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 Table of Contents  
CLINICAL INNOVATION
Year : 2019  |  Volume : 53  |  Issue : 1  |  Page : 81-83

Modification in transpalatal arch used in conjunction with a fixed twin block


1 Prof. and HOD, Department of Orthodontics and Dentofacial Orthopaedics, KVG Dental College and Hospital, Sullia, Karnataka, India
2 PG Student, Department of Orthodontics and Dentofacial Orthopaedics, KVG Dental College and Hospital, Sullia, Karnataka, India
3 Prof., Department of Orthodontics and Dentofacial Orthopaedics, KVG Dental College and Hospital, Sullia, Karnataka, India

Date of Submission27-Oct-2017
Date of Acceptance24-Feb-2018
Date of Web Publication04-Feb-2019

Correspondence Address:
Dr. A Roginth Vigneshwaran
Department of Orthodontics and Dentofacial Orthopaedics, KVG Dental College and Hospital, Sullia, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jios.jios_214_17

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  Abstract 


A simple and innovative method of merging the free end of transpalatal arch into the acrylic used as bite blocks in fixed twin block appliance is presented. Inadequate retention of any orthodontic appliances could lead to aspiration of the foreign body posing medical emergency. The proposed method helps in additional retention as well as prevents the possibility of accidental ingestion of the fixed twin block appliance.

Keywords: Free end of transpalatal arch, modified transpalatal arch, twin block


How to cite this article:
Shetty SK, Vigneshwaran A R, Kumar Y M. Modification in transpalatal arch used in conjunction with a fixed twin block. J Indian Orthod Soc 2019;53:81-3

How to cite this URL:
Shetty SK, Vigneshwaran A R, Kumar Y M. Modification in transpalatal arch used in conjunction with a fixed twin block. J Indian Orthod Soc [serial online] 2019 [cited 2019 Apr 26];53:81-3. Available from: http://www.jios.in/text.asp?2019/53/1/81/251547




  Introduction Top


Twin block appliance was developed more than 30 years ago by Dr. Clark[1],[2],[3] in Scotland, which recently has gained popularity in North America. Twin block appliances are intended for the purpose of bringing the mandible forward in patients with skeletal class II malocclusion. Twin block appliance brings about dento-alveolar changes mostly with little skeletal effects. The success of the appliance greatly relies on the patient's compliance. Removable twin blocks are prescribed routinely but pose the risk of breakage due to faulty usage by the patient. The incidence of aspiration or swallowing of foreign body is about 3.6%–27.7%.[4] Meticulous care should be taken by the orthodontist ensuring adequate retention of the orthodontic appliance thereby preventing medical emergency situation which is undesirable. Fixed twin blocks can be preferred over removable twin block, where the acrylic blocks of the twin block appliance are stabilized using transpalatal arch (TPA) in upper and lingual stabilizing arch in lower arch and the bite blocks attached to molar bands. The TPA can be used as an adjunct during orthodontic treatment to help control the movement of the maxillary first molars in 3 dimensions, including producing molar rotation and uprighting, maintaining transverse dimensions posteriorly during treatment and maintaining leeway spaces during the transition of the dentition.[5]

Normally, the ends of the TPA are soldered to molar bands or engaged in the palatal sheath. A modified technique of occlusal adaptation of free end of TPA is presented which will ensure adequate retention of the fixed twin block.


  Procedures Top


TPA is constructed from a 0.036 inch (0.9 mm) stainless steel wire [Figure 1]. The central loop is directed posteriorly [Figure 2]. Each end of the palatal arch is doubled over for insertion into the cleats on the lingual surface of upper first molar bands. Then, the free end of the TPA are bent occlusally into acrylic used as bite blocks in fixed twin block appliance [Figure 3]. This occlusal adaptation of the free end of the TPA helps in additional retention of the fixed twin block appliance.
Figure 1: Basic armamentarium

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Figure 2: Modified transpalatal arch

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Figure 3: Modified transpalatal arch (left oblique view)

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  Discussion Top


Many modifications of the TPA are found in the literature which includes addition of “U” loops on either side of the palatal arm that can be adjusted by constricting the loops to keep the TPA away from the mucosa,[6] addition of two loops directed mesially for engaging E-chain,[7] incorporation of helix in front of palatal sheath and wire extended by adapting it on the palatal surface of premolar and canine teeth for slow expansion.[8]

The modification of TPA presented in this paper helps in additional retention of the fixed twin block appliance by the concept of cross arch stabilization [Figure 4] and [Figure 5].
Figure 4: Twin-block appliance with modified transpalatal arch attached

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Figure 5: Twin-block appliance with modified transpalatal arch cemented

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  Conclusion Top


Although there are many modifications being carried out in the past with respect to TPA, this modification will also fulfill the actual purpose of TPA as with an added advantage of additional retention. The actual function of TPA being anchorage is not really needed if the molars are covered with bite blocks as the bite blocks will itself prevent molar migration. The addition of the wire end of the TPA into the acrylic is only of benefit to join the acrylic of the two sides together in case one debonds. However, in the conventional design of the bonded TPA, a cross archwire is always added to prevent this.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Clark WJ. The twin block traction technique. Eur J Orthod 1982;4:129-38.  Back to cited text no. 1
    
2.
Clark WJ. The twin block technique. A functional orthopedic appliance system. Am J Orthod Dentofacial Orthop 1988;93:1-8.  Back to cited text no. 2
    
3.
Clark WJ. Twin Block Functional Therapy: Applications in Dentofacial Orthopedics. Turin: Mosby-Wolfe; 1995.  Back to cited text no. 3
    
4.
Tamura N, Nakajima T, Matsumoto S, Ohyama T, Ohashi Y. Foreign bodies of dental origin in the air and food passages. Int J Oral Maxillofac Surg 1986;15:739-51.  Back to cited text no. 4
    
5.
Zablocki HL, McNamara JA Jr., Franchi L, Baccetti T. Effect of the transpalatal arch during extraction treatment. Am J Orthod Dentofacial Orthop 2008;133:852-60.  Back to cited text no. 5
    
6.
Kumar ND, 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. 6
    
7.
Mehta F, Patel R, Kharadi L, Mehta S. A Modified transpalatal arch for correction of bucally placed maxillary 2nd molars: non–compliant mechanics. IOSR-JDMS 2014;13:24-6.  Back to cited text no. 7
    
8.
Thomas A, Afshan T, Deru T. Modification of transpalatal arch for expansion. JIOS 2017;51:289-90.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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Abstract
Introduction
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Discussion
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