August’s Tip

In this IAO Monthly Tip I will review simple application of Helical loop – space maintenance with protrusion and retrusion of anterior teeth.

Protrusive Space Maintainer – lengthens the dental arch

            In a situation in which the incisors are too vertical (i.e., Angle division 2) the orthodontic practitioner may desire to procline them (to create a labial moment).  A good solutionin this given scenario is to fabricate a Protrusive space maintainer.

Protocol:

1. Do not Lace back the anterior teeth until the desired proclination is achieved
2. Fabricate a .018 SS space maintainer 2.5 mm in front of the slot of the incisor brackets. Two helical loops are abutted to the molar tubes.  Tie the arch wire to the brackets.
3. Heat treat (anneal) the ends of the arch wire and bend-back (cinch)

Retrusive Space Maintainer – shortens the dental arch

If the incisors are too proclined (i.e., Angle division 1), the orthodontic practitioner may desire to retrocline them (to create lingual moment).  A good choice is to fabricate a Retrusive space maintainer.  The lingual moment can only materialize, if there is adequate space (i.e., diastema, open contacts, loose contacts) to de-torque.  This issue comes up often with our course participants.

Protocol:

1. Lace back the anterior teeth, alternatively, the clinician may place an elastomeric chain
2. Fabricate a .018 SS space maintainer with two Helical loops 5 – 7 mm in front of the molar tubes. Tie the arch wire to the brackets. 
3. Heat treat (anneal) the ends of the arch wire and bend-back (cinch)
4. Place two links of elastomeric chain from the molar hook to the helical loop.  Change this elastomeric chain every two weeks

References

1. Ellchiro Nakajima, Manual of Wire Bending Techniques; 22 – 23
2. Rondeau Seminars, Case Finishing manual; 121,