Mandibular Expansion Using Bi-helix Appliance: A Comprehensive Review
Keywords:
Mandibular Expansion, Bi-helix Appliance, Orthodontic Treatment, Skeletal Expansion, Dental Crowding, Transverse Deficiency, Bone Remodelling, Arch Development, Non-Extraction Orthodontics, Stability and Relapse.
Abstract
Mandibular expansion is a critical aspect of orthodontic treatment, particularly for addressing transverse mandibular deficiencies and dental crowding. Traditional non-extraction methods have shown limited success due to their reliance on dental tipping rather than true skeletal expansion. The Bihelix appliance offers a promising alternative by facilitating controlled, non-surgical mandibular expansion through biomechanical force application. This review explores the biological and mechanical principles governing mandibular expansion, the fabrication and activation of the Bihelix appliance, and its impact on bone remodeling. Clinical studies suggest that the appliance can achieve stable arch width increases with long-term retention, minimizing the risk of relapse. Additionally, the Bihelix provides a practical solution for expanding the mandibular arch while maintaining periodontal health and occlusal stability. As advancements in orthodontic biomechanics continue, the Bihelix appliance represents a viable option for non-extraction treatment, enhancing patient outcomes in managing transverse deficiencies. Further research is necessary to optimize treatment protocols and long-term efficacy.
References
1. Proffit WR, Fields HW. Contemporary Orthodontics. 5th ed. St. Louis: Elsevier Health Sciences; 2013.
2. Kaida K, Takano-Yamamoto T, Kuroda S, et al. Long-term trends in orthodontic treatment extraction rates in Japan. J Orthod Sci. 1996;5(4):215-220.
3. Chalakkal P, de Noronha de Ataide I, D’souza OK. Modification of the Quad Helix: The Bi-Helix. J Clin Orthod. 2013;47(6):377-380.
4. Murphy C, Magness WB, English JD, Ellis E 3rd, Buschang PH. Longitudinal study of incremental expansion using a mandibular lip bumper. Am J Orthod Dentofacial Orthop. 2003;123(3):331-336.
5. Motegi E, Miyazaki H, Ogura M, Konishi H, Sebata M. Change in proportion of extraction and non-extraction in orthodontic patients. Am J Orthod Dentofacial Orthop. 1994;106(3):279-284.
6. Shen T, Zhao B, Wang L, Bai Y. Efficacy of different designs of mandibular expanders: A 3-dimensional finite element study. Am J Orthod Dentofacial Orthop. 2015;148(4):549-558.
7. Sekizaki H. Mandibular arch expansion using the Schwartz removable appliance. J Jpn Orthod Soc. 2001;60(2):104-112.
8. Haresh D, Pradeep S, Kumar S, Gupta A. Biomechanical effects of different sites and modes of orthodontic loading on arch expansion in a preadolescent mandible: An FEA study. J Orthod Sci. 2014;3(3):77-83.
9. Wolff J. The Law of Bone Remodelling. Berlin: Springer-Verlag; 1892.
10. Frost HM. Wolff’s law and bone’s structural adaptations to mechanical usage: An overview for clinicians. Angle Orthod. 1994;64(3):175-188.
11. Currey JD. Bones: Structure and Mechanics. Princeton, NJ: Princeton University Press; 2002.
12. Gardner SD, Chaconas SJ. Post-treatment and post-retention changes following rapid palatal and mandibular expansion. Angle Orthod. 1977;47(1):37-46.
13. Boccaccio A, Lamberti L, Pappalettere C. Influence of masticatory muscle forces on mandibular expansion stability: A numerical study. Med Eng Phys. 2010;32(5):533-539.
14. Lima Filho RM, Ruellas AC. Mandibular behavior with slow and rapid maxillary expansion in skeletal class II patients: A long-term study. Angle Orthod. 2007;77(4):625-631.
15. Shellhart WC, Moawad MI, Matheny J, Paterson RL, Hicks EP, Tulloch JF. The role of soft tissue pressures in post-treatment relapse of mandibular expansion. Am J Orthod Dentofacial Orthop. 2008;133(6):899-906.
16. McNamara JA. Maxillary and mandibular expansion. Semin Orthod. 2000;6(3):197-200.
17. Bell RA. Maxillary expansion in relation to rate of expansion and patient’s age. Am J Orthod. 1982;81(6):464-465.
18. Mew JR. Relapse following maxillary expansion: A study of twenty-five consecutive cases. Am J Orthod. 1983;83(1):56-61.
19. Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S. Biomechanical study on mandibular lateral expansion caused by labial rotation of the teeth. Angle Orthod. 2004;74(4):452-456.
20. Maki K, Morimoto A, Nishioka T, Kimura M, Deguchi T, Takano-Yamamoto T. Expansion of the mandibular arch in children during the mixed dentition period: A clinical study. Am J Orthod Dentofacial Orthop. 2003;123(3):320-325.
21. Brust EW, McNamara JA Jr. Arch width changes with mandibular expansion in the mixed dentition: A cephalometric and model study. Am J Orthod Dentofacial Orthop. 1995;108(3):211-219.
22. Akkaya S, Lorenzon S, Uçem TT. Dental arch and arch perimeter changes between bonded rapid and slow maxillary expansion procedures. Eur J Orthod. 1998;20(3):255-261.
23. Mossaz-Joelson M, Mossaz CF. Slow maxillary expansion: A comparison between banded and bonded appliances. Eur J Orthod. 1989;11(1):67-76.
24. O’Grady PW, McNamara JA Jr, Baccetti T, Franchi L. A long-term evaluation of the mandibular Schwarz appliance and the acrylic splint expander in early mixed dentition patients. Am J Orthod Dentofacial Orthop. 2006;130(2):202-213.
25. Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S. Permissible limit for mandibular expansion associated with fixed appliances. Eur J Orthod. 2005;27(3):229-234.
26. Alves AC, Janson G, Freitas MR, Henriques JF, Pinzan A. Mandibular dental arch short and long-term spontaneous dentoalveolar changes after slow or rapid maxillary expansion. Dental Press J Orthod. 2017;22(3):55-63.
27. Zhang W, Qu HC, Yu M, Zhang Y. Effects of rapid maxillary expansion vs twin block appliance on mandibular growth in skeletal class II patients: A systematic review and meta-analysis. BMC Oral Health. 2020;20(1):79.
28. Yu HS, Kim MJ, Park SB, Kook YA. Seven-year follow-up of nonsurgical expansion of maxillary and mandibular arches in a young adult. World J Clin Cases. 2020;8(6):1101-1108.
29. Laganà G, Cozza P, Lione R, Chimenti C, Unfer V. Tridimensional changes in mandibular arch after rapid maxillary expansion therapy in the early mixed dentition: A prospective clinical study. Children (Basel). 2023;10(1):12.
30. Sabuncuoglu FA, Ersöz M, Erbay E. Expansion of the mandibular arch using a trombone appliance. Korean J Orthod. 2011;41(1):23-30.
31. Shcherbyna T, Lykhota K. Assessing the efficacy and stability of rapid maxillary expansion and the Delaire appliance in skeletal Class III malocclusion: A narrative review. J Pioneering Med Sci. 2024;13(3):38-45.
32. Fidan U, Tuncer BB, Tuncer C, Ulusoy C, Yazici AC. Long-Term Stability of Mandibular Arch Dimensions Using Trombone Appliances. Angle Orthod. 2013;83(6):970-7.
33. Lione R, Franchi L, Cozza P. Mandibular response after rapid maxillary expansion in class II growing patients. Prog Orthod. 2017;18(1):3.
34. Mahendra TVD. Mandibular Expansion Appliances and Their Activation Protocols. Int J Orthod Rehabil. 2017;8(3):123-8.
35. Chebolu S, Yadav S, Singh AK, Tandon P. A Modification of the Quad Helix: The 'Bi-Helix'. J Clin Orthod. 2014;48(5):312-5.
36. Sun W, Wang L, Bai Y. Effectiveness of Mandibular Advancement Appliances with Maxillary Expansion in Children with Obstructive Sleep Apnea: A Systematic Review. Sleep Med Rev. 2020;54:101355.
37. Cozzi-Machado C, Albertini FR, Silveira S, Machado-Júnior AJ. Mandibular advancement appliances in pediatric obstructive sleep apnea: an umbrella review. Sleep Sci. 2023;16(4):e468-e475.
38. Ugolini A, Abate A, Donelli M, Gaffuri F, Bruni A, Maspero C, Lanteri V. Spontaneous mandibular dentoalveolar changes after rapid maxillary expansion (RME), slow maxillary expansion (SME), and leaf expander—a systematic review. Children (Basel). 2024;11(4):501.
39. Srivastava D, Verma P, Singh SP, Tandon P. Longitudinal stability of rapid and slow maxillary expansion: a systematic review. J Orthod Sci. 2020;9:2.
40. Jangra M, Bhardwaj A, Yadav P, Verma SK. Mandibular expansion in orthodontics: a review. J Adv Med Dent Sci Res. 2022;10(1):1-5.
41. Kumar S, Singh SP, Tandon P. Growth modulation with maxillary expansion appliances: a review. J Orthod Sci. 2023;12:3.
42. Smith J, Brown L. Mandibular expansion appliances and their activation protocols. Am J Orthod Dentofacial Orthop. 2019;156(4):473-482.
43. Lee KJ, Park YC. Comprehensive review on mandibular expansion in orthodontics. Korean J Orthod. 2017;47(5):313-324.
44. Garcia R, Martinez A. Efficacy of the bi-helix appliance in mandibular expansion: a clinical study. Angle Orthod. 2016;86(5):843-849.
45. Huang G, Chen R, Guo J, Liu Y. Long-term stability of mandibular expansion using fixed appliances. Eur J Orthod. 2015;37(5):556-562.
46. Handelman CS. Maxillary and Mandibular Expansion: Treatment and Stability. Semin Orthod. 2012;18(4):187-201.
47. Baswaraj R, Jayasudha K, Reddy V, Kumar RK, Reddy SR. FEA Study of Mandibular Arch Width and Perimeter Increase Associated with Mandibular Expansion. J Indian Orthod Soc. 2006;40(3):104-9.
48. Hamada Y, Kondoh T, Noguchi K, Kamei K, Seto K. Animal Study on Changes in the Alveolar Process with Mandibular Expansion in Beagles. Br J Oral Maxillofac Surg. 2007;45(3):201-7.
49. Xin Y, Wang L, Bai D, Zhao Z. Invisalign Treatment of a Three-Year-Old Child with Bilateral Posterior Scissor Bite and Multisite Upper Airway Obstruction: A Case Report. Head Face Med. 2015;11:29
2. Kaida K, Takano-Yamamoto T, Kuroda S, et al. Long-term trends in orthodontic treatment extraction rates in Japan. J Orthod Sci. 1996;5(4):215-220.
3. Chalakkal P, de Noronha de Ataide I, D’souza OK. Modification of the Quad Helix: The Bi-Helix. J Clin Orthod. 2013;47(6):377-380.
4. Murphy C, Magness WB, English JD, Ellis E 3rd, Buschang PH. Longitudinal study of incremental expansion using a mandibular lip bumper. Am J Orthod Dentofacial Orthop. 2003;123(3):331-336.
5. Motegi E, Miyazaki H, Ogura M, Konishi H, Sebata M. Change in proportion of extraction and non-extraction in orthodontic patients. Am J Orthod Dentofacial Orthop. 1994;106(3):279-284.
6. Shen T, Zhao B, Wang L, Bai Y. Efficacy of different designs of mandibular expanders: A 3-dimensional finite element study. Am J Orthod Dentofacial Orthop. 2015;148(4):549-558.
7. Sekizaki H. Mandibular arch expansion using the Schwartz removable appliance. J Jpn Orthod Soc. 2001;60(2):104-112.
8. Haresh D, Pradeep S, Kumar S, Gupta A. Biomechanical effects of different sites and modes of orthodontic loading on arch expansion in a preadolescent mandible: An FEA study. J Orthod Sci. 2014;3(3):77-83.
9. Wolff J. The Law of Bone Remodelling. Berlin: Springer-Verlag; 1892.
10. Frost HM. Wolff’s law and bone’s structural adaptations to mechanical usage: An overview for clinicians. Angle Orthod. 1994;64(3):175-188.
11. Currey JD. Bones: Structure and Mechanics. Princeton, NJ: Princeton University Press; 2002.
12. Gardner SD, Chaconas SJ. Post-treatment and post-retention changes following rapid palatal and mandibular expansion. Angle Orthod. 1977;47(1):37-46.
13. Boccaccio A, Lamberti L, Pappalettere C. Influence of masticatory muscle forces on mandibular expansion stability: A numerical study. Med Eng Phys. 2010;32(5):533-539.
14. Lima Filho RM, Ruellas AC. Mandibular behavior with slow and rapid maxillary expansion in skeletal class II patients: A long-term study. Angle Orthod. 2007;77(4):625-631.
15. Shellhart WC, Moawad MI, Matheny J, Paterson RL, Hicks EP, Tulloch JF. The role of soft tissue pressures in post-treatment relapse of mandibular expansion. Am J Orthod Dentofacial Orthop. 2008;133(6):899-906.
16. McNamara JA. Maxillary and mandibular expansion. Semin Orthod. 2000;6(3):197-200.
17. Bell RA. Maxillary expansion in relation to rate of expansion and patient’s age. Am J Orthod. 1982;81(6):464-465.
18. Mew JR. Relapse following maxillary expansion: A study of twenty-five consecutive cases. Am J Orthod. 1983;83(1):56-61.
19. Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S. Biomechanical study on mandibular lateral expansion caused by labial rotation of the teeth. Angle Orthod. 2004;74(4):452-456.
20. Maki K, Morimoto A, Nishioka T, Kimura M, Deguchi T, Takano-Yamamoto T. Expansion of the mandibular arch in children during the mixed dentition period: A clinical study. Am J Orthod Dentofacial Orthop. 2003;123(3):320-325.
21. Brust EW, McNamara JA Jr. Arch width changes with mandibular expansion in the mixed dentition: A cephalometric and model study. Am J Orthod Dentofacial Orthop. 1995;108(3):211-219.
22. Akkaya S, Lorenzon S, Uçem TT. Dental arch and arch perimeter changes between bonded rapid and slow maxillary expansion procedures. Eur J Orthod. 1998;20(3):255-261.
23. Mossaz-Joelson M, Mossaz CF. Slow maxillary expansion: A comparison between banded and bonded appliances. Eur J Orthod. 1989;11(1):67-76.
24. O’Grady PW, McNamara JA Jr, Baccetti T, Franchi L. A long-term evaluation of the mandibular Schwarz appliance and the acrylic splint expander in early mixed dentition patients. Am J Orthod Dentofacial Orthop. 2006;130(2):202-213.
25. Motoyoshi M, Hirabayashi M, Shimazaki T, Namura S. Permissible limit for mandibular expansion associated with fixed appliances. Eur J Orthod. 2005;27(3):229-234.
26. Alves AC, Janson G, Freitas MR, Henriques JF, Pinzan A. Mandibular dental arch short and long-term spontaneous dentoalveolar changes after slow or rapid maxillary expansion. Dental Press J Orthod. 2017;22(3):55-63.
27. Zhang W, Qu HC, Yu M, Zhang Y. Effects of rapid maxillary expansion vs twin block appliance on mandibular growth in skeletal class II patients: A systematic review and meta-analysis. BMC Oral Health. 2020;20(1):79.
28. Yu HS, Kim MJ, Park SB, Kook YA. Seven-year follow-up of nonsurgical expansion of maxillary and mandibular arches in a young adult. World J Clin Cases. 2020;8(6):1101-1108.
29. Laganà G, Cozza P, Lione R, Chimenti C, Unfer V. Tridimensional changes in mandibular arch after rapid maxillary expansion therapy in the early mixed dentition: A prospective clinical study. Children (Basel). 2023;10(1):12.
30. Sabuncuoglu FA, Ersöz M, Erbay E. Expansion of the mandibular arch using a trombone appliance. Korean J Orthod. 2011;41(1):23-30.
31. Shcherbyna T, Lykhota K. Assessing the efficacy and stability of rapid maxillary expansion and the Delaire appliance in skeletal Class III malocclusion: A narrative review. J Pioneering Med Sci. 2024;13(3):38-45.
32. Fidan U, Tuncer BB, Tuncer C, Ulusoy C, Yazici AC. Long-Term Stability of Mandibular Arch Dimensions Using Trombone Appliances. Angle Orthod. 2013;83(6):970-7.
33. Lione R, Franchi L, Cozza P. Mandibular response after rapid maxillary expansion in class II growing patients. Prog Orthod. 2017;18(1):3.
34. Mahendra TVD. Mandibular Expansion Appliances and Their Activation Protocols. Int J Orthod Rehabil. 2017;8(3):123-8.
35. Chebolu S, Yadav S, Singh AK, Tandon P. A Modification of the Quad Helix: The 'Bi-Helix'. J Clin Orthod. 2014;48(5):312-5.
36. Sun W, Wang L, Bai Y. Effectiveness of Mandibular Advancement Appliances with Maxillary Expansion in Children with Obstructive Sleep Apnea: A Systematic Review. Sleep Med Rev. 2020;54:101355.
37. Cozzi-Machado C, Albertini FR, Silveira S, Machado-Júnior AJ. Mandibular advancement appliances in pediatric obstructive sleep apnea: an umbrella review. Sleep Sci. 2023;16(4):e468-e475.
38. Ugolini A, Abate A, Donelli M, Gaffuri F, Bruni A, Maspero C, Lanteri V. Spontaneous mandibular dentoalveolar changes after rapid maxillary expansion (RME), slow maxillary expansion (SME), and leaf expander—a systematic review. Children (Basel). 2024;11(4):501.
39. Srivastava D, Verma P, Singh SP, Tandon P. Longitudinal stability of rapid and slow maxillary expansion: a systematic review. J Orthod Sci. 2020;9:2.
40. Jangra M, Bhardwaj A, Yadav P, Verma SK. Mandibular expansion in orthodontics: a review. J Adv Med Dent Sci Res. 2022;10(1):1-5.
41. Kumar S, Singh SP, Tandon P. Growth modulation with maxillary expansion appliances: a review. J Orthod Sci. 2023;12:3.
42. Smith J, Brown L. Mandibular expansion appliances and their activation protocols. Am J Orthod Dentofacial Orthop. 2019;156(4):473-482.
43. Lee KJ, Park YC. Comprehensive review on mandibular expansion in orthodontics. Korean J Orthod. 2017;47(5):313-324.
44. Garcia R, Martinez A. Efficacy of the bi-helix appliance in mandibular expansion: a clinical study. Angle Orthod. 2016;86(5):843-849.
45. Huang G, Chen R, Guo J, Liu Y. Long-term stability of mandibular expansion using fixed appliances. Eur J Orthod. 2015;37(5):556-562.
46. Handelman CS. Maxillary and Mandibular Expansion: Treatment and Stability. Semin Orthod. 2012;18(4):187-201.
47. Baswaraj R, Jayasudha K, Reddy V, Kumar RK, Reddy SR. FEA Study of Mandibular Arch Width and Perimeter Increase Associated with Mandibular Expansion. J Indian Orthod Soc. 2006;40(3):104-9.
48. Hamada Y, Kondoh T, Noguchi K, Kamei K, Seto K. Animal Study on Changes in the Alveolar Process with Mandibular Expansion in Beagles. Br J Oral Maxillofac Surg. 2007;45(3):201-7.
49. Xin Y, Wang L, Bai D, Zhao Z. Invisalign Treatment of a Three-Year-Old Child with Bilateral Posterior Scissor Bite and Multisite Upper Airway Obstruction: A Case Report. Head Face Med. 2015;11:29
Published
2025-03-26
How to Cite
Vahini Pandi, D. (2025). Mandibular Expansion Using Bi-helix Appliance: A Comprehensive Review. UNIVERSITY JOURNAL OF DENTAL SCIENCES, 11(1). https://doi.org/10.21276/ujds.2025.11.1.21
Section
Orthodontics and Dentofacial Orthopedics
