10.

5005/jp-journals-10021-1151
CLINICAL INNOVATION
Abraham Thomas et al

Bi-Helix Space Opening Spring for

Lingual Orthodontics
1
Abraham Thomas, 2Vinaya Pai, 3Sadegh Birjandi, 4Vishal Nalawade

ABSTRACT

Orthodontists are perpetually challenged with gaining space. In lingual orthodontics, correction of crowding and rotations is even more challenging
compared to labial orthodontics because of the decreased interbracket span. In the present article, the fabrication of a bi-helix spring is
described which can be prepared easily, chairside and effectively creates space in crowded lingual orthodontic cases. The clinical application is
demonstrated in two cases.
Keywords: Lingual orthodontics, Bi-Helix spring, Crowded dentition.

How to cite this article: Thomas A, Pai V, Birjandi S, Nalawade V. Bi-Helix Space Opening Spring for Lingual Orthodontics. J Ind Orthod Soc
2013;47(3):166-168.

INTRODUCTION Fabrication and Activation

Interest in lingual orthodontics has increased recently due to
increase in the awareness of this treatment modality and adult
patients’ desires for a less conspicuous appliance. Lingual
orthodontics, however, presents a few biomechanical
challenges to the orthodontist compared to labial appliances.
According to Scuzzo and Takemoto,1 the interbracket distance
in lingual orthodontics is shorter than the labial appliances.
This shorter wire span translates to lesser efficient coupling
of forces during rotational correction, increased wire stiffness
makes it difficult to engage in lingual brackets in crowded
cases. This makes space creation for alignment of crowded
anterior teeth one of the major challenges of lingual treatment.
Amm Elie2 had introduced an inexpensive, custom-made
auxiliary bi-helix opening spring made from 0.016" SS wire
that can be easily clipped on the archwire after bonding and
engagement of blocked out teeth during the leveling and
alignment stage. Alignment and space opening occurs
simultaneously, thus saving treatment time. Fabrication of the
same spring from 0.016" premium plus Australian wire (AJ
Wilcock, Whittlesea, Victoria, Australia) is demonstrated
which has high resilience which is specially used for auxiliaries
and springs in Begg mechanotherapy.
1. Cut a small piece of wire (about 6-7 cm) from the spool
and straighten the segment using fingers or Delarosa plier.
Make a small helix of approximately 1.5 mm diameter
with a bird beak plier (Fig. 1).
2. After measuring the space needed between the first and
second helices, mark the position of the second helix in
the appropriate location on the wire and bend a second
helix similar to first one (Fig. 2).
3. Mark the legs of the spring with the locations of the bends
that will place the spring at the appropriate height, usually
at the gingival margin.
4. Bend the leg into J hooks and cut off the excess wire ends
(Figs 3A and B).
5. Hook one leg of the spring over the archwire, compress
the spring slightly to place the second leg and then close
the hooks with a Weingart plier (Fig. 4).
6. Further activations may be performed intraorally by
bending the horizontal section between the helices with a
three prong or Tweed loop forming plier.

1
Reader, 2Professor and Head, 3Postgraduate Student, 4Former
Postgraduate Student
1-4
Department of Orthodontics, Bangalore Institute of Dental Sciences
Bengaluru, Karnataka, India

Corresponding Author: Abraham Thomas, Reader, Department of

Orthodontics, Bangalore Institute of Dental Sciences, Bengaluru
Karnataka, India, e-mail: thomasrenju@yahoo.com

Received on: 7/3/12

Accepted after Revision: 16/7/12 Fig. 1: Bi-helix 1st loop

166
 JIOS

Bi-Helix Space Opening Spring for Lingual Orthodontics

CASE REPORTS
Case 1
A 23-year-old female patient presented with Class I bimaxillary
protrusion and lower anterior crowding of 2 mm. An extraction
treatment plan involving all first bicuspids was chosen. Lingual
brackets (Dentos smile lingual brackets, Dentos Co., Korea)
were bonded in both upper and lower arches following the
extractions. In the lower arch, 0.014" nickel-titanium archwire
was placed. Four weeks later, a bi-helix opening spring was
inserted to create space for correction of rotation of tooth 42.
After 2 weeks space opening was evident. Alignment was
completed with 0.016" nickel-titanium wire (Fig. 5).
Fig. 2: Bi-helix 2nd loop
Case 2
A 19-year-old female patient presented with Class II division 1
malocclusion with upper and lower anterior crowding of
6 and 3 mm respectively. A uniarch extraction involving the
upper bicupsids was planned. Lingual brackets (Dentos smile
lingual brackets, Dentos Co., Korea) were bonded in both
upper and lower arches following the extractions in the upper
arch. In the lower arch, 0.014" nickel-titanium archwire was
placed. Four weeks later, a bi-helix opening spring was inserted
for space in relation to tooth 41. After 2 weeks, space was
created and alignment was completed in another 4 weeks with
0.016" nickel-titanium wire (Fig. 6).

Figs 3A and B: Marking for hooks and completed bi-helix spring Fig. 5: Case 1 progress

Fig. 4: Insertion of spring Fig. 6: Case 2 progress

The Journal of Indian Orthodontic Society, July-September 2013;47(3):166-168 167

Abraham Thomas et al
DISCUSSION
Lingual orthodontic mechanics does have limitations
especially in terms of rotational control due to reduced
interbracket span and lingual bracket design. Correction of
rotation and crowding can be problematic especially in the
anterior segment. Open coil springs are used frequently in
conventional labial orthodontics for space opening to correct
blocked out or rotated teeth. 3 Open coils, however, are
difficult to insert and manipulate in lingual orthodontics. They
can also cause unwanted side effects, such as rotations due to
the single wing lingual bracket design. Interproximal reduction
is another popular method for space gaining but the procedure
is invasive leading to loss of the fluoride rich enamel layer.4
This spring with the twin helix design delivers light forces and
is comfortable for the patient. Because of the clip on design,
168
they can be used in combination with round wires without
hampering leveling and aligning process, thus saving time.
CONCLUSION
The bi-helix spring could be an important adjunct to lingual
orthodontics which is economical, easily fabricated at chairside
and effectively creates space with no significant side effects.
REFERENCES
1. Scuzzo G, Takemoto K. Biomechanics and comparative
biomechanics. Invisible Orthodontics: Current concepts and
solutions in lingual orthodontics (1st ed). Germany: Quintessenz
Verlags- GmbH 2003;1:55-60.
2. Amm EW. The bi-helix opening spring for lingual orthodontics. J
Clin Orthod 2010;44(10):617-20.
3. Manhartsberger C, Seidenbusch W. Force delivery of NiTi coil
springs. Am J Orthod Dentofacial Orthop 1996;109(1):8-21.
4. Sheridan JJ. Air-rotor stripping update. J Clin Orthod 1987;21:781-87.