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August's Tip: The Sling Shot Appliance

 By: Dr. Rick Grant

By: Dr. Rick Grant

A couple of years ago I had the opportunity to speak at the Pittsburgh Study Club.  The following day Dr. Jack Pechersky, a practicing Pediatric Dentist and an associate Professor at the University of Pittsburgh, spoke on an appliance that I thought would be excellent to share with his permission.  He calls it the "Sling Shot Appliance."  This is another "tool" that you can use to help align ectopically erupting teeth.

Sometimes, in the mixed dentition the first molar may ectopically erupt under the angle of the second primary molar (Figure 1).

In the permanent dentition the second the molar may ectopically erupt at an angle distal to the first permanent molar (Figure 2).

Sling Shot Appliance 1.jpg

The "Sling Shot" appliance was modified by Dr. Jack Pechersky and Dr. Aaron Valasek from an appliance introduced Dr. Begg and Dr. Kessling. (1)  Using an .020 Australian wire a helical is bent on one end and the other end is an 8mm straight section.  The distal of the straight end is annealed to make it soft enough to either bend back through a tube or eyelet or create a fixed loop.  The following are illustrations that show a fixed connection and a "loose" connection.  

Sling Shot Appliance 2.jpg
Sling Shot Appliance 3.jpg

Loose connection
The loose connection is fabricated in a similar manner with the exception that a button with and eyelet or tube is attached to the impacted molar.  The annealed end of the Australian wire is passed through the end of the eyelet or tube, double backed, and tied.  This allows the wire to be removed at subsequent visits (Figures 10-15).

Sling Shot Appliance 4.jpg
Sling Shot Appliance 5.jpg

An example of a loose connection is as follows:

Sling Shot Appliance 6.jpg
Sling Shot Appliance 7.jpg

Here is a clinical example in mixed dentition:

Sling Shot Appliance 8.jpg

Below is an example of correcting a lower impacted molar demonstrates the effectiveness of the fixed connection (Figure 26).

Sling Shot Appliance 9.jpg

This is just another "tool" you can use to de-impact or correct an ectopically erupting molar.  Other methods such as separating springs, brass ligatures, or ramping are other ways to accomplish correction.  Other appliances such as the Halterman (2) appliance may be used.  One advantage of the "Sling Shot" appliance is that it can be fabricated at chair side without having to remove a band and solder wire.  

I would like to thank Dr. Pechersky for introducing me to this appliance.  It has been very helpful in finishing cases where I need to ensure the second molar will be in occlusion.  I would encourage its use.  It is easy to use.  Give it a try!

References:

  1. Begg. P.R., Kessling, P.C., Orthodontic Theory and Technique, WB Saunders, Philadelphia, PA, pg. 640-664
  2. Halterman, C.W., A Simple Technique for the Treatment of Ectopically Erupting Permanent First Molars, J.ADA, Dec. 1982, Vol 105(6): 1031-1033.

 

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