SPEED Paradigm

The four steps to using this self-ligating bracket system

By Sylvain Chamberland, DMD, MSc
elf-ligating appliances were first introduced to the profession in the 1930s by Ford and Boyd.1 Over the next 40 years, many selfligating designs were conceived but none resulted in any clinical or commercial impact. In the early 1970s, G. Herbert Hanson, DDS, began to work on the design of a new orthodontic bracket that would improve operator efficiency and achieve greater precision and control of tooth movement than previous designs had. This led to the release of the SPEED bracket in the early 80s.2 Since then, several modifications have made clinical use easier, but the fundamental design remains unchanged. One of the most significant modifications was the introduction of a superelastic nickel titanium spring clip.3 The clip maintains its stiffness and exerts consistent force on ligated archwires throughout treatment, while clips made of weaker material such as Elgiloy have shown extensive relaxation after use.4 Hansons design also offers the often-overlooked advantage of providing the user with a mix of so-called passive and active archwire interaction. Enhanced cooperation between the bracket and the archwire gives the user full 3D control over rotation, tip, and torque. Any deviation of the bracket position relative to the wire will result in deflection of the spring clip that will then seat the wire into its home position. As with many other systems, precise bracket positioning is very important with the SPEED system. The basic placement principles are the same as with any straightwire edgewise appliance. The orthodontist determines the archwire plane by locating the maximum buccal convexity of the posterior teeth (Figure 1). This plane usually coincides with placing the slot of the bracket 4 mm to 4.5 mm from the incisal edges of the anterior teeth. A more incisal or gingival position of 0.5 mm may

The

Sylvain Chamberland, DMD, MSc

Bracket Placement

Figure 1: Selecting the archwire plane based on maximal buccal convexity.

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be decided accordrectangular NiTi ing to the clinical archwire. crown length. The archwire The user should sequence of this consider two other phase may include parameters when .016 x .022, .020 placing the brackets: x .020, or .020 x the long axis and .025 nickel titathe mesiodistal posinium wire (Figure tion of the bracket. 4). Any significant The long axis of the Figure 2: The long axis is assessed from the lingual for anterior teeth. Mesiodistal bracket-placement placement is on the middle lobe prominence of the teeth. anterior teeth is best errors that become assessed using the lingual and with a panoramic view (Figure apparent should be rectified at this stage before moving 2). A meticulous bonding technique will pay dividends later into heavier stainless steel wires. in terms of efficiency and quality of treatment. This sequence should be followed by a .020 x.025 stainless steel SPEED archwire or .021 x .021 stainless steel Archwire Progression D-wire. The goal would be to enhance torque, achieve A typical archwire progression may be divided into archform coordination, and obtain a flat curve of Spee. four segments: ini3) Tooth transtial alignment, arch lation and retraclevelling and torqution: As mentioned ing, tooth translaabove, en-masse tion, and retraction retraction should and finishing. Each be preceded by a segment of treatment full-dimensional, has different goals rigid archwire. This and thus requires encourages full different wire charexpression of the acteristics. interaction between 1) Initial align- Figure 3: The initial archwire, a .016 Supercable, is left in place for 11 weeks. the superelastic As unraveling occurs, the excess wire extends distally. ment: The preferred spring clip, the archwire at this stage of treatment is .016 or .018 SPEED wire, and the archwire slot. The torque prescription will be Supercable. Supercable contains multiple strands of expressed, and the curve of Spee will continue to flatten. superelastic nickel titanium wire. Regardless of malalignEn-masse retraction is achieved using a dual-geometry ment, Supercable archwire provides 3 to 5 times less force wire (Figure 5, page 24), square in the anterior (.021 x than .014 or .016 solid nickel titanium wire.5 .021) and round in the posterior (.018 or .020). This conThe initial phase of treatment varies significantly from figuration allows full torque control of the incisors durone patient (or malocclusion) to another, but generally it is ing retraction, with significantly reduced friction in the accomplished in 6 to 18 weeks (Figure 3). The added value posterior since the rounded part of the wire will be in the of taking time to align teeth in first and second order is that passive zone of the spring clip/archwire configuration. you might be able to skip a wire in the next phase. When inserted into the arch, E-Links force module 2) Arch leveling: The second phase of treatment (TP Ortho) can be attached to the first or second molars consists of leveling the curve of Spee, coordination of according to the anchorage requirement. The force used the archform, and torquing. This should be done with to close the extraction space is applied above the center

Figure 4: Note archform development from A at 21 weeks to C at 33 weeks. A .020 x .020 heat-activated NiTi wire is engaged 27 weeks into treatment (B) followed by a .020 x .025 SPEED nickel titanium wire 6 weeks later (C).
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brackets prescription, it is necessary to fill the archwire slot. A .021 x .021 or .020 x .025 wire has a torque loss of about 4 to 5, which means effective torque of 6 to 7 in a brackets that is preangulated at 11.8 With this data Figure 5: A .021 x .021 x .018 Dual-geometry wire with reversed curve of Spee and posterior toe-in. If in mind, we can conclude that active in the maxillary arch, the preactivation bend would SLBs with a full-dimensional archwire accentuate the curve of Spee. will express torque earlier than passive SLBs. A torquing moment of at least of resistance of the posterior unit and anterior unit in the 8 to 10 Nmm will be attained, which is enough to torque sagittal view. The previously formed reversed curve of maxillary incisors. Spee creates a moment that will counteract the tipping of Figure 7 shows a situation where the lateral incisors the anterior and the posterior unit toward the extraction are in palatal position relative to the central incisors. site. If you note that the curve of Spee is increasing while Special brackets with 0 of torque were bonded on the closing the space, you should increase the reverse curve or lateral incisors. The canines were retracted and the lateral reduce the force used to close the space. incisors were aligned. A rectangular nickel titanium wire Occlusally, expansion at the molars could occur if was engaged early in treatment to initiate third-order posterior constriction is not incorporated into the arch. In movement of the laterals, while the canines were retracted some situations, extraction spaces close almost spontane- with an elastomeric chain. At 61 weeks, a .020 x .025 ously during alignment and initial torque correction. (See stainless wire was engaged. Note the alignment of the cinthe maxillary arch in Figure 6.) If this occurs and there is gulum of the incisors, showing adequate root movement and torque at this only 2 or 3 mm of stage. Finishing space to close, it can bends and detailing be done with an elasof the occlusion is tomeric chain placed done with a .020 x under the archwire. .025 stainless steel The closure of such SPEED wire. small spaces can be The concept that accomplished on l a r g e - d i m e n s i o n Figure 6: Mandibular arch: .021 x .021 .018 preformed (reversed curve and posterior toe SPEED pioneered in) and E-Links #5 attached from the hook to the first molar. Maxillary arch: .020 x .025 archwires such as stainless steel SPEED wire and elastomeric chain underneath the wire to closed residual 30 years ago is this: .020 x .025 stainless extraction space. no tie wings, no ligasteel and does not tures, single-point require specialty mechanics or archwires. attachment, miniaturization, and full control. This is the 4) Torquing and finishing: Torque expression of paradigm. OP self-ligating brackets (SLBs) have been compared in different studies. Using a .019 x .025 stainless steel wire, Sylvain Chamberland, DMD, MSc, is in private practice in Badawi et al6 found that active SLBs started to expressed Quebec, Canada. He is a diplomate of the ABO. He can be torque at an angle of torsion of 7.5, while passive SLBs reached at drsylchamberland@biz.videotron.ca. start to express the torque at a much higher angle of torsion (15). Morina et al7 found that the torquing moment References for this article can be found with the at 20 of torsion of a .019 x .025 stainless steel wire in a .022-slot bracket is around 8 Nmm for both passive and online version at OrthodonticProductsOnline.com. active SLBs. To take advantage of the tip and torque of the

Figure 7: (A) The initial photo. (B) 45 weeks into treatment, a .020 x .025 NiTi wire is engaged. (C) At 61 weeks into treatment, a .020 x .025 stainless steel SPEED wire is engaged to express 3D control.
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