Quad-helix Appliance Research Articles

Effect of three different maxillary expansion appliances on root resorption

Aim: The study was to examine rapid maxillary expansion (RME), semi-rapid maxillary expansion (SRME), and slow maxillary expansion (SME) compare the root resorptions occurring in the supporting upper first premolar teeth during treatment by using micro-computed tomography (micro-CT). Methodology: Thirty individuals that required maxillary expansion and upper first premolar tooth extraction were divided into three groups consisting of 10 individuals for RME, SRME, and SME. RME group, first premolar and first molar teeth with hyrax screw were activated ¼ tour twice daily with the banded hyrax appliances. SRME group, acrylic-bonded hyrax appliances were activated ¼ tour per morning and night until the opening of the suture. Upon the opening of the suture, it was activated ¼ tour per every two days until sufficient maxillary expansion was gained. SEM group, quad helix appliances were activated every 20 days. After 12 weeks of the retention period, the upper first premolar teeth were extracted. The teeth were scanned with Micro-CT (SkyScan 1172, Kontich, Belgium), and images were analyzed with a Dell Precision T5500 to determine the resorption crater volumes. Results: In all samples, the resorption craters were concentrated on the buccal surfaces of the tooth roots. The highest resorption craters volume, the total resorption volume, was observed in the RME group, followed by the SRME group, and the least resorption crater volume was detected in the SME group. Conclusion: Since the supporting teeth were exposed to more force on the root surfaces, the most resorption was seen in the RME group. How to cite this article: Topal R, Gündüz Arslan S. Effect of three different maxillary expansion appliances on root resorption. Int Dent Res 2023; 13(1):19-26. https://doi.org/10.5577/idr.2023.vol13.no1.4 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Comparison of alveolar bone thickness and height after slow expansion using quad-helix or clear aligners

ObjectiveThe study was conducted to investigate the thickness and height of the alveolar bone of individual teeth after slow maxillary expansion (SME) with quad helix or clear aligner appliances and hypothesized that there is no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. Material and MethodsThis is a retrospective study; the records of 22 patients treated between December 2019 to April 2020 by dental arch expansion using either clear aligners or quad helix appliances were retrieved and studied. The results obtained through cone beam computed tomography (CBCTs) before and immediately after maxillary expansion (2 + 1 mm per side) were analyzed (11 in the Quad Helix group and 11 in the clear aligner). The data collected was analyzed using linear and angular measurements obtained through On-demand 3D App software. Furthermore, Statistical Package for Social Sciences (SPSS) version 25.0 was used to present the findings by mean and standard deviations, and Scheffe’s test was applied for comparing forces. ResultsThe results showed that the mean age of patients in the clear aligner group and Quad Helix was 16.27 ± 0.56 years and 15.5 ± 1.53 years, respectively. There was no difference in buccal alveolar bone thickness or heights in patients treated by either quad helix or clear aligners. This is due to the findings that suggest that there was a decrease in bone height and bone width when treated with a quad helix as compared to clear alignment. ConclusionIt can be concluded that the quad helix SME treatment affects alveolar bone integrity; therefore, clear aligners might be better for treating patients than the quad helix.

Rapid maxillary expansion vs slow maxillary expansion in patients with cleft lip and/or palate: a systematic review and meta-analysis.

To compare the dentoalveolar outcomes of slow maxillary expansion (SME) and rapid maxillary expansion (RME) used for maxillary expansion before secondary alveolar bone grafting in patients with cleft lip and/or palate (CL/P). Secondarily, the advantages and disadvantages of SME vs RME were reviewed. A systematic search was conducted up to November 2021, including Medline (via PubMed), Embase (via Ovid), Web of Science, Cochrane Central, and Google Scholar. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Risk-of-bias assessment was performed using the Risk of Bias (RoB 2.0) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS I) tool. Overall quality was assessed using the Grading of Recommendations Assessment, Development, and Evaluation tool. Of 4007 records, five studies met the inclusion criteria. The randomized control trial (RCT) had a low risk of bias, the non-RCTs presented with a moderate risk of bias. Arch width and perimeter increased significantly with both SME and RME treatments. No difference in the increase in palatal depth was found. The meta-analysis showed a greater anterior-to-posterior expansion ratio for the Quad Helix (QH) appliance. The results for dental tipping were not conclusive. SME and RME promote equal posterior expansion in cleft patients. The anterior differential expansion is greater with SME (QH appliance). No clear evidence exists concerning the amount of dental adverse effects of SME and RME in cleft patients.

Correction of a prominent premaxilla in a juvenile with a bilateral cleft lip and palate using a novel, hybrid function regulator, the FR-BCPPm, followed by preadjusted fixed appliances: A 20-year follow-up.

A seven-year-old boy with a repaired bilateral cleft lip and palate, presented with a severe skeletal II base and an extremely prominent premaxilla. He had grossly incompetent lips with lower lip trapping, an 18.5-mm overjet, a deep overbite, markedly retroclined lower incisors, bilateral crossbites and 12-mm-wide alveolar gaps together with 6-mm vertical steps between the extruded premaxillary incisors and the posterior teeth. Before the eruption of the permanent canines, there was an urgency to approximate the opposing cleft alveolar margins and to level the split maxillary occlusal plane, in order to facilitate the successful insertion and subsequent consolidation of secondary alveolar bone grafts.A new functional appliance was therefore designed to achieve this objective, which drew components from Fränkel's FR I and FR III function regulators. Together with a couple of novel components, it created a hybrid appliance, namely the function regulator for juveniles with a bilateral cleft and a prominent premaxilla: the FR-BCPPm.The patient was treated with this appliance and a nocturnal headgear at 7-13 years, together with a concomitant quad helix appliance followed by a transpalatal arch and bilateral bone grafts. He was then treated non-extraction up to the age of 17 years with preadjusted fixed appliances to correct his residual, crowded Class II malocclusion.The marked improvement in his occlusion, dentofacial appearance and his perioral function after a decade of treatment was then followed up over 20 years, during which time mild relapse of the incisor overjet and moderate recurrence of the lower anterior misalignment was noted two years after treatment.While no further relapse was observed at the four-year post-treatment review, by 20 years after treatment, a little further misalignment of the lower anterior teeth was noted, half of which was deemed to be attributable to age-related maturation.

Intercenter comparison of slow and rapid maxillary expansion in unilateral complete cleft lip and palate.

ABSTRACTObjective: The aim of this study was to compare the occlusal changes of rapid maxillary expansion (RME) and slow maxillary expansion (SME) in patients with unilateral complete cleft lip and palate (UCLP), by means of digital dental models. Methods: Group RME was composed by 22 patients (13 males and 9 females), with mean age of 9.9 years, treated with rapid maxillary expansion with Hyrax appliance in Center 1. Group SME was composed by 29 patients (14 females and 15 males), with mean age of 10.7 years, treated with slow maxillary expansion with quad-helix appliance in Center 2. Digital dental models of the maxillary dental arch were obtained immediately pre-expansion (T1) and 6-month post-expansion (T2). Transversal distances, arch perimeter, arch length, palatal depth, palatal volume and posterior tooth inclination were digitally measured. Interphase and intergroup comparisons were performed with paired t-test and independent t-test, respectively. Results: Intercanine expansion was 4 to 5mm in both groups, and increase in the intercanine distance was similar for both groups. RME group showed a greater increase in arch distances at the region of permanent premolar and molars, compared to SME group. Arch perimeter increase was greater for RME group, compared to SME. No differences were found for arch length, palatal depth, palatal volume and posterior tooth buccal tipping. Conclusion: RME and SME produced similar dentoalveolar outcomes, with greater amount of expansion on RME group.

An RCT on clinical effectiveness and cost analysis of correction of unilateral posterior crossbite with functional shift in specialist and general dentistry.

To evaluate the costs of quad-helix (QH) and removable expansion plate (EP) treatments performed either in specialist or general dentistry for the correction of unilateral posterior crossbite with functional shift in the mixed dentition. Four-arm parallel group multicentre randomized controlled trial. One hundred and ten patients with unilateral posterior crossbite with functional shift were recruited. The patients were randomized by an independent person not involved in the trial. The randomization used blocks of 20 and into the following four groups: QH treatments in specialist orthodontic clinics (QHS), QH treatments in general dentistry (QHG), EP treatments in specialist orthodontic clinics (EPS), and EP treatments in general dentistry (EPG). Blinding was accomplished of the outcome assessor and data analyst. A cost analysis was performed with reference to intention-to-treat (ITT), regarding direct costs, indirect costs, and societal costs (the sum of direct and indirect costs) for calculations of successful treatments alone and for retreatments when required. To determine which alternative has the lower cost, a cost-minimization analysis was undertaken, based on that the outcome of the treatment alternatives were broadly equivalent, so the difference between them reduces to a comparison of costs. In the QHS group, 28 of 28 patients were successfully corrected compared to 23 of 27 in the QHG group. Treatment with expansion plate was less successful: 18 of 27 patients in the EPS group and 18 of 28 in the EPG group. QH treatment performed in specialist orthodontic clinics had significantly lower costs than QH or EP treatment accomplished in general dentistry as well as EP treatments in specialist orthodontic clinics. Costs depend on local factors and should not be directly extrapolated to other locations. Treatment of unilateral posterior crossbite in the mixed dentition is recommended to be performed by a specialist orthodontist using the QH appliance. The trial was not registered.

Cephalometric evaluation of rapid and slow maxillary expansion in patients with BCLP: Secondary data analysis from a randomized clinical trial.

To compare the dentoskeletal effects of rapid (RME) and slow (SME) maxillary expansion in patients with bilateral complete cleft lip and palate (BCLP). This was a secondary analysis of a previous randomized controlled trial (RCT). Forty-six patients (34 male, 12 female) with BCLP and posterior crossbite (mean age of 9.2 years) were randomly assigned to two study groups. Group RME comprised subjects treated with Haas/Hyrax expander. Group SME included patients treated with quad-helix appliance. Cone-beam computed tomography (CBCT) was performed before expansion (T1) and after appliance removal at the end of a 6-month retention period (T2) for a previous RCT that compared the transverse skeletal effects of RME and SME. CBCT-derived cephalometric images were generated and cephalometric analysis was performed using Dolphin Imaging Software (Chatsworth, Calif). Intergroup comparisons were performed using t tests (P < .05). Baseline forms were similar between groups. No significant differences between RME and SME groups were found. Rapid and slow maxillary expansion produced similar sagittal and vertical changes in patients with BCLP. Both Haas/Hyrax and quad-helix appliances can be used in patients with vertical facial pattern. Clinical relevance: RME and SME can be equally indicated in the treatment of maxillary arch constriction in patients with BCLP.

Periodontal side effects of rapid and slow maxillary expansion: A systematic review.

To identify the scientific evidence that demonstrates which of the transverse maxillary treatments has the least effect on periodontal tissues. PubMed (MEDLINE), Cochrane Library, Scopus, Web of Science, Virtual Health Library, Google Scholar, and OpenGrey were searched without restrictions. A hand search was also carried out in the reference lists of the articles selected. The related articles tool in the PubMed database was checked for each article included. Risk of bias assessment was performed using Cochrane Collaboration's Risk of Bias tool for randomized clinical trials and the ROBINS-I tool for nonrandomized studies of interventions. The GRADE tool was used to assess the quality of the evidence. After examination of the full texts, three studies were finally included. Two studies used a Haas expander with different protocols, and one study used a Haas expander compared with a quad-helix appliance. These studies evaluated periodontal parameters and periodontal indices by clinical examination with a millimeter probe, and one study examined computed tomography images. After quality assessment, two studies were considered as having a "low" risk of bias. One study was scored as having a moderate risk of bias. The evidence was graded as moderate quality for alveolar bone level, tooth displacement, and inclination and very low for all other outcomes. There were no significant differences to enable a sound conclusion about which type of maxillary expansion has the least periodontal side effects.

Corticotomy-assisted slow maxillary expansion with bone allograft assessed with cone beam computed tomography in young adults

Introduction: There is low evidence regarding the effect of slow palatal expansion in the treatment of bilateral posterior cross-bite. In adults the treatment had always been directed to surgical maxillary expansion. Therefore, this study aimed at evaluating corticotomy-assisted slow palatal expansion using cone beam computed tomography (CBCT). Subjects and Methods: The study included six females, 19-20 years old, with bilateral posterior cross-bite and Class III malocclusion. CBCT was taken pretreatment (T0), immediately post-expansion (T1) and three months following the end of orthodontic treatment (T2). Four banded quad-helix appliance assisted with buccal corticotomy and bone allograft was used for expansion. The expansion was activated every two months. Fixed orthodontic appliance was performed to continue the treatment of the cases. CBCT was used to measure and record amount of expansion and tipping of premolars and first molars. The bone fenestrations were also recorded as scores. Data were statistically analyzed. Results: The bilateral posterior cross-bite was treated in 8.5 months. The amount of expansion increased significantly from T0-T1; 5.58±0.77mm, yet it was non-significant from T1-T2; 1.16±0.34mm. There was a significant increase in mean tipping angle from T0-T1 without a significant increase from T1-T2. Regarding buccal bone fenestrations, there was a significant increase from T1-T2 (1.59±1.19,1.79±1.18mm respectively). An inverse correlation was found between bone fenestration and cervical and middle buccal cortical bone thicknesses at T1 and T2. Conclusions: Corticotomy-assisted expansion with quad-helix was an efficient treatment modality of bilateral posterior cross-bite in young adults. Moderate bone fenestration was recorded at the end of expansion.

Improving gingival zenith in a unilateral cleft patient using Platelet-Rich Fibrin (PRF)

This case evaluated the short term outcome of alveolar ridge augmentation in a unilateral alveolar cleft patient. A 22year old female patient reported with gaps in her front teeth in 2011. Clinical examination revealed a repaired unilateral cleft of the hard palate (on left side) with a missing 21 and 22. Diagnosis was class II Subdivision with crossbite in 13 region. A non-extraction plan with a quad helix appliance, proximal stripping of lower anteriors. Canine substitution of 23 to replace 22 and prosthetic rehabilitation to replace 21. An alveolar ridge augmentation procedure using PRF (Platelet-rich fibrin) extracted from patient blood using a plasma centrifuge system. The success of grafted bone were evaluated radiologically at 6 months, 12 months postoperatively.

Residents’ journal review

Residents’ journal review

Stability comparison of two different dentoalveolar expansion treatment protocols.

ABSTRACTObjective: The aim of this study was to compare the longitudinal stability of the conventional straight-wire system after the use of a quad-helix appliance with Damon self-ligating system in patients with Class I malocclusion. Methods: 27 adolescent patients were evaluated at three different periods: pre-treatment (T1), post-treatment (T2) and three years post-treatment (T3). Group 1 included 12 patients (with a mean age of 14.65 year) treated with Damon 3MX bracket system; and Group 2 included 15 patients (with a mean age of 14.8 year) who underwent orthodontic treatment with Roth prescribed brackets after expansion with Quad-Helix appliance. Relapse was evaluated with dental cast examination and cephalometric radiograph tracings. Statistical analysis was performed with IBM-SPSS for Windows software, version 21 (SPSS Inc., Chicago, IL). A p-value smaller than 0.05 was considered statistically significant. Results: There were significant increases in all transverse dental and postero-anterior measurements (except for UL6-ML mm in Group 1) with active treatment. There was some significant relapse in the long-term in inter-canine width in both groups and in the inter-first premolar width in Group 2 (p< 0.05). Significant decrease in all frontal measurements from T2 to T3 was seen for both groups. Upper and lower incisors significantly proclined in T1-T2 (p< 0.05), however no relapse was found for both groups. When two systems were compared, there was no significant difference for the long-term follow-up period. Conclusion: Conventional (quad-helix appliance with conventional brackets) and Damon systems were found similar with regard to the long-term incisor positions and transverse dimension changes of maxillary arch.

Cephalometric Outcomes of Maxillary Expansion and Protraction in Patients With Unilateral Cleft Lip and Palate After Two Types of Palatoplasty.

To clarify the differences in the long-term effects of maxillary expansion (ME) and protraction (MP) in patients with complete unilateral cleft lip, alveolus, and palate (UCLP) undergoing two types of palatoplasty. Retrospective longitudinal study. Institutional study. Thirty-eight patients with UCLP treated at Osaka University Dental Hospital, Japan, were divided into two groups: 19 patients were treated using Wardill-Kilner push-back palatoplasty (PB), and 19 patients were treated with early two-stage palatoplasty according to the modified Furlow technique (ETS). All patients exhibited a short maxilla at the initial orthodontic visit and were treated with ME using a quad helix appliance and MP with a face mask. Lateral cephalometric data recorded in the initial stage were compared with those obtained at the end of treatment. The dentoskeletal features and facial soft tissue profile were evaluated before and after orthodontic treatment. The variation and rate of change during treatment were also calculated. The Mann-Whitney U test was used for the statistical analyses. The ETS group showed significantly greater SNA, SNB, and U1-Pp angles and smaller SN-Mp angles than the PB group after face mask treatment. The variation in the anteroposterior length of the maxilla during treatment was significantly greater in the ETS group than in the PB group. Maxillary protraction was more efficiently accomplished in the patients with UCLP after early two-stage palatoplasty compared with push-back palatoplasty.

A comparison of three-dimensional stress distribution and displacement of naso-maxillary complex on application of forces using quad-helix and nickel titanium palatal expander 2 (NPE2): a FEM study

BackgroundOur objectives are to analyse and to compare the stress distribution and displacement of the craniofacial structures, following the application of forces from quad-helix and Nickel Titanium Palatal Expander-2 (NPE2) using finite element analysis.MethodsThree-dimensional finite element models of young dried human skull, quad-helix appliance and NPE2 were constructed, and the initial activation of the expanders was stimulated to carry out the analysis and to evaluate the Von Misses stresses and displacement.ResultsBoth the models demonstrated the highest stresses at the mid-palatal suture, with maximum posterior dislocation. The second highest stress was recorded at the fronto-zygomatic suture. The pattern of stress distribution was almost similar in both the groups, but NPE2 revealed lower magnitude stresses than quad-helix. The only exception being quad-helix model showed high stress levels around pterygo-maxillary suture whereas minimal stress around pterygo-maxillary suture was noticed after NPE2 activation. The cusp of the erupting canine and the erupting mesiobuccal cusp of the second molar showed outward, backward and downward displacement signifying increase in their eruption pattern following maxillary expansion.ConclusionsMaxillary expansion using quad-helix and NPE2 can be used in posterior crossbite correction in cases where maximum skeletal changes are desirable at a younger age; it is furthermore effective in treating young patients with impacted or displaced teeth. Quad-helix and NPE2 produced acceptable forces for orthopaedic treatment even after being orthodontic appliances; their clinical application should be correctly planned as the effects of these appliances are largely age dependent.

Short-term treatment effects of the quad-helix appliance on dentofacial morphology of hyperdivergent patients

Abstract Objectives The purpose of this study was to evaluate the effects of short-term expansion treatment using the quad-helix appliance on dentofacial morphology in orthodontic patients presenting with a hyperdivergent facial pattern. Methods The treatment group consisted of 40 patients with a hyperdivergent facial pattern, who were treated for maxillary incisor crowding with a quad-helix appliance during the mixed dentition period. Lateral cephalograms taken at the start (T0) and end (T1) of the treatment were obtained as a course of care. A similar number of patients, who possessed the same type of facial pattern and who remained untreated, were assigned to a control group. Two consecutive lateral cephalograms of each untreated patient were taken at the same time points as T0 and T1. All cephalograms were traced, analysed and compared between the two groups. Results The treatment changes as a result of the quad-helix appliance were expressed in an upward rotation of the mandible (2.34°) and distal tipping and impeded mesial movement of the maxillary first molars. Significant differences were evident between the treatment and control groups. Conclusion Quad-helix appliance treatment can be appropriate for significantly decreasing the mandibular plane angle in hyperdivergent patients presenting with moderate maxillary incisor crowding and a positive overjet and overbite.

Zespołowe leczenie ortodontyczno-chirurgiczne szkieletowej klasy III – opis przypadku

Skeletal class III malocclusion can be caused by excessive mandibular growth, maxillary hypoplasia, or a combination of both. The aim of this study was to present a multidisciplinary treatment of a 28 year-old female with a skeletal class III malocclusion and bilateral hypodontia of the first and second maxillary premolars. Orthodontic treatment, as a part of the patient’s preparation for surgery, included a straight wire appliance using Roth prescription for both dental arches. A transpalatal distractor (TPD) was used to correct the transversal maxillary deficiency. The expansion was later continued using the quad-helix appliance. The second stage of surgical management included the bimaxillary osteotomy (BIMAX) in order to correct the skeletal malocclusion (mandibular prognathism and maxillary hypoplasia). Orthodontic treatment was continued after surgery, until the normal occlusal relationships were restored. The outcomes included a complete functional repair of the patient’s stomatognathic system and a significant improvement of the aesthetic appearance of her face. Multidisciplinary management was used involving orthodontic and surgical strategies. The treatment restored normal occlusal relationships, improved the stomathognatic function, the patency of upper airways as well as the aesthetic appearance of the patient’s face and smile.

Analysis of the dentoalveolar effects of slow and rapid maxillary expansion in complete bilateral cleft lip and palate patients: a randomized clinical trial.

The purpose of this study was to compare the dentoalveolar effects of slow (SME) and rapid (RME) maxillary expansions in patients with complete bilateral cleft lip and palate (BCLP). A sample of 50 patients with BCLP and maxillary arch constriction was randomly and equally allocated into two groups. Group SME comprised patients (mean age of 8.8years) treated with quad-helix appliance. Group RME comprised individuals (mean age of 8.9years) treated with Hyrax expander. Digital dental models obtained immediately pre-expansion (T1) and 6months after the active expansion period (T2) were used for measuring maxillary dental arch widths, arch perimeter, arch length, palatal depth, buccolingual inclination of posterior teeth and differential amount of expansion accomplished at the canine and molar regions. Inter-phase and intergroup comparisons were performed using paired t tests and t tests, respectively (p<0.05). SME and RME caused significant increase of arch widths and arch perimeter. Arch length and palatal depth decreased nonsignificantly with SME but significantly with RME. Buccal tooth inclination was significant only for maxillary deciduous canines in both groups. The quad-helix appliance showed a significant differential expansion between anterior and posterior regions. No differences were observed between SME and RME for all variables. Differences were not found between the dentoalveolar effects of SME and RME in patients with BCLP. SME demanded a greater therapy time compared to RME. Both expansion procedures can be similarly indicated to correct maxillary arch constriction in patients with BCLP in the mixed dentition.

Quad-helix appliances may be more successful than removable expansion plates at correcting posterior crossbites.

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) Medline, Embase, the US National Institutes of Health Trials Register and the World Health Organisation (WHO) Clinical Trials Registry Platform were searched with no restrictions. Randomised controlled trials (RCTs) of orthodontic treatment for posterior crossbites in children and adults were considered. Study selection, data abstraction and risk of bias assessment were carried out independently by two reviewers. Dichotomous data were summarised with risk ratios (RR) and 95% confidence intervals (CIs) and continuous data with mean differences (MD) with 95% CIs. Meta-analyses were conducted when comparisons and outcomes were sufficiently similar. Fifteen studies were included; seven were at high risk of bias, two at low risk and six at unclear risk. Nine studies compared fixed appliances with mid-palatal expansion but no difference between appliances was reported. Low quality evidence from two studies with 96 participants found that fixed quad-helix appliances may be 20% more likely to correct crossbites than removable expansion plates (RR 1.20; 95% CI 1.04 to 1.37), and quad-helix appliances may achieve 1.15 mm more molar expansion than expansion plates (MD 1.15 mm; 95% CI 0.40 to 1.90;). Very limited evidence showed that both fixed quad-helix appliances and removable expansion plates were superior to composite onlays in terms of crossbite correction, molar and canine expansion. There is a very small body of low to moderate quality evidence to suggest that the quad-helix appliance may be more successful than removable expansion plates at correcting posterior crossbites and expanding the inter-molar width for children with early mixed dentition (aged eight to 10 years). The remaining evidence we found was of very low quality and was insufficient to allow the conclusion that any one intervention is better than another for any of the outcomes in this review.

A Single Versatile Appliance for Habit Interception and Crossbite Correction.

Digit sucking is a common childhood behavior, which has an adaptive value for children up to the fourth year of life. It is usually associated with oral pleasure and self-comforting behavior. But chronic practice may produce deleterious effect in the form of dental and skeletal deformities. Adjunctive therapy using bluegrass appliance as a permanent reminder and quadhelix appliance as a reminder as well as a slow palatal expander has proven successful in intercepting digit-sucking habit and expanding the arch for crossbite correction. In the present case, a versatile modified quadhelix appliance incorporating a roller was designed to clinically correct the habit and its resulting dentofacial deformities.

Biomex Quad Helix

Introduction: Anterior deep bite with narrow maxillary arch is a most common clinical situation orthodontists have to deal with in Class I as well as Class II malocclusions.Objective: To present a modification of the quad helix appliance which incorporates acrylic anterior bite plane for simultaneous bite opening with maxillary expansion (Biomex Quad helix). Appliance design: The appliance is made of 0.036 inch stainless steel wire. The anterior bridge of the quad helix is modified by extending it anteriorly. The wire is soldered to the stainless steel bands on the maxillary first permanent molars. Acrylic anterior bite plane is added to this anterior extension keeping the anterior helices exposed. It combines advantages of a quad helix with that of anterior bite plane. Hence it can be useful for simultaneous bite opening with maxillary expansion, deprogramming, and relieving TMJ symptoms by unlocking the occlusion.Conclusion: Biomex Quad Helix is a versatile appliance which is simple in design, easy to fabricate, comfortable for the patient, and economical for the operator and the patient.