New design space regainers:

'Lingual arch crossbow' and 'Double

banded space regainer'

P Chalakka, AM Thomas, F Akkara, R

Pavaskar
J Indian Soc Pedod Prev Dent 2012;30:161-5
 Introduction
The transition from mixed dentition to a
permanent one is seldom accurate,
hurdles being
– space loss,
– tooth size arch length discrepancy,
– early exfoliation of primary teeth,
– premature eruption of permanent teeth.
When the usual sequence of eruption of
permanent teeth does not occur, it must warn
the clinician of monitoring the arches and
intervening with extractions, space maintainers,
or space regainers.
• This article highlights the use two new design
space regainers, the "lingual arch crossbow" (LAC)
and the "double-banded space regainer" (DBSR).
• LAC can be used on the lower arch if the first
premolar erupts prior to the canine and needs to
be distalized to prevent it from encroaching into
the canine space.
• The DBSR may be used in conventional cases of
interdental space loss.
 Materials and Methods
• 8-year-old boy
• Department of Pedodontics and Preventive
Dentistry
• misaligned teeth
 Teeth Present

16 55 54 53 12 11 21 22 63 64 26

46 84 42 41 31 32 34 75 36

• Space loss for eruption of 33,43,25

 Maxillary arch Mandibular arch

26 54 36

Band 0.006 Χ 0.18 inch 0.005 Χ 0.18 0.006 Χ 0.18 inch

inch
Molar tube 1.1 mm diameter ; 10 mm 1.1 mm diameter; 10
length mm length

SS wire 0.9 mm width 0.9 mm width

NiTi open coil 0.012 mm diameter 0.012 mm

springs 0.045 mm lumen diameter
15 mm length 0.045 mm lumen
10 mm length
1. Pretreatment orthopantomograph
2. Pretreatment orthopantomograph showing mesially migrated 34
3 . Mandibular arch with a noncemented lingual arch before constructing the
space regainer
4. "Lingual arch crossbow"
5 . "Lingual arch crossbow" lateral view
6. "Lingual arch crossbow" - medial view
7 . "Lingual arch crossbow" - intraoral view
8. Mandibular post-treatment left lateral view
After 5 mths, space regained in mandibular arch 4 mm

9. Mandibular post-treatment occlusal view

10. Post-treatment orthopantomograph after distalization of 34
11 . Post-treatment orthopantomograph
12. Maxillary arch showing mesially migrated 26 onto the space of 65 (exfoliated)
13 . Periapical view showing mesially migrated 26 onto the space of 65 (exfoliated)
14 . Components of the maxillary space gainer
15. Maxillary arch showing space regainer on 26 and 64 before
distalization
 After 6 mths, space regained 5.1 mm

16. Maxillary arch showing space regainer on 26 and 64 after distalization

17. Periapical view after distalization of 26
18. Post-treatment maxillary view after removal of space regainer
 Discussion
• SPACE REGAINING:
The process of gaining the space lost by drifting of
adjacent teeth following premature loss of
deciduous teeth/tooth.

• SPACE REGAINER:
A fixed or removable appliance capable of
moving a displaced permanent tooth into its
proper position in dental arch.
• Fixed appliances includes:
1. Open coiled space regainer: Herbst space regainer
2. Jackscrew space regainer
3. Gerber space regainer
• Removable appliances include:
1.Upper & lower Hawley’s appliance with helical spring
2. Hawley’s appliance with split acrylic dumb-bell spring
3. Hawley’s appliance with sling shot elastic
4. Hawley’s appliance with palatal spring
5. Hawley’s appliance with expansion screws
 Following premature loss of a primary molar,
mesial migration of molars and distal drift of
canines occur, and the extent to which these occur
will depend upon the timing of tooth loss,the
severity of crowding, and the actual tooth lost.

• Laing E, Ashley P,Naini FB & Gill DS. Space

maintenance.International Journal of Paediatric Dentistry 2009; 19:
155–162
 The reduction in arch length is more severe in the
maxilla, but there is more distal movement of the
primary canines in the mandible, in the order of 1
mm.

• Rao AK, Sarkar S. Changes in the arch length following premature

loss of deciduous molars.J Indian Soc Pedod Prev Dent 1999;17:
29–32.
 The space regaining procedure that involves
tipping of first permanent molar can be
accomplished more easily in the maxillary arch
than in the mandibular arch.

Textbook of Pediatric dentistry.Nikhil Marwah

• NiTi coils – demonstrate a wide range of super- elastic
activity with a small fluctuation of load in spite of a large
deflection and exhibit small increments of deactivation over
time ,thus reducing the number of reactivation
appointments ( Miura et al.,1988)
• According to the manufacturers, the compression of the Ni
Ti coil to half its length provides approx 200 g of maximal
force and because of small fluctuation of load,inspite of a
large deflection of the coil,the force fell from approx 200 to
180 g as the molars moved distally.

• Bondemark L. A comparative analysis of distal maxillary molar movement

produced by a new lingual intra-arch Ni-Ti coil appliance and a magnetic appliance.
Eur J Orthod 2000;22:683- 95.
 The New lingual NiTi coil appliance was a better choice
than the magnet appliance for maxillary molar
distalization due to the design preventing molar tipping
and its single activation .

• Bondemark L. A comparative analysis of distal maxillary molar movement produced by a

new lingual intra-arch Ni-Ti coil appliance and a magnetic appliance. Eur J Orthod
2000;22:683- 95.
• The amount of distal movement of the maxillary
first molars was significantly higher and more
rapid with the IOA (superelastic NiTi coils) than
the EOA (cervical headgear), with moderate to
acceptable anchorage loss and both only be used
in cases of moderate dental sagittal discrepancies
and arch length discrepancies.

• Bondemark L, Karlsson I. Extraoral vs intraoral appliance for distal

movement of maxillary first molars: A randomized controlled trial. Angle
Orthod 2005;75:699-706
 A favorable time to move molars distally
appears to be the mixed dentition, before the
eruption of the second molars; an efficient
force system to move molars distally is a
continuously acting force.
Movement of the molars is the fastest (at times
exceeding 1 mm/month) and anchorage loss is
the least when compared with treatment after
the eruption of the second molars.

• Gianelly AA. Distal movement of the maxillary molars. Am J Orthod

Dentofacial Orthop 1998;114:66-72.
 From anecdotal reports, an estimate of the
anchorage loss that occurs when moving first
molars distally with NiTi coils in the mixed
dentition is that it will not exceed 2 mm in most
persons when the molars are moved distally 4
to 5 mm. One possible reason for this
observation is that the second molars are not
near eruption.

• Gianelly AA. Distal movement of the maxillary molars. Am J

Orthod Dentofacial Orthop 1998;114:66-72.
When first molars are moved distally in the
late mixed dentition stage of development,
the procedure is 90%+ successful. And molar
correction can be completed within 4 to 8
Months.

• Gianelly AA. Distal movement of the maxillary molars. Am J Orthod Dentofacial

Orthop 1998;114:66-72.
 presented 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.

• Negi KS. NiTi bonded space regainer/maintainer. J Indian Soc

Pedod Prev Dent 2010;28:113-5
 In this case
• In mandibular arch,
– Distal tipping of premolar
– Orthodontic movement of incomplete root- force
to cause resorption or ankylosis
– Distalization of molar might be reqd for 2nd
premolar eruption
– Anchorage loss
• In maxillary arch,
– Anchorage loss
– Distal movement rate
– Distalization better period irt 2nd molar eruption
– Better than Gerber appliance as no tipping
 References
• Bondemark L, Karlsson I. Extraoral vs intraoral appliance for distal
movement of maxillary first molars: A randomized controlled trial. Angle
Orthod 2005;75:699-706.
• Bondemark L. A comparative analysis of distal maxillary molar
movement produced by a new lingual intra-arch Ni-Ti coil appliance and
a magnetic appliance. Eur J Orthod 2000;22:683- 95.
• Gianelly AA. Distal movement of the maxillary molars. Am J Orthod
Dentofacial Orthop 1998;114:66-72.
• Laing E, Ashley P,Naini FB & Gill DS. Space maintenance.International
Journal of Paediatric Dentistry 2009; 19: 155–162
• Negi KS. NiTi bonded space regainer/maintainer. J Indian Soc Pedod Prev
Dent 2010;28:113-5
• Textbook of Pediatric dentistry.Nikhil Marwah
THANK YOU