SPEED Bracket Placement Guide v2012

SPEED Bracket Placement
Guide
3 rd edition
2012
©Sylvain Chamberland

http://www.slideshare.net/sylvainchamberland

Bracket Placement Key Points

©Dr Sylvain Chamberland


• Rounded portion of the spring
clip faces occlusally in both
arches

• Mesial and distal edges of the
bonding pads ➜ parallel to the
long axis of the middle lobe of
each tooth.


SPEED Rhomboid
• Narrow SE Spring clip

• Horizontal Positioning
✦ Mesial and distal edges of the SPEED bonding
base / spring clip / bracket body.

• Vertical Positioning
✦ Archwire slot / occlusal edge of the bonding
pad and the bracket body



• Not necessary to angulate bracket
slots into extraction sites or to
use special extraction brackets.

• Spring clip on the arch wire • Rounded portion of the spring clip faces occlusally

continuously maintains excellent
root parallelism as spaces are
closed.


Bonding SPEED Attachments
• Incisor brackets
✦ Forcing excess adhesive to exude
toward the gingival reduces the risk of
clogging the spring clips on these
brackets with miniaturized pads.

• Posterior brackets
✦ Larger bonding pads = not a problem

✦ Excess adhesive may be forced toward
the occlusal.
✦ Less residual ﬂash removal at the
©Dr Sylvain Chamberland gingival.

Bonding SPEED Attachments

• Care must be taken during bonding
to avoid clogging the gingival end of
the bracket / spring slot.

• If some composite is inadvertently
squeezed over the gingival edge of a
bonding base and into a spring slot,
immediately wipe it out with the tip
of a sharp explorer.


Bonding Set Up

• Cheek retractor
✦ #0118-HA - Adult High Heat Sterilizable Cheek Retractor
#0118-HC - Child Hight Heat Sterilizable Cheek Retractor
#0118-NA Nola Dry Field Kit Adult
#0118-NC Nola Dry Field Kit Child
Ortho-Pli corp

• Saliva ejector


Bonding Set Up
• Bracket placement trays
✦ 20-050-99 (GAC)

✦ 740-0076 (Ormco)

• Graduated perio probe
✦ Hu-Friedy: XP23/OW6

• Self-locking pliers
✦ #0152 Cotton Plier, self locking (Ortho-Pli)

• Boone gauge
✦ #BBG4 - Boone Bracket Positioning Gauge (Ortho-Pli)

Bonding Technique Key Points

• Hold the bracket with
• Wipe into the bonding paste
self-locking plier



• Place the bracket



• Place the bracket • Push to exude excess
bonding paste and
obtain close contact



Measure height



Measure height Assess long axis



Measure height Assess long axis Remove ﬂash

Note: Position of the bracket on tooth #22
is not adequate. Instructing the
photographer while positioning the bracket
was distracting. The bracket was
repositioned...off camera.

SPEED System

• Straight wire appliance
✦ Long axis (facial axis) of clinical crown

✦ Facial axis point: maximal buccal convexity


• Andrews’s plane

✦ Plane of the bracket’s slot


• Mandibular arch

✦ Average tip (2nd order)

✦ Average torque (3rd order)

✓ Molar crown = -30°

✓ Incisors = -1°

✦ Roth prescription


• Maxillary arch

✦ Average tip (2nd order)

✦ Average torque (3rd order)

✓ Incisors = 7°

✦ Roth prescription


• Long axis


• C

• Maxillary incisors

✦ Locate the long axis from the
lingual view


Archwire plane selection
• Anteriors
✦ 4 to 4,5 mm from incisal edge

✦ May vary with shorter or
longer crown


• Far enough gingivally to
avoid occlusal contact
✦ 4 to 4,5 mm in most situation

✦ 5 mm or more may prevent
leveling the curve of Spee


• Far enough gingivally to
✦ 4 to 4,5 mm in most situation

✦ 5 mm or more may prevent • Maximum buccal convexity
leveling the curve of Spee • 4,5 mm is better to avoid
unwanted upper incisal contact


✦ Long axis located from the
lingual view


• Long axis assessed by the lingual

• MD placement:

✦ middle lobe prominence


• Placement of 2nd molar occlusally reduce the likelihood of
extrusion


• Placement of 2nd molar occlusally reduce the likelihood of
extrusion

• Reﬂection lines on the labial aid to slot alignment


Mx central incisors
• Bracket body centred on the facial
surface of the tooth

• Rhomboid angulated design provides
better visual references to match the 4 to 4,5

long axis of the bracket with the long
axis of the tooth

• Long axis of the tooth bisect middle lobe
and the centre of the talon


How to measure?

• Boone Gauge
✦ From slot to incisal edge 4 to 4,5

• Perio probe
✦ From bracket base to incisal edge


Bracket Placement Tips

• Direct view may differ
from mirror view

• Assess long axis using
both direct view and
mirror view


Mx Lateral Incisors
• ~ 0,5 mm shorter than the central

• Bracket body centred on the facial surface of the tooth

• Rhomboid design facilitates precise bracket placement


Caution: Incisal Wear &
Lateral Incisors
• Bracket slot
✦ Not necessarily parallel to
incisal edge because of incisal
wear


Mx Canines
• ~ 0,5 mm longer than the
central incisor

• Mesial and distal edges
parallel to long axis

• Compound contoured design
of the bonding pad seat the
bracket on the greatest
contour of the middle lobe


Mini Bracket for Canine


Bracket long axis = Parallel lingual long axis


Mx 1st Premolars

• At its maximal height of labial
convexity 5

• Mesial and distal edges parallel to
long axis

• Centre with the middle lobe


Mx 2nd Premolars
• At its maximal height of labial
convexity

• Mesial and distal edges parallel to
long axis

• Occlusal edge of the bonding pad
parallel to the ridge line

• Centre with the middle lobe


Mx 2nd Premolars

• Larger mesh pad

• Occlusal offset

• Easier placement for
partially erupted tooth

• Difﬁcult to align mesh pad
with Pm1 and M1


Mx 1st & 2 nd Molars
• At 3 to 3,5 mm or at its maximal
convexity

• Bk positioned with MB cusp tip

• Occlusal edge parallel to the ridge line
if cusp tips are not worn

• Distal cusp longer than mesial cusp

• Middle groove aid to locate the long
axis

Marginal Ridges

• Marginal ridges aid to assess bracket position
and height

• The mirror occlusal view show the bracket
centred with middle lobe or mesiobuccal cusp
tip

• Mx 2ndmolar is oriented distally when
emerging

Marginal Ridges

Same remarks as the
previous slide


Md Central & Lateral
Incisors Rhomboid
• Central & Lateral: At 4,5 from incisal edges

• Central & Lateral: Centred with the middle lobe M-D

• Long axis located from the lingual

• 4,5 mm is recommended if one
wants to avoid unwanted upper
incisal contact


Lower Anteriors

• View from operator chair
✦ Long axis assess from lingual

✦ Note minimal paste thickness
between bracket base and tooth
surface
✦ Bracket centred with the middle
lobe


Lower Canines & Lateral
Incisors

• View for operator chair
✦ Canine bracket centred
with cusp tip
✦ Lateral centred with
middle lobe


Md Canine Rhomboid
• Slot at 4,5 to 5 mm from
cusp tip

• Centre on the middle
lobe

• Long axis located from
the lingual


Canine_Occlusal View

• Bracket centred with cusp tip


Md 1st Premolars

• At its maximal height of convexity

• Centred with cusp tip


Md 2nd Premolars


• Centred with cusp tip

• Longer mesh pad occlusal may cause
placement too gingival

• Concentrate on the bracket slot and
the height of convexity


Assessment of Pracket Position

• After direct bonding
✦ Reassessment of bracket
position to pick any
discrepancy
✦ Note parallelism with
marginal ridges


Assessment of Bracket Position

• After direct bonding
✦ Same remarks as
previous slide
✦ Mirror viewed are use
to do these assessments


Md 1st Molars


• Indent on the bonding pad centred
opposite buccal groove

• Indent is off centre mesiodistaly

• Slot parallel to marginal ridges


Md 1st Molars
• SPEED Convertible Tube
✦ Align indent with buccal groove

✦ Parallel to occlusal

Clip closed Clip open


Md 1
Molars
st

Double tube
• Double Tube may lead to a too occlusal placement

• If one place a Single Tube the same manner (too occlusal),
antogonist occlusion may cause indent into the tube


Md 1
Molars
st

Double tube
• Wire engaged in the auxiliary tube by error

• Extrusion occurred

• Single tube rebounded at maximal convexity: wire is
straight


• Press brackets ﬁrmly

• Centre the bracket on the middle
lobe
✦ MD slot axis tangent to MD lobe
curvature

• Molar bk are placed on the MB
cusp
Large base U6 ERX
For 2nd premolar extraction case

• Placement on MB • ER bk rotate 1st • ERX bk will rotate
cusp help achieve molar distally 1st molar mesially
molar derotation

©Dr Sylvain Chamberland An.No. 12-08

At least 10° offset
Cl.Tu.0507


At least 10° offset
Cl.Tu.0507 Cl.Tu.0209

• Derotation of the 1st molar helped:

✦ To gain arch length

✦ To achieve class I relationship


To Maintain Molar Rotation
• Use Bk ERX


To Maintain Molar Rotation
• Place regular bk at the middle grove


• Reﬂection lines on the
labial aid to slot alignment


• Reﬂection lines on the
labial aid to slot alignment

• Speed mini-tubes for 2 nd

molar


• Molar tube
✦ Indent off-centre to the distal


Reassessment of Bracket
Positions

Off centred Re-centred

• A non ideal bracket placement due to initial crowding
should be corrected after alignment

• Rotation wedge is of no help and cumbersome


Bracket Placement Error
• Note Bk #23 too distal
✦ Mesial rotation not corrected

• Bk #13 centred with cusp tip
✦ Rotation is corrected


• Rebond #23
✦ Note derotation



• Bracket inclined too distally
✦ Need to be rebonded


• Upper left canine
✦ Bk long axis incline to distally

✦ Bk not at maximal convexity

• Bracket was rebonded


• Bk on the 2 nd molar should be placed slightly more
occlusally
✦ To avoid unwanted extrusion during treatment



• Note composite on #42 to

• Clinical view reproduce
model set up



• Self-uprighting of 43 is
anticipated after
extraction of lower
right premolar

• Labial tipping of 42 is
expected


• Clinical view reproduce model set up



El.Jo.100309

Adhesive thickness distally under the mesh
pad create distal rotation and uneven
contact point with the canine



El.Jo.100309

Adhesive thickness distally under the mesh Bracket on the lower right central is bonded too
pad create distal rotation and uneven mesially and create a distal rotation and uneven
contact point with the canine contact point with the lateral



El.Jo.100309


El.Jo.240409
Rebonded bracket help to achieve better
alignment of the contact points


El.Jo.100309


El.Jo.240409 El.Jo.130709
Rebonded bracket help to achieve better 3rd order (torque) is needed to improved
alignment of the contact points aligment of the incisal edges and the talon

• 2 nd order error
✦ The bracket is inclined distal to the long axis of the lateral

Mi.Pi 270809

✦ Rebonded to the long axis


• Bk error #35 • Solution
✦ Slightly too distal
✦ Re-position the bracket
✓ Mesial rotation occured

✦ Do an offset bend

✦ Rotation wedge is not an
option


Precise Bracket Position
• Carefull and precise bracket positioning is essential to achieve
perfect alignment in the 3 planes of space

• A misplaced bracket can never help achieve perfect alignment


SPEED Bracket Placement Guide v2012

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SPEED Bracket Placement Guide v2012

Notes de l'éditeur