A Self-Secured Spring Separator

Although molar banding remains an important aspect of fixed orthodontic treatment, placement of a thick metal band without proper tooth separation can lead to contraction of the alveolar bone, hyalinization in the periodontal ligament, and a pain response from resident mechanoreceptors.¹ Ideally, orthodontic separators should provide adequate space without causing significant patient discomfort.² Currently available materials require two separators—one placed mesially and one distally—either of which can be inadvertently dislodged and potentially swallowed, aspirated, or submerged beneath the gingiva.

We have developed the Kansal Separator,^* a two-in-one wire separator that is self-secured to the molar, allowing separation of both mesial and distal interdental spaces with little risk of dislodgment.

Procedure

1. Use .016" stainless steel Regular Plus or Premium Plus Australian^** wire to fabricate the Kansal Separator (nickel titanium wire fractures too easily for this purpose). Bend mesial and distal helices, joined by a stabilizing wire segment that will lie along the lingual surface of the first molar (A).

2. Insert the separator from the buccal by grasping the distal helix with a No. 139 lightwire plier and inserting the gingival leg of the spring below the contact area on the distal side of the molar. Insert the mesial helix in the same way, thus placing the connecting wire segment on the molar’s occlusal surface.

3. Lift and pull the connecting wire lingually, so that it clears the molar cusps and rests near the lingual gingival margin (B).

The removal procedure is the opposite of insertion: lift the connecting wire to the occlusal surface, then grasp and gently pull the mesial and distal helices buccally until the unit is disengaged.

Discussion

Our office has pre-bent a supply of separators in three sizes that we determined by measuring 800 molars on plaster casts. We select the appropriate size either by referring to the patient’s diagnostic cast or by trying the separator in the mouth; about 90% of our patients can use the “medium” size (connecting bar = 9.5mm; occlusal leg = 7.5mm; gingival leg = 6.5mm). The separator can easily be customized for unusual tooth morphology, and activation forces can be increased or decreased simply by adjusting the spring legs. Like other wire separators, the Kansal Separator can be placed in patients with extremely tight contacts.