Modified transpalatal arch to correct sagging of palatal cusp of maxillary 2nd molar

“Sagging” of the palatal cusp of upper second molars is a common finding observed during orthodontic treatment which may develop heavy balancing side contacts, which have been found to be detrimental to harmonious function of the masticatory system. Various modifications of transpalatal arch (TPA) are advocated to correct crossbite, but most of them will utilize an additional step of soldering a wire attachment to TPA. In this clinical pearl, the TPA was fabricated using a single wire component, eliminating an additional step of soldering.

Optimization of Loading Condition for Maxillary Molar Intrusion with Midpalatal Miniscrews by Using Finite Element Analysis

An anterior open bite is one of the most difficult malocclusions in orthodontic treatment. For such malocclusion, orthodontic miniscrew insertion into both buccal and palatal alveolar regions has been indicated for molar intrusion, but it involves a risk of tooth root injury. To solve the problem, a midpalatal miniscrew-attached extension arm (MMEA) is adopted. However, this method causes palatal tipping of the molar because intrusive loads were applied only from the palatal side. Currently, a transpalatal arch is added to avoi0d tipping movement, but it induces the patient’s discomfort. Hence, the objective of this study was to evaluate the loading conditions for maxillary molar intrusion without tipping movement, only by MMEA through finite element (FE) analysis. FE models of maxillary right first molar and surrounding tissues were created. Three hook positions of MMEA were set at 6.0 mm perpendicular intervals in the occluso-apical direction along the mucosal contour. An intrusive unit load was applied from the palatal side of the molar, and various counter loads were applied from the buccal side. An optimal counter load for molar intrusion without palatal tipping was observed in each hook position. In conclusion, an ideal maxillary molar intrusion can be achieved only by MMEA with an optimal counter load.

Effects of Palatal Expansion with Torque Activation using a Transpalatal Arch: A Preliminary Single-Blind Randomized Clinical Trial

Purpose. The literature regarding the treatment of posterior crossbites using a transpalatal arch (TPA) is scarce. Moreover, there is only one clinical study on the correction of unilateral crossbites using torque activation. This is an important clinical issue; therefore, this study was conducted to show the effects of an active Goshgarian TPA in correcting nonfunctional single-tooth unilateral crossbite. Methods. The present single-blind, randomized clinical trial examined 60 observations on 30 individuals with nonfunctional single-tooth unilateral crossbites in the first permanent molar area. Patients were randomly divided into two groups of “symmetric expansion” [control] and “expansion + torque activation” using Goshgarian TPAs [experimental]. The palatal arch was expanded at a rate of 2 mm/month, for 2–8 months. The average treatment durations were 157.9 and 117.1 days, respectively, for the control and experimental groups. Dentoskeletal alterations were assessed on dental records, posteroanterior frontal cephalographs, and occlusal radiographs taken before and after treatment. Changes induced by treatments in each group and differences between changes in both groups were analyzed statistically (α = 0.05). Results. The treatment duration was significantly shorter in the experimental group ( P < 0.05 ). The extent of dental displacement on the crossbite side was significant no matter what treatment was applied ( P < 0.001 ); no between-group difference was detected ( P > 0.05 ). Both treatments tilted the teeth in crossbite ( P < 0.001 ) without any between-group difference ( P > 0.05 ). The noncrossbite molar was displaced in the control group, whereas this did not occur in the experimental group (between-group P < 0.001 ). Conclusions. The Goshgarian TPA can be used with torque activation in order to deliver a more effective and faster correction of nonfunctional single-tooth unilateral crossbites with more favorable clinical results.

A Retrospective Study Assessing the Frequency of Patient’s Requiring TPA/LSA During Orthodontic Therapy- An Institutional Study

TPA, also known as Transpalatal Arch is used as an adjunctive equipment during orthodontic therapy to regulate anchorage in the vertical, transverse and sagittal (antero-posterior) dimensions. TPA have many uses such as space maintenance, retention and molar anchorage after rapid maxillary expansion. TPAs have eminent versatility, appearing as a stand-alone appliance or as an accessory appliance to fixed appliances. Hence the aim of this study is to assess the number of patients who required TPA/LSA during an orthodontic therapy. Retrospective cross sectional study was carried out and the case records of patients requiring TPA/LSA was collected by reviewing patient records and analyzing the data of patients between June 2019- April 2020. The collected data was subjected to Chi-square test for statistical analysis and correlation using the SPSS software. The findings of this study showed female predilection with a percentage of 53% and males with a percentage of 47%. It also revealed that the prevalence of patients requiring TPA during an orthodontic therapy was 32% and LSA was 26%. This study shows that 32.24% of the patients required TPA and 25.75% of the patients also required LSA during an orthodontic treatment and this was found to be statistically significant.

Combined orthodontic and surgical treatment of impacted maxillary canine in young patient with class II malocclusion: A case report

The impaction of maxillary canines is one of the biggest challenges in orthodontics practice. This case report describes successful surgical and orthodontic approach to the treatment of palatally impacted maxillary canine in a 14-year-old boy. Intraoral clinical examination revealed an absence of the upper right canine, an ectopic position of the upper left canine and crowding in the maxillary arch. The impaction of right maxillary canine and class II malocclusion were confirmed by lateral cephalogram, orthopantomogram and cone beam computed tomography. In the first phase, a transpalatal arch to the upper first molar teeth was applied, first premolars were extracted, and brackets were placed on all teeth and nickel-titanium arch wire was applied. The initial orthodontic phase was soon thereafter followed by the surgical exposure and orthodontic traction of the impacted canine using ligature wire attached from the button with chain to the open coil on the arch wire. The orthodontic treatment took two years with satisfactory aesthetic and functional results at the end. This clinical case has shown that adequate treatment of impacted maxillary canine can be achieved by using combined surgical technique and appropriate orthodontic approach.