The “ballista spring” system for impacted teeth

doi:10.1016/0002-9416(79)90183-0

American Journal of Orthodontics

Volume 75, Issue 2, February 1979, Pages 143-151

https://doi.org/10.1016/0002-9416(79)90183-0 Get rights and content

Abstract

The ballista spring system is a simplified orthodontic system for treating impacted teeth. The impacted tooth is retracted by a spring that accumulates a continuous force from being twisted on its long axis.

The necessary operation on the impacted tooth is simple and less traumatic. The force exerted on the tooth is vertical, without compressing the impacted tooth toward the adjacent roots. This force is well controlled and easily modified. By the lack of appliance on the front teeth during a great part of the treatment, the esthetic side of the treatment is respected. Complicated impacted teeth in adults can be treated.

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The management of impacted canines: Free physiologic eruption
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There are more references available in the full text version of this article.

Cited by (57)

An Introduction to the systematic evaluation and management of complex malocclusions
2024, Seminars in Orthodontics
The introductory editorial comment succinctly presents different topics related to complex malocclusions covered in this Seminar in Orthodontics issue to inform clinicians on a reasonable path to solve their daily practice challenges. Complex malocclusions should not be underestimated. Many management steps can go sideways and potentially create patient complaints or claims that may raise significant regulatory or legal challenges. Careful steps, multiple interdisciplinary meetings during the planning stage, and continuous interactions within the interdisciplinary team are paramount and a good recipe for success. A continuous informed consent process is critical to remind these patients what is possible, what is working, and what is not developing as planned. At the same time, the outcome is one of the most rewarding experiences for the treating team. The remaining articles in this issue will delve into many details and tips that will help us better treat our complex malocclusion cases.
Management of maxillary impacted canines: A prospective study of orthodontists' preferences
2021, Saudi Pharmaceutical Journal
Citation Excerpt :
Different methods have been invented to pull the impacted canine to its desired position. These methods include the K-9 spring, the ballista spring, the cantilever spring, active palatal arch, elastomeric chains or threads, and piggyback (double archwire) (Fischer et al., 2000, Kalra, 2000, Jacoby, 1979, Becker and Zilberman, 1978, Iancu Potrubacz et al., 2018). The piggyback wire was the most preferable traction method followed by the ballista spring.
Maxillary canines are considered the most commonly impacted teeth, after the third molars. Orthodontists have different preferences on how to approach maxillary impacted canines (MIC). The objective of this article was to investigate orthodontists’ approach to managing MIC.
A cross-sectional study comprising a comprehensive survey with 22 questions was sent to practicing orthodontists. This study explored the preferred diagnostic measures, surgical techniques, materials, and mechanics utilized to manage MIC;104 responses were returned.
Palatal impaction was reported to be encountered more often than labial impaction by 60% of the respondents. In 62% of the respondents, an oral and maxillofacial surgeon was the specialist preferred to perform the surgical exposure. In 66%, the choice of required surgical techniques was reported as a joint decision between orthodontists and other specialists who perform the surgery. Cone-beam computed tomography (CBCT) was reported to be the diagnostic x-ray of choice. The gold button with a chain was the preferred bonded attachment in 86% of cases. Less than half of the respondents bonded the attachments themselves during surgical exposure. A clear plastic retainer was the preferred retainer in 61% of the respondents, and 43% of the respondents tended to use a closed exposure technique. Coe-pak^TM was the preferred surgical pack for orthodontists who prefer an open exposure technique. Piggyback (double wire) was the preferable mechanic to move a palatally impacted canine.
Our findings indicate that there are variations among orthodontists on how to manage MICs in terms of diagnostic methods, surgical management, materials, and mechanics.
Treatment of 2 impacted molars in a large dentigerous cyst (expansile cystic lesion) with combined orthodontic and surgical therapy
2020, American Journal of Orthodontics and Dentofacial Orthopedics
Nonmineralized cysts and cyst-like lesions that frequently occur in the mandible include ameloblastomas, odontogenic keratocysts, and dentigerous cysts. They have specific features of well-demarcated, unilocular, and radiolucent lesions that are often associated with tooth impaction. Although it rarely occurs, these cysts can become extremely large. Furthermore, cyst enlargement causes additional symptoms that can challenge the success of tooth recovery through orthodontic treatment. This clinical report presents the successful eruption of 2 impacted molars in a large dentigerous cyst treated with marsupialization and orthodontic traction using an orthodontic miniplate anchorage over a 4-year treatment period.
Effect of force direction and tooth angulation during traction of palatally impacted canines: A finite element analysis
2020, American Journal of Orthodontics and Dentofacial Orthopedics
Citation Excerpt :
A full constraint was applied on the maxilla (in translation and rotation) superiorly and posteriorly, representing the attachment to the zygomatic, palatal, and sphenoid bones. A traction force of 1.0 N was applied in 3 different force directions (Fig 4, A): a vertical extrusive force simulating the use of a ballista spring8 or a palatal spring anchored over a transpalatal bar12 or a mini-implant11; a distal force reproducing the pull toward a palatal bar or a palatal mini-implant; a buccal force reflecting the direct pull against the archwire.1 The force was applied from the canine at a point on the archwire in the middle of the space defined for the alignment of the canine.
Treatment of a palatally impacted canine (PIC) is associated with demanding anchorage control, increased treatment duration, and undesirable side effects. Accurate PIC localization and force application impact treatment success. The objective of this research was to determine the stresses on the PIC when subjected to initial force activation in various directions (buccal, vertical, and distal) and relative to impaction severity.
Thirty PICs from 21 scans underwent finite element modeling. A prototype 3D model was reconstructed and segmented into its anatomic components. Each PIC was precisely positioned in the prototype model according to impaction position. Stresses in response to a (1.0 N) force in the distal, vertical, and buccal directions were evaluated at different levels of the root (apical, middle, and cervical).
Distal and buccal forces yielded higher stress (6.64 and 6.41 kPa, respectively) than the vertical force (5.97 kPa) on the total PIC root and the apical and cervical root levels, but not at midroot. Statistically significant differences between severity groups were found mostly at the apical level among all force directions, except between distal and buccal forces in the higher severity group. In this group, stress was greatest at the cervical level with the buccal force significantly different from the stresses generated by either the distal or the vertical force.
Vertical forces generated the lowest stresses. Differentially distributed stresses over the root reflected an initial tipping movement. Greater cervical stresses from the buccal force indicate resistance to movement, suggesting treatment initiation with vertical and distal forces over buccal forces, particularly with severely inclined canines.
Influence of impacted maxillary canine orthodontic traction complexity on root resorption of incisors: A retrospective longitudinal study
2019, American Journal of Orthodontics and Dentofacial Orthopedics
The orthodontic traction of impacted canines is a procedure of variable complexity. The objective of this study was to determine the influence of this complexity on the root resorption (RR) of adjacent incisors, using cone-beam computed tomography.
This longitudinal retrospective study included 45 patients (19 female, 11 male; ages, 18.16 ± 7.3 years) with maxillary impacted canines, classified into 2 groups according to the level of orthodontic traction complexity: low complexity group (n = 20) and high complexity group (n = 25). The amounts of RR of 45 maxillary central and 45 lateral incisors were evaluated before and after treatment. Complexity was defined considering impaction sector, eruption inclination angle, and canine position (palatal, buccal, or bicortical). Three orthodontists measured RR in each maxillary incisor. Independent t tests or Mann-Whitney U tests were used to compare resorption between groups depending on the normality of the data. A multiple linear regression was calculated to evaluate the influence of all variables on RR (α = 0.05).
RR of maxillary incisors in the sagittal, coronal, and axial sections showed no significant differences between groups (P > 0.05). Independently of the groups, RR ranged approximately from 1 to 1.5 mm and from 3 to 4 mm². RR was less than 2 mm² in the axial sections. Multiple linear regression indicated no significant influence of orthodontic treatment complexity on RR. Male patients had more RR, specifically in the maxillary central incisors than female patients (P < 0.05).
The complexity of orthodontic traction of impacted maxillary canines is not a risk factor for greater RR of maxillary incisors close to the impaction area.
Root resorption of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage
2018, American Journal of Orthodontics and Dentofacial Orthopedics
The aim of this study was to compare the root resorption (RR) of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage.
This retrospective longitudinal study included 60 cone-beam computed tomography scans of patients with maxillary impacted canines: 30 scans taken before and 30 taken after orthodontic traction with nickel-titanium coil springs. Two groups were formed according to the impaction condition: 15 with unilateral maxillary impacted canines and 15 with bilateral maxillary impacted canines. Three trained orthodontists made the measurements. Demographic variables, occlusal characteristics, skeletal class, and measurements related to canine impaction were collected from the clinical history, dental models, and radiographs of each patient. RR (mm and mm²) for each maxillary incisor was measured in 3 dimensions. Independent t or Mann-Whitney U tests were used, depending on data normality. Multiple linear regression analyses were used to evaluate the influence of all variables (predictors) on RR (α = 0.05).
RR did not show significant differences between groups in any section (P > 0.05). No subject had RR greater than 2 mm or 5 mm². The specific influence of some predictor variables varied depending on the type of maxillary incisor.
RR of maxillary incisors after traction of unilateral vs bilateral impacted canines with reinforced anchorage was similar and is not a risk to the integrity of the maxillary incisor root.

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Original articleThe “ballista spring” system for impacted teeth

Abstract

Am. J. Orthod.

Am. J. Orthod.

J. Am. Dent. Assoc.

Original article
The “ballista spring” system for impacted teeth