orthodontic waves 70 (2011) 39–42

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Short communication

A modified transpalatal arch with customized bonding base

Masato Fujisawa, Akira Komori *

Division of Orthodontics, The Nippon Dental University Hospital, Tokyo, Japan

article info abstract

Article history: In orthodontic treatment using fixed appliances, a transpalatal arch acts as an anchorage to
Received 11 March 2010 stabilize against the movement of other teeth. However, due to the usage of multiple bands,
Received in revised form this appliance requires complicated laboratory procedures, and often involves technical
23 June 2010 errors. A modified transpalatal arch (M-TPA) was developed for simple laboratory proce-
Accepted 25 June 2010 dures and for versatile designs. M-TPA can be attached by using direct bonding with resin-
Published on line 9 September 2010 reinforced glass ionomer cement. M-TPA contacts over a large area, which allows a tight fit.
Since M-TPA is bonded only on the lingual side, it can be removed according to anchorage
Keywords: requirements without disturbing labial fixed appliances.
Transpalatal arch Crown Copyright # 2010 Published by Elsevier Ltd on behalf of Japanese Orthodontic Society.
Flowable composite resin All rights reserved.
Resin-reinforced glass ionomer
cement

1. Introduction orthodontic banding revealed a postoperative bacteremia

incidence of 7.5% [6]. Even they rinsed their mouth with
A transpalatal arch is an appliance used in orthodontic 0.2% chlorhexidine gluconate, their venous blood samples
treatment that requires anchorage. Since a wire of transpa- showed 2.5% bacteremia [7]. These results suggest that
latal arch is not touched the oral mucosa, the anchorage is orthodontic appliances without bands are preferable.
reinforced by using the vertical pressure of the tongue to the A modified transpalatal arch (M-TPA) was developed to
palatal direction. The reinforced anchorage prevents the solve above problems. This method does not require inter-
mesial movement of the upper molars [1,2]. However, dental separation and band transfer. Therefore, the compli-
interdental separation is required to apply multiple bands cated laboratory and clinical procedures can be eliminated.
on teeth for fabrication, and this often causes pain and The aim of this report is to introduce laboratory procedures
discomfort. White spot lesions seem to develop underneath and clinical procedures of M-TPA.
orthodontic bands [3,4].
Because the cervical margin of a band is adjacent to the
gum or subgingival margin, it may cause poor oral hygiene on 2. Laboratory procedure
the cervical area, and may result in gingivitis and periodonti-
tis. The plaque index and bleeding scores are significantly 1. Prepare a model with model soaping medium. This
increased for banded teeth as compared with control sites [5]. procedure helps separate the base from the model and
A microbiologic evaluation of the venous blood samples of 40 prevent contamination of the interior surface of the base
healthy orthodontic patients with good oral hygiene after (Fig. 1A).

* Corresponding author. Tel.: +81 3 3261 4753.

E-mail address: como@tky.ndu.ac.jp (A. Komori).
1344-0241/$ – see front matter . Crown Copyright # 2010 Published by Elsevier Ltd on behalf of Japanese Orthodontic Society. All rights reserved.
doi:10.1016/j.odw.2010.06.002
40 orthodontic waves 70 (2011) 39–42
[(Fig._1)TD$IG]

Fig. 1 – Laboratory procedure: (A) prepare the model with model soaping medium; (B) make the transpalatal arch with a
clearance of 1.0–1.5 mm in the plate; (C) coat with highflow flowable composite resin and put low-flow flowable composite
resin on the coated wire; (D) expose the coated wire to visible light.

2. Make the transpalatal arch with a clearance of 1.0–1.5 mm 6. Check the position of the wire, and expose to visible light
to the plate. Aluminum oxide abrasion with a particle size (Fig. 1D).
of 50 mm and metal priming of the wire is carried out to 7. Extend the base with high-flow flowable composite resin
enhance the bond strength. with an explorer. The resin base is vertically and antero-
3. Fix the wire with paraffin wax on the model (Fig. 1B). posteriorly extended (Fig. 2A).
4. Coat with high-flow flowable composite resin (UniFil Flow, 8. Expose to visible light.
GC Corp., Japan). 9. Remove the appliance from the set-up model using
5. Put low-flow flowable composite resin (UniFil Low Flow, tweezers (Fig. 2B). In this procedure, the base does not
GC Corp., Japan) on the coated wire. Low-flow flowable break since the flowable composite resin is more flexible
composite resin helps to stick the wire to the model than a conventional composite resin (Fig. 2C).
(Fig. 1C). 10. Clean the interior surface of the base with absolute ethanol.
[(Fig._2)TD$IG]

Fig. 2 – Laboratory procedure: (A) extend the base with high-flow flowable composite resin with an explorer; (B) remove the
appliance from the set-up model using tweezers; (C) the bonding base of M-TPA fits the model.
 orthodontic waves 70 (2011) 39–42 41
[(Fig._3)TD$IG]

Fig. 3 – Clinical procedure: (A) place the base on the tooth; (B) remove excess cement with an explorer; (C) floss the base
margin close to the adjacent tooth to avoid the overflow of RGIC on the contact area; (D) the bonding base of M-TPA fits tooth
surface.

3. Clinical procedure 5. Remove excess cement with an explorer (Fig. 3B).

6. Expose to visible light. The base margin close to the
1. Clean the teeth with a rotating brush and fluoride-free adjacent tooth is flossed to avoid the overflow of RGIC on
pumice, followed by rinsing and drying with a three-way the contact area (Fig. 3C and D).
syringe. This step also can be achieved by air-powder
polishing.
2. Apply 20% polyacrylic acid gel conditioner for 10 s, and 4. Discussion
rinse with the three-way syringe.
3. Apply light-cured resin-reinforced glass ionomer cement The bonding base of M-TPA contacts over a large area of
(RGIC, Glass Bond, GC Corp., Japan) to the interior surface of retaining tooth. There are many landmarks on lingual surface
the base. such as lingual glove, lingual ridge, lingual fossa, etc. These
4. Gently place the base on the tooth. Then, press the base landmarks act as reference on bonding procedure, which lead
[(Fig._4)TD$IG] with an explorer to the best-fit position (Fig. 3A). to tight fit [8]. This prevents drifting of M-TPA from the tooth

Fig. 4 – A case applied with M-TPA: (A) first visit; (B) after leveling; (C) M-TPA can be applied without interrupting the
treatment with fixed appliances.
42 orthodontic waves 70 (2011) 39–42

surface when removing excessive cement with the explorer. detach the flowable composite resin with instruments such as
Since M-TPA does not require interdental separation and band adhesive removing pliers. Therefore, further development of
transfer, it eliminates complicated laboratory and clinical flowable composite resin that deforms and detaches during
procedures and prevents technical error, unlike other appli- removal will be needed to achieve easy debonding.
ances with bands. With this simple laboratory procedure, an
immediate application on the same day as impression taking
references
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