Case Report
New design space regainers: ‘Lingual arch
crossbow’ and ‘Double banded space regainer’
Abstract
This article highlights the use of two new design space
regainers – the “lingual arch crossbow” and the “double-
banded space regainer.” The former may be used for distalizing
a mesially migrated mandibular first premolar, if it erupts prior
to the canine. The latter may be used in conventional cases
of interdental space loss. They both contain assemblies that
function through the action of NiTi open coil springs.
Key words
Crossbow, lingual arch, NiTi, space regainer
Introduction
The transition from mixed dentition to a permanent
one is seldom accurate, the hurdles being space
loss, tooth size arch length discrepancy, early
exfoliation of primary teeth, or premature eruption
of permanent teeth. When the usual sequence of
eruption of permanent teeth does not occur, it must
warn the clinician of monitoring the arches and
intervening with extractions, space maintainers, or
space regainers.
This article highlights the use two new design space
regainers, the “lingual arch crossbow” (LAC) and
the “double-banded space regainer” (DBSR). LAC
can be used on the lower arch if the first premolar
erupts prior to the canine and needs to be distallized
to prevent it from encroaching into the canine space.
The DBSR may be used in conventional cases of
interdental space loss.
Materials and Methods
An 8-year-old boy reported to the department of
Pedodontics and Preventive Dentistry with the
complaint of misaligned teeth.
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 |
Chalakka P, Thomas AM1, Akkara F2,
Pavaskar R3
Department of Pedodontics and Preventive Dentistry, 1Christian
Dental College and Hospital, Ludhiana, Punjab, 2Department
of Oral and Maxillofacial Surgery, Dental College and Hospital,
Bambolim, Goa, 3Department of Conservative Dentistry and
Endodontics, Index Institute of Dental Sciences, Indore,
Madhya Pradesh, India
Correspondence:
Dr. Paul Chalakkal, Department of Pedodontics and Preventive
Dentistry, Goa Dental College and Hospital, Bambolim, Goa
403202. E-mail: atomheartpaul@yahoo.com
Access this article online
Quick Response Code: Website:
www.jisppd.com
DOI:
10.4103/0970-4388.100001
PMID:
***
His mandibular arch contained all permanent incisors
and first molars, primary right first molar, primary left
second molar and the left first premolar [Figure  1].
The reason for exfoliation of the primary canines and
the primary right second molar was unknown and the
boy gave no history of extractions. This had resulted in
mesial migration of the left first premolar, limiting the
canine space to just 3 mm [Figure 2]. It was decided
to regain the canine space using a space regainer by
distalizing the first-left premolar after extracting
the primary second-left molar. A lingual arch space
maintainer was constructed to prevent mesial migration
of the permanent first molars [Figure 3]. Molar tubes
(1.1 mm diameter, 10 mm length) were welded to molar
bands (0.006 × 0.180 in) on the lingual arch, buccally
and lingually. A stainless steel curved wire (0.9 mm
width) was constructed angled medially forward with
its free ends passing posteriorly through molar tubes
and NiTi open coil springs (GAC Int Inc, Central Islip,
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 Chalakkal, et al.: New design space regainers

NY; 0.012 in diameter; 0.045 in lumen; 10 mm length)
on the permanent left first molar [Figures 4-6]. This
wire was medially angled to enable distalization of the
premolar along the ridge, preventing any buccal or
lingual displacement. The primary second left molar
was extracted and the LAC was cemented on to the
mandibular first permanent molars. After cementation,
the curved wire was pulled forwards to engage the first
premolar at its mesio-cervical margin [Figure 7]. In
doing so, the NiTi open coil springs got compressed
to half their original lengths. Under compression, the
springs exerted forces between stops anteriorly (molar
tubes) and posteriorly (wire tags). These forces tend to
push the wire tags posteriorly, while simultaneously
pulling the first premolar distally. After 5 months,
the space gained mesial to the first-left premolar was
4 mm, improving the canine space to 7 mm [Figures
8-11]. Following this, self-cure acrylic was added to
the springs to prevent further space gain, as further

Figure 1: Pretreatment orthopantomograph

Figure 2: Pretreatment orthopantomograph showing mesially migrated
34

Figure 3: Mandibular arch with a noncemented lingual arch before

constructing the space regainer

Figure 4: The “Lingual arch crossbow”

Figure 5: “Lingual arch crossbow” lateral view Figure 6: “Lingual arch crossbow” – medial view

162 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 |
 Chalakkal, et al.: New design space regainers

NY; 0.012 in diameter; 0.045 in lumen; 10 mm length)
on the permanent left first molar [Figures 4-6]. This
wire was medially angled to enable distalization of the
premolar along the ridge, preventing any buccal or
lingual displacement. The primary second left molar
was extracted and the LAC was cemented on to the
mandibular first permanent molars. After cementation,
the curved wire was pulled forwards to engage the first
premolar at its mesio-cervical margin [Figure 7]. In
doing so, the NiTi open coil springs got compressed
to half their original lengths. Under compression, the
springs exerted forces between stops anteriorly (molar
tubes) and posteriorly (wire tags). These forces tend to
push the wire tags posteriorly, while simultaneously
pulling the first premolar distally. After 5 months,
the space gained mesial to the first-left premolar was
4 mm, improving the canine space to 7 mm [Figures
8-11]. Following this, self-cure acrylic was added to
the springs to prevent further space gain, as further

Figure 1: Pretreatment orthopantomograph

Figure 2: Pretreatment orthopantomograph showing mesially migrated
34

Figure 3: Mandibular arch with a noncemented lingual arch before

constructing the space regainer

Figure 4: The “Lingual arch crossbow”

Figure 5: “Lingual arch crossbow” lateral view Figure 6: “Lingual arch crossbow” – medial view

162 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 |
 Chalakkal, et al.: New design space regainers

distalization would compromise the space available for unknown. This had resulted in mesial migration of
eruption of the second-left premolar. the permanent left first molar [Figure 13] resulting in
3.5 mm of space between it and the primary left first
His maxillary arch showed mild anterior crowding. molar, compared to 8.8 mm on the contralateral side.
It contained all permanent incisors and first molars;
all primary molars except the left second primary
molar [Figure 12]. The reason for its exfoliation was

Figure 8: Mandibular post-treatment left lateral view

Figure 7: “Lingual arch crossbow” – intraoral view

Figure 10: Post-treatment orthopantomograph after distalization of 34

Figure 9: Mandibular post-treatment occlusal view

Figure 12: Maxillary arch showing mesially migrated 26 onto the

Figure 11: Post-treatment orthopantomograph space of 65 (exfoliated)

JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 | 163
 Chalakkal, et al.: New design space regainers
A space regainer was designed to regain the space as
follows [Figure  14]. The permanent left first molar
was banded (0.006  ×  0.180 in) with molar tubes
(1.1 mm diameter, 10 mm length) welded to it buccally
and palatally. The primary first-left molar was also
banded (0.005 × 0.180 in) with two stainless steel wires
(0.9 mm width) soldered to it buccally and palatally,
extending posteriorly to insert into the molar tubes of
the permanent first molar. NiTi open coil springs (GAC
Int Inc, Central Islip, NY; 0.012 in diameter; 0.045 in
lumen; 15 mm length) were incorporated into the wires
between stops anteriorly (solder joints) and posteriorly
(molar tubes). The assembly (DBSR) was cemented
on to the teeth with the springs held in compression
to half their lengths [Figure 15]. After 6 months,
the space gained was 5.1 mm, making the total space
available between the permanent first-left molar and
the primary left first molar to be 8.6 mm [Figures 16
and 17]. The appliance was removed soon after, because
Figure 13: Periapical view showing mesially migrated 26 onto the
space of 65 (exfoliated)
Figure 15: Maxillary arch showing space regainer on 26 and 64
before distalization
164 JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 |
the second-left premolar had erupted into the space up
to its mesial and distal heights of contour [Figure 18]
and the primary left first molar was nearing exfoliation
[Figure 8].
Discussion
NiTi coils have a long range of the superelastic activity
with minimal load fluctuation in spite of large deflection
due to excellent springback and superelasticity.[1]
This property makes it possible to achieve large tooth
movements without having to replace the springs.
In the mandibular arch, noticeable amount of distal
tipping had occurred on the first-left premolar following
distalization. However, it will most probably self-correct
following appliance removal after the eruption of the
permanent left canine. Although it is generally not
advised to orthodontically move a tooth with incomplete
root formation, the premolar showed continuation of
Figure 14: Components of the maxillary space gainer
Figure 16: Maxillary arch showing space regainer on 26 and 64 after
distalization
 Chalakkal, et al.: New design space regainers
Figure 17: Periapical view after distalization of 26
root formation during the course of distalization. There
was no radiographical evidence of root resorption or
ankylosis. Distalization of the permanent first-left molar
may be required after the eruption of the permanent
left canine, if the space available for eruption of the
left second premolar is found to be insufficient. There is
negligible risk of anchorage loss while using the “lingual
arch crossbow,” as the entire lingual arch takes the role
of anchorage distributing force over a large number of
teeth. On the right side, the radiograph suggests the
eruption of the first premolar ahead of the canine. If
this happens, the treatment protocol would be similar
to that undertaken on his left side.
In the maxillary arch, a resorbing primary first molar
was used as anchorage to distalize a permanent first
molar. It is certain that the anchor tooth must have
transmitted considerable force to the teeth anterior
to it, contributing to the already existent anterior
crowding. A distal movement rate of approximately 1
mm per month has been reported for permanent first
molars, but there is marked individual variation. [2-6]
However, in this case, 5.1 mm of space was gained
over a period of 6 months. Distalizing the permanent
first molar was easily possible in this case because the
permanent second molar had not erupted and its crown
was at the midroot level of the permanent first molar.
Since both, the permanent first molar and the primary
first molar were banded for space regaining, and the
wires were soldered to pass paralleling the molar tubes,
there was no observable tipping on the permanent first
molar. This is an advantage of the DBSR over the
conventionally used Gerber space regainer, where only
JOURNAL OF INDIAN SOCIETY OF PEDODONTICS AND PREVENTIVE DENTISTRY | Apr - Jun 2012 | Issue 2 | Vol 30 |
Figure 18: Post-treatment maxillary view after removal of space regainer
one of the two teeth is banded allowing a possibility
for tipping.
The boy is currently being monitored at three month
intervals to ensure successful transition to a permanent
dentition. He has been advised a unitufted brush to
help in brushing efficiently throughout the course of
treatment.
References
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for distal movement of maxillary first molars: A randomized
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3. Papadopoulos MA, Mavropoulos A, Karamouzos A. Cephalometric
changes following simultaneous first and second maxillary molar
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Orthop 2004;65:123-36.
4. Bondemark L. A comparative analysis of distal maxillary
molar movement produced by a new lingual intra-arch Ni-
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How to cite this article: Chalakka P, Thomas AM, Akkara F,
Pavaskar R. New design space regainers: 'Lingual arch crossbow'
and 'Double banded space regainer'. J Indian Soc Pedod Prev
Dent 2012;30:161-5.
Source of Support: Nil, Conflict of Interest: None declared.
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