The SPEED System™ Users Guide
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TABLE OF CONTENTS INTRODUCTION. .................................................................................................................................. 1 SPEED — THE NEW PARADIGM............................................................................................................3 HOW THE SPEED APPLIANCE WORKS...................................................................................................5 THE SPEED APPLIANCE.........................................................................................................................6 ARCHWIRE PLANE SELECTION..............................................................................................................9 BRACKET PLACEMENT.........................................................................................................................10 BONDING SPEED ATTACHMENTS........................................................................................................14 INDIRECT BONDING SPEED ATTACHMENTS........................................................................................17 SPEED ARCHWIRES.............................................................................................................................19 RECOMMENDED ARCHWIRE PROGRESSION.......................................................................................21 SPEED APPLIANCE MECHANICS...........................................................................................................24 SPEED HOOKS....................................................................................................................................25 SPEED ARCHWIRE HOOKS..................................................................................................................27 HOW AND WHEN TO LIGATE.............................................................................................................29 ELASTOMERICS AND THE SPEED APPLIANCE.......................................................................................30 SPLIT STOPS™ AND THE SPEED APPLIANCE........................................................................................30 SPEED IDENTIFICATION SYSTEM..........................................................................................................31 SPEED SYSTEM IDENTIFICATION CHART..............................................................................................32 RECYCLING SPEED BRACKETS.............................................................................................................33 TRANSFER PATIENTS...........................................................................................................................33 SPEED COURSES.................................................................................................................................33 THE SPEED UNIVERSITY PLAN.............................................................................................................33 ADDITIONAL READING.......................................................................................................................34 NOTES. .............................................................................................................................................. 35 “SPEED System” is a Trademark of Hespeler Orthodontics Limited. SPEED Products are Patent Protected. ©2008 SPEED System Orthodontics. All Rights Reserved. No part of this book may be reproduced without the expressed written permission of SPEED System Orthodontics - Hespeler Orthodontics Limited.
1 INTRODUCTION Dr. G. Herbert Hanson, D.D.S. Prior to 1981, it was illegal for an orthodontist in the Province of Ontario, Canada to delegate procedures such as archwire removal and bracket ligation to auxiliary personnel. This was a large factor in my decision to design a new edgewise appliance for greater operator efficiency. Although my initial goals were primarily to eliminate the need for ligation, it gradually became apparent that other desirable features were possible. Some of these were: • improved esthetics • significant miniaturization • greater precision and control • reduced tendency to trap food • greater predictability of friction I purchased drafting equipment and started work on the design of prototypes in 1970. During the following six years several models were tested in vitro and clinically. Despite their numerous deficiencies, these early prototypes led me to new concepts which finally culminated in the basic SPEED Bracket design by 1976. It was at this time that Strite Industries became involved in my project and the long, arduous task of design optimization began. Today, the SPEED Appliance has reached a level of sophistication far exceeding my original expectations. It now enables me to achieve better treatment results with less chair time than ever before. This syllabus is intended to familiarize clinicians with the SPEED System™ and provide a rough outline of possible treatment methods at its present stage of evolution. It is my hope that SPEED Appliance users will find some pointers in it for adaptation to their own preferred techniques. MY TREATMENT PHILOSOPHY The teachers who influenced me most during the formative years of my career were Donald Woodside, Aaron Posen, Holly Halderson and Egil Harvold. Their dedication to high standards, with great emphasis upon biological considerations, has left an indelible imprint on my thinking. Mindful of the limitations imposed upon us by nature, we should strive to: Although few orthodontists would disagree with these objectives, I doubt that any two will use precisely the same methods for achieving them. 1. Establish a good functional occlusion 2. Maximize dental and facial esthetics 3. Avoid or at least minimize such possible “scars” of orthodontic treatment as enamel decalcification, root resorption or accelerated aging of the dentition 4. Maximize the long-term stability of our treatment results 5. Nurture in the patient a high appreciation of good dental health and beauty 6. Accomplish these objectives with a minimum of inconvenience, discomfort or embarrassment to the patient while sparing ourselves the needless chair time associated with anything less than the most efficient appliance 7. Systemize the mechanotherapy where possible 8. Make the patients happy about their orthodontic treatment 9. Give ourselves cause to feel proud of the work we have done
2 My approach is as follows: • Try to treat without extractions in all cases which appear to have the necessary potential. • If treatment objectives cannot be accomplished without extractions, extract second bicuspids to minimize any tendency toward unattractive reduction in the prominence of the dentition. • Use preliminary functional appliances to favorably alter jaw growth patterns wherever it is desirable and feasible. • Employ intra-oral distalization mechanics instead of headgear when conditions permit. • Expand arches which have failed to develop to their full potential. • Intrude upper anterior teeth in patients who exhibit a lot of gingival tissue. • Correct tooth rotations to ideal alignment without any over-correction and rely upon interproximal reshaping and circumferential supra-crestal fiberotomies to enhance retention. • Overcorrect Class II or Class III buccal segment relationships where a strong relapse tendency is expected. Concluding NOTES If you are trying the SPEED Appliance for the first time, I would urge you to consider the following: • Take great care to position the brackets and tubes as accurately as possible during initial bonding. • If significant bracket placement errors become apparent during the course of treatment, it is better to rectify them by re-bonding than to continually compensate with bends in the archwires. • A meticulous bonding technique will pay worthwhile dividends later in terms of efficiency and quality of treatment. • Use very light forces and go easy on over-correction. The customary anti-tip and antispin provisions in conventional edgewise appliances would be excessive if incorporated into the SPEED technique. • Because of the small area of bracket-arch contact and the concentration of rotational control, it is easy to underestimate the effectiveness of the appliance at first. • Use a light touch in manipulating the appliance and avoid “forcing” any component. Many of my patients have expressed their delight with the appearance of the SPEED appliance and with the treatment results I have been able to achieve with it. With a little extra care initially, you will most certainly have similar success. G. Herbert Hanson, D.D.S.
3 Low Friction — Poor Control (Undersized Archwire) High Friction — Full Control (Full Sized Archwire) SPEED — THE NEW PARADIGM EDWARD ANGLE’S EDGEWISE APPLIANCE With its introduction almost a century ago, Edward Angle’s edgewise appliance represented the culmination of years of work and many variations in appliance design. Testimony to his genius lies in the striking similarity of his original design to modern orthodontic appliances, in spite of the incorporation of significant improvements. Improvements such as direct bonding and a reduced need for archwire bends have contributed to increased clinical and treatment efficiencies while improving patient acceptance. However, reliance on a refinement of an original design, possesses inherent limitations. GOALS IN APPLIANCE DESIGN An appliance design which provides a truly efficient means of achieving treatment objectives demands more than simply certain built-in features. This is only the starting point. A truly efficient orthodontic appliance must provide predictability and control. It must enhance, and not inhibit, treatment progress. It must maximize clinical efficiency, while simplifying treatment modalities. It must be aesthetically pleasing, while providing ease of hygiene. And, it must be safe for patient, clinician and staff. Twin edgewise appliance design has fallen short of this ideal. THE TWIN EDGEWISE APPLIANCE The twin edgewise bracket is a passive appliance, generic in design. Unable to independently affect and control tooth movement, it relies on a ligature to secure it to the archwire. Together they are wholly dependent on the archwire for their control. The inherent limitations imposed by this bracket - ligature - archwire relationship ultimately compromise the treatment and clinical efficiency of the appliance. Conventional “tie-wing” appliances have found themselves designed into an uncomfortable corner. Their dependency on biodegradable elastomeric ligatures and full sized wires for control comes at the price of predictability and clinical efficiency. Only with full-sized wires do these elastomeric ligatures maximize their limited control and that control diminishes with time. Their frictional properties tend to inhibit treatment progress in an unpredictable manner; reducing this frictional burden through the utilization of undersized wires sacrifices control. In addition, the degeneration and unhygienic nature of elastomerics require that they be continuously maintained, thereby compromising clinical efficiency.
Attempts to address some of these limitations through appliance redesign have been superficial. Miniaturization has been thwarted by a dependency on ligatures which do not provide the sustained force required for adequate control. This was fully illustrated by the re-emergence and subsequent disappearance of the single tie wing bracket. Designers have since been forced into exploring a variety of exotic materials, which exhibit some unpleasantly surprising characteristics. These failures in appliance redesign limit their focus to cosmetic modifications, and do not provide the evolutionary modifications necessary to advance the state of the art. A new Paradigm is in order. SPEED — THE NEW PARADIGM Unique in concept and design, SPEED is the new Paradigm. Transcending the limitations imposed by dated designs, SPEED provides unmatched clinical and treatment efficiency while enhancing patient acceptance: The Future of Appliance Design. Employing a resilient super-elastic Spring Clip to secure the archwire, SPEED requires no ligatures. SPEED snaps open to accept the archwire and snaps closed to entrap it. Archwire changes are fast; self-ligation minimizes chair time, maximizing clinical efficiency. Able to store energy, the SPEED Spring Clip actively cooperates with virtually any sized archwire in precise, corrective tooth movement. SPEED enhances treatment progress. The mutual action of Spring Clip and archwire extends the range of appliance activation reducing both patient visits and treatment duration. No other design offers stored energy or comparable treatment efficiency. Simply engage the archwire activating the Spring Clip and SPEED begins to work. And work, until its corresponding tooth has been precisely delivered to its proper location and inclination. Any subsequent deviation from this ideal is corrected through the reactivation of SPEED’s unique homing action. SPEED’s memory never forgets. Such precision and control simplifies treatment. There’s no need for exaggerated built-in features or compensatory mechanics. Excellent results with minimal effort — what could be simpler? Cosmetic, Comfortable and Hygienic — SPEED makes patients feel great, resulting in increased referrals. Patients appreciate SPEED’s comfortably light forces and find the mini-wingless attachments easy to clean. SPEED enhances the patient’s appearance and yours! Safe for patient, clinician and staff, SPEED reduces risks. Gloves, Masks, Infection Control: the modern orthodontic environment has changed. SPEED’s ligatureless design virtually eliminates the danger of laceration or puncture wounds. Clinicians wearing gloves find SPEED safe and easy to work with. SPEED offers superior results you don’t have to worry about. Combining the sound fundamentals embodied in Edward Angle’s original design with the revolutionary modifications of stored energy and self-ligation, SPEED has advanced the state of the art. Providing patients and clinicians with unparalleled clinical and treatment efficiency since 1980, SPEED is the new Paradigm. 4 Full Control — Stored Energy Low Friction
5 HOW THE SPEED APPLIANCE WORKS FULL 3-DIMENSIONAL CONTROL The fully preadjusted SPEED appliance provides patients and clinicians with the ultimate in 3-dimensional control. By employing a resilient super-elastic, nickel titanium Spring Clip to entrap and seat the archwire, SPEED provides a constant corrective force which 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. ROTATION AND TIP CONTROL SPEED’s Spring Clip is activated upon archwire engagement. Once deflected by the archwire, the SPEED Spring Clip provides corrective forces which ensure “full” tip and rotational correction. Any subsequent deviation from this ideal is corrected through the reactivation of SPEED’s unique homing action. Activated Passive Rectangular Archwire SPEED Wire™ Archwire Side View (Spring Clip Activated) Top View (Sectioned) Archwire Bracket Spring Clip Corrective Force Spring Clip Activated Ideal Tooth Position TORQUE CONTROL SPEED’s edgewise slot will accommodate square, rectangular, or SPEED Wire™ shaped archwires for full torque control. SPEED Wire™ 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.
THE SPEED APPLIANCE 6 Lingual In-Out Adaptor Auxiliary Slot Archwire Slot Occlusal Labial (Buccal) Undercut for Chain Elastics Opening Instrument Access Slot Escape-Proof Super-Elastic Spring Clip SPEED Mushroom Hook™ Micro-Retentive Mesh™ Bonding Pad Gingival THE SPEED APPLIANCE WITH SPRING CLIP IN THE “SLOT OPEN” POSITION Labial Window™ SPEED attachments are similar in appearance but are specifically designed for each individual tooth. Each attachment consists of up to 5 components: a Rhomboid shaped bracket body, a permanently installed super-elastic Spring Clip which may occupy either of two equilibrium positions—”slot open” or “slot closed”, an in-out adapter, an integral Mushroom Hook™, and a Micro-Retentive Mesh™ bonding base. Appliance landmarks include an edgewise archwire slot available in either .018 or .022, an .016 square auxiliary slot, which may house a variety of auxiliaries including preformed SPEED Hooks, and a colored 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 most popular are: The HANSON Torque Prescription The Medium Torque or MBT** Prescription The Regular Torque or Roth* Prescription The High Torque Prescription These prescriptions reflect the most current philosophies in orthodontics and each is used successfully in many SPEED practices. (* Does not imply endorsement) (** MBT is a trademark of 3M/Unitek)
7 Open from the Gingival Simply apply a light occlusally directed sliding force to the gingival indent. OPENING THE SPEED APPLIANCE 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 required is very light: approximately 300 gms when using the Labial Windo . Apply a light occlusally directed sliding force to either the Labial Window™ or the Gingival Indent in the Spring Clip. It is important to give the Spring Clip a sufficiently long opening stroke to allow its labial end to rest in the parking groove and thereby stay in the open position. Sometimes, it is more comfortable for the patient if the occlusal surface of the tooth is supported with a thumb or finger while exerting the opening force. Each Spring Clip is carefully examined and opened several times at the factory to ensure proper performance. Should excessive force be required to open a Spring Clip, reorient the Opening Instrument and reapply the opening force. If resistance to the opening force is still encountered, one should check to see if any excess bonding adhesive is impeding the movement of the Spring Clip. A Multi-Fluted FG 7901 Flame Jet Carbide burr may be used “dry” to remove hardened adhesive from behind the Spring Clip. The opening force may then be reapplied. CALCULUS AND THE SPEED BRACKET The formation of calculus around the Spring Clip can inhibit the movement of the Spring Clip into the ‘open’ position. This rare occurrence usually happens in the lower incisor region with a small percentage of adult patients. A Cavitron® may be used to dislodge the calculus by placing the vibrating tip onto the surface of the Spring Clip. Care must be taken not to touch the bracket body or pad of the bracket with the vibrating tip as this will almost certainly result in a bond failure. Once the calculus is dislodged, the bracket can be opened in the usual manner. Open with the Labial Window™ Simply insert the tip of an “opening instrument” or explorer into the Labial Window™ and apply a light occlusally directed force.
8 CLOSING THE SPEED APPLIANCE Before attempting to apply a closing force to the Spring Clip, care must be taken to ensure that the archwire is fully seated in its slot. This is most conveniently accomplished by holding the archwire in the slot with the forked end of the SPEED Opening Instrument while a closing force is applied with the operator’s thumbnail. Closing the SPEED Appliance is so easy it can be done with a fingernail. It is important, however, to confirm that the archwire is fully seated against the base of the slot to ensure that the SPEED Spring Clip will close completely. The illustration on the left shows a bracket in its closed position with its archwire fully seated. The illustrations on the right show how the Spring Clip can be prevented from closing if the archwire is not properly seated. Improper closure, as illustrated above, is the most common cause of archwire escapes. THE SPEED OPENING INSTRUMENT The SPEED Opening Instrument was designed by the inventor of the SPEED Appliance, Dr. G.H. Hanson, specifically for use with the SPEED appliance. The slender single prong is ideal for opening SPEED Spring Clips. The forked end may be used for a variety of tasks, such as closing Spring Clips and directing and seating archwires. Wire seated in the slot Wire not seated in the slot
ARCHWIRE PLANE SELECTION MAXILLARY ARCH When the upper second bicuspids have short clinical crowns at the time of bonding, they determine, in large measure, the height and orientation of the most suitable archwire plane. This is particularly true if upper second molars are to be included in the strap up. In such situations, the upper second bicuspid brackets may be looked upon as pivotal. For example, placing the upper incisor brackets too far gingivally can result in an archwire plane which will fall occlusal to the second molars, and possibly even miss them entirely. MANDIBULAR ARCH Lower brackets should be positioned far enough gingivally so that they will not come into occlusal contact with any of the upper teeth at any time during treatment. If this is not possible, the bonding of certain brackets may have to be postponed unless a bite plate or bite shelf is used. 9 SPEED BRACKETS AND OCCLUSAL INTERFERENCE 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. Bonding a bite shelf to upper anterior teeth 4. Bonding a bite shelf to lower posterior teeth Mistakenly leaving lower attachments directly in the occlusion can result in damage to the Spring Clip. Anterior brackets with the “Protector Rail” feature reduce the vulnerability of damage due to occlusal contact in deep bite cases. 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. Normal Spring Clip Broken Spring Clip
BRACKET PLACEMENT Labial Precise visual references for ideal bracket placement are provided by SPEED Rhomboid’s silhouette. Lingual Gingival Occlusal The mesial and distal edges of the bracket body, Spring Clip and pad are parallel to the long axis of the middle lobe of the tooth to which it has been assigned. The occlusal edges of the bracket body, Spring Clip and pad are parallel to the archwire slot. The occlusal edges of the bracket body, Spring Clip and pad can be used to assist in incisal edge and marginal ridge alignment. Distal 10 Mesial Take care to position the brackets and tubes as accurately as possible during initial bonding. If significant bracket placement errors become apparent during the course of treatment, it is better to rectify them by rebonding than to continually compensate with bends in the archwires. A meticulous bonding technique will pay worthwhile dividends later in terms of efficiency and quality of treatment. • The curved portion of the bracket which has the Spring Clip wrapped over it should be directed toward the occlusal in both arches. • Accurate positioning of SPEED brackets is aided by bearing in mind that the mesial and distal edges of the bracket body, Spring Clip and pad are parallel to the long axis of the middle lobe of the tooth to which it has been assigned. Numerous horizontal reference lines are provided by these components to enhance incisal edge and marginal ridge alignment.
• Lines of reflected light on the highly polished surfaces of the Spring Clips serve as excellent labial or occlusal placement guides. They are always parallel to the mesio-distal slot axis. 11 The SPEED Spring Clip provides control during bodily translation thus ensuring excellent root parallelism. Occlusal reflection lines may be used for incisor positioning. Reflection lines on the labial of the Spring Clips can be used to aid in slot alignment. It is easy to initially underestimate the effectiveness of the SPEED Spring Clip. These early SPEED prototype brackets were placed with their slots tipped into the extraction sites. Once positioned correctly, the brackets realigned the roots and crowns into their proper position. • Pressing bicuspid brackets into place without rotational restraint during bonding causes them to spin until the axis of bend of the bonding base aligns with the long axis of the middle lobe of the tooth. A light force to tease the brackets into more or less tip angulation must be used with care to avoid pulling the pad away from the tooth in the middle area thereby creating a void. • The upper brackets are positioned to conform to an archwire plane compatible with brackets placed as far gingivally as possible on the typically short clinical crowns of upper second bicuspids in 12-13 year old children. • 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 because of the unique action of the Spring Clips in restoring a close fit between the archwire and the entire length of the occlusal wall of the archwire slot even after the smallest amount of crown tipping.
12 Take great care to position brackets and tubes as accurately as possible during initial bonding. If significant bracket placement errors become apparent during the course of treatment, it is better to rectify them by rebonding than to continually compensate with bends in the archwires. A meticulous bonding technique will pay worthwhile dividends later, in terms of efficiency and quality of treatment. • Always position Mandibular attachments far enough gingivally to avoid occlusal contact with the Maxillary teeth. It may be necessary, in some cases, to postpone bonding brackets to certain lower teeth or to employ a temporary bite plate. In deep overbite cases, lower incisor attachments should be positioned more gingivally. This requires an increase of built-in lingual root torque. • Unless over-rotations are required, center the brackets on the middle lobe with the mesio-distal slot axis lying tangent to the lobe’s mesio-distal curvature. Exceptions to this are the upper molars where brackets are placed on the mesial buccal cusp. • Generally, lower lateral brackets are placed on the centre of the clinical crown, while lower canine brackets are placed centrally on the middle lobe of the crown. • Due to the interaction between the SPEED Spring Clip and the initial archwires, placement errors become evident very early in treatment. This allows the novice operator to more easily “zero in” on ideal positioning and helps develop the right feel. • Always rebond brackets which have been incorrectly positioned; this eliminates wire bending and the numerous problems associated with it. • The SPEED system of in-out adapters was designed to work with the SPEED System of Coordinated Arch Forms to create ideal tooth alignment without compromising patient comfort. • Harmonious relationships of the lower anterior teeth permit the creation of flat contacts which are ideally oriented to enhance stability. Such contacts are achieved through judicious interproximal stripping after ideal relationships have been established (The small spaces created by interproximal stripping should be closed before cementing bonded lingual retainers. Sometimes it is possible to bond the lower lingual “canine-tocanine retainer early in treatment.). The flat interproximal contacts are continuous with vertical planes which all intersect at a common lingual focus. This keying together is comparable to the way a stone arch is constructed to resist collapse.
MANDIBULAR MOLAR ATTACHMENTS To avoid occlusal interference, it is not recommended that SPEED brackets be used on the lower molars. SPEED mandibular tubes are ideal for the lower molars. These low profile tubes eliminate the danger of occlusal interference while offering the following benefits: 13 The SPEED molar tube base has the indent off-centre to the distal; this, along with its curvature, permits positioning further mesially for correct tube orientation. Off-centre placement of lower second molar tubes allows them to be positioned far enough gingivally, even in young patients. Note that the base is also cut away at the distal gingival to prevent gingival interference. MAXILLARY MOLAR ATTACHMENTS It is important to remember when bonding molars to use a #2 round burr in reverse to remove pellicle prior to etching. There are significant advantages to using single SPEED brackets on the mesiobuccal cusps of the upper molars: It is recommended that the upper second molar brackets be positioned further occlusally so that the upper second molars end up being positioned further gingivally to create the desired Curve of Spee and reduce the likelihood of upper second molar extrusion. • They permit the archwire to lie very close to the buccal surfaces of the molars. • The base of the lower second molar tube has been shaped to permit bonding even when the gingival margins rise steeply at the distal. Often, this permits bonding of partially erupted second molars even when there is a deep cusp overhang. • The anatomically formed Micro-Retentive Mesh™ bonding base maximizes bond strength. • The laser welded hooks are shaped to avoid the gingival/mucosa tissue. • Optimal placement relative to all reference planes is easily accomplished. • The longer span between molar brackets provides for more efficient use of compression coil springs for second molar distalization. • Distal extensions of the archwire as long as 6 mm are possible without soft tissue injury; this is a big advantage when employing distalization mechanics.
With all posterior SPEED brackets, apply a slightly firmer force against the labial surface of the bracket body near the gingival initially, and then a more uniform force to press it home. This causes most of the excess paste to exude toward the occlusal, thereby reducing the need for residual flash removal at the gingival. On posterior brackets with larger bonding pads, excess adhesive may be forced toward the occlusal. This reduces the need for residual flash removal at the gingival. BONDING SPEED ATTACHMENTS SPEED attachments feature Micro-Retentive Mesh™ bonding bases. Each bracket base is carefully contoured to precisely mirror the anatomy of its corresponding tooth. For this reason, SPEED attachments are not interchangeable. When bonding SPEED attachments, no special bonding technique or adhesive is required. No one technique is most preferred by SPEED users. SPEED attachments may be bonded using the direct or indirect technique with equal effectiveness. Similarly, the appliance may be bonded using any one of a variety of adhesive types: • Paste-to-Paste • No-Mix • Light Activated 14 MICRO-RETENTIVE MESH ™ All SPEED attachments feature Micro-Retentive Mesh™ bonding bases. Micro-Retentive Mesh™ has been proven in large scale clinical studies to reduce bond failures by 50% and, in laboratory simulations, to double bond strength. Micro-Retentive Mesh™ bonding bases are dull in appearance but require no special bonding technique or adhesives. THE DIRECT TECHNIQUE - POSTERIOR BRACKETS When direct bonding SPEED attachments, be certain that the composite paste is thoroughly incorporated into the retentive mesh of each bracket base. Sufficient excess should be left in the middle to allow for deficiencies between the fit of the bracket and the tooth’s surface. Try to gauge the amount of paste so as to give a peripheral seal without requiring a lot of flash clean-up. After lightly applying the attachment to the tooth at the pre-selected bond location, firmly press it home with a sickle scaler.
15 Care must be taken during bonding to avoid clogging the occlusal end of the Spring Clip. If composite is inadvertently squeezed over the incisal edge of a bonding base and onto a Spring Clip, immediately wipe it out with the tip of a sharp explorer. By forcing excess adhesive to exude toward the gingival on incisor brackets, one reduces the risk of clogging the Spring Clips on these brackets with miniaturized pads. When bonding SPEED brackets, care must be taken to avoid clogging the moveable Spring Clip with either adhesive or sealant. Minimizing the application of adhesive and sealant during bonding, not only reduces the danger of this occurring, but also maximizes the strength of the bond. BONDING SPEED ATTACHMENTS THE DIRECT TECHNIQUE - ANTERIOR BRACKETS Present upper incisor brackets to the tooth surface in the opposite way to posterior brackets, i.e., the incisal edge of the base comes in contact first, so that subsequent pressure will cause excess flash to exude toward the gingival. To do otherwise could result in the clogging of the Spring Clip slots and resultant seizure. The attachment can then be teased into its best possible position as viewed from both the occlusal and labial. Some clinicians find that the use of a hairdryer to circulate the moisture laden air present in the mouth, reduces the risk of moisture condensation on the teeth.
16 REBONDING OR RE-POSITIONING SPEED ATTACHMENTS Any bondable SPEED attachment may be rebonded successfully by following the proper technique. Rebonding though, may compromise bond strength relative to that achieved with an unused attachment. Remove excess adhesive from the tooth, using a finishing burr in a high speed rotor. At low speed, reduce the bulk of adhesive to as thin a layer as possible without going through to the enamel. This, of course, is only possible if there is a good pad of adhesive on the tooth. If the tooth surface is exposed at any point, the tooth must be fully reprepared. If the bracket is to be rebonded, carefully remove all adhesive from the mesh by Micro-Etching. Care should be taken not to damage the mesh surface as such damage may result in reduced bond strength or leakage. Care should also be taken not to direct the Micro-Etching nozzle toward the Spring Clip, as the etching medium may damage, or foul the Spring Clip. Soak the bracket in acetone. Rebond the attachment in the usual manner. Hardened excess sealant or composite may prevent the Spring Clip from opening. A carbide burr may be used to carefully remove the sealant or composite. The Spring Clip can then be gently teased into the open position. BONDING SPEED ATTACHMENTS OPENING “CLOGGED” SPRING CLIPS Should an attachment inadvertently become clogged during bonding, one should never attempt to “force” open the Spring Clip. Instead, a Multi-Fluted FG 7901 Flame Jet Carbide burr or FG 7904 Pear Jet Carbide burr may be run “dry” between the Spring Clip and base to remove the hardened adhesive. The Spring Clip may then be teased open using the usual technique.
17 INDIRECT BONDING OF SPEED ATTACHMENTS BY DR. FRANÇOIS BÉRUBÉ D.M.D. CERT. ORTHO One of the primary advantages of indirect bonding SPEED brackets is the accuracy of bracket positioning. The procedure below ensures full control by you and your auxiliary staff. The simplicity of this procedure allows for delegation of the laboratory procedure, and its flexibility permits you to check, and if necessary, adjust bracket positioning before finalizing the case. MATERIALS 1. Stone model from an accurate alginate impression 2. Panoramic x-ray 3. Treatment plan 4. SPEED brackets 5. Separating medium (Al-Cote, Dentsply International) 6. Phase II adhesive kit (Reliance Orthodontic Products) 7. Reprosil Low Viscosity (Dentsply International) 8. Cutter Sil Putty Plus (Heraeus Kulzer) 9. Cutter Sil Hardener Universal Paste (Heraeus Kulzer) 10. Fastray (Bosworth Company) 11. Acetone 12. Cheek retractor (Nola Specialties) 13. Dry Angles (Young Dental) 14. Instrumentation: Pencil .03 Bracket gauge Bracket tweezer (Ortho Pli) Lecron spatula Explorer Plastic spatula Mixing pad Heatless wheel Mixing spatula Scalpel knife LAB PROCEDURE • Dental stone working models prepared from an accurate alginate impression are necessary. After the treatment plan is established, and the patient’s model has been trimmed and dried for at least 24 hours, reference lines are drawn on the teeth using a very sharp pencil (.03 mm). Mark the long axis, the incisal edge and the marginal crest of each tooth. Determine and mark on each tooth the desired height of the archwire. • On the model, individually check each bracket’s bonding pad relative to its corresponding tooth to ensure proper “base-to-tooth” adaptation. Modify the contour of the bracket’s pad, if necessary, to ensure an exact fit. • Apply a thin coat of separating medium (Al–Cote, Dentsply International) to the models and allow to dry. • Mix Phase II Paste A and B (Reliance Orthodontics) and apply to the mesh bonding base of the bracket. Locate the bracket correctly on the model’s tooth and press firmly into place. Excess adhesive is removed and the position of the bracket is carefully checked and aligned relative to the pencil reference lines previously drawn on the model. The adhesive is allowed to set. • Once all brackets have been placed, the indirect bonding tray may be created. With self-ligating brackets such as SPEED, it is of paramount importance to prevent sealant or composite from obstructing the bracket’s moving components. Therefore the minute crevasses in the self-ligating bracket’s mechanism must be completely filled and a close fit must exist between the indirect bonding tray material and the bracket mesh pad. For this reason a hydrophilic vinyl polysiloxane impression material like Reprosil ‘Low Viscosity’ (Dentsply International) is used to cover each bracket. Let this set for approximately 5 minutes. • Mix the Cuttersil Putty Plus (Heraeus Kulzer), a very high viscosity Silicone Impression material, with the paste hardener and manually roll into a strip. Place the putty around the facial surfaces of the model pressing the putty onto the brackets. Carry the putty over the incisal, occlusal and at least all of the lingual surfaces for accurate indexing. Allow a thickness of at least 5 mm of putty for proper tray strength.
• Let the putty set for 5 minutes, immerse in water for 1 hour and remove bracket tray from the model. Trim silicone tray just under the bracket’s mesh pad and make three indents on the occlusal of the indirect bonding tray. For greater rigidity, the bonding tray’s hard “outer shell” should be made with Fastray (Bosworth). Mark the midline to facilitate proper placement. CHAIRSIDE PROCEDURE Remove the indirect trays from the stone model. Examine the trays carefully for remaining stone covering the adhesive “custom base” on each bracket. Use a scaler to remove any stone from the custom adhesive bases. Be careful not to abrade the resin base. Apply acetone to adhesive bases and air dry them. Prepare teeth for bonding by following normal tooth preparation procedures. Make sure that saliva does not contact the etched enamel. Bonding is accomplished with bonding resin, therefore all visible moisture should be removed. The etched teeth should have a frosty appearance and be completely desiccated. Small amounts of Phase II Resin A and B liquids should be poured into plastic mixing wells. Resin A can be painted onto the tooth surface with a brush, and Resin B can be painted, in the same way, on the resin pads in the indirect bonding tray. Position the tray over the teeth and seat the tray. Apply equal pressure to the occlusal, labial and buccal surfaces. Hold for a minimum of 2 minutes. Allow 2 more minutes of cure time before removing the tray. This procedure is now repeated for the opposite arch. Upon tray removal verify that there is not an excess of resin obstructing the SPEED Spring Clip. If necessary, scale off any excess resin around the brackets and from the interproximal contacts. Use dental floss interproximally to ensure that all contacts are free. SPEED SYSTEM OF COORDINATED ARCH FORMS The SPEED System of Coordinated Arch Forms, developed by Dr. G. H. Hanson (SPEED Inventor), is based on his in-depth analysis and twenty years of clinical experience with the SPEED System™. The archforms reflect the subtle nuances of SPEED’s sophisticated standoffs which allow the archwire to sit as close as possible to the teeth. They provide optimal tooth positioning for all phases of tooth movement from unravelling and aligning to finishing and retention. Clinically proven, these archforms provide beautifully coordinated upper and lower arches without any modification of the form as received. Upper Arch Large Medium Small Lower Arch Large Medium Small 18
19 SPEED SUPERCABLE ™ ARCHWIRES SPEED Supercable™ is a multi-stranded Super Elastic Nickel Titanium Coaxial Wire. Unmatched as an initial aligning and leveling wire, it replaces .014 or .016 solid Nickel Titanium wires which can exert 3 to 5 times more force. Regardless of the malalignment, Supercable™ archwires are easily and fully engaged with no plastic deformation of any component. Its extremely low unloading force plateau assures that appliance-induced stresses within the periodontium will remain at near optimal levels throughout. Supercable™ is designed to accept sharp bends without taking a permanent set. Its unique design and construction combined with its super-elastic properties allow it to recover fully even when severely deformed. Therefore, distal end bends are impossible and distal stops must be used instead. Specially designed SPEED Split Stops™ may be used for this purpose. SPEED SPLIT STOPS ™ FOR THE DISTAL ENDS Distal stops are used to secure Supercable™ ends. A SPEED Split Stop Plier or dull distal end cutter is used to secure the stops. Distal end bends with Supercable™ are impossible. Supercable™ is designed to accept sharp bends without taking a set. Never “flame” the end of Supercable™. Distal CUTTING SUPERCABLE ™ ARCHWIRES Frayed end due to dull cutter Cut Supercable™ with a sharp “Distal End” or “Ligature” cutter Sharply cut end ready for distal stop A sharp Distal End Cutter or Ligature Cutter must always be used when cutting Supercable™. This will ensure a sharp cut through Supercable’s™ tiny individual strands. Use of a dull cutting instrument may cause tearing or fraying of the wire ends, which may result in patient discomfort. Mesial
20 SPEED D-Wire™ is a unique half-round, half-square wire which is ideally suited for full 3-Dimensional control while sliding. The unique D-Wire™ profile ideally cooperates with the SPEED Spring Clip to ensure precision and control during sliding mechanics even when used as a sectional. The unique shape of Preformed SPEED Wire™ archwires enhances cooperation between SPEED brackets and archwires (see illustration). Any rotation of the bracket relative to the wire, away from the relationship shown on the right, results in labial deflection of the Spring Clip and thereby storage of appropriate energy for recovery. This relentless homing action enables precise tooth positioning in all planes of space. • Facilitates wire insertion and Spring Clip closure • Saves time - almost no primary bending required • Arch form reflects in-out offsets of the SPEED appliance • Rounded edge is always directed toward the labial-gingival in either arch SPEED WIRE ™ FINISHING ARCHWIRES NICKEL TITANIUM AND STAINLESS STEEL HILLS DUAL-GEOMETRY ™ ARCHWIRES STAINLESS STEEL The HILLS Dual-Geometry™ archwire is the optimal wire for sliding mechanics and anterior retraction while maintaining nearly perfect torque control. • Square anterior portion ensures full torque control by filling the slot occluso-gingivally • Easy to engage and close the Spring Clip due to the reduced labio-lingual dimension • Perfectly round and polished posterior section minimizes friction and cooperates with the Spring Clip for optimal rotation and tip control during tooth translation • Made of ultra-high tensile strength stainless steel for optimum stiffness • Available for both the .018 slot and .022 slot in a variety of archform sizes Full sized square anterior section fills the slot for optimal torque control Round posterior section is polished to minimize friction ACTIVATED THE SPEED WIRE™ ARCHWIRE PASSIVE SPEED D-WIRE ™ ARCHWIRES NICKEL TITANIUM AND STAINLESS STEEL
INITIAL ALIGNMENT .018 SLOT UPPER - LOWER ARCH .022 SLOT UPPER - LOWER ARCH Severe Malalignment (1) .016 Supercable ™ or .014 HA nickel-titanium (1) .016 Supercable ™ or .014 HA nickel-titanium (2) .018 Supercable ™ or .016 HA nickel-titanium (2) .020 Supercable ™ or .018 HA nickel-titanium (3) .016 or .018 HA nickel-titanium or (3) .020 HA nickel-titanium or .017 x .022 SPEED Wire™ nickel-titanium .020 x .025 SPEED Wire™ nickel-titanium Moderate Malalignment (1) .018 Supercable ™ or .016 HA nickel-titanium (1) .018 Supercable ™ or .016 HA nickel-titanium (2) .016 or .018 HA nickel-titanium or (2) .020 HA nickel-titanium or .017 x .022 SPEED Wire™ nickel-titanium .020 x .025 SPEED Wire™ nickel-titanium • If the malalignment is severe an .016 Supercable™ sectional arch is used. This wire is terminated distal to the first molar, or even the second bicuspid attachments, because of its relative vulnerability to functional stresses in the molar region. Engagement of brackets on severely rotated teeth is simply a matter of manipulating Supercable™ fully into place with a ligature director and then closing the Spring Clips to trap it. Regardless of the malalignment, Supercable™ archwires are easily and fully engaged with no plastic deformation of any component. Its extremely low unloading force plateau assures that appliance-induced stresses within the periodontium will remain at near optimal levels throughout. The threshold forces exerted by this light wire, initially increase cellular activity thus preparing the surrounding tissue for impending changes. Continued use of such light forces eliminates excessive tissue compression thus allowing optimal tooth movement. 21 ROUND RECTANGULAR or SQUARE SPEED WIRE™ SPEED’s edgewise slot will accommodate virtually any size or configuration of archwire except those with an extremely large labio-lingual dimension (e.g. .018 x .025 in an .018 slot or .022 x .028 in an .022 slot). RECOMMENDED ARCHWIRE PROGRESSION 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, maximize efficiencies of tooth movement while ensuring excellence in finishing. Although 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.
22 The combined effect of the initial light multi-stranded Supercable™ archwire, the wide interbracket span between the narrow SPEED brackets, and the energy storing capability of the Spring Clip, greatly increases the range of appliance activation. A Supercable™ sectional may be used for initial alignment prior to the engagement of a full archwire. If necessary, stainless steel coil or tubing is used to reinforce extraction spaces once alignment will allow engagement of a full archwire. Alternatively, solid Nickel Titanium archwires may be used during initial alignment and leveling. Care should be taken when choosing such wires to avoid brands of wires that impart excessive force. Attention should be paid to the amount of force imparted by the wire in the ‘Unloading’ phase at mouth temperature (approximately 37°C), as this is the force that would be imparted to the dentition. Numerous studies have been published comparing the unloading force of various commercially available archwires. One such study (Berger J.L., Waram T., Force Levels of Nickel Titanium Initial Archwires, J. Clin. Orthod. 2007; 41:(5): 286-292) compares the loading and unloading forces of more than 40 Nickel Titanium archwires. • When the malalignment is not severe, the first archwire used is usually an .018 Supercable™ wire or .016 solid Heat Activated (HA) Nickel Titanium wire. • When permitted by alignment, a continuous super elastic archwire is inserted into all attachments. The specially shaped nickel-titanium SPEED Wire™ is ideal for final aligning and leveling. Its unique shape and mechanical properties ensures full cooperation between the archwire and the SPEED brackets thus providing optimal tooth movement. • Occasionally, stainless steel tubing or SPEED Protector Coil may be used to reinforce a long span of wire at extraction sites. This reinforcement reduces the likelihood of accidental archwire deformation.
23 SPEED’s .016 square horizontal auxiliary slot may be used to house an .016 Supercable™ or solid nickel-titanium sectional for individual tooth movement. Here a coil is used to create space while the sectional gently moves the “blocked out” tooth labially to its proper location. DISTALIZATION AND RETRACTION Upper Arch — (1) Molar - Bicuspid Distalization, Canine retraction Full sized Square, Stainless steel SPEED D-Wire™ or HILLS Dual Geometry™ wire (2) Anterior retraction Full Sized Square Stainless steel wire or HILLS Dual Geometry™ wire Lower Arch — Full Sized Nickel Titanium or Stainless Steel Square archwire or SPEED D-Wire™ • It is important to remember that ideal root parallelism during bodily translation is ensured by the unique homing action of the SPEED Spring Clip. If retraction forces are great enough to dominate the Spring Clip, they will cause a very small amount of tipping or rotation which automatically places the appropriate energy into storage for a perfect homing in to the programmed bracket-wire relationship. Light forces are always recommended. • Stiff stainless steel archwires are best for extraction space closure and non-extraction distalization if lingual collapse is to be avoided. This is especially true in the mandibular arch. • When posterior torque control is a main concern, full sized square stainless steel wires are ideal. • HILLS Dual Geometry™ wire is well suited to controlling anterior torque while providing a round polished posterior segment for bodily translation. By filling the slot occluso-gingivally, full torque control is ensured. The wire’s reduced labio-lingual dimension ensures easy archwire insertion and Spring Clip closing. This wire is made of an ultra-high tensile strength stainless steel. Its stiffness virtually eliminates undesirable dumping often associated with similar wires. FINISHING AND RETENTION .018 Slot Upper and Lower Arch — .017 x .022 stainless steel SPEED Wire™ .022 Slot Upper and Lower Arch — .017 x .022 or .020 x .025 stainless steel SPEED Wire™ • Finishing is best accomplished with a stainless steel SPEED Wire™. The unique shape of the SPEED Wire™ enhances cooperation between SPEED brackets and the archwire. The homing action of the Spring Clip combined with the unique cross sectional shape of this wire provides precise tooth positioning in all planes of space. • SPEED Wires™ are also frequently used for slow arch expansion with a minimum of crown tipping. The relatively light torque forces working to hold the buccal teeth upright should ideally compress the periodontal ligaments gently and uniformly and so as to prevent areas of ischemia. This delicate action is intended to encourage alveolar bone apposition buccal to the labially translated roots.
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