THE   LINGUAL   BALLISTA   SPRING

Prof .Dr. Julia Harfin , Dr.  Roberto Lapenta and Dr. Augusto  Ureña

www.lingualnews.com Vol 5 No 1 - May 2007

The treatment of impacted canines represents one of  the greatest challenges in our office.
The prevalence is really low  in the caucasian population  but some authors (Dachi , Becker , Oliver , Johnston ) describe that  the frecuency  in women is greater than in  men.

The ethiologic causes were well described  earlier  but we can  highlight  the following ones: 1) lack  of space, 2) supernumerary teeth, 3) non- resorption of the root of the deciduous canine, 4)  tumors  and  dentigerous cysts , 5) trauma, 6) aberration in the normal process of eruption, etc.

The prognosis of treatment results is based on the position of  the canine, root shape and form,  type and height  of periodontal  attachment.,bone height  and type of biomechanics.

The labial “Ballista Spring “ system  was  described  by Dr. Jarry  Jacoby in 1979 and published in the February issue of  the American Journal of Orthodontics .It is a simplified orthodontic system that  delivers a controlled force and can be used  in all type of  patients

Fig 1: JACOBY´S    LABIAL   BALLISTA    SPRING

Fig 2: CLOSE   BALLISTA   SPRING

In this article a new device “THE  LINGUAL BALLISTA SPRING “  will    be described
Taking into account that using the  lingual technique we  use only   a lingual tube  instead of  three as in the labial technique,  we have  to modify the ballista spring.
In these cases it  is recomended to use a self-ligating  tube.

Two different   ballista springs  will be described: a closed and an open one.

In the  “CLOSED  BALLISTA SPRING “ the “molar end “ changes if we are treating a labially or palatally impacted canines.

 Fig 3:  WHEN   THE   CANINE  IS   LABIALLY  IMPACTED  THE  MOLAR  END  IS    OCCLUSALLY  DIRECTED 

Fig 4:  ACTIVATION  OF  THE CLOSE   BALLISTA  SPRING   FOR  LABIALLY  IMPACTED CANINE

The “ molar end “ is a rectangular shaped wire   that wraps around the tube with an extended wirecalled  “antirotational arm “

When the canine is labially impacted,  the  antirotational  wire is occusally directed and  when  the canine is palatally  impacted,  it  is gingivally  directed as you can observe  in this following photograph. The  period of activation depends on each patient but  a 6-week  period is highly  recommended.  
 

Fig 5:  WHEN   THE  CANINE   IS  PALATALLY  DISPLACED THE  MOLAR END  IS     DIRECTED TO THE PALATE

Fig 6: LABIAL  AND  PALATAL  OPEN BALLISTA  SPRINGS

The most important advantage of  the OPEN  BALLISTA   SPRING is  that   we can use  a  normal  tube , not a self ligating  one.
It has a mesial omega loop  .   It´s position   depends  on  the  location  of  the  canine .
This omega loop   acts as a rotacional arm.
If the canine is labial the omega loop has to be  behind    the  hook  as   we   can   observe in  the  following  picture, but  if  the canine  is  palatally   displaces  the loop   has  to  be directly  in front   of the molar tube  as  you  can  see  in the  next    picture

 Fig 7: WHEN    THE    CANINE   IS    LABIALLY    IMPACTED   THE   OMEGA  LOOP  IS  LOCATED  BEHIND  THE    HOOK

Fig 8: WHEN    THE    CANINE   IS    PALATALLY   IMPACTED   THE   OMEGA  LOOP  IS  LOCATED  IN  FRONT   OF    THE    HOOK

Fig 9:  Here we can observe the abscense of  the  upper right  canine and  the crossbite position of the central and lateral right  incisors

Fig 10: The abnormal position of the upper right canine is confirmed  in the panoramic radiograph

Fig 11:  A   CLOSED  LINGUAL  BALLISTA  SPRING  is considered effective for this patient . A labial  bracket  is  bonded to the upper right canine  in order to improve  its eruption .  Special  consideration  to the gingival  tissues is important

Fig 12: This is the situation 3 months later 

.

Fig  13:  At  this moment, the closed lingual ballista spring  is removed and an open coil spring is placed  to obtain  the adequate  space for the canine .

  Fig 14:  When  the correct space  is achieved and before the canine bracket is bonded on  the  palatal side,   some  gingival  esthetic  surgery  is  performed

Fig 15: This is the situation  4  months  later  The canine is nearly in its final position.
 Esthetic brackets , with  a  steel  slot ,  on the lower teeth  are used to  reach a normal occlusion

Fig 16: These are  the  results at  the end of  the treatment. Normal gingivoperiodontal  tissues are achieved.

Fig 17: Comparison of the smile pre and post-treatment The  middle line  , the  overbite  and  overjet  were  normalized

Fig  18: Comparison pre and post  treatment. Looking at the canine and at the gingivoperiodontal  tissues it is difficult to determine if  the  impacted canine was treated with the  labial or  lingual  technique.

The following patient is a 22 year old patient. She was  worried  because her right upper deciduous canine began to move and she was looking for a second opinion about the best solution  for her problem.
The  first  doctor suggested the extraction of the temporary canine, the canine that has a palatal displacement, and  its replacement by an implant.
   

Fig 19: The patient presents Class I molar and canine on the left side and Class I molar on the right side. Overjet  and  overbite are normal 

Fig 20: The palatal displacement of the  canine is confirmed on the panoramic radiograph. No other significant alterations are visible

Fig  21:  An open ballista spring was used in this patient. The total eruption of the canine on the palatal side is recommended before the beginning of the labial activation

Fig 22:  A close look of  the open lingual ballista spring is shown

Fig 23:  Alter 6 months a segmental arch is performed in order to vestibulize the upper canine. The deciduous canine  was  extracted one  month earlier.

Fig 24:  Buccal and palatal view of the canine two months later. The gingiva-periodontal tisues are nearly normalized.

Fig 25: The crown of  the canine has reached its place in the arch and a  0.0175”  x 0.0175  TMA  wire is recommended as a  finishing arch.

Fig 26: The objectives were reached at the end of the treatment  The canine is in place and  the gingival -periodontal tissues are totally normalizad. Overjet and overbite are  normal too.
The achievment of a normal occlusion is an important goal.  A fixed flexible wire is usd as a retention for  long  periods of  time.

CONCLUSIONS

THE   “LINGUAL  BALLISTA  SPRING”   IS  A  SIMPLIFIED  ORTHODONTIC SYSTEM   FOR  TREATING  LABIALLY  AND  PALATALLY IMPACTED  CANINES.

THE   REASONS  THE  USE  OF  THE  “LINGUAL  BALLISTA  SPRING “  IS STRONGLY RECOMMENDED, ARE: 

1) IT IS EASILY  CONSTRUCTED
2) IS    INDEPENDENT   FROM   OTHER   PARTS  OF  THE   APPLIANCE
3) THE  SPRING PROVIDES   A   WELL   CONTROLLED  CONTINUOUS  FORCE
4) THE     FORCE    PERFORMED  ON   THE  TOOTH    IS  VERTICAL   WITHOUT COMPRESSSING  THE IMPACTED  TOOTH  TOWARD THE   ADJACENT  ROOTS
5) IT   IS  EASILY  MODIFIED
6) AS IT BECOMES TANGENT  TO THE  MUCOSA,   IT DOES  NOT DISTURB THE  TONGUE

www.lingualnews.com 
Adult and Lingual Orthodontics
EDITORS:
Dr. Silvia Geron D.M.D., M.Sc
Dr. Rafi Romano D.M.D., M.Sc
Dr. Pablo Echarri D.M.D., M.Sc