Lingual Arch Research Articles

Bilateral Intrusion of Molar using Modified transpalatal Arch in Mutilated Case

Bilateral Intrusion of Molar using Modified transpalatal Arch in Mutilated Case

Non-surgical profile correction in a class II malocclusion

Case report of a 17-year-old male patient, skeletal class II, convex profile, not pleased with his facial appearance and without any intention to undergo surgical treatment. He presents severe protrusion and crowding, lip incompetence and protrusion, 7mm overjet and -3mm overbite. The treatment goals were to improve lip relation and esthetics, establish a functional occlusion, to improve the profile and muscular balance. Four first premolar extractions were performed and anchorage control was accomplished with a transpalatal and lingual arch. Treatment results were very successful achieving functional occlusion, lip competence, mandibular rotation and a decrease in profile convexity without surgical treatment. It is important to know the scopes and limits of orthodontic treatment regarding soft tissues, as well as maintaining anchorage to achieve profile changes with maxillary incisor retraction.

Corrección no quirúrgica del perfil de una maloclusión clase II

Case report of a 17-year-old male patient, skeletal class II, convex profile, not pleased with his facial appearance and without any intention to undergo surgical treatment. He presents severe protrusion and crowding, lip incompetence and protrusion, 7mm overjet and -3mm overbite. The treatment goals were to improve lip relation and esthetics, establish a functional occlusion, to improve the profi le and muscular balance. Four first premolar extractions were performed and anchorage control was accomplished with a transpalatal and lingual arch. Treatment results were very successful achieving functional occlusion, lip competence, mandibular rotation and a decrease in profile convexity without surgical treatment. It is important to know the scopes and limits of orthodontic treatment regarding soft tissues, as well as maintaining anchorage to achieve profile changes with maxillary incisor retraction.

Treatment of Class II Maxillary Retrusion Case Using Miniscrew (Nonextraction Treatment of Adolescent Patient)

ABSTRACT Objective: This case report describes the protocol employed in the treatment of a patient with Class II subdivision malocclusion, with sagittal, transverse, and occlusal disharmonies. Materials and Methods: Treatment included the expansion of the maxilla with a banded Hyrax appliance over a period of 14 days. After a retention period, the device was removed and a stainless steel transpalatal arch was attached. The maxillary arch was bonded with MBT prescription brackets, and distalization of the left maxillary first molar commenced on a 0.016 × 0.022-inch stainless steel archwire supported by a miniscrew for indirect anchorage. After 4.7 mm of molar distalization, a Nance appliance with a bite plane was placed, and the mandibular arch was bonded to continue treatment, which lasted 18 months. Mandibular and maxillary fixed retainers were placed at the end of active treatment. Results: Pretreatment and posttreatment records showed that vertical and sagittal skeletal cephalometric findings were stab...

The Comparison of Silver and Laser Soldering Techniques on Periodontal Tissues: A Preliminary Study

ABSTRACT Objective: The aim of this study was to compare the inflammatory effects of conventional and laser soldering methods on periodontal tissues in orthodontics. Materials and Method: Forty specimens were acquired from 10 patients whose treatment plan consisted of extraction of 4 first premolars. Before performing the extractions, a transpalatal arch (TPA) for the upper first molars and a lingual arch for the lower first molars were placed for anchorage purposes. Upper left and lower right first molar bands were soldered using the laser welding (LW) technique, and upper right and lower left first molar bands were soldered using the conventional silver soldering technique (CSS). Gingival crevicular fluid (GCF) analysis was used for determining the effects of welding procedures on periodontal tissues. All variables were analyzed by nonparametric tests. Results: Myeloperoxidase levels ranged between 2.46 and 3.56 for the CSS group and between 2.20 and 3.39 for the LW group; nitric oxide levels ranged bet...

Treatment effects of the Carrière distalizer using lingual arch and full fixed appliances

BackgroundThis study evaluated the treatment effects of the Carrière Distalizer used with either full fixed appliances (FA group) or lower lingual arches (LLA group). MethodsCephalometric radiographs from 41 orthodontic patients with Class II Division 1 malocclusion before and after use of the Carrière Distalizer were investigated. Eligible individuals possessed a normal maxilla, retrognathic mandible, normal growth pattern, permanent dentition, minimal crowding with well-aligned dental arches, and at least an end-on Class II molar relationship bilaterally. Two matched groups were formed according to sagittal and vertical skeletal characteristics. Full fixed appliances and a lower lingual arch supported Class II elastic use in the FA (n = 19) and LLA (n = 22) groups, respectively. The Wilcoxon signed rank test was used to compare the treatment changes between the two groups. The differences between the study groups were compared using the Mann-Whitney U test. ResultsThe maxillary molar was distalized between 1.6 and 2.5 mm, with the mean amount of molar tipping not exceeding 3.7° in the study sample. No significant differences were observed between the study groups with regard to molar distalization and tipping. Significant reductions in both the Wits and over-jet measurements were observed in both groups (all, P < 0.05 vs. baseline). Significant differences in over bite and mesial movement of both the mandibular molar and the incisors were observed between the two study groups (all, P < 0.05). ConclusionsSuccessful correction of Class II malocclusion was achieved with the Carrière Distalizer appliance in both groups, with minimal molar tipping. However, adverse effects common with Class II elastics accompanied the correction at variable rates in the groups.

Stability of surgically assisted rapid palatal expansion with and without retention analyzed by 3-dimensional imaging

Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treatment of adults with transverse maxillary deficiency greater than 7 mm. There is no consensus about the dentoskeletal effect of an orthodontic retainer on the outcome of SARPE. Our objective was to assess the effectiveness of an orthodontic retainer on dentoskeletal stability. Ninety digitized dental casts of 30 adults undergoing SARPE were divided into 2 groups-no retention (n = 15) and retention (n = 15)-and assessed. The dental casts were obtained at 3 checkpoints: (1) 7 days on average before SARPE (preoperatively), (2) 4 months after expansion, and (3) 10 months after expansion was completed. The retention patients received a transpalatal arch just after expander removal, at checkpoint 2. The transpalatal arch was kept for 10 months after completion of the expansion (checkpoint 3 and end of the study). The dental casts were scanned with a Vivid 9i 3D laser scanner (Konica Minolta, Wayne, NJ). The distances measured were premolar and molar intercusp distances, premolar and molar intercervical distances, premolar and molar inter-WALA (Will Andrews and Lawrence Andrews) ridge distances, and palate height at the maxillary first molar. The planned maxillary expansion was within the expected amount (P <0.05). Palatal height at the 4-month checkpoint decreased by 0.79 mm (4.38%) (P <0.001) and again at the 10-month checkpoint by 0.38 mm (0.98%) (P >0.05) but not significantly in both groups. The premolar intercusp distance had a relapse at checkpoint 3 of 1.84 mm (7.18%) (P <0.001) in the no-retention group. Both groups had average relapses of 0.95 mm in the premolar intercervical distances, of 0.88 mm in the premolar inter-WALA ridge distances, of 1.04 mm in the molar intercusp distances, of 0.74 mm in the molar intercervical distances, and of 0.84 mm in the molar inter-WALA ridge distances (P <0.05) at checkpoint 3. The analysis of relapse in both groups suggests that the use of a transpalatal arch as a retaining device does not improve dento-osseous stability.

An ortho-surgical approach to severe impaction using bone crestal bridge: a case report.

Impaction of both mandibular canine and lateral incisor is a rare clinical finding which is often treated by way of surgical extraction. This decision is often taken because of the anatomical limitations presented by the mandible, and the horizontal position of the impacted teeth, which have occasionally transmigrated, placing them in close proximity to the roots of neighboring teeth and with a high risk for causing their resorption. In addition, this condition significantly increases the likelihood that the area involved will undergo gingival recession and loss of crestal bone if an unsophisticated ortho-surgical approach is undertaken. The present report describes a novel ortho-surgical technique which maintains the alveolar crestal bone and utilizes a lingual arch attached to the first molars with traction through tunneling with super-elastic springs. This combined approach eliminated the need for extraction of the impacted teeth, and accomplished their full alignment without any of the aforementioned side effects. Every dentist (general practitioners as well as specialists) should be aware of this procedure and refer patients to a specialist.

Orthodontic treatment of a stubborn palatally ectopic canine: a case report

This is a case report that highlights a different treatment approach in dealing with palatally ectopic canines. The modified transpalatal arch with an 'active' arm was used to align a palatally ectopic canine with 'push' mechanics after the initial use of more conventional 'pull' mechanics (piggy-back archwire technique) had failed.

Analysis of Stress in the Periodontal Ligament and Alveolar Bone of the Maxillary First Molars during Intrusion with Microscrew Implants: A 3D Finite Element Study

ABSTRACTObjectivesThe objective of this study was to graphically display the pattern and magnitude of stress distribution along the periodontal ligament and the alveolar bone of upper first molars on application of intrusive forces using microscrew implants.Materials and methodsA computer simulation of threedimensional model of maxillary first molars and second molars bilaterally with their periodontal ligament and alveolar bone, with microscrew implants, force element and a transpalatal arch were constructed on the basis of average anatomic morphology. Finite element analysis was done to evaluate the amount of stress and its distribution during orthodontic intrusive force.ResultsOverall maximum stress in this study was seen in the alveolar bone in the implant insertion area of 7.155 N/mm2.Maximum stress in the periodontal ligament was seen in middle third distocervical palatal root surface of the first molar (0.008993 N/mm2). Maximum stress in the enamel was seen in the distal aspect of the cementoenamel junction (0.423 N/mm2). Maximum stress in the dentin was observed in apical one-third of the mesiobuccal root surface of first molar (0.1785 N/mm2).ConclusionIn this study with the use of palatal implant and transpalatal arch, we found that there was no tipping observed during intrusion. This study demonstrates that significant true intrusion of maxillary molars could be obtained in a wellcontrolled manner by using fixed appliances with microscrew implant as bony anchorage.How to cite this articlePavithra AS, Prashanth GS, Mathew S, Shekar SE. Analysis of Stress in the Periodontal Ligament and Alveolar Bone of the Maxillary First Molars during Intrusion with Microscrew Implants: A 3D Finite Element Study. World J Dent 2014;5(1):11-16.

A Simple 2D Accurate Mini Implant Positioning Guide.

One of the major issues in orthodontic treatment is anchorage planning when using a pre adjusted edgewise appliance system. The conventional methods described in the literature include banding of second molars, transpalatal arches and headgears that involve additional teeth or wire components. With the introduction of temporary anchorage devices, anchorage can be ideally planned to treat a case successfully. However, the stability and placement of these mini implants demands accurate positioning, good bone thickness without damaging the adjacent structures. Here, we illustrate a very economical and two dimensional mini implant guide for accurate and easy placement.

A Modified Transpalatal Arch for Correction of Bucally Placed Maxillary 2nd Molars: Non-Compliant Mechanics

The transpalatal arch (TPA) can be used as an adjunct during orthodontic treatment to help control the movement of the maxillary first molars in three dimensions including molar rotations, uprighting and maintaining transverse dimensions posteriorly. In addition it can also be used to maintain leeway space, as an additional anchorage to achieve active movement of teeth, modified for space maintenance, intrusion, etc. Here modified Transpalatal arch is used with E-chain - a non-compliant mechanics for correction of Maxillary 2 nd

Bilateral Intrusion of Molar using Modified transpalatal Arch in Mutilated Case

For treating the extruded molars, various orthodontic techniques have been introduced. In this article, bilateral molar intrusion is carried out with a modified transpalatal arch.

Lingual Approach to Buccally Impacted Teeth

ABSTRACTOrthodontic management of impacted teeth is one of the most challenging aspects in terms of diagnosis and treatment planning and execution. Treatment is usually prolonged in duration and often complicated by various local factors. This article describes a simplified method toward management of an impacted tooth through the medium of a case report. A patient reported with impacted maxillary canine and an impacted mandibular premolar, was treated orthodontically. The impacted premolar was aligned using a new approach through the modification of the lingual arch. This article describes the design, mechanism of action and the relative advantages and disadvantages of the technique used.How to cite this articleTahilramani SM, Gaikwad S, Karandikar G, Ravindranath VK. Lingual Approach to Buccally Impacted Teeth. J Contemp Dent 2014;4(3):162-166.

Space supervision and guidance of eruption in management of lower transitional crowding: A non-extraction approach

Mandibular incisor crowding in the mixed dentition is one of the most common problems presenting to the orthodontist. Asymmetry of alignment, premature loss of primary canine(s), and disruption in arch integrity are all early benchmarks of a tooth size/arch length discrepancy in the transitional dentition that can occur independent of any skeletal discrepancy. Space supervision and guidance of eruption refer to treatment interventions during the early to mid-mixed dentition periods that influence the eruption patterns and positioning of the permanent teeth during their transition. Generally considered applicable to individuals with adequate overall arch dimensions to accommodate a normal complement of permanent teeth with an acceptable esthetic and functioning occlusion, guidance of eruption involves the implementation of directed interventions to optimize the eruption and alignment patterns of the permanent teeth as part of a non-extraction protocol.

Treatment of a Class II Division 2 Patient with Severe Skeletal Discrepancy by Using a Custom Made TPA Proclination Spring

This case report describes the orthodontic treatment of a boy, aged 15.3 years, with permanent dentition, mesofacial typology, affected with a severe sagittal skeletal Class II division 2 malocclusion, due to a mandibular retrusion. His chief compliant was the position of the maxillary incisors, displaced too palatally, and an impaired facial profile. Herbst and multi-bracket straightwire fixed appliances, together with a custom made modified transpalatal arch (i.e. TPA proclination spring), were used to correct the sagittal discrepancy and to improve the attractiveness of the impaired facial profile.

Optimization of unilateral molar rotation correction by a trans-palatal bar: a three-dimensional analysis using the finite element method

The main goal of this study was to optimize unilateral molar rotation correction by modifying a trans-palatal arch (TPA) design using the finite element method. Three-dimensional analysis of different TPA designs was carried out using the finite element method. Department of Orthodontics, Tehran University of Medical Sciences, Iran. For this investigation, 13 three-dimensional finite element models were produced for different TPA designs without pre-activation bends. Each model contained a palatal bar and two tubes. Optimizing unilateral molar rotations was achieved by five separate different paths: incorporating U-loop(s), 'R' loop(s) or helix/helices, a reverse action of the helix/helices and adding a straight wire to the design. The mesial part of the left side tube was displaced 0·1, 0·25, 0·5 and 1 mm, successively towards the midline, simulating palatal bar tab engagement in a mesio-palatal rotated maxillary left molar. The mesio-distal force, moment and energy produced in the normal side (right) molar were recorded for each of the models. Findings showed that in all designs, the associated mesializing force was lower than that seen in the traditional design and the moment showed an increasing pattern when compared with a simple palatal bar. Regarding energy levels, the same increasing pattern was observed in the designs between activations of 0·1 and 1·0 mm. According to our optimized system, the TPA design with the highest energy and moment, but the lowest mesializing force associated with derotating a maxillary molar tooth was a parallel wire II design (i.e. adding a straight wire).

Midpalatal miniscrews and high-pull headgear for anteroposterior and vertical anchorage control: Cephalometric comparisons of treatment changes

Our aim was to evaluate which anchorage system is better suited for both anteroposterior and vertical anchorage control of maxillary posterior teeth. Fifty-one subjects requiring maximum anchorage were divided into 2 groups according to maxillary posterior anchorage reinforcement: high-pull headgear, conventional transpalatal arch, and interarch elastics (n= 28); or modified transpalatal arch supported by 2 midpalatal miniscrews (n= 23). Bilateral maxillary first premolars were extracted in all patients. Pretreatment and posttreatment lateral cephalometric radiographs were superimposed to compare skeletal and dental changes between the groups. (1) The miniscrew group had less mesial movement of the maxillary first molars (0.85 vs 3.63 mm) and greater maxillary incisor retraction (6.87 vs 4.50 mm) than did the headgear group with the same treatment duration. (2) The maxillary molars were significantly intruded in the miniscrew group (1.30 mm), whereas they were extruded in the headgear group (0.71 mm). In the miniscrew group, intrusion of the maxillary molars resulted in a statistically significant decrease in the mandibular plane angle (0.80°). Patients using high-pull headgear showed no significant decrease in these measurements. In both the anteroposterior and vertical directions, a modified transpalatal arch supported by 2 midpalatal miniscrews provided more stable anchorage.

Assessment of changes following en-masse retraction with mini-implants anchorage compared to two-step retraction with conventional anchorage in patients with class II division 1 malocclusion: a randomized controlled trial

No randomized controlled trial has tried to compare treatment outcomes between the sliding en-masse retraction of upper anterior teeth supported by mini-implants and the two-step sliding retraction technique employing conventional anchorage devices. To evaluate skeletal, dental, and soft tissue changes following anterior teeth retraction. Parallel-groups randomized controlled trial on patients with class II division 1 malocclusion treated at the University of Al-Baath Dental School in Hamah, Syria between July 2011 and May 2013. One hundred and thirty-three patients with an upper dentoalveolar protrusion were evaluated and 80 patients fulfilled the inclusion criteria. Randomization was performed using computer-generated tables; allocation was concealed using sequentially numbered opaque and sealed envelopes. Fifty-six participants were analysed (mean age 22.34 ± 4.56 years). They were randomly distributed into two groups with 28 patients in each group (1:1 allocation ratio). Following first premolar extraction, space closure was accomplished using either the en-masse technique with mini-implants or the two-step technique with transpalatal arches (TPAs). The antero-posterior displacements of upper incisal edges and upper first molars were measured on lateral cephalograms at three assessment times. Assessor blinding was employed. A bodily retraction (-4.42 mm; P < 0.001) with a slight intrusion (-1.53 mm; P < 0.001) of the upper anterior teeth was achieved in the mini-implants group, whereas upper anterior teeth retraction was achieved by controlled palatal tipping in the TPA group. When retracting anterior teeth in patients with moderate to severe protrusion, the en-masse retraction based on mini-implants anchorage gave superior results compared to the two-step retraction based on conventional anchorage in terms of speed, dental changes, anchorage loss, and aesthetic outcomes.

Sagittal changes in lower incisors by the use of lingual arch

The objective of this study was to evaluate a sagittal variation on the lower incisors with the use of the lingual arch on the transition from mixed to permanent dentition. The sample was constituted of 44 Caucasian patients (26 girls and 18 boys), divided in two groups: CG, control group, monitoring the lower arch space with no orthodontic/orthopedic treatment during the rated period (n = 14); EG, experimental group, presenting anterior inferior mild crowding and installation of the lingual arch for space maintenance (n = 30). The position of the lower incisors was analyzed on computerized cephalometric tracings performed at the beginning of the monitoring (T1) and at the end, on the permanent dentition (T2). In order to evaluate the position of the incisors it was used Tweed and Steiner measurements: IMPA, 1.NB and 1-NB. The alterations were analyzed through the "t" test for paired samples, while the differences between the groups were analyzed through the "t" test for independent samples, as for sexual dimorphism. The values in T2 were greater in relation to T1 for all measurements on EG (IMPA, p = 0.038; 1.NB, p = 0.007 and 1-NB, p < 0.0001). On comparing the differences (T2-T1) between CG and EG, it can be gauged differences significantly superior for measure 1.NB (p = 0.002) and 1-NB (p < 0.0001) on EG. There was no statistically significant difference between genres. It was concluded that the lower incisors were projected after using the lingual arch to control the space on the transition from mixed to permanent dentition, however, within acceptable standards, not having difference between genres.