CASE REPORT

Banded Helical Space Regainer—an Innovative Approach for

Management of Space Loss: A Case Report
Neeti Tatiya1 , Rituraj Kesri2, Kirti Pattanshetti3, Shreya Sankalecha4

A b s t r ac t
The transitory phase of the 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. Space regainers are appliances used to regain and
maintain space, so as to guide the unerupted tooth into the proper position in the arch. It not only maintains function and preserves arch length,
but also maintains esthetics, prevents the development of deleterious oral habits, and eliminates any potential psychological damage a child
could face. This case report aims to describe an effective, easy-to-fabricated, and innovatively designed space regainer that showed excellent
patient compliance and was superior to the present space regainer designs/appliances.
Keywords: Case report, Interceptive orthodontics, Premature loss, Space management, Space maintainer, Space regainer.
International Journal of Clinical Pediatric Dentistry (2023): 10.5005/jp-journals-10005-2714

Introduction
Primary teeth play a vital role in the development of harmonious,
functional, and esthetically acceptable occlusion of permanent
teeth.1 Hoffding and Kisling reported major space loss due
to premature loss of primary teeth. 2 The most crucial factor
associated with mesial migration of permanent molar is caused
due to loss of proximal contact. 3 The age range between 7 and
10 years old proves to be best for tipping or bodily moving
molars distally to recover lost arch space.4 Maxillary molars have
a distalization potential of 5–7 mm per side, while mandibular
molar distal movement is limited to 1 or 2 mm per side. 3 The
prerequisites of proper treatment planning are patient study
models, periapical radiographs, clinical assessment, and
cephalometric analysis. 5 Thus, a new innovative “fixed banded
helical retractor space regainer” was considered to destabilize the
mandibular first permanent molars. This case report discusses the
need for prompt intervention in regaining space in the mandibular
arch caused by the early loss of a second primary molar.
Case Description
An 8-year-old female patient presented to the Department of
Pedodontics and Preventive Dentistry with a complaint of pain
and missing teeth in the left back tooth region for 10 months.
The history revealed that the tooth was extracted as it was grossly
decayed. Clinical examination revealed prematurely missing 75
(Fig. 1). On radiographic examination it was observed that the
permanent molar was mesially inclined and radiolucency was seen
with respect to the occlusal surface of 74 involving enamel, dentin,
and pulp (Fig. 2). Moyer’s mixed dentition space analysis was done
and it revealed a space loss of 1.8 mm. The decision of pulpectomy
followed by a stainless-steel crown with respect to 74 was made
followed by an innovative fixed banded helical type space regainer.
1–4
Department of Paediatric Dentistry, Maitri College of Dentistry and
Research Centre, Durg, Chhattisgarh, India
Corresponding Author: Neeti Tatiya, Department of Paediatric
Dentistry, Maitri College of Dentistry and Research Centre,
Durg, Chhattisgarh, India, Phone: +91 7987959356, e-mail:
drneetitatiya@gmail.com
How to cite this article: Tatiya N, Kesri R, Pattanshetti K, et al. Banded
Helical Space Regainer—an Innovative Approach for Management of
Space Loss: A Case Report. Int J Clin Pediatr Dent 2023;16(6):840–842.
Source of support: Nil
Conflict of interest: None
Patient consent statement: The author(s) have obtained written
informed consent from the patient’s parents/legal guardians for
publication of the case report details and related images.
active arm that was fabricated using 23-gauge wire on the mesial
surface of the first molar and the open end of the active arm was
engaged into the buccal tube on the molar band of the first perma-
nent molar. The length of the active arm was the measured space
from distal to helix and to the end of the molar tube buccally which
was calculated to be 10 mm. Soldering of the retentive arm was
done on the buccal surface of the first deciduous molar band (Fig. 3).
For alignment of the first permanent molar an additional space of

Appliance Fabrication
The first deciduous molar was banded and a molar band with a
buccal tube was placed on the first permanent molar. The active
component of the regainer consisted of a 4 mm helix and 10 mm Fig. 1: Clinically missing 75 and permanent molars were mesially drifted

© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
 New Innovative Space Regainer

2.5 mm was included and to avoid soft tissue laceration the retentive
arm was given buccally. Postfinishing and polishing the appliance
was cemented using type 1 HY-Bond GlasIonomer Cx-Smart (Figs 4
and 5). The appliance was activated by opening the coil of the spring
that transmitted force onto the permanent first molar.
Follow-up
The patient was followed up weekly for the activation of the
appliance and the required space was regained within 3 weeks
(Fig. 6). The appliance was removed (Fig. 7) and a reverse type of
crown band and loop space maintainer was delivered (Fig. 8).

Fig. 2: Radiograph showing radiolucency involving pulp with 74, missing

75, and mesially shifted permanent molar Fig. 5: Buccal view of banded helical retractor

Fig. 3: The retentive component was soldered to a band of 74 with the Fig. 6: Post 3-week appliance follow-up showing space regained
spring of 4 mm helix and 10 mm active arm

Fig. 4: Cementation of the banded helical retractor Fig. 7: Postremoval of appliance

International Journal of Clinical Pediatric Dentistry, Volume 16 Issue 6 (November–December 2023) 841
 New Innovative Space Regainer
Fig. 8: Reverse crown band and loop space maintainer
Discussion
Management of developing malocclusion requires a thorough
assessment of the growth parameter, tooth–jaw size discrepancy,
the curve of Spee, overline persistence of bone on the remaining
deciduous tooth position, and morphology of adjacent tooth,
etc. Whenever teeth are moved orthodontically, the remaining
teeth act as anchorage units. The anchoring potential of teeth
is determined by a variety of characteristics such number of
roots, root size, root form, root inclination, and root length. 6
Interceptive orthodontic techniques include removable and
fixed space regainers to distalize the mesially drifted first
permanent molar.
The fixed space regainers are preferred over the removable
space regainers as they have benefits like patient cooperation,
chewing habit or oral hygiene maintenance, efficacy, and less
treatment time. The retentive arm of the springs soldered onto
a deciduous molar band provided anchorage. The active arm
length was in compliance with the Adams ratio of 1:3, therefore
the efficacy was achieved by the active arm’s small range of action
in the available space.7
The helix and appliance were placed buccally to promote
better accessibility to activate the appliance, avoid hindrance to
tongue movement, and better hygiene.8 Fixed maintainers like
open coil space regainer are also used to regain space but the major
disadvantage is the requirement of a special armamentarium and
it is a technique-sensitive approach in comparison to buccally-
842 International Journal of Clinical Pediatric Dentistry, Volume 16 Issue 6 (November–December 2023)
banded helical space regainer, which is easy to fabricate, is effective,
has good control over tooth movement, requires minimal patient
cooperation, and is economic. The time required to regain space in
open coil space regainer is usually 4 weeks9 and in our case, 2.5 mm
of space was regained in 3 weeks.
C o n c lu s i o n
Space management in mixed dentition is critical in pediatric
dentistry. Patient compliance in this innovative banded space
regainer was good, the appliance was easy to fabricate, and found
to be efficacious in achieving space loss in the short time span.
K e y M e s s ag e s
Early orthodontic interventions done at the beginning of
developing dentition help to promote favorable developmental
changes. Space maintainers and space regainers are effective in
managing space loss.
Orcid
Neeti Tatiya https://orcid.org/0000-0002-0099-8064
Shreya Sankalecha https://orcid.org/0000-0001-5551-2976
References
1. Muthu. Paediatric Dentistry: Principles and Practice, 2nd edition.
Elsevier; 2011. pp. 360–364.
2. Hoffding J, Kisling E. Premature loss of primary teeth; part 1, its overall
effect on occlusion and space in the permanent dentition. J Dent
Child 1978;45(4):279–283.
3. Raymond L, Braham Merle E, Morris. Textbook of Paediatric Dentistry.
Delhi: CBS Publishers & Distributors; 1990. pp. 617–618.
4. Sim JM. Minor Tooth Movement, 2nd edition. Saint Louis: The CV
Mosby Company; 1977. pp. 11–12.
5. Bishara Tex tbook of Or thodontics, 2nd edition. Elsevier.
pp. 410–412.
6. Nahidh M, Al Azzawi AM, Al-Badri SC. Understanding anchorage in
orthodontics-review article. J DentOral Disord 2019;5(2):1117.
7. Adams CP, Kerr W. The design, construction and use of removable
orthodontics appliances, 6th edition. Mumbai: Varghese Publishing
house. p. 199.
8. Uppal A, Singh R. Space regainers –a review. Int J Appl Dent Sci
2020;6(2):654–660.
9. Mallikarjun SB, Wilson B, Joppan S, et al. An Innovative space
regainer “banded helical retractor” in space management: a case
report. Int J Clin Pediatr Dent 2019;12(5):467–469. DOI: 10.5005/
jp-journals-10005-1677