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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 2  |  Page : 122-125

Open-coil orthopedic traction spring: An innovative approach for force delivery with face-mask therapy


1 Department of Orthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi (Meghe), Wardha, Maharashtra, India
2 Department of Pedodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi (Meghe), Wardha, Maharashtra, India
3 Department of Endodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Web Publication26-Jul-2013

Correspondence Address:
Pavankumar Janardan Vibhute
Department of Orthodontics, Sharad Pawar Dental College, Datta Meghe Institute of Medical Sciences (Deemed University), Sawangi (Meghe), Wardha - 442 004, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.115689

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  Abstract 

Facemask therapy/reverse pull headgear is the popular method for maxillary protraction in maxillary deficient adolescence cases. Furthermore, various protraction methods and appliances have been developed, and evaluated extensively for their clinical efficiency. Their effectiveness enhanced with optimum orthopedic force magnitude and low-load deflection rate (LDR) and force constancy over a period of time. With the advent of NiTi springs or springs prepared from thinner wires, force decay has been markedly reduced. For use of NiTi, clinician has to depend upon prefabricated closed coil springs, which are expensive. Open-coil orthopedic traction spring (OCOTS) is developed utilizing 0.012" Australian stainless steel wire for orthopedic traction. This paper describes fabrication and clinical application of OCOTS, with numerous advantages. It sustains low LDR with optimum force magnitude. Its design is adjustable for desired length and force level. It is fail-safe for both activation and deactivation (i.e., it cannot be overstretched or over activated, and decompression limit of open-coil is also controlled by the operator).

Keywords: Facemask therapy, open-coil orthopedic traction spring, open-coil orthopedic traction spring, reverse pull headgear


How to cite this article:
Vibhute PJ, Shenoy U, Fulzele P, Bhede R. Open-coil orthopedic traction spring: An innovative approach for force delivery with face-mask therapy. Int J Health Allied Sci 2013;2:122-5

How to cite this URL:
Vibhute PJ, Shenoy U, Fulzele P, Bhede R. Open-coil orthopedic traction spring: An innovative approach for force delivery with face-mask therapy. Int J Health Allied Sci [serial online] 2013 [cited 2019 Sep 21];2:122-5. Available from: http://www.ijhas.in/text.asp?2013/2/2/122/115689


  Introduction Top


A developing class III malocclusion can include maxillary skeletal retrusion, mandibular skeletal protrusion, or a combination of both. [1],[2] Interceptive approaches for correction include, fixed, [3] removable, [4] removable functional, [5] chin cup, [6] protraction headgear appliances, [7] and skeletal anchorage. [8] Maxillary protraction is an emerging paradigm in the early management of skeletal class III malocclusion. Facemask therapy is the popular method for maxillary protraction in maxillary deficiency cases. Open-coil orthopedic traction spring (OCOTS) is developed utilizing 0.012" Australian stainless steel (SS) wire for orthopedic traction. This paper describes fabrication and clinical application of OCOTS, which have number of advantages.

Fabrication

OCOTS is constructed using open-coil-spring made from 0.012" SS wire. Design and fabrication of OCOTS is described by taking into consideration the distance between the anterior (horizontal arm of facemask) and posterior (intraoral) attachment of about 4.5-5 cm.

  1. Using spring-winder of wire-core diameter 1.2 mm [Figure 1], 15 mm closed-coil-spring of 1.2 mm diameter is prepared from the 0.012" SS wire. Then it is stretched apart to make it an open-coil-spring of about 30 mm length, leaving two end-coils in closed position.
    Figure 1: Spring‑winder of wire‑core 1.2 mm diameter, 15 mm long closed‑coil‑spring of 1.2 mm diameter is prepared from the 0.012" Australian stainless‑steel wire. It is then converted to 30 mm open‑coil‑spring leaving two end coils in closed position

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  2. Take two pieces of 0.6 mm diameter SS wires of 8 cm in length as "guide wires (GW)," and prepare a double helix at one end in each guide wire to form "Helical Stop" (HS). Keep plane of "HS" perpendicular to the long axis of guide wire and its diameter approximately equal to that of open-coil-spring lumen [Figure 2]a.
    Figure 2: (a) Two 0.6 mm diameter stainless steel (SS) wires having "Helical Stop (HS)" and a piece of 28 mm open‑coil‑spring. (b) Insert both guide wires (GW) (straight parts) through open‑coil‑spring from both sides (lumen opening) and pass them through the entire lumen coaxially. (c) 1st round engaging hook prepared in one of the guide wire. (d) 2nd round engaging hook prepared in another guide wire at the other end of spring. This will be the posterior side of open‑coil orthopedic traction spring, for engaging the posterior attachment hook on maxillary appliance. (e) Stretching apart of two terminal hooks results compression of open‑coil spring in between the two "HS", which confirms precise insertion of GW through "HS" of opposing GW. (f) Bigger engagement ring made from the thicker (0.8 mm) wire is attached to anterior spring end, which will be engaging horizontal arm of facemask

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  3. Insert both GW (straight parts) through open-coil-spring from both sides (lumen opening) and pass them through the entire lumen coaxially, toward each other [Figure 2]b, and also through "HS" of opposing GW [Figure 2]c. Stretch apart completely penetrated GW of both sides; Compression of open-coil-spring in between the two "HS" confirms precise insertion of GW.
  4. Prepare 1 st round engaging hook in one of the guide wire; while open-coil-spring is not allowed to over compress from its length of 30 mm [Figure 2]c.
  5. Prepare 2 nd round engaging hook in another guide wire at the other end of the spring [Figure 2]d. This will be the posterior side of OCOTS, for engaging the posterior intraoral attachment. Recommended total length between the two hooks of OCOTS at rest position is about 12-14 mm less than distance of intraoral maxillary hook and horizontal bar of the facemask.
  6. Confirm the extent of OCOTS activation with stretching both hooks apart [Figure 2]e. Dontrix gauge is used to measure and confirm orthopedic force of about 400-450 g. Bigger engagement ring made from the thicker (0.8 mm) wire may be attached to anterior spring end, which will be engaging the horizontal arm of the facemask [Figure 2]f.
  7. In modus operandi of OCOTS, when applied for maxillary protraction case, its total length at rest position is about 12-14 mm shorter than the span between the anterior and posterior points of attachments (horizontal bar of face mask anteriorly and molar hook or miniscrew head posteriorly). Forces are generated when compressed open-coil in OCOTS try to decompress while approaching towards its rest position.

  Case Report Top


Diagnosis and treatment planning

A 9-year-old female child was presented with chief complaint of dished in profile [Figure 3]. Her anterior teeth were in crossbite and maxillary left permanent lateral incisor erupted palatally due to over-retained maxillary left deciduous lateral incisor. She had negative overjet and overbite. Cephalometric examination revealed maxillary deficiency. Treatment plan called for immediate anterior maxillary protraction facemask with relieving the reverse overbite. It was decided to use the OCOTS for delivering protraction force.
Figure 3 (a‑f): Pre‑treatment photographic record

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Treatment progress

Maxillary left deciduous lateral incisor was extracted immediately to allow the buccal displacement of palatally erupted permanent lateral incisor. Acrylic plate with posterior bite plane and hooks for protraction were embedded in maxillary [Figure 4]. OCOTS with incorporated open-coil was used for protraction, with force directed forward and downward approximately 30-40° to the maxillary occlusal plane [Figure 5]. The patient was instructed to wear it for 18 h a day. A force of 400 g on each side was delivered by OCOTS attached to hooks on either side of the intraoral appliance in the region of the premolar. Malocclusion of patient was resolved within 18 months without any additional mechanics except only once requiring of increase of bite plane thickness with additional acrylic. Once, positive overjet and overbite achieved, bite plate removal displayed temporary posterior open bite [Figure 6]. After correction of the crossbite and creation of a Class I occlusion, detailing and finishing were undertaken with fixed appliance. Posterior open bite was corrected in few days with normal eruption of premolars and canines. Patient compliance was good in using all appliances and OCOTS during the active treatment.
Figure 4: Maxillary appliance with posterior bite plane and hooks for protraction are embedded in appliance

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Figure 5: (a-c): Maxillary appliance bonded and Facemask with open‑coil orthopedic traction springs in place

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Figure 6 (a‑c): At stage of removal of maxillary appliance with posterior bite plane

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  Results Top


After 24 months of total treatment, patient shows general improvement in the facial profile [Figure 7]. Satisfactory dental alignment, Class I canine and molar relationships, normal overjet, overbite, and transverse relationships was established. There was significant improvement in the maxilla-mandibular relationship [Table 1]. The superimposition shows forward movement of maxillary apical base, increase in lower anterior facial height with opening of the mandibular plane angle [Figure 8].
Figure 7 (a,b): Post‑treatment photographic record

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Figure 8: Cephalometric superimposition

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Table 1: Cephalometric Norms

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  Conclusion Top


OCOTS serves the best alternative for headgear elastics for low-load deflection rate (LDR) and a long range of action required in orthopedic forces. OCOTS provides results similar to those of other with the following advantages.

  1. Low LDR and force constancy over a period of time, while the design is adjustable for length and force level
  2. Design is fail-safe in both ways for activation (Cannot be over activated/overstretched) and deactivation (decompression limit of open-coil can be decided by the operator)
  3. Chair side fabrication is possible and can be sterilized and is more economical.

  Acknowledgment Top


The author would like to thank the patient for providing consent to use her photograph in this article.

 
  References Top

1.McNamara JA Jr. An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod 1987;21:598-608.  Back to cited text no. 1
[PUBMED]    
2.Haas AJ. Palatal expansion: Just the beginning of dentofacial orthopedics. Am J Orthod 1970;57:219-55.  Back to cited text no. 2
[PUBMED]    
3.Gu Y, Rabie AB, Hägg U. Treatment effects of simple fixed appliance and reverse headgear in correction of anterior crossbites. Am J Orthod Dentofacial Orthop 2000;117:691-9.  Back to cited text no. 3
    
4.Seehra J, Fleming PS, DiBiase AT. Orthodontic treatment of localised gingival recession associated with traumatic anterior crossbite. Aust Orthod J 2009;25:76-81.  Back to cited text no. 4
[PUBMED]    
5.Frankel R. Maxillary retrusion in class III and treatment with the function corrector III. Trans Eur Orthod Soc 1970;46:249-59.  Back to cited text no. 5
    
6.Thilander B. Treatment of angle class III malocclusion with chin cap. Trans Eur Orthod Soc 1963;39:384-98.  Back to cited text no. 6
    
7.Nartallo-Turley PE, Turley PK. Cephalometric effects of combined palatal expansion and facemask therapy on Class III malocclusion. Angle Orthod 1998;68:217-24.  Back to cited text no. 7
[PUBMED]    
8.Cevidanes L, Baccetti T, Franchi L, McNamara JA Jr, De Clerck H. Comparison of two protocols for maxillary protraction: Bone anchors versus face mask with rapid maxillary expansion. Angle Orthod 2010;80:799-806.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1]



 

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Abstract
Introduction
Case Report
Results
Conclusion
Acknowledgment
References
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