Part I-Management of Class II Malocclusion with SPEED Appliance Part I

©Dr Sylvain Chamberland

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Management of Class II Malocclusion with SPEED

AppliancePart I


Clinical case presentation

• Class II div 2

• Class II div 1

• Pendulum Appliance

• Forsus

• Crossbow appliance and Forsus class II corrector

©Dr Sylvain Chamberland 3

Cl II div 2

# 2- Ém. Ma.


• RPE. Distallize 6|6

• Decompensation 1|1, Level Md curve of Spee

É.M. 13a10m; 10-03

É.M. 14a3m; 04-04


É.M. 12-03 É.M. 4-04

É.M. 06-04 É.M. 01-05 É.M. 06-05


• Note hook toward occlusal plane

! Reduce vertical component of distallizing force

Em. Ma 06-04

Em. Ma 11-04


Em. Ma 01-05

Em. Ma 03-05: Reassessment of bk position

Em. Ma 05-05:


É.M. 06-05

É.M. 02-06

Em. Ma 08-05:


SNA = 79 78

SNB = 73 73,5

ANB= 6 4,6

ABOP = 5 2,4

FMA= 20,4 20,3

ANS-Me=51 56

1/SN = 70 99

1/1 = 175,4 128,6

/1-PM= 86 101,5


• 2 years into retention

Em. Ma 02-08,


Cl II div 1

# 4- Vi. Ga.


• Cl II div 1

• Bimaxillary protrusion

• Mesially rotated 1st molar

Vi.Ga. 15-04-08


• Proclined Mx & Md 1/1


• At 7 months

! .020x.020 neost/ .19x.25 resolv

! Chain 6-5-4 | 4-5-6 + cl II elastic

Vi.Ga. 09-12-08

TPA helped to derotate the molars, change the arch form and obtain class I molar relationship


• At 10 months

• Reassessment of bk position 15, 13, 12

Vi.Ga. 19-02-09


• 21x21x20 enmasse ret + Class II elastic at occlusal plane

• Class 1 E-links; md: 20x25 nitisw

Vi.Ga. 12-05-09 at 13 months

Vi.Ga. 25-08-09 at 16 months


Vi.Ga. 25-06-10 tx time: 113 weeks

Note 1st molar derotation


Vi.Ga. 25-06-10 at 113 weeks


Cl II div 1

# 5- Jo. Si.


• Mesially rotated 1st molar

Jo..Si. 27-02-08



• Molar derotation with TPA

• Class I relationship achieved

Jo..Si. 25-11-08


Jo..Si. 28-01-09

• At 10 months: Finishing

• At 13 months: more finishing

Jo..Si. 28-03-09


• Tx duration 15 months (62 w.)

Jo..Si. 01-06-09




Cl II div 1

# 6- Gu. Ma.


• Class II div 1

• Constricted maxilla

Gu.Ma. 0707


• Forsus spring-rod (insertion April 07)

! RPE

! Md + Mx: .019 x .025 SS cinched distal /7’s

! Loops distal /3’s

Gu.Ma. 0708


• Offset bend

Tricks


• At 5 months: removal of RPE and Forsus

• Molar distallization 6’s/

• Anterior proclination

Gu.Ma. 0908


• Bone deposition lamina dura


• Palatoversion de 1/

• Proclination /1

• Lip incompetency



• Mx: .020 x .025 SW + ART

Gu. Ma 01-09

Gu. Ma 04-09


Gu. Ma 01-09

Gu. Ma 06-09


• Finishing bend 11, 21

• Note expansion of buccal segment

Gu. Ma 23-06-09

Gu. Ma 21-05-09


• Tx duration: 25 months

Gu. Ma 29-09-09



• Favorable growth occurred

• Adverse side effect relapsed

• /1 inclination maintained


• He's happy!


Gu.Ma.250811

99 weeks into retention


Cl II div 1

# 7- Sh. La.


• ♀, 12 a. 5 m.

• Cl II div 1

La.Sha 0807


• Md retrusion, SNB = 5°, ABOP = 6,5 mm

• Md dento-alveolar retrusion


• Post-expansion

• Forsus inserted

! Note:

! Occlusal rest on 7’s

! Engaged 17 & 27 on the archwire

! Posterior cinch

La.Sha 1007


• Labial tipping of lower incisors

• Distal drift of 6’s

La.Sha 0308


• Lower buccal segment moved mesially

• Upper buccal segments moved distally



• 5 months: Xbow

• Hyrax impingement

• Md buccal segment tipped mesially

• Cl III molar relationship

La.Sha 0308


• Mx: .019 x .025 resolve

• Md: .016 neost, rebond 35

La.Sha 0608


• 12 months into treatment

• Mx: .021 x .021 x .020 SW en masse retraction

• Md: .020 x .020 neost

La.Sha 0908


• At 18,8 months

• Mx & Md: .020 x .025 SW

! Arch form coordination, torquing & finishing

La.Sha 0309


• Torquing arch ART and finishing bend

La.Sha 0309

La.Sha 13-04-09


La.Sha 13-04-09

• Finishing bend

• Note expansion side effect at 1st molar

! Crown buccal-root lingual cause by intrusive force at the attachment point:

! Use a TPA or cut the wire and let it relapse

La.Sha 26-05-09

Lindauer et al, Semin Orthod 2001;7:207-214.)


• Tx duration = 23 months

La.Sha 26-05-09

La.Sha 26-08-09



• Mx incisors retraction occurred

• Torque was maintained

! ART + full dimensional archwire + Speed

• Severe lower incisors proclination returned to normal value


• She's happy!


• 82 weeks into retention

La.Sha 22-03-11

La.Sha 0807


Cl II div 1

# 8- M.-P. Ga.


• Cl II div 1

• Proclined 1/

• Retroclined /1

• Impacted 23

Ma-Pi.Ga.0508 11y 5 m


Ma-Pi.Ga.0508


Tx plan

• Goals

! Retract 1/

! Procline /1

! Achieve cl I molar and canine

• Tx mechanics:....?


• /1 proclined

• 1/ retroclined

• 6/ distalized

• #23 is erupting (through mucosa!!!)

Ma-Pi.Ga.1108

•5 months into treatment: RPE + Forsus Xbow removed


• Delayed eruption of #35 & 45 is expected

• Pr: exo #75 & #85

Ma-Pi.Ga.1108


Ma-Pi.Ga.0109

Ma-Pi.Ga.0409

• Lack of keratinized gingiva #23 buccal

Ma-Pi.Ga.0609

• At 12 months: class I relationship is achieved


At 14 months

• Reassessment of brackets position

! #12 & #22 to be rebondedMa-Pi.Ga.0609


• Tx time = 119 weeks

• Narrow band of keratinized gingiva is noted #23 buccal

Ma-Pi.Ga.0910


Ma-Pi.Ga.0910


• Growth expressed vertically

• Mandibular dentition mesialized

• She's happy


Cl II div 1

# 9- Al. Du.


• Cl II div 1

• Severe ALD

• Impacted 23

Al.Du.0608


Al.Du.0608


Tx Planning

• Goals

! Achieve cl I molar relationship

! Obtain intra-arch symmetry

! Maintain /1-MP AP-wise

! Retract 1/


• Voussure vestibulaire

• Incision

Al.Du.0109

Al.Du.0209


• Incision sulculaire et sommet de la crête

• Incision de relâche au distal

! Préserver tissu kératinisé


• Rugine pour

! Décoller lambeau périosté

• Farabeuf

! Relèvement du lambeau


• Canine exposée

• Enlèvement du sac folliculaire


• Mordançage

! Self etching primer (ESPE)

• Collage du bouton

! Transbond XT


• Ligature métallique

• Activation sur l’arc


• Fermeture du lambeau

Merci au Dr Michel Fortin


• Guérison à 14 jours post op

! Absence de cicatrice

! Réactivation de fil de traction Du.Al. 18-02-09


• Guérison ~ 2 mois

! Excellente bande de gencive kératinisée

! Absence de cicatrice visible

Du.Al. 01-04-09

Du.Al. 05-07-10


Al.Du.0409

Al.Du.0209

Al.Du.0509


Al.Du.0809

• Note Class I E-links module• Note iatrogenic cant of the occlusal plane• Forsus modules = 4 months

Al.Du.1209


• Tx time = 104 weeks

• Arch symmetry achieved

• Class I molar and canine relationship

Al.Du.0710



• 1/-MP maintained

• /6 protracted

• 1/-SN retracted, maintain torque

Health & Medicine

Part I-Management of Class II Malocclusion with SPEED Appliance Part I