Benefits of SPEED bracket_Getting to Know the SPEED Appliance

Getting to Know the
SPEED Appliance
UNC2011
Dr Sylvain Chamberland
slideshare.net/sylvainchamberland
www.sylvainchamberland.com

Fr.La. 0602

An.Ju.Cl. 0807

He.Pe. 0608

©Dr Sylvain Chamberland

Fr.La. 0602 68! weeks

An.Ju.Cl. 0807

He.Pe. 0608


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

An.Ju.Cl. 0807

He.Pe. 0608


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

69 weeks

An.Ju.Cl. 0807

He.Pe. 0608


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

69 weeks

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

He.Pe. 0608


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

69 weeks


66" weeks
He.Pe. 0608


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

69 weeks


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


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

69 weeks


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

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


The SPEED Appliance - 1980

• Invented: Dr. G.H. Hanson.

• Manufactured: Strite Industries.

• Introduced to market in 1980 after 5 years of
clinical development.

• The 1st commercially successful Self-Ligating
appliance.


SPEED’s Unique Mode of Action
A New Paradigm - Exceptional Control
Rotation Tip Torque


SPEED’s Unique Mode of Action
A New Paradigm - Exceptional Control
Rotation Tip Torque

• Spring-Clip activated once deﬂected by the archwire.

• Gradual homing position ! corrective tooth movement in all 3 planes of space.

• Constant corrective action ! ligation stability.

• No elastomeric ties = " frictional resistance.


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

• Damon MX • Smartclip™
Damon Q

• Discovery™
• Vision LP
American Ortho
Dentauraum

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

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

• Time 3 & Empower
American Ortho

• Quick 2.0 • Nexus
Forestadent Ormco

Do We Need Fancy
Advertisement ...

Do We Need Fancy
Advertisement ...

• To know that this....

Do We Need Fancy
Advertisement ...

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

Damon Sequel
• Large twin design, rigid clip, high proﬁle
• Several generations of the Damon bracket have already
been released
• Clinical efﬁciency remains to be seen
• Passive system: 4 solid walls
• Only the name Damon has not changed for obvious
marketing issue

3MX Q C

Meanwhile

• Several improvement, same bracket design


Therefore
Active Self Ligation’s Rise

1980 SPEED

In the beginning, in the end and all along the way, it’s been SPEED

Therefore
Active Self Ligation’s Rise

1980 SPEED InOvation BioQuick

EmPower Nexus SPEED
In the beginning, in the end and all along the way, it’s been SPEED

SPEED Convertible Tube

• Re-Convertible
form start to ﬁnish

Insert Press Rotate



• Self-ligating re-convertible tube

• Nicket-Titanium Microlatch entraps
and securely holds the archwire
! Greater buccal force # Greater resistance to opening

• Repeatedly convertible for unlimited
archwire engagements


• Lowest proﬁle convertible tube

SPEED Convertible Tube In-Ovation SL Tube Damon SL Tube


How to open Speed


How to open Speed

• From SPEED labial window

• From the gingival


How to close SPEED
• Most of the time
! Easily closed with gloved hands

• Closing instrument
! To engage large or heavy wire


Closing SPEED

• Wire not properly engaged

• Pay attention!


Closing SPEED

• Wire not properly engaged

• Pay attention!
Use this

©Dr Sylvain Chamberland For heavy wire

How does the SPEED Appliance Work?

SPEED envelope of action: PASSIVE ZONE



SPEED envelope of action: PASSIVE ZONE

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



SPEED envelope of action: ACTIVE ZONE



SPEED envelope of action: ACTIVE ZONE

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


How does the SPEED Appliance Differ?
• Choosing between low friction or full control

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


• SPEED offers both low friction AND full control

SPEED spring clip Archwire fully seated by
Activated by archwire SPEED spring clip


Better torque control
• Active spring clip seat the wire into the slot

• Passive clip can't seat the wire unless ﬁlling
the slot
! Therefore, torque is dependant of the wire play and
the torsional moment (N-mm) created by its Torque play: ± 5° for .020 x .025 wire in .022 slot

relationship to the bracket slot
! Torsional moment is related to wire stiffness in
torsion $ Bigger wire = Bigger moment
! Use of pretorqued wire is an implicit admission that
the bracket can’t achieve torque Torque play: ± 10,5° for .019 x .025 wire in .022 slot

Koziowski, CI v 16, #1, 2008, p.25

SPEED Paradigm
!So many advantages!
" No tie wing.
" No ligature tie.
" Miniaturized.
" Better control in the 3 planes of space

!SPEED was thinking of self-ligation 30 years ago
!SPEED = Ahead of its time? Revolutionary?
!The 1st active SLB

Why my patients prefer
SPEED brackets?
• The smallest bracket on the market = SPEED


How to market SPEED bracket?



• Do your want one of these big chunky ceramic bracket?




• Do you want this other regular bracket with colored elastics that
accumulated bacterial plaque, are difﬁcult to clean and that the
color will look dirty quickly?





• Do you want one of those big SLB?





• Do you want one of those big SLB?

• Or do you prefer this tiny mini braket?


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Proposed Core Advantages of Self-Ligating brackets
Eliasdes T., Pandis N., Self-Ligation in Orthodontics,2009, Wiley-Blackewell

• Faster ligation = Less chair time
! Save up to 10 minutes for replacement of a wire

• Ligation stability - Secure archwire engagement

• Low friction??
! Ligature ties and elastomeric ties may cause friction

! Resistance to slide if affected by bending and notching

! Passive zone = low friction

! Active zone = higher friction

Proposed Core Advantages of Self-Ligating brackets

• Practice builder
! Promote the smallest SLB = SPEED

• Assistance to good oral hygiene??

• More comfortable treatment??
! Initial .016 Supercable wire will more likely cause less pain
than a solid .016 niti wire
! Differences in design of SLB have important consequences
! SmartClip: marked increase discomfort when removing and engaging wire

! Damon2: low discomfort initially, but higher discomfort at later stage

Beneﬁts of a Self-Ligating Bracket System for a
Patient

• Minimal initial discomfort
! Light, continuous forces if used with Supercable™

• Better oral hygiene, minimal tissue lacerations, if any

• Shorter ofﬁce visits !less chair time

• Longer interval between visits


Do you think self ligating brackets will replace
conventional brackets in the future?


Do you think self ligating brackets will replace
conventional brackets in the future?

• "In the near future, yes, they will, to some degree, replace
conventional brackets." ... "I am extremely surprised to see

Ye s!
that ligation brackets are still so much in use. Clinical
advantages of the self-ligating brackets are not limited to
saving chairside time; they also produce less wire-to-bracket
friction, require less stock in the practice and if used
efﬁciently they may increased the practice production by
15% to 30%."

VIP interview: Dr Ali Darendeliler, WJO v10, #1, 2009

Self-ligating bracket claims
Ask us, AJODO 2010, 138, #2, 128-131

• SLB do not grow buccal alveolar bone
! Cevidanes L, Treccani M, Myrda A, Melsen B. Transversal expansion and SLB brackets: A CBCT study

! Paventy A. Facial alveolar bone evaluation with CBCT in non extraction treatment using the Damon system: a prospective
clinical trial [thesis] Norman, Okla: U of Oklahoma; 2008

• Lateral expansion of the dental arch by SLB
! Can not be compared to RME

! Not more stable


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

• SLB more efﬁcient and more effective than conventional
edgwise bracket systems in treating malocclusion
! Current evidence does not indicate differences for treatment time, rate
of alignment, rate of space closure, ﬁnal arch dimension or occlusal
outcomes
! Neither for : reduced friction between archwire and bracket, reduced
clinical forces, patient pain, more hygienic


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

• 2 assertions supported
! Reduced chair time

! Control of mandibular incisor inclination???

! This last afﬁrmation don't seem to be supported by recent study


Neat beneﬁts of the SPEED Bracket

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


Neat beneﬁts of the SPEED Bracket

•Escape-proof spring clip (no ligation decay)

•Increased inter-bracket distance
Cl.Tur. 0209

• More springiness


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


Super-elastic spring clip
• Clip is 400% more elastic than SS
! No difference between “as received” and “used”
brackets in the SPEED Group

! Range of activation did not change
1,6
! No permanent deformation 1,2
0,6

• Spring Clip deliver 1,2 N per mm of
activation

• Performance and aging depend on the
alloy composition of the Spring Clip

©Dr Sylvain Chamberland Changes in the stiffness of the ligating mechanism in retrieved active self-ligating brackets
AJODO 2007; 132: 834-7

Aging of the Spring Clip
• Performance and aging depend on the alloy composition of
the Spring Clip

• Clinical relevance
! Inability of the relaxed clip to apply forces due to aging

! Inadequate engagement of the wire into the bracket slot may arise in the
last stages of treatment when rectangular wires are inserted
! Undesirerable outcome on associated mechanotherapeutical schemes


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


Do We Need Fancy Study
to...

• Know that wire ligature takes
time to do and remove


to...


to...

• Know that elastomeric ligature
takes less time to place and
remove than wire ligature but...


to...

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


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

Study Findings - Bond strength after 24 hours

9.73
10,0
8.05

7,5
Mean SBS
5.25
(MPa)
4.47
5,0

2.20
2,5

0
Time SPEED Ormco GAC American

Bracket Type

Source: AJODO - Volume 124, Number 1

Bond Strength - Lab

• Despite it’s smaller base size, the
SPEED appliance demonstrated
statistically signiﬁcant superior
Shear Bond Strength than 4 of the
10,0
9.73
5 brackets tested.
8.05

7,5
Mean SBS
5.25
(MPa)
4.47
5,0

2.20
2,5

0

Bracket Type


Bond Strength - Lab

10,0
9.73
5 brackets tested.

•
8.05
No statistically signiﬁcant
7,5
difference in SBS between the
Mean SBS
(MPa)
5.25
4.47
SPEED appliance and the Time
5,0 bracket.
2.20
2,5

0

Bracket Type


Bond Strength - Lab

10,0
9.73
5 brackets tested.

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

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


LOW FRICTION
Will be discussed later

Plaque retention by self-ligating vs elastomeric orthodontic
brackets: Quantitative comparison of oral bacteria and detection
with adenosine triphosphate-driven bioluminescence
(Am J Orthod Dentofacial Orthop 2009;135:426.e1–426.e9)

• Methods: Patients (ages, 11-17 years) were bonded with SL and E brackets in 14
maxillary and 12 mandibular arches by using a split-mouth design.

! Recall visits were at 1 and 5 weeks after bonding.

• Editor's summary:
! The ﬁndings indicate that self-ligating appliances might promote reduced retention of
bacteria, including streptococci, than appliances with elastomeric ligation.

! Of course, you must assume that this advantage would be lost by placing
elastomeres over the self-ligating brackets.


to...

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


to...

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


to...
• Know that poor oral hygiene
may lead to white spot lesion
• WSL is not related to bracket
systems
• One should focus on reducing
potential damage
! Fluoride rinses, varnishes, sealants & frequent
cleanings


HYGIENE
• What is the difference between these 2 patients?


HYGIENE
• What is the difference between these 2 patients?

This patient brushes his teeth This patient doesn’t!


• Next!


Ligature derived force
Reznikov, N et al, Measurement of friction forces between stainless steel wires and reduced-friction self-ligating brackets, AJODO 2010;
138:330-8

• Depends on ligation mode
! Can be smaller in SLB or greater in conventional systems

• Shear force increase linearly with wire deﬂection relative to the
bracket slot

• Friction resistance is proportional to the grade of the wire
securing elements rigidity and to the extent of wire deﬂection

• Correlation between passive clip design and wire surface
scratching


Reznikov, N et al, Measurement of friction forces between stainless steel wires and reduced-friction
self-ligating brackets, AJODO 2010; 138:330-8

• Some clip ﬂexibility might provide a considerable beneﬁt during
the working stage of the orthodontic treatment, when residual
malalignment of the teeth still persists.

• Either an active clip or an elastomeric module can absorb minor,
clinically undiscernible tooth irregularities and does not hinder
sliding mechanics.

• In contrast, a passive clip demands ideal alignment of the teeth
subjected to a retraction force.


Therefore

Wi.Be.290609 Wi.Be.120809 Wi.Be.250909

• Swinging the teeth on a very small wire

• Few if any friction is involved:
! Passive zone

! No binding

! No notching
Wi.Be.131109 Wi.Be.100510


Benefits of SPEED bracket_Getting to Know the SPEED Appliance

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Benefits of SPEED bracket_Getting to Know the SPEED Appliance