113J INDIAN SOC PEDOD PREVENT DENT | Apr - June 2010 | Issue 2 | Vol 28 |

CASE REPORT

NiTi bonded space regainer/maintainer

Negi KSAssistant Professor, Department of Orthodontics, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India

Correspondence:Dr. K. S. Negi, Assistant Professor, Department of Orthodontics and Dentofacial Orthopedics, H. P. Government Dental College and Hospital, Shimla, Himachal Pradesh, India.E-mail: docksnortho@yahoo.com

Abstract

Early orthodontic interventions are often initiated in the developing dentition to promote favorable developmental changes. Interceptive orthodontic can eliminate or reduce the severity of a developing malocclusion, the complexity of orthodontic treatment, overall treatment time and cost. Premature loss of deciduous tooth or teeth can often destroy the integrity of normal occlusion. There are many space regaining and maintaining devices mentioned in literature. In this article, I present a simple space regaining method by a piece of nickel titanium (NiTi) wire bonded between the teeth in active loop form, and the unique shape memory property of NiTi wire will upright or move the teeth and the lost space can be regained easily.

Key words

Light cure composite, NiTi wire, space-regainer

DOI: 10.4103/0970-4388.66751 PMID: ****

Introduction

The dental profession is concerned with the prevention and the effective interception of developing occlusion. An important part of preventive orthodontics is the correct handling of spaces created by the untimely loss of deciduous teeth. As more and more people become aware of the importance of the repair of deciduous teeth, this problem is bound to arise less often, but at present it is major one. Unfortunately, some dentists have been guilty of advising patient to disregard the repair of deciduous teeth because they will be lost. Perhaps it is because children are sometimes more difficult to manage, or on a time and fee basis the results are less productive to the dentist.[1]

The space loss

due to premature loss of deciduous teeth, especially deciduous molars, can lead to mesial migration of the first permanent molar, disturb the integrity of arch and may cause the impaction or ectopic eruption of

the second premolar [Figures 1a and b]. Conventional space regainers used, e.g., spring regainer, lip bumper, active lingual bar, extraoral appliances, etc., have disadvantages like:

• Require multiple visits to dental office,• Need band formation,• Complicated laboratory procedures,• Band may effect gingival health adversely,• Possibilities of secondary caries under the band, and• Need patient compliance.

Materials and Methods

NiTi space regainer/maintainer is simple appliance, can be used chairside in a single visit. A composite dimple is bonded on the buccal side of permanent first molar and with the help of an explorer burrow a tunnel into the mesial of dimple, creating a composite tunnel that is open only on the mesial end. A piece of 0.016 inch NiTi wire is then bonded on the buccal side of primary molar/first premolar and extended beyond the dimple [Figure 2a].

After the composite has set on both the teeth with the help of birdbeak plier, the free end of wire is directed into the tunnel made in the dimple of first molar [Figure 2b]. This will give a form of activated loop of NiTi wire [Figure 2]. A small amount of bonding material is placed in the opening of the tunnel to make the attachment more permanent [Figure 2c].

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114 J INDIAN SOC PEDOD PREVENT DENT | Apr - June 2010 | Issue 2 | Vol 28 |

Figure 1: Pretreatment (a) Orthopantomogram (b) photograph showing premature loss of deciduous second molar leading tospace loss

a

b

Figure 3: (a, b) Photograph and orthopantomogram showing NiTi wire regaining its shape, applying light continuous force on fi rst premolar and fi rst molar by drifting them apart from each other or uprighting mesially tipped permanent fi rst molar providing adequate space for the eruption of second premolar.

a

b

Figure 2: (a) Light cure composite dimple i placed on buccal surface of permanent fi rst molar and a small blind tunnel opening on the mesial side is made, and a piece of 0.016 inch NiTi wire is bonded on the buccal side of fi rst premolar. (b) Free end of the wire is inserted into the tunnel forming active loop. (c) Opening of the tunnel is sealed with composite fi lling material.

a

b

c

Over time the loop returned to its original shape due to unique shape memory property of NiTi wire, distalizing and uprighting the first molar [Figure 3a and b]. Once the active correction completes, the wire segment is left in place as a passive space maintainer till the eruption of second premolar [Figure 4a and b].[2]

Advantages of this method are

• The whole procedure can be completed in a single visit at the chair side,

Negi: NiTi space regainer / maintainer

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115J INDIAN SOC PEDOD PREVENT DENT | Apr - June 2010 | Issue 2 | Vol 28 |

Figure 4: (a) After regaining space, wire is left as a retainer till the second premolar erupts. (b) Orthopantomogram showing second premolars erupted in regained space.

a b

• No need of procedures like impression taking, fitting of bands and soldering,

• Better oral hygiene can be maintained as the appliance is self-cleansing and

• Improved patient compliance.

Conclusion

Bonded space regainer using NiTi wire is one sitting effective method of regaining and maintaining space.

Negi: NiTi space regainer / maintainer

References

1. Graber TM. Orthodontics Principle and Practice. 3rd ed.

Philadelphia: W.B. Saunders Company; 1988. p. 637-8.

2. Negi KS. Modified bonded space Regainer/Retainer. Orthod

Cyber J 2007. Available from: http://www.oc-j.com/sept07/

bonded.htm. [cited in 2007].

Source of Support: Nil, Confl ict of Interest: Nil

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