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Modified Ballista Spring for Impacted Maxillary Canine

Article · January 2015

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Modern Dental College & Research Centre, Indore, INDIA
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 MODIFIED BALLISTA SPRING FOR IMPACTED MAXILLARY
CANINE
Sharma S*, Bhardwaj A**, Makhija P.G***, Thukral R****

Abstract :

Malocclusions of impacted teeth are not uncommon. Many approaches with auxiliary
springs have been reported till date for the correction of malocclusions. They had
biomechanical, retentive and stability inherent in their designs. This article represents the
innovative approach for orthodontic correction of impacted tooth, especially with light
force appliance i.e: begg’s appliance where round wires are used in round molar tubes
throughout the treatment. This modified spring is fabricated in 0.018 australian stainless
steel wire, which may be anchored on round molar tube and desirable force vector may be
applied in any of the three directions. Fabrication and its clinical application are discussed.

Keywords: auxiliary orthodontic spring, impacted tooth, impacted canine, cantilever spring

INTRODUCTION force6.

The ectopic eruption of maxillary canine is
frequently encountered problem. Lowest
incidence of impacted canine is 0.27%
reported in literature relates to Japanese
population1. In Americans2,3 and israeli4 ,it
is 1.5% while it is highest 7.9% in
Icelandic population5 . Maxillary
caninelast in eruption sequence (except
third molars) is most prevalent due to tooth
size arch length discrepancy (TSDL).
In Begg’s light force appliance, various
methods have been used, including the use
of light wire springs, springs soldered to
the heavy labial or palatal base wire and
mousetrap loops bent in the archwires.
With the use of these methods orthodontist
had no precise control of direction of
* Post Graduate Student
** Professor and Guide
*** Professor and Head,
**** Professor. Department of Orthodontics,
Modern Dental College & Research Centre,
Indore.
NJDSR. Volume 3, Number 1, 2015
Ballista spring7 a unilateral spring made of
round wire and is tied into one of the molar
tube, lacks the versatility in its use.
Seongang used auxiliary wire comprising
0.014 inch Australian Willcock wire8. In
1995, Kornhauser et al used labial spring
auxiliary9. Orton in 1995 used a
combination of the lower removable
appliance and gold chain since this can be
readily fabricated10. Magnets are also
utilized for the correction of impacted
canines11. Bowman and Carano introduced
the Kilroy spring in 2003.13
FABRICATION
A 0.018 inch round stainless steel wire
(Australian), ribbon arch plier, distal end
cutter, scale and marking pencil are needed
for fabrication of this spring2.
Fig. 1: Straight length piece of 8 cm wire
bent to prepare a loop of 1 mm width for
Page 7
keeping one long and one short arm. Fold
5 mm length of loop.
To about 60° with respect to rest of the
wire arms (Fig. 2).
Fig. 2: Loop is folded at 5 mm from its tip
to about 60° with respect to rest part of the
wire.
Fig. 3: Molar buccal adaptation curvature
is prepared in loop. Curvature is limited to
the 6 mm span of wire which later on
forms the stabilizing arms in the spring.
Fig. 4: Bend the long arm to crossover
short arm by about 60° to 70° from the
side of previously folded loop. Therefore,
span between crossover point and 5 mm
loop section is about 6 mm known as
‘molar buccal adaptation curvature’.
Fig. 5: Short retentive arm bent
perpendicular to the middle curved wire
segment (molar buccal adaptation
curvature) toward same side of the
previously folded portion of the loop
NJDSR. Volume 3, Number 1, 2015
Fig.6: a &b
Fig. 7: a &b
CASE REPORT DIAGNOSIS AND
TREATMENT PLAN
A 12 year old boy reported to the
department of orthodontics and dentofacial
orthopaedics with the chief complaint of
forwardly placed upper front teeth and
missing tooth on the right side which was
12mm above occlusal level. Treatment
plan called for extraction of all the 1st
premolars. Position and angulation of
impacted canine was found favourable and
the orthodontic traction of impacted canine
was planned. A bracket was bonded on the
impacted canine and the flap was
repositioned. A ligature wire was attached
to the bonded bracket before repositioning
the flap and its free ends were extended
outside the flap. Modified ballista spring,
made from 0.018 inch Australian SS wire,
was placed on the right maxillary 1st
molar tube. The active arm was set to exert
an occlusal pull of about 2 to 3 ounces.
Hook of the active arm of the MBS
(modified ballista spring) was ligated to
Page 8
the bracket on the impacted tooth with the
ligature wire extended outside the flap.
There was no evidence of soft tissue
irritation, distortion of spring.
Extraoral front and side profile
pictures : posed and smiling
Intraoral pretreatment pictures
NJDSR. Volume 3, Number 1, 2015
Intraoral pictures after 1 month
mo
month
Intraoral pictures after 3 months
mo
A bracket was bonded on the impacted
canine and the flap was repositioned. A
ligature wire was attached to the bonded
bracket before repositioning the flap and
itsmonth
free ends were extended outside the
flap. Modified ballista spring, made from
0.018 inch Australian SS wire, was placed
on the right maxillary 1st molar tube. The
active arm was set to exert an occlusal pull
of about 2 to 3 ounces. Hook of the active
arm of the MBS (modified ballista spring)
was ligated to the bracket on the impacted
tooth with the ligature wire extended
outside the flap. There was no evidence of
soft tissue irritation, distortion of spring.
DISCUSSION
The insertion of the retentive arm of this
spring into the round buccal tube engages
the buccal tube from the cervical, occlusal
and buccal aspect, the elasticity of this
versatile spring causes it to exert a force
Page 9
when it returns to its original/neutral
position, which resultantly applies an
optimum force in a desired direction to the
impacted tooth. Magnitude and vector of
the force exerted by cantilever arm may be
controlled in all three dimensions. Force
level recommended for extrusion of
impacted tooth range from 60 to 75 gm,
which is easily attained with this type of
spring. Force may be adjusted according to
the type of movement required. This
spring has less adverse effects on the
adjacent teeth than the use of continuous
flexible archwires. Furthermore, this
spring can be used even if the
malocclusion is limited to a single tooth,
i.e. this type of spring does not require
fully bonded appliance unless full arch
corrections are warranted, rather treatment
can be carried out without placement of
complete bonded appliance on all teeth
except first molars which are supported
with a transpalatal arch. Adverse forces,
tipping, and torquing movements on
anchor molars may be controlled with a
transpalatal arch between the two molars.
Thus,it has wide range of applicability
with the appliances having round molar
buccal tube of dimensions 0.036 inch ×
0.25 cm.
ADVANTAGES
1. Design of the spring is unique in such a
way that although it is prepared in round
wire and engaged in round molar tube it
does not rotate or destabilize
2. It has wide range of clinical
applicability with the appliances having
round molar buccal tube of dimensions
0.036 inch × 0.25 mm, i.e. Tip edge
appliances, Begg’s appliance and
rectangular buccal tubes
3. Versatility of spring’s unique design
allows it to be used in various conditions
of correcting single tooth malposition in
NJDSR. Volume 3, Number 1, 2015
any arch, e.g. blocked-out canine or
palataly impacted canine or premolar
4. Adverse effects on adjacent teeth are
eliminated because no reactionary forces
exerted on adjacent teeth
5. Light controlled and continuous force is
generated by this spring to work over a
long range of movement to bring the tooth
to desired position
6. Two springs with active arms placed
opposite in direction to each other can be
used for correction of canting of occlusal
plane
7. Its use can be extended for uprighting of
the molars
8. Such type of spring can be removed and
replaced without disengaging the
continuous base archwire
9. More economical than any other
previously reported approach. Spring may
be prefabricated and kept in stock.
Thus, reduce the chairside time while
treating the patient.
REFERENCES
1. Takahama Y, Aiyama Y. Maxillary
canine impaction as a possible microform
of cleft lip and palate. Eur J Orthod
1982;4:275-77.
2. Cramer HC. Dental survey of one
thousand adult males: A study correlated
with physical and laboratory findings. J
Am Dent Assoc 1929;16:122.
3. Mead SV. Incidence of impacted teeth.
Internat J Orthod 1930;16:885-90.
4. Brin I, Becker A, Shalhav M. Position
of the maxillary permanent canine in
relation to anomalous or missing lateral
incisors: A population study. Eur J Orthod
1986;8:12-16.
5. Thilander B, Jacobson JO. Local factors
in impaction of maxillary canine. Am J
Orthod 1968;26:145-68.
6. Bishara SE. Impacted maxillary canines.
A review. Am J Orthod 1992;101:159-71.
Page 10
 7. Jacoby H. The ballista spring system for
impacted teeth. Am J Orthod 1979;75:143-
51.
8. Seong-Sang T. Canine extrusion
auxiliary. J Clin Orthod 1983;17:130-31.
9. Kornhauser S, Abed Y, Harari D,
Becker A. The resolution of palataly
impacted canines using palatal-occlusal
force from a buccal auxiliary. Am J
Orthod 1995;110:528-34.
10. Orton HS, Garrey MT, Pearson MH.
Extrusion of the ectopic maxillary canines
using a removable appliance. Am J Orthod
1995;107:349-59.
11. Vardimon AD, Graber TM, Drescher
D, Bourauel C. Rare earth magnets and
impactions. Am J Orthod 1991;100:494
512.
12. Bowman SJ, Carano A. The kilroy
spring for impacted teeth. J Clin Orthod
2003;37:683-88.
13. Becker A. The orthodontic treatment
of impacted teeth. Martin Dunitz London
2007

Corresponding Author

Shaivi Sharma
P.G final year student
Department of orthodontics and
Dentofacial orthopaedics
Modern Dental college and Research
centre
E-mail-drshaivisharma@gmail.com

NJDSR. Volume 3, Number 1, 2015 Page 11

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