The Quad Helix Appliance

Ruel W. Bench

Along with the utility arch and sectional mechanics, the quad helix appliance
has become an integral part of the Bioprogressive technique, The quad helix
is mostly used to unlock malocclusions and to establish normal function and
arch form by expanding the dental arches, It is also a useful adjunct in the
treatment of Class II malocclusions and mostly in those cases in which molar
derotation is required as part of the treatment, Expansion of the alveolar
ridges is only undertaken after correlating measurements taken from the
study casts with those obtained from frontal cephalometric radiographs. In
terms of dental arch alignment, a quad helix can achieve in 3 to 4 months
what would otherwise take a great deal longer and at least a series of arch
changes, (Semin Orthod 1998;4:231-237,) Copyright © 1998 by W,B. Saun-
ders Company

he quad helix appliance with its four helical
T loops is a modification of the earlier trans-
palatal Coffin ~-~spring. Each of the helical loops
adds an additional 25 m m of wire to the appli-
ance (Fig 1) which lightens the force magnitude,
rendering a more continuous action due to the
greater range of activation provided by the longer
wire. Most of the other transpalatal arches are used
to provide clinically useful but simpler movements
than are possible with the quad helix appliance.
The quad helix appliance as described by
Ricketts 4 in 1975, or the earlier "W" appliance 5
were both used with great success in the early
treatment of those patients with cleft palate in
whom the lateral maxillary segments had col-
lapsed b e h i n d the p r o t r u d i n g premaxillary pro-
cesses (Fig 2). In patients with cleft palates, the
narrowness of their palates results primarily
from unilateral or bilateral deficiencies in their
bony palates. Contraction of scar tissue, follow-
ing attempts to effect a surgical closure of palatal
defects in patients with cleft palates, may cause
or aggravate an existing palatal constriction.
Because of the bony defects that are present, the
effects of a quad helix may be readily observed in
patients with cleft palates. These effects include
From the Department of Orthodontics, Loma Linda Dental
School, Loma Linda, CA.
Address correspondence to Ruel W. Bench, DDS, 9538 Starlight
Lane, La Mesa, CA 91941.
Copyright© 1998 by W.B. Saunters Company
1073-8746/98/0404-000558. 00/0
the derotation of the maxillary molar teeth as
well as some expansion of the lateral maxillary
shelves. These changes observed in patients with
cleft palates may also be noted in patients with
intact palates. In the latter group of patients (Fig
3) it takes longer than it does in patients with
cleft palates for the palatal expansion and alveo-
lar remodeling to take place.
Haas 6 and Wertz 7 have shown that the some-
what rigid jackscrew palatal e x p a n d e r produces
an orthopedic separating force that lies in the
range of 3 to 10 lbs. This relatively heavy orthope-
dic force is able to produce a midpalatine separa-
tion of 10 to 15 mm. A quad helix appliance
expands the maxilla slower than a Haas palatal
e x p a n d e r and has been shown to produce forces
in the range of 0.5 to 1.5 lbs (200 to 600 g). The
latter force levels are well below those exerted by
the jackscrew expanders.
Frank 8 studied the use of quad helix appli-
ances in younger patients and f o u n d that in his
sample, these appliances p r o d u c e d a slight mid-
palatal separation of .92 ram. He also reported
that the majority of the change was of an orth-
odontic nature and that the average intermolar
expansion was 5.88 mm. His study suggested that
with the quad helix appliance there was a 6:1
ratio between the orthodontic and the orthope-
dic expansion.
The action of the quad helix appliance is to
buccally expand and to distally rotate the maxil-
lary molar teeth and then, because the extended

Seminars in Orthodontics, Vol 4, No 4 (December), 1998: pp 231-237 231

232 Ruel W. Bench

Figure 1. The quad helix with its four helical loops (A) is a modification of the earlier transpalatal Coffin I spring
(B).

arms have a fan-like sweeping action, they can be
adjusted to e x p a n d the maxillary bicuspid and
cuspid teeth (Fig 4). Studies investigating the
force vectors of the quad helix appliance 9 r e p o r t
that the anterior arms of the appliance affect
b o t h the forces p r o d u c e d by the appliance as
well as the force couples operating on the m o l a r
teeth. This results f r o m the fact that the anterior
arms are a rigid part of the whole appliance.
O t h e r studies 1° indicated that the quad helix
appliance has the ability to derotate the m o l a r
teeth m o r e efficiently than the Haas appliance,
and that the quad helix appliance can e x p a n d
differentially anterioposteriorly.
A quad helix appliance that is activated to
derotate a maxillary m o l a r on one side of the
arch provides a distalizing force at the m o l a r on
the opposite side of the same arch (Fig 5). An
understanding of this reciprocal force system
enables orthodontists to activate the arms of the
quad helix to provide the desired forces at
individual teeth. By extending the palatal arms
of the appliance on one side, it can involve m o r e
teeth on that side to act as a n c h o r a g e in the
distal m o v e m e n t of a single m o l a r on the oppo-
site side of the arch.
It has b e e n suggested 11,12that in the treatment
of narrow restricted maxillary arches, the quad
helix appliances tip the maxillary m o l a r teeth
and their alveolar sockets bucally, and that this
tipping results in a warping of the alveolar
ridges. Those cases presenting with a reversed
(negative) curve of Wilson, and in w h o m the
alveolar ridges are tipped palatally, are good
candidates for dentoalveolar expansion.
Because of the previously m e n t i o n e d studies,

Figure 2. In patients with cleft palates, the maxillary buccal segments are collapsed behind the premaxillary
segment (A). The quad helix rotates and distalizes the molars and expands the buccal segments (B).
 The Quad Helix Appliance 233

Figure 3. A quad helix appliance (A) can derotate the maxillary molar teeth (B).

Sellke 13 believes that the quad helix appliance
and its variations have a place in almost 80% of
orthodontic treatments. To c o u n t e r the tipping
action of the quad helix appliance, buccal root
torque can be placed in the m o l a r bands before
cementation of the appliance. With this appli-
ance, m o l a r derotation is best accomplished by
leaving the anterior arms of the quad helix away
f r o m the lingual surfaces of the cuspid teeth. As
the m o l a r teeth derotate, the anterior arms will
come to push against the cuspid teeth and they
will then e x p a n d together with the rest of the
maxillary teeth. T h e advantage of activating the
quad helix appliance in this m a n n e r lies in the
fact that the maxillary teeth are e x p a n d e d in a
differential m a n n e r that "sweeps" t h e m into the
ovoid arch f o r m of the final occlusion.
Prefabricated quad helices generally c o m e in
four different sizes 14 and they may be fabricated
f r o m 0.38" r o u n d stainless steel or blue Elgiloy
wire (Rocky Mountain Orthodontics, Inc, Den-
ver, CO). T h e a m o u n t of expansion force ex-
erted by a particular quad helix depends on the
a m o u n t that it is e x p a n d e d before insertion
(Fig 6). T h e relationship between the expansion
force p r o d u c e d , the size of the quad helix, and
the a m o u n t of activation are shown in Table 1.
T h e No. 4 quad helix that seems to fit m a n y if not
most patients, delivers 370 to 420 g of expansion
force when activated 10 to 15 m m respectively. 5,14
A steel quad helix exerts similar force as does a
like, n o n - h e a t - t r e a t e d Elgiloy appliance. 14
As a r o u g h guide, it is usual to e x p a n d a quad
helix appliance so that the bands lie " h a l f way

Figure 4. The initial expansion activation placed in the quad helix (A). Expansion and derotation activation
placed in one side of the quad helix, distalizes the molar on the opposite side (B).
234 Ruel W. Bench
Figure 5. Activation to produce molar derotation on
one side of the maxillary arch will result in molar
distalization on the opposite side. The quad helix has
been modified to use one entire buccal segment of the
arch to a single molar on the opposite side.
past" the molar crowns (Fig 6) before cementa-
tion. ff the maxillary molar teeth require derota-
tion, all o f the expansion force will be directed at
these molars in the initial stages of treatment. As
the maxillary molar teeth are derotated, the
palatal arms of the appliance will engage the
teeth in the buccal segments of the arch and
when this occurs, the expansion force on the
molar teeth is reduced. In many instances, the
molar derotation effected by the quad helix
appliance causes sufficient molar distalization to
resolve most m i n o r Class II end-to-end molar
malocclusions. The a m o u n t of 3 to 5 m m of arch
length is gained as the molar teeth are rotated
buccally and distally.
Figure 6. Maxillary molar distalization can be achieved with a quad helix appliance. It is usual to activate the
appliance to move one molar first and then the other (A). Expansion and distal rotation of the maxillary first
molars can gain 3 to 5 mm arch length (B).
Table 1. Forces Developed by the Activation
of the Quad Helix Appliance
Activation Expansion 5 mm 10 mm 15 mm
Size No. 1 370 gm 720 gin
No. 2 350 gm 490 gm
No. 3 310 gm 440 gm 480 gm
No. 4 260 gin 370 gm 420 gm
NOTE. Data from.15
The magnitudes of dental expansion that can
be achieved with quad helix appliances are
illustrated in Figures 7, 8, and 9. In most patients,
expansion o f the maxillary arch results in a
"passive" expansion of the mandibular widths. It
is sometimes advantageous to place a bi-helix
appliance in the mandibular arch to obtain and
maintain a balance in the dimensions of the
maxillary and mandibular arches (Fig 10).
Although it takes some experience, it is pos-
sible to activate a quad helix after it has been
c e m e n t e d to the teeth (Fig 11). In those in-
stances in which complex activations are re-
quired, it may be advisable to remove the appli-
ance and then to activate it before recementation.
There are a n u m b e r o f useful modifications
that can be made to the basic quad helix appli-
ance. By placing .045" wire sections in the head-
gear tubes o f the maxillary molar bands (Fig 12),
the appliance may be used in conjunction with a
protraction face mask 16 to advance the maxilla.
The anterior bar of the quad helix appliance
may be modified to control t h u m b sucking and
tongue thrusting habits (Fig 13), or to control
the eruption of anterior teeth (Fig 14). A quad
 The Quad Helix Appliance 235

Figure 7. The expansion achieved with the quad helix appliance is 8 m m in the bicuspid area. The arch shape has
been changed from a narrow tapering form (A) to one that is more r o u n d e d (B).

Figure 8. The lower arch form (A) has changed (B) in response to the arch form changes in the maxillary arch
(Fig 7).

Figure 9. Radiograph (A) shows crowded incisor teeth with cuspid teeth erupting forward against the lateral
incisor roots. Radiograph (B) is of the same patient. A quad helix was used to create space for the incisor and
cuspid teeth.
236 Rue1147.. Bench

Figure 12. An extension of .045" wire t h r o u g h the

Figure 10. T h e bi-helix appliance has two helical h e a d g e a r tube of the molar b a n d enables the q u a d
loops. It is used to upright the lower buccal teeth in a helix appliance to be used in conjunction with a
buccal direction as the quad helix appliance expands protraction face mask.
the u p p e r arch.

j "

Figure 13. A q u a d helix appliance can be modified as

shown to correct certain a b n o r m a l t h u m b sucking or
tongue habits.

Figure 11. The intraoral activations that are possible

with a quad helix appliance. (1) A n t e r i o r adjustments
p r o d u c e expansion in the posterior molar area on
both sides. This expansion activation on the m o l a r
tends to move the m o l a r into a mesial rotation. T h e
mesial rotation effect of the molar teeth is c o r r e c t e d
by an activation of No. 9 to restore the distal rotation
of the molar. (2) Lateral adjustment expands and
rotates the m o l a r on the activated side. T h e molar on
the opposite side is distalized. Activation on b o t h sides
causes the rotation of expansion to be on b o t h sides.
(3) Adjustments to the buccal arm expands the
bicuspids and cuspids. W h e n h e l d away f r o m the teeth
it allows the molars to rotate. (4) Adjustments t h r o u g h Figure 14. A quad helix can be used to rotate an
the distal loop gives expansion to buccal arms. incisor tooth. In this case, a cleft palate was present.
 The Quad Helix Appliance
helix appliance may also be used to maintain
space and to augment anchorage when required.
References
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7. Wertz RA. Skeletal and dental changes accompanying
237
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