D-Arch: An interdisciplinary approach to absolute anchorage

HS Dharmesh; SV Bharathi; H Kiran

doi:10.4103/jios.jios_229_17

CLINICAL INNOVATION

Year : 2019 | Volume : 53 | Issue : 1 | Page : 84-86

D-Arch: An interdisciplinary approach to absolute anchorage

HS Dharmesh¹, SV Bharathi², H Kiran³
¹ Reader, Department of Orthodontics and Dentofacial Orthopeadics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
² Senior Lecturer, Department of Orthodontics and Dentofacial Orthopeadics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India
³ Prof., Department of Orthodontics and Dentofacial Orthopeadics, Rajarajeswari Dental College and Hospital, Bengaluru, Karnataka, India

Date of Submission	21-Oct-2017
Date of Acceptance	14-Mar-2018
Date of Web Publication	04-Feb-2019

Correspondence Address:
Dr. H S Dharmesh
Department of Orthodontics and Dentofacial Orthopeadics, Rajarajeswari Dental College and Hospital, Kumbalgudu, Mysuru Road, Bengaluru - 560 074, Karnataka
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/jios.jios_229_17

Abstract

Anchorage is the most important consideration in any orthodontic treatment planning. The main aim of the D-Arch is to produce absolute anchorage in all three dimensions which cannot be obtained in the conventional transpalatal arch. D-Arch is a rigid, noninvasive appliance to avoid unwanted tooth movement.

Keywords: Absolute anchorage, D-Arch, transpalatal arch

How to cite this article:
Dharmesh H S, Bharathi S V, Kiran H. D-Arch: An interdisciplinary approach to absolute anchorage. J Indian Orthod Soc 2019;53:84-6

How to cite this URL:
Dharmesh H S, Bharathi S V, Kiran H. D-Arch: An interdisciplinary approach to absolute anchorage. J Indian Orthod Soc [serial online] 2019 [cited 2019 Feb 21];53:84-6. Available from: http://www.jios.in/text.asp?2019/53/1/84/251549

Introduction

Various methods to reinforce anchorage are available such as transpalatal arch (TPA), Nance button, double transpalatal arch, intraoral maxillary elastics, and headgears.^[1] The TPA helps control movement of the maxillary molars in all three dimensions, including producing molar rotation, uprighting, maintaining transverse dimensions posteriorly during treatment, and maintaining leeway spaces during the transition of the dentition.^[2],[3]

There is no systematic review that has evaluated the effectiveness of TPA as an absolute anchorage plan. It was observed that transpalatal bar provided insufficient anchorage during the extraction treatment; however, skeletal anchorage is more effective than the conventional TPA anchorage.^[4]

D-Arch is fabricated on the maxillary second premolar, first molar, and second molar and is a successful appliance to control the posterior sections, to improve the torsion of the molars, and to provide an absolute anchorage in all three dimensions.

The resistance to movement is primarily dependent on the root surface area called as anchorage value. D-Arch uses the root surface area of the second premolar, first molar, and second molar bilaterally with an anchorage value of 1938/mm², which is greater than that of the total root surface of the six anterior teeth which is 1420/mm².^[5]

Appliance Design

This appliance is fabricated using cast cobalt-chromium alloy. It has dental and palatal component.

Dental component: It includes wings on the palatal surface of the second premolar, first molar, and second molar bilaterally with 0.5–1 mm thickness and 1.5 mm short of cervical margin and occlusal surfaces as one unit [Figure 1]
Palatal component:

Figure 1: Wings on the palatal surface of the second premolar, first molar, and second molar

Click here to view

Palatal bar of 2–4 mm width and thickness of 2 mm is connected to on either side of the metal wings of the upper first molar bilaterally 2 mm away from the palate [Figure 2]
Midpalatal D-shaped plate with a dimension of 10 mm length and 10 mm width is connected in the midpalatal area to the palatal bar on either side [Figure 3].

Figure 2: Lingual view showing the D-Arch kept 2 mm away from the palate

Click here to view

Figure 3: Occlusal view of the D-Arch

Click here to view

The fabricated D-Arch is then transferred to the patient mouth and cemented using glass ionomer cement [Figure 4].

Figure 4: Intraoral image of the D-Arch

Click here to view

Advantages

It is rigid, customized, and relatively hygienic
It provides absolute anchorage in all three dimensions

Anteroposterior dimension: It helps resist mesial migration during retraction of anteriors in the first premolar extraction cases
Transverse dimension: It preserves intermolar and interpremolar distance
Vertical dimension: In vertical growers and open-bite cases, this appliance brings about molar intrusion and promotes autorotation of the mandible

In cases where the second molar is not completely erupted, the anchorage will be obtained from first molars and second premolars
Less chairside time and more accurate as it is fabricated in the laboratory.

Drawbacks

It needs to be prefabricated in the laboratory
It cannot be used on rotated teeth and cross-bite cases
It cannot be used in cases of multiple missing posterior teeth
It cannot be used in severe periodontally compromised cases
Unlike TPA, D-Arch cannot derotate or upright molars.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Amarnath BC. Chromosomal arch- Non-invasive anchorage device. J Dent Sci Res 2013;4:10-20.
2.	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.
3.	Diar-Bakirly S, Feres MF, Saltaji H, Flores-Mir C, El-Bialy T. Effectiveness of the transpalatal arch in controlling orthodontic anchorage in maxillary premolar extraction cases: A systematic review and meta-analysis. The Angle Orthodontist 2017;87:147-58.
4.	Diar-Bakirly S, Feres MF, Saltaji H, Flores-Mir C, El-Bialy T. Effectiveness of the transpalatal arch in controlling orthodontic anchorage in maxillary premolar extraction cases: A systematic review and meta-analysis. Angle Orthod 2017;87:147-58.
5.	Root surface area measurement of permanent dentition in Indian population-CBCT analysis. Inform Med Unlocked 2017;9:1-5.