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Table of Contents
CLINICAL INNOVATION
Year : 2020  |  Volume : 8  |  Issue : 2  |  Page : 26-28

Modified transpalatal auxiliary arch for enhanced anchorage and tooth movement


1 Department of Orthodontics and Dentofacial Orthopedics, Hazaribag College of Dental Sciences & Hospital, Hazaribag, Jharkhand, India
2 Department of Conservative and Endodontics, Hazaribag College of Dental Sciences & Hospital, Hazaribag, Jharkhand, India
3 Department of Public Health Dentistry, Hazaribag College of Dental Sciences & Hospital, Hazaribag, Jharkhand, India
4 Department of Prosthodontics and Crown & Bridge, Hazaribag College of Dental Sciences & Hospital, Hazaribag, Jharkhand, India
5 Consultant Orthontist, Dr. Swati’s Clinic, Hazaribag, Jharkhand, India
6 Consultant Endodontist, Baradwaj Dental Clinic, New Delhi, India

Date of Submission22-Apr-2020
Date of Acceptance19-May-2020
Date of Web Publication27-Jun-2020

Correspondence Address:
Dr. Dhananjay Rathod
Department of Orthodontics and Dentofacial Orthopedics, Hazaribag College of Dental Sciences & Hospital, Jharkhand State Highway 7, Bara Bazar, Matwari, Demotand, Hazaribag, Jharkhand.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_10_20

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  Abstract 

Intraoral appliances such as transpalatal arch and Nance appliance fail to resist forces that tend to loosen the anchorage. The infirmity arises due to the long-lever arm and the mesial force that is perpendicular to the long axis of the appliance. The butterfly arch is presented here as an intraoral appliance that withstands the mesially directed forces with a mechanism that puts strain on a stiff wire along its long axis. The unique shape of the butterfly arch is advantageous in maximum anchorage cases, cases in which arch width preservation is critical and cases with a vertical growth pattern. With the aid of the butterfly arch, clinical concerns such as patient cooperation, wearing extraoral appliances, complicated mechanics in extraction cases, and control of the arch length, arch width, and vertical dimension would be greatly diminished.

Keywords: Anchorage, tooth movement, transpalatal auxiliary


How to cite this article:
Rathod D, Priya S, Chatterjee S, Shankar D, Rai S, Rathore A. Modified transpalatal auxiliary arch for enhanced anchorage and tooth movement. Int J Oral Care Res 2020;8:26-8

How to cite this URL:
Rathod D, Priya S, Chatterjee S, Shankar D, Rai S, Rathore A. Modified transpalatal auxiliary arch for enhanced anchorage and tooth movement. Int J Oral Care Res [serial online] 2020 [cited 2020 Jul 3];8:26-8. Available from: http://www.ijocr.org/text.asp?2020/8/2/26/288061




  Introduction Top


A controversial topic in orthodontics is the extraction of teeth and the effects on the skeleton, the dentoalveolar complex, and the soft-tissue profile. Teeth are removed in a variety of patterns, and many treatment protocols are used to achieve the desired treatment goals. The mechanics involved in the management of the extraction spaces depend on the amount of anchorage required. Maximum anchorage, when the first molars maintain their position and do not move into the extraction site, often is desirable in the maxillary arch. Several devices, both extraoral (extraoral traction) and intraoral (transpalatal arch [TPA] and Nance holding arch), have been proposed to provide maximum anchorage. The TPA is a commonly used appliance for anchorage in the maxillary arch and for controlling the position of the molars. TPA has been widely used as an adjunct in clinical orthodontics for the correction of molar rotations, anchorage reinforcement, molar expansion, molar distalization, and vertical molar control.[1],[2]

On the working maxillary cast, a removable type TPA as designed by Goshgarian was fabricated using a 0.036-inch stainless steel wire. The TPA was originally described by Robert Goshgarian.[3] It is constructed from 0.9 or 1.25mm stainless steel wire and crosses the palate to connect one molar or premolar to a contralateral tooth. The TPA is a wire or bar spanning the palate connecting two bands on the maxillary first permanent molars. This auxiliary appliance is used widely to change or stabilize the position of the maxillary molars in three dimensions, including producing molar rotation and uprighting, stabilizing transverse dimensions posteriorly during treatment, and maintaining leeway spaces during the transition of the dentition. It is also used for additional anchorage during the retraction of the anterior segments during extraction treatment.[4]

Some clinicians theorize that splinting the two maxillary first molars together provides a rigid anchor that can be useful in preventing the mesial movement of these teeth. Although this concept seems logical and appears to be commonly accepted, this supposition is based almost entirely on clinical experience rather than on hard science. TPA has been used for many different orthodontic purposes. Previous reports analyzed the value of TPA to control anchorage using finite element analysis. Their findings showed that TPA did not prevent molars from moving mesially.

TPA had almost no effect on anchorage preservation against mesial movements. We have developed a simple and cost-effective slow dental expansion appliance by slightly modifying the classic TPA design.

TPA has become an integral part of orthodontics, and this auxiliary appliance is used widely to change or stabilize the position of the maxillary molars in all three dimensions. The versatile nature of the appliance has been marked by its use in arch width maintenance, correction of molar rotations, root torquing, reinforce anchorage, expansion of molars, distalization of molars, and intrusion of molars.

Anchorage is defined as the resistance to unwanted tooth[4] movement. Control of anchorage is one of the most important aspects of orthodontics. Conventional methods of reinforcing orthodontic anchorage, such as[5] TPA, double TPA, Nance[1],[2] button, intraoral intermaxillary elastics, and head gears, have certain practical limitations, including complicated appliance design, produce unwanted reciprocal effects, and necessitate exceptional patient cooperation. Although newer anchorage devices,[6] such as microimplants, provide excellent sites of force delivery without taxing anchorage, these devices have the disadvantages of invasiveness and are expensive. The chromosome arch is a simple, effective, and versatile means of controlling anchorage.

This case report shows the outcomes of the treatment of two cases treated using chromosome arch and conventional TPA anchorage in patients with bimaxillary protrusion.


  Construction Top


A modified TPA of 1.0mm hard stainless steel round wire with middle loop directed was constructed and distally adapted along the palatal curvature approximately 2mm away from the palatal tissues. Once adapted to the palatine vault, the center of resistance of the molars was marked and distal bends were made.[4] The distal bends were made, and the end of the wire was adapted to the palatal aspect of the second molars. It was then soldered on the first molar bands. This assembly is cemented on the maxillary first molars. The versatility of the appliance lies in the fact that it can provide anchorage in all the three dimensions by merely adding a few wire components and thereby affecting multiple tooth movements simultaneously [Figure 1][Figure 2][Figure 3][Figure 4].
Figure 1: Constructed appliance with the wire framework soldered onto the molar bands

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Figure 2: Appliance with wire framework after finishing

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Figure 3: Appliance cemented on the first and second molars

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Figure 4: Appliance used an auxiliary for rotation correction

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  Advantages of Modified Transpalatal Arch Top


The following are the advantages of the modified TPA:

  1. This is an excellent maximum anchorage appliance that includes a greater number of teeth to the anchorage unit.


  2. This device can be used along with other auxiliaries for affecting multiple tooth movements without taxing the anchorage.


  3. The retraction movement is carried out in a more bodily fashion, with no undesired rotations and less time.


  4. It is a noninvasive, inexpensive device, which is easy to fabricate.


  5. Multiple tooth movements, such as individual canine retraction, disimpaction, decrowding, and cross-bite correction, can be carried out during the initial stages of the treatment itself.



  Conclusion Top


Thus, the modified TPA provides an anchorage control better than conventional TPA. Chromosome arch is an effective, noninvasive anchorage device for reinforcing anchorage with Pre Adjusted Edgewise. It provides excellent anchorage control in sagittal and vertical planes. Butterfly arch provides a good control on the position of the upper posterior teeth in all three dimensions. For good performance, the appliance should be fabricated precisely and symmetrically and must be placed passively into the mouth.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kumar ND, Gopal Krishna BR, Shamnur N, Mithun K. Modified transpalatal arch for molar intrusion. J Int Oral Health 2014;6:88-9.  Back to cited text no. 1
    
2.
Spena R. Nonextraction Treatment: An Atlas on Cetlin Mechanics. Birmingham, AL: GAC International; 2002. p. 19-72.  Back to cited text no. 2
    
3.
Goshgarian RA. Orthodontic palatal arch wires. United States Government Patent Office; 1972.  Back to cited text no. 3
    
4.
McNamara JA, Brudon WL, Kokich VG. Transpalatal Arch. Orthodontics and Dentofacial Orthopedics. 1st ed. Ann Arbor, MI: Needham Press; 2001. p. 199-209.  Back to cited text no. 4
    
5.
Nanda RS, Tosun YS. Correction of Vertical Discrepancies Biomechanics in Orthodontics: Principles and Practice. 1st ed. New Malden, UK: Quintessence Publishing; 2010. p. 122-3.  Back to cited text no. 5
    
6.
Zachrisson BU. Clinical use of custom-made transpalatal arches—why and how. World J Orthod 2004;5:260-7.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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