Case Type:
Class II Div I - Extraction of upper 1st and lower 2nd premolars
Problem List:
Skeletal hyperdivergency
Upper incisor proclination
Extrusion of upper/lower incisors
Treatment Plan
Extraction of upper 1st and lower 2nd premolars
Correction of upper and lower crowding
Reciprocal closure of extraction spaces
Avoid Cl. II elastics due to excessive incisor/gingival display
Maxillary arch:
Extract 14, 24
Alignment with 0.016 Supercable followed by 0.014 Nickel Titanium and then 0.016 Nickel Titanium. Leveling and
initiation of torque via 0.018 D Wire, followed by 0.017 x 0.022 SPEED Wire in Nickel Titanium to finalize torque correction
and idealize archform. Upper arch space consolidation was accomplished using 0.018 x 0.018 x 0.018 Hills Dual Geometry
Wire. The upper arch was finished using 0.017 x 0.022 SPEED Wire in Stainless Steel.
Mandibular arch:
Extract 35, 45
Alignment with 0.016 Supercable followed by 0.014 Nickel Titanium and then 0.016 Nickel Titanium. Leveling and
initiation of torque via 0.018 x 0.018 Nickel Titanium D Wire, followed by 0.017 x 0.022 SPEED Wire in Nickel Titanium to
finalize torque correction and idealize archform. 0.018 x 0.018 Stainless Steel D Wire with reverse curve of Spee was then
placed to complete bite opening, followed by 0.017 x 0.022 SPEED Wire in Stainless Steel to finish.
Comments from Dr. Hime
I have used the SPEED Appliance since 1998. In the mid/late ‘90s, I tried all self ligation systems available on the US
market. In the end, I selected the SPEED Appliance due to its active spring clip, small bracket design (hygienic and
esthetic), and the extreme precision of tooth movement that I observed. Given my engineering background, I appreciate
the unique design of the SPEED bracket, and its ability to apply a continuous seating force to the archwire throughout
treatment, making SPEED unique among all orthodontic appliances. I find that tooth movement is predictable, and that
control in all 3 dimensions is extremely precise.
This case is a very typical case in my practice. The case has significant rotational correction requirements, and one of the
concerns among doctors unfamiliar with SPEED is whether or not the appliance can control rotations adequately. As this
case demonstrates, not only does it fully correct rotations, it does so rapidly, and then utilizes the spring clip to actively seat
the archwire throughout the remainder of treatment. This maintains the correction, and contributes to short term stability.
The small size also allows early engagement of significantly displaced teeth, such as the 12 and 32 in this case. In addition,
it was necessary to retract the upper incisors to correct the overjet. Excellent torque control was necessary to maintain a
proper interincisal angle, and to improve facial and dental esthetics. The torque control is evident in the final photographs,
and is confirmed in the cephalometric superimpositions. The low friction environment offered utilizing small diameter
wires during initial alignment allowed for alignment correction to be achieved within 3 months. This is despite rotations
of greater than 45˚ on 2 teeth. At the 2-year post-treatment evaluation, the alignment has been maintained, with healthy
periodontal tissues, despite the fact that the patient had not worn the retainer in 23 months, and only wore her maxillary
retainer for 4 months after active treatment. Slight rotational relapse of the 12 was observed, but since this tooth began
with a 45˚ rotation, and she only wore her retainer for such a short time, this relapse was understandable. The alignment
of this tooth has since been corrected with a spring retainer worn full time for 2 months.
Case Presentation by: Dr. David Hime
B.S. Chemical Engineering, D.D.S, M.S. Oral Biology, Diplomate American Board of Orthodontics
Treatment of: Class II Div. I -
Extraction of Upper 1st and Lower 2nd Premolars
End-on Class II buccal occlusion
Severe upper and lower arch length deficiency
Pre-pubescent, with growth remaining
Forsus Springs™ as needed to augment anchorage
-6˚ torque bracket on 32 for additional labial root torque
CSF on the severely rotated upper incisors (UL2-UR2)
Removable upper and fixed lower retention
