Chapter 8

Transpalatal arches, lingual arches and quad helix

The transpalatal arch, lingual arch and quad helix are fixed appliances that are:

• fitted on teeth, most commonly on molar teeth, using bands
• usually part of standard fixed appliance therapy

The transpalatal arch and lingual arch are used to maintain space.

Sometimes, when Ds and Es are lost and their permanent successors are slow to erupt, the first permanent molars drift forwards, into the space.

This can happen if there is early loss due to caries, etc., which would mean that the successor tooth was not ready to erupt and the space would need to be held for some time.

This space may also be used:

• To correct mild anterior crowding
• To reinforce anchorage by holding the banded molar teeth in position while active fixed appliance treatment progresses
• To allow consolidation of the developing occlusion

If there is to be a delay in starting the next phase, after preliminary molar movements and perhaps while awaiting eruption of teeth, a transpalatal arch can be fitted. This can be used as a holding device and can be retained right up until such time as heavy gauge wires in the fixed appliances can then maintain the molar positions.

The transpalatal or lingual arch consists of:

• molar bands cemented onto the first molars
• a fitted arch a cross the palate or lingually to the lower teeth and extending to the lower first molars
• the upper arch often has a pad of acrylic at its centre, known as a Nance button, which prevents it from pressing onto the palate

The bar can be either

• soldered to the bands in the laboratory

or

• fitted into a palatal or lingual tube on the band

MAKING AND FITTING OF ARCHES

For this treatment,

at the first appointment, the nurse will need to prepare:

• the patient’s clinical notes
• mouth mirror
• dental floss
• posterior separating modules
• separating module pliers

Procedure:

• The nurse ensures that everyone is wearing personal protective equipment
• The patient is seated comfortably in the chair
• The patient is then told what is to happen and what the aim is, i.e. why this is happening and what it is going to achieve
• Using separating module pliers, elastic rings are placed either side of the molar around which the bands are to be fitted (This is done several days in advance of fitting the bands as it ‘springs’ the teeth a tiny space apart which makes it easier for the clinician and more comfortable for the patient when trying on the bands)
• The patient is then told what to expect over the next few days:
  • that it may be painful around the molar teeth for about 24–48 hours
  • what to do if a ‘ring’ falls out
  • that if it is swallowed, it will not be harmful
  • how to clean their teeth without dislodging the separating rings

On the second visit, the nurse will need to prepare:

• clinical notes
• study model box
• mirror, probe, College tweezers
• trays of appropriate molar bands
• bite stick
• floss
• Mershon pusher or plugger
• impression trays
• alginate, bowl, spatula (putty, if preferred)
• receiver for gagging reflex
• posterior separating modules
• separating module pliers
• laboratory instruction sheet
• plastic bag, label and disinfectant for impression

Procedure:

• The nurse must ensure that everyone is wearing personal protective equipment
• The patient is made comfortable in the chair
• A probe is used to remove these parating modules one by one (it is important to make sure that all separators are taken out as, if accidentally left, they can cause periodontal problems. For this reason, many elastic separators are radiopaque)
• Floss is used between the teeth to remove any debris
• The correct size of band for each tooth is selected
• These are fitted and contoured to the teeth using a Mershon pusher/plugger and bite stick, and left on the teeth
• An alginate or putty impression is taken with the bands in position
• The impression is removed from the mouth
• The bands are then removed from the teeth and placed back in their correct position in the impression
• The separating modules are replaced between the teeth either side of the first molars to maintain the s/>
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