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TECHNIQUECLINICPreventionofQuadHelixSoft-Tissue

Irritation

SEONG-HUNKIM,DMD,MS

YOUNG-GUKPARK,DMD,MS,PHD

TheQuadHelix,amodificationofthe?W?archdevelopedbyCoffin,1isusedformaxillary

expansion,anchoragereinforcement,andcorrectionofunilateralcrossbite.2-9Theremovabletype

hasseveraladvantagesoverthefixedtype,includingeaseofactivation.

AccordingtoRickettsandProffit,thelingualarchoftheQuadHelixshouldlie1-1.5mmawayfrom

thepalatalsofttissue.2,3Proffitwarned,however,thattheflexibilityofthelonganteriorarmscan

temptchildrentomanipulatethemandthuseitherdistortorweakenthewires,causingsoft-tissue

irritationorappliancebreakage.3Deformationoftheanteriorarmscanalsoresultfrombitingon

hardfoodorevennormalwear,especiallyincasesthatneedalongerperiodofanteriorexpansion

(Fig.1).

Soft-tissueirritationfromtheanteriorarmscanbeavoidedbyusingthefollowingsimplemethod:

1.Takeanimpressionofthemaxillaryarchwithbandsonthefirstpermanentmolars.Onthe

workingcast,constructtheremovableQuadHelixfrom.036stainlesssteelwire.

2.Graspinganelastomericmodulewithamosquitoforceps,inserta7cmlengthof.010ligature

wire,andtwistitlightlytoattachittothemodule(Fig.2).

3.SlipanelastomericmoduleandligaturewireovereachanteriorarmoftheQuadHelix(Fig.3).

Doubleoverthemodulesasnecessarysotheyfitsnugly.

4.WhenplacingtheQuadHelixinthemouth,tietheligaturewirestotheupperpremolarbracket

slots(Fig.4).Inthemixeddentition,thewirescanbetiedtobondedlingualbuttonsonthe

deciduousteeth.

5.Placean.016nickeltitaniumarchwireovertheligaturewiresforinitialleveling(Fig.5).

Thismeth