Quad Helix—A Versatile Appliance in Pedodontist’s Arsenal: A Case Series

INTRODUCTION

A well-aligned and disease-free dentition adds to the personality and significantly improves the radiance of a smile. The growth of the craniofacial complex undergoes skeletal, dental, and soft tissue changes from birth to childhood and adolescence along with the transition from deciduous to mixed and permanent dentition. Any imbalance of intrinsic and extrinsic growth factors during this period leads to a discrepancy in occlusion which manifests in form of crowding, spacing, and proclination which warrants either removable or fixed orthodontic therapy.

The Quad Helix appliance, as described by Ricketts in 1975, is a modification of the transpalatal Coffin spring. ^1–4 It has four helical loops, two incorporated in the posterior region and two introduced in the anterior part of the arch. This helps in providing continuous action during expansion because of a greater range of activation provided by the longer wire. ⁵ The appliance is constructed of 0.038″ (0.975 mm) stainless steel wire and soldered to bands that are cemented to the maxillary first permanent molars or the deciduous second molars, depending on the age of the patient.

This case series describes the application of quad helix in multiple clinical scenarios as follows.

CASE DESCRIPTIONS

DISCUSSION

The quad helix may be activated extraorally or intraorally. Extraoral activation is done by opening the helices where activation of anterior helices increases intermolar width and adjusting posterior helices caused lateral arm expansion which counteracted mesial rotation of anterior helices activation. Extraoral activation allows the amount of activation to be clearly seen and is the preferred method despite the extra work involved in removing and recementing the appliance. The intraoral method was criticized by Chaconas and de Alba Levy (1977) in that each bend produced a progressive decrease in the force originally placed in the appliance.

Intraoral activation is made with the triple peak plier by making three bends. The first bend is made in the anterior bridge by placing a single peak lying anteriorly while the second and third bends were made on palatal bridges by placing a single peak mesially on both the posterior bridges. ⁶

In the presented cases, slow maxillary expansion with a quad helix appliance was done using the intraoral activation method. At the end of treatment, normal overjet and overbite were achieved. Adequate dental alignment and leveling, as well as maxillary and mandibular midline symmetry, were also established.

Several complications have been seen with the QH appliance; these included dental tipping, ulcerations at the area of the helix, loose bands, and breakage of the appliance. However, most of the complications are easily avoidable by careful chairside and laboratory practices such as proper band pinching and adaptation, an adequate adaptation of the wire components of the appliance, and an appropriate selection of wire gauges.

REFERENCES

1. Brandt S, Ricketts RM. Interview: Dr. Robert M. Ricketts on growth prediction 2. J Clin Orthod 1975;9(6):340–349,352.

2. Coffin WH. A generalized treatment of irregularities. Paper read to section XII of the international medical congress. Trans Int Cong Med 1881;3:542–547.

3. Talbot ES. Irregularities of the teeth. Philadelphia, PA: P. Blakiston; 1888. pp. 121–125.

4. Friel S, McKeag HT. The design and construction of fixed orthodontic appliances in stainless steel, European Orthodontic Society, Report of the Twenty-Second Annual Congress. London, England: The Dental Manufacturing Company; 1934. pp. 53–84.

5. Bench RW. The quad helix appliance. Semin Orthod 1998;4(4):231–237. DOI: 10.1016/s1073-8746(98)80028-5.

6. Birnie DJ, McNamara TG. The quadhelix appliance. Br J Orthod 1980;7(3)):115–120. DOI: 10.1179/bjo.7.3.115.