miniaturization actually enhances base fit. Every SPEED bracket base is carefully contoured to precisely mirror the anatomy of its corresponding tooth. The result is a “bracket to tooth” fit that is unparalleled. SPEED’s bond strength is further enhanced through the use of Micro-Retentive Mesh™. SPEED's unique Micro-Retentive Mesh was tested in large scale clinical studies. The results were a reduction in bond failures of 50%, and a 200% increase in bond strength in laboratory tests. SPEED Micro-Retentive Mesh bonding bases are dull in appearance but require no special bonding technique or adhesives. Yes! The Self-Ligating SPEED Appliance eliminates the two most common food traps; tie wings and elastomeric or steel ligatures. The clean lines of the SPEED Appliance have resulted in a smooth rounded silhouette that is easy for all patients to clean. Patients, parents and referring dentists appreciate the hygienic ease of SPEED’s miniature wingless attachments. Whether brushing or flossing, patients find the mini-wingless SPEED attachments easy to keep clean. 16
SELF LIGATION www.speedsystem.com What wires have been specially designed for use with SPEED? Aligning and Leveling – SPEED Supercable™ Sliding Mechanics – Hills Dual-Geometry™ Wire The proper selection and progression of archwires is most important in ensuring excellence in treatment efficiency and results. SPEED Appliance design greatly simplifies and enhances archwire selection and effectiveness. SPEED's wide interbracket span, predictably light frictional drag and full control with even the most undersized archwires maximizes efficiencies of tooth movement while ensuring excellence in finishing. While SPEED's edgewise slot will accommodate virtually any size or configuration of archwire, experienced SPEED users have found that the selected archwires outlined below most fully exploit SPEED's unique benefits. These are recommended for best results. SPEED Supercable™ contains multiple strands of superelastic nickel titanium wire. SPEED Supercable’s™ incredible super-elastic range combines with the energy storing SPEED Spring Clip to create a near optimal force system. Supercable’s™ extremely low unloading force plateau assures that appliance-induced stresses within the periodontium will remain at near optimal levels throughout. The Hills Dual-Geometry™ archwire is the optimal wire for “sliding mechanics” and “anterior retraction” while maintaining nearly perfect torque control. The square anterior portion ensures full torque control by filling the slot occluso-gingivally. The round and polished posterior section minimizes friction and cooperates with the Spring Clip for optimal rotation and tip control during tooth translation. Made of an ultra-high tensile strength stainless steel, the Hills Dual-Geometry™ Wire provides optimum stiffness for predictable and precise tooth translation. SPEED Supercable™ Finishing – SPEED Wire™ The unique shape of Preformed SPEED Wires™ enhances cooperation between the SPEED Spring Clip and archwire. Any movement of the bracket relative to the wire, away from its “home” position, results in labial deflection of the Spring Clip and thereby storage of appropriate energy for recovery. This relentless homing action is ideal for finishing as it enables precise tooth positioning in all three planes of space. SPEED Wire ™ SPEED Supercable™ archwire 1/5 the force of solid Nickel Titanium 17 Hills Dual-Geometry™ Wire
SELF LIGATION www.speedsystem.com Package Includes: • 10 Cases 7-7 with Free Auxiliaries* *Applies to the first 5 intro kits purchased. Additional Auxiliaries Included Free of Charge: • 20 SPEED Supercable ™ . . . . . (Nickel Titanium .016 Round) • 20 SPEED Supercable ™ . . . . . (Nickel Titanium .018 Round) • 100 SPEED Split Stops ™ • 10 Hills Dual-Geometry Wire ™ . (Stainless Steel .018x.018x.017 or .021x.021x.018, Upper) • 10 Hills Dual-Geometry Wire ™ . (Stainless Steel .018x.018x.017 or .021x.021x.018, Lower) • 10 SPEED Wire™ . . . . . . . (Stainless Steel .017x.022 or .020x.025, Upper) • 10 SPEED Wire™ . . . . . . . (Stainless Steel .017x.022 or .020x.025, Lower) • 1 SPEED Opening Instrument • 1 SPEED Instructional Manual • 1 SPEED Instructional DVD • 1 SPEED Study Model • Various Patient Consultation Material ORDER NOW - FAX 1-519-658-6925 speedback@speedsystem.com How do I get started with the SPEED System™? If you are looking to evaluate the SPEED appliance, may we suggest our “Spring into SPEED” Introductory package? This specially priced package has been uniquely formulated for the first time user and provides enough supplies to fully evaluate the system. 18
SELF LIGATION www.speedsystem.com Behind The SPEED System™ The Inventor Dr. Herbert Hanson received his D.D.S. degree from the University of Toronto in 1959 and entered the graduate orthodontic program there the following year. He became a certified orthodontist in 1962 and quickly developed a thriving practice in the city of Hamilton in Ontario, Canada. Dr. Hanson was actively engaged in research and development related to orthodontic products for more than thirty years. He held numerous patents and devoted much time, in collaboration with Strite Industries, to the creation and refinement of the SPEED System™. Dr. Hanson passed away in 2012 at the age of 78. One need only examine the current product landscape in Orthodontics to see what an enormous contribution Dr. Hanson made to the profession. About the Manufacturer Hespeler Orthodontics and Strite Precision Machining are wholly owned subsidiaries of Strite Industries Limited. Operating out of a 100,000 square foot manufacturing facility in Cambridge, Ontario, Canada. Hespeler Orthodontics and Strite Precision Machining use the most advanced machine tools capable of producing small and medium sized parts manufactured to the ultra-precision tolerances required by highly sophisticated industries. Strite Precision Machining specializes in the manufacture of complex aerospace components that demand extreme precision. These are supplied to both the commerical and military aviation industries. Strite is currently working on precision components for the “Joint Strike Fighter”, the Boeing “Dreamliner” and Airbus “A380” Superjumbo. Hespeler Orthodontics is solely focused on the development and manufacturing of the SPEED appliance and the SPEED family of products. Personnel, expertise, machine tools, and manufacturing techniques are shared between the two subsidiaries, making Hespeler Orthodontics superbly qualified to develop and produce the SPEED Appliance. SPEED System Inventor Dr. Hanson preparing orthodontic design drawings in his office 19 Approved supplier for: Messier-Dowty
Treatment with the SPEED System™ Case Presentation by: Dr. François Bérubé D.M.D. Cert. Ortho. Québec City, Canada
TREATMENT WITH SPEED www.speedsystem.com Case Type: Class II Div II - Extraction of Upper First Bicuspids Problem List: Class II occlusion Transverse discrepancy Arch Length discrepancy Torque problems Over eruption of upper and lower incisors Case Resumé: A young lady age 14y 7m; more than 3 years post-puberty with a retrognathic mandible. Her parents declined surgery so the Cl II problem must be resolved via 2 pre-molar extraction. Extractions were not performed in the mandibular arch so as not to further compromise the profile and lip support. On the ceph tracing one can see the severity of the linguo-version of the upper incisors and the retrognathic mandible. She is a little brachycephalic. Treatment Plan Maxillary arch: X-tooth 14, 24 Alignment with .018 Supercable and .016 Super Elastic Nickel Titanium. Upper Canine retraction with .018 Stainless Steel, Upper Arch space closure and Torque control with .021 x .025 posteriorly reduced and finish with .018 x .025 Stainless Steel. Mandibular arch: Alignment with .014 Super Elastic Nickel Titanium, .018 Super Elastic Nickel Titanium and level arch .016 x .022 Stainless Steel and .018 x .025 Stainless Steel. Anchorage and Torque control (Transversely and Anteriorly) with .021 x .025 Stainless Steel. Treatment with the SPEED System™ - Class II Div. II Comments from Dr. Bérubé I have used the SPEED appliance since the start of my practice in 1986 because it offers many benefits. My patients appreciate SPEED’s miniaturized size and appearance. They find the mini-wingless attachments comfortable to wear and easy to clean. My staff find the appliance easy to work with and appreciate not having to change ligatures at each appointment. SPEED permits me to efficiently achieve my treatment objectives through the application of comfortably light forces applied in a very precise manner. My choice for slot size is the .022 slot as it gives me more versatility in choosing archwires. My prescription choice is the Hanson Prescription, developed by SPEED inventor Dr. G. H. Hanson. My bracket placement, especially in the lower arch, reflects this prescription choice. I have successfully treated thousands of patients with SPEED over the past 22 years of practice and I have been very satisfied with what it has enabled me to achieve. This case is typical of those seen everyday in my practice and was not chosen as a “miracle case”. It illustrates SPEED’s ability to correct severe crowding and impart incisor torque control during space closure. It is my feeling that SPEED is a very capable appliance, able to handle sliding mechanics and to control the transverse without tooth tipping. 21
TREATMENT WITH SPEED www.speedsystem.com 14 Years 7 Months Class II Div. II Start of Treatment Note: Canadian government privacy laws forbid the disclosure of patient's identity. For this reason, selected facial photographs have been blurred. Treatment with the SPEED System™ - Class II Div. II 22
TREATMENT WITH SPEED www.speedsystem.com Cephalogram Ceph Tracing Panorex Treatment with the SPEED System™ - Class II Div. II 23
TREATMENT WITH SPEED www.speedsystem.com 10 0 20 30 40 50 60 70 80 90 100 Cl I el U3 - U7 Cl I Elastics Anterior Retraction Triangular elastics U3 / L3 - L4 Cross Bite elastics Cl I el U3 - U7 Weeks Total Treatment Duration 84 Weeks 12 W 29 W 30 W 5 W 8 W 7 W 59 W 5 W 5 W 8 W Mandibular Arch Maxillary Arch .018 Supercable .016 SE .018 Stainless Steel .014 SE .018 x .025 Stainless Steel .018 SE .021 x .025 Stainless Steel (Posterior Reduced) .021 x .025 Stainless Steel .016 x .022 SS .018 x .025 SS Archwire Progression: The initial archwires were chosen keeping in mind the degree of malalignment and our goal of utilizing light forces. In the Upper arch, SPEED Supercable was chosen due to the severity of the malalignment. Supercable is able to impart rather low forces despite severe deflection. In the Lower arch, a low force .014 Nickel Titanium wire was chosen. Although it is arguable whether they are required, my choice was to use steel ligature ties selectively to eliminate any possibility of archwire release on severly malaligned teeth. During tooth translation, a full sized Stainless Steel wire, with an electrolytically reduced posterior section, was utilized in the Upper arch. This wire inhibits anterior torque loss while permitting controlled posterior tooth translation. Finishing in the upper arch was acheived with a slightly undersized Stainless Steel wire into which required detailing bends were easily and accurately placed. A full sized Stainless Steel wire was used in the lower arch, because no detailing bends were required. W = Weeks (eg. 29 W = 29 Weeks) Treatment with the SPEED System™ - Class II Div. II 24
TREATMENT WITH SPEED www.speedsystem.com .016 Nickel Titanium/.016x.022 Stainless Steel 12 Weeks .021x.025 Stainless Steel (reduced posterior) /.021x.025 Stainless Steel 47 Weeks .018 Supercable/.014 Nickel Titanium Bonding Appointment 84 Weeks .021x.025 Stainless Steel (reduced posterior) /.021x.025 Stainless Steel 25 Weeks Treatment with the SPEED System™ - Class II Div. II 25
TREATMENT WITH SPEED www.speedsystem.com 84 Weeks .016 Nickel Titanium/.016x.022 Stainless Steel 12 Weeks .021x.025 Stainless Steel (reduced posterior) /.021x.025 Stainless Steel 47 Weeks .018 Supercable/.014 Nickel Titanium Bonding Appointment .021x.025 Stainless Steel (reduced posterior) /.021x.025 Stainless Steel 25 Weeks Treatment with the SPEED System™ - Class II Div. II 26
TREATMENT WITH SPEED www.speedsystem.com .016 Nickel Titanium 12 Weeks .021x.025 Stainless Steel reduced posterior 47 Weeks .018 Supercable Bonding Appointment .021x.025 Stainless Steel reduced posterior 25 Weeks Treatment with the SPEED System™ - Class II Div. II 84 Weeks 27
TREATMENT WITH SPEED www.speedsystem.com .016x.022 Stainless Steel 12 Weeks .021x.025 Stainless Steel 47 Weeks .014 Nickel Titanium Bonding Appointment .021x.025 Stainless Steel 25 Weeks Treatment with the SPEED System™ - Class II Div. II 84 Weeks 28
TREATMENT WITH SPEED www.speedsystem.com Age: 16 years 4 months 2 months after treatment Active treatment duration: 1 year 7 months Treatment with the SPEED System™ - Class II Div. II 29
TREATMENT WITH SPEED www.speedsystem.com Final Records: The case finished with Class I canine and Class II molars with excellent interdigitation. An ideal overjet and overbite was achieved with mid-line correction and a nice fully developed arch form. The anterior torque and over eruption of the incisors have been corrected. Note on the Superimpostion, by torquing the upper incisors, lip support has not been lost in spite of the extractions. The panorex shows good root parallelism with space being created for upper 3rd molar eruption. The finished result is more esthetic and functional. In addition, the periodontal structures have become healthier and it is easier for the patient to maintain proper oral hygeine. The long term prognosis for dental health is thus improved. Cephalogram Ceph Tracing Panorex Treatment with the SPEED System™ - Class II Div. II 30
TREATMENT WITH SPEED www.speedsystem.com Initial Final Nasion Basion at Nasion Corpus Axis at PM Maxillary Plane at ANS Nasion Basion at CC Profile Treatment with the SPEED System™ - Class II Div. II 31
TREATMENT WITH SPEED www.speedsystem.com Age: 18 years 1 month 1 year 11 months after active treatment. Harmonious profile, good lip support, and radiant smile. Treatment with the SPEED System™ - Class II Div. II 32
TREATMENT WITH SPEED www.speedsystem.com Post Retention Panorex: The result is stable because excellent interdigitation was achieved and the dental environment has not been compromised. Initial Panorex: The patient is in permanent dentition. Third molars are present and in a developing stage. The condyle morphology appears symmetrical and normal. There are no other apparent pathologies present. Treatment with the SPEED System™ - Class II Div. II 33
TREATMENT WITH SPEED www.speedsystem.com Age: 19 years. 2 years 10 months after active treatment. Stable result. 3rd molars are erupting. Treatment with the SPEED System™ - Class II Div. II 34
www.speedsystem.com 35 Additional Reading The Most Clinically Researched Self-Ligating Orthodontic Appliance ~ A Selection of Independant Published Research ~ Treatment Efficiency Biju S. Alignment efficiency of superelastic coaxial nickel-titanium vs superelastic single-stranded nickel-titanium in relieving mandibular anterior crowding Angle Orthodontist; 82:(4):703-708 _______________________________________________________________________________________ Active Self Ligating Appliance Design Pandis N., et al Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets Am. J. Orthod. Dentofacial. Orthop. 2007; 132:(6):834-837 Hanson G.H. Superelastic Nickel Titanium Spring Clips for the SPEED Appliance J. Clin. Orthod. 2002; 36:(9):520-523 _______________________________________________________________________________________ Clinical Efficiency Berger J.L., Byloff F.K. The Clinical Efficiency of Self-Ligated Brackets J. Clin. Orthod. 2001; 35:(5):304-308 Shivapuja P.K., Berger J.L. A comparative study of conventional ligation and self-ligation bracket systems. Am. J. Orthod. Dentofacial. Orthop. 1994; 106:(5):472-480 _______________________________________________________________________________________ Reduced Friction Berger J.L. The influence of the SPEED bracket’s self-ligated design on force levels in tooth movement: A comparative in vitro study. Am. J. Orthod. Dentofacial. Orthop. 1990; 97:(3):219-228. _______________________________________________________________________________________ Light Forces Berger J.L., Waram T. Force Levels of Nickel Titanium Initial Archwires J. Clin. Orthod. 2007; 41:(5): 286-292 Berger J.L., Byloff F.K., Waram T. Supercable and the SPEED System J. Clin. Orthod. 1998; 32:(4):246-253 _______________________________________________________________________________________ Bond Strength Ewing M. Bond Failure in Clinical Practice Australian Orthod. J, 2009; 25:(2): 128-135 Sharma-Sayal S.K., Rossouw P.E. et al The influence of Orthodontic Bracket Base Design on Shear Bond Strength Am. J. Orthod. Dentofacial. Orthop. 2003; 124:(1):74-82.
www.speedsystem.com 36 Tooth Control Badawi H. et al Torque expression of self-ligating brackets Am. J. Orthod. Dentofacial. Orthop. 2008; 133:(5):721-728. _______________________________________________________________________________________ Advanced Manufacturing Bhalla N.B. et al Assessment of slot sizes in self ligating brackets using electron microscopy Aust Orthod J. 2012 May;26(1):38-41 Joch A. et al Bracket slot and archwire dimensions: manufacturing precision and third order clearance J Orthod 2010 Dec;37(4):241-9 _______________________________________________________________________________________ Clinical Applications Blake M., Garvey M.T. Use of SPEED Supercable with Sectional Mechanics J. Clin. Orthod. 1998; 32:(4):227-229 Berger J.L. Archwire Hooks for the SPEED System J. Clin. Orthod. 1997; 31:(6):354-357 Garino F., Garino B. Distalization of Maxillary Molars Using The SPEED System - A Clinical and Radiological Evaluation World J Orthod. 2004; 5:(4): 317-323 Hanson G.H. The SPEED Bracket Auxiliary Slot J. Clin. Orthod. 1999; 33:(6):318-321 _______________________________________________________________________________________ Historical Perspective Berger J.L. Self-Ligation in the Year 2000 J. Clin. Orthod. 2000; 34:(2):74-81 Berger J.L. The SPEED Appliance: A 14-year update on this unique self-ligating orthodontic mechanism. Am. J. Orthod. Dentofacial Orthop 1994; 105:(3):217-223 Hanson G.H. The SPEED System: a report on the development of a new edgewise appliance. Am. J. Orthod. 1980; 78:(3):243-265 Hanson G.H. J.C.O. interviews Dr. G. Herbert Hanson on the SPEED bracket. J. Clin. Orthod. 1986; 20:(3):183-189
No part of this book may be reproduced without the expressed written permission of Hespeler Orthodontics Limited Portions of this material were contributed by: Dr. G. H. Hanson and Dr. J. L. Berger SPEED System™ Orthodontics HESPELER ORTHODONTICS LIMITED 298 Shepherd Avenue Cambridge Ontario N3C 1V1 Canada Tel:1-800-26-SPEED 1-519-658-2925 Fax:1-519-658-6925 www.speedsystem.com Printed in Canada SSQ&A Rev B. © 2017 Hespeler Orthodontics Limited
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