See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/303898443

Transpalatal, Nance & lingual arch appliances: Clinical tips and applications

Article · July 2015

DOI: 10.12968/ortu.2015.8.3.92

CITATION READS

1 12,393

4 authors, including:

Mohammed Almuzian Fahad Alharbi

The University of Edinburgh Prince Sattam bin Abdulaziz University
49 PUBLICATIONS   79 CITATIONS    15 PUBLICATIONS   28 CITATIONS   

SEE PROFILE SEE PROFILE

Grant T McIntyre
University of Dundee
128 PUBLICATIONS   801 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

School of Dentistry, University of Dundee, UK View project

Orthodontics View project

All content following this page was uploaded by Mohammed Almuzian on 26 June 2016.

The user has requested enhancement of the downloaded file.

92 Orthodontics July 2015

Mohammed Almuzian Fahad Alharbi, Lucy Lai-King Chung and Grant McIntyre

Transpalatal, Nance and

Lingual Arch Appliances:
Clinical Tips and
Applications
Abstract: Transpalatal arches (TPAs) are widely used in clinical orthodontics. The versatility of the TPA makes it an extremely useful
adjunct to both conventional and contemporary fixed appliance treatment. This paper describes the history, the variety of designs and
the clinical steps and laboratory methods for TPA construction. The range of clinical applications of the TPA are presented using a series
of cases.
Clinical Relevance: The TPA is widely used in clinical orthodontics but published information is scarce with no review article having
been published to date.
Ortho Update 2015; 8: 92-100

The transpalatal arch (TPA) is a
stainless steel wire connecting the
maxillary molars during fixed appliance
orthodontic treatment to assist with
anchorage reinforcement. Although, in
most countries, the term lingual arch
is reserved for the lower arch, in North
America, auxiliary arches used for both
the lower and upper dentition are
termed lingual arches.
The TPA was originally
described by Robert Goshgarian.1 It
is constructed from 0.9 or 1.25 mm
stainless steel wire and crosses the
palate to connect one molar or premolar
to a contralateral tooth. This connection
can be fixed by welding/soldering or be
removable by insertion into a lingual
sheath on the molar bands. These molar
band sheaths are known as Wilson
tubes2 or Mershon attachments.2,3 A
modification of the attachment involves
bonding the palatal wire directly to the
lingual surface of the molars.2
Although the TPA does
not provide absolute anchorage, it is
used as an adjunctive appliance during
orthodontic treatment to control
anchorage in the vertical, transverse and
sagittal (antero-posterior) dimensions.
The extent of anchorage it provides
depends on the design and the
anatomical/morphological features of
the palate. Where the TPA is modified
by the addition of acrylic for the palatal
vault (see Nance arch below), the depth
and width of the palate contribute to
the potential increase in anchorage.
Logically, a shallow and wide palate has
less anchorage potential than that of a
deep-vaulted palate.4
The Nance appliance
The Nance appliance or
Nance palatal arch (NPA) was one of
the earliest modifications of the TPA,
first described in 1947.5 The palatal
wire is welded/soldered to the molar
bands and is connected anteriorly by
an acrylic button positioned in the

Mohammed Almuzian, BDS(Hons), MFDS RCS(Edin), MFD RCS(Irel), MJDF RCS(Eng), MSc(Orth), MScHA(USA), DClinDent(Orth) (Glasg),
MOrth RCS(Edin), MRCDS Ortho(Aus), IMOrth RCS(Eng)/RCPS(Glasg), Specialist Orthodontist, ASOD Centre, Dubai, Fahad Alharbi,
Orthodontic PhD student, Dundee Dental Hospital and School, Lucy Lai-King Chung, BSc, BDS, FDS RCPS(Glasg), MSc, MOrth RCS(Edin),
FDS(Orth) RCPS(Glasg), Consultant Orthodontist, Glasgow Dental Hospital and School, 378 Sauchiehall Street, Glasgow, G2 3JZ and Grant
McIntyre, BDS, FDS RCPS(Glasg), MOrth RCS(Edin), PhD, FDS(Orth) RCPS(Glasg), FDS RCS(Edin), FHEA, Consultant/Honorary Reader in
Orthodontics, Dundee Dental Hospital and School, 2 Park Place, Dundee, DD1 4HR, UK.
July 2015
Figure 1. A conventional Nance palatal arch in
a patient with a broad palate providing antero-
posterior anchorage for retraction of the canine
in space-opening treatment for a missing upper
lateral incisor.
Figure 2. An offset Nance button to
accommodate the instanding lateral incisor with
U-loops to allow adjustment. This potentially
increases the flexibility of the appliance and
hence reduces the anchorage provision.
Figure 3. Nance palatal arch being used to
maintain the position of the second molars
where the first molars have been extracted.
(Note: the button has been positioned too
vertical in the palate and this has reduced the
anchorage support of the appliance.)
Figure 4. Conventional lingual arch.
Figure 5. Modified lingual arch with U-loops for
activation and adjustment.
Figure 6. Uses of the TPA.
highest part of the palatal vault resting on
non‐compressible mucosa. The button is
made of heat-cured, cold-cured or light-
cured acrylic. Light-cured composite has
also been used.5 Modifications of the wire
design and minor alterations in the position
of the button can also be made (Figures
1−3).
The lower lingual arch
The lingual arch was used
extensively by Nance in the mid-1940s.6
The same 0.9 mm diameter wire is used
for construction as with the palatal arch
(Figure 4). Again the stainless steel wire can
be either welded/soldered to molar bands,
inserted into molar sheaths (removable),
or bonded directly to the lingual surface
of lower molars. Modifications in wire
construction (Figure 5) allow direct
attachments of exposed teeth to the arch
to improve patient comfort and allow
initial traction. The wire diameter can be
increased where greater rigidity is required.
However, Owais et al showed that, when
using 1.25 mm wire compared with 0.9 mm
Orthodontics 93
Figure 7. TPA being used for transverse
anchorage (for alignment of a palatally impacted
canine).
wire, the increased wire stiffness results
in increased forces on the lower incisors
and first molars.7 Consequently, more
proclination of the incisors and loss of the
Leeway space loss may occur.7 Additionally,
the increase in wire stiffness of the lingual
arch results in higher cementation failure
and wire breakage.7
Clinical steps
The clinical steps involved in
construction of all types of transpalatal
and lingual arches are similar. It is best to
fit the appliance before extractions are
undertaken or active orthodontic treatment
is commenced to avoid tooth movement
which can make fitting of the appliance
difficult, with the potential loss of vital
space. The traditional clinical steps include
prior placement of separators for 5−7 days8
in order for molar bands to fit well.
When selecting bands, it is a
common practice to choose bands one
size bigger since the lumen of the band
can reduce during the laboratory welding
and soldering procedures. An impression
 94 Orthodontics
is then taken over the bands; these are
repositioned in the impression, which is
decontaminated before transporting to
the laboratory. When the anchor molars
are rotated, this makes band placement
difficult and so four options are available:
1. Position the band in an offset position
so that a rigid stainless steel wire can
be easily passed passively through the
molar tube bilaterally. This requires the
bands to be repositioned to the correct
axial position after molar derotation;
2. Use an initial sectional fixed appliance to
derotate the molars before construction
a versatile design, TPAs can provide passive
b situations, as when aligning palatally
a
c a
d b
c
Figure 8. (a) Constricted maxilla. (b) RME
used for expansion. (c) The maxilla after active
expansion phase. (d) TPA as a retainer after RME.
July 2015
of the transpalatal or lingual arch; a
3. Place the molar bands in the
conventional (correct) position with
adjustment and activation of the
appliance at the cementation stage to
aid molar derotation;
4. Use molar bands with convertible tubes
allowing sliding of the non-fully seated
archwire through molar tubes and
aiding molar derotation.
Indications for transpalatal,
Nance and lingual arches b
TPAs have great versatility,
acting as a stand-alone appliance or as an
adjunct to fixed appliances. Owing to the
and active orthodontic forces in all three
dimensions (Figure 6):
1. Transverse;
2. Vertical; and
3. Anteroposterior.
Transverse dimension
TPAs and lingual arches can c
be used to provide transverse anchorage
and arch width stabilization in clinical
impacted maxillary canines (Figure 7).9 The
TPA is also effective as a holding appliance
or as a retainer after active maxillary
Figure 10. (a) Right side view of a TPA in
conjunction with segmental arch mechanics. (b)
Occlusal view. (c) Left side view.
Figure 9. (a) Occlusal view of TPA used in
conjunction with fixed orthodontic appliances to
stabilize the premaxilla in a case with a bilateral Figure 11. (a) AdvanSync bite correctors
cleft lip and palate. (b) Lateral view. (c) Frontal (Ormco®, CA, USA. (b) Forsus (Ortho Organizers®,
view. Ca, USA) used in conjunction with TPA.
 July 2015
a a
b d
b
c a
Figure 12. (a) Palatally placed TADs and NiTi
springs used to intrude posterior teeth. (b) Close
view of the TAD on right side. (c) Close view of
the TAD on the left side.
Figure 13. Hay-rake habit breaker appliance, a
mechanical hindrance for the treatment of digit-
sucking and tongue-thrusting habits.
expansion with a quadhelix or rapid
maxillary expansion (RME) (Figure 8). For
patients with an alveolar cleft, the TPA can
also be used to maintain the form of the
expanded arch immediately before alveolar
bone grafting (Figure 9).10
Another traditional use of
TPA in the transverse dimension is as an
adjunctive appliance in segmental Burstone
arch (intrusion) mechanics used to correct
Orthodontics 95
c
Figure 14. (a–d) Modified bucco-lingual arch. (Reprinted from Orthodontic Pearls: A Clinician’s Guide.
Taylor Publishing Co, Dallas, TX, USA with permission from author).18
anterior deep bites or to decompensate the
anterior segment (in the case of a skeletal
anterior open bite) before proceeding with
a two piece Le Fort I osteotomy (Figure
10).11 The TPA counteracts the buccal
tipping of the crown of the molars during
intrusion of the anterior teeth.
A TPA in combination with a
fixed-functional appliance can also be used
b
to counteract the buccal forces produced
by Class II bite correctors, such as the Twin
Force Bite Corrector (Ortho Organizers®,
Ca, USA) or AdvanSync appliance (Ormco®,
CA, USA) (Figure 11).12 Although TPAs have
been advocated as an adjunct to headgear
(to reduce the buccal tipping of molars
and palatal cusp extrusion during molar
distalization),13 no difference has been
found between the use of headgear with
or without a TPA for molar distalization.14
More recently, the use of TPA-
temporary anchorage devices (TADs)
combination to correct anterior open bites
has been reported.15 A TPA is frequently
used to control molar tipping when
posterior teeth are intruded using this
method (Figure 12). A further use of the TPA
is in the interceptive treatment of palatally
displaced canines (PDC): this has been
shown in a clinical trial by Baccetti et al to
be as efficient as a combination of RME and
a TPA.16 Figure 15. (a) High arch TPA for treatment of an
The TPA can also be used as anterior open bite. (b) Close view of the TPA loop
a habit deterrent for persistent thumb away from the palate.
and digit-sucking habits (Figure 13). This
requires the soldering/welding of a crib to
the TPA.17 Furthermore, the requirement indication for the use of a TPA or lingual
for bilateral space maintenance following arch for both the upper and lower arches
premature loss of primary molars is an to prevent loss of Leeway space and
96 Orthodontics July 2015

Figure 16. Nance appliance providing antero-

posterior (palatal vault and cortical) anchorage.

potential crowding of the premolars

where extractions of the deciduous
molars are planned in order to harness
the Leeway space, a TPA and lingual Figure 17. Method to use the TPA for molar rotation and derotation.
arch is also indicated. However, one of
the potential problems when using a c
a
lingual arch as a space maintainer is the
interference of the wire with the erupting
premolars. A modification of this has been
suggested which involves soldering the
wire on the buccal surface of the molars
and allowing it to pass along the buccal
vestibule before it passes over the canine
embrasure to run behind the lower
incisors (Figure 14).18
TPAs can be used actively to
minimally expand or constrict the dental d
b
arches in a similar way to the quadhelix
appliance. In this situation, the TPA can
be expanded or contracted by 3−4 mm
to provide a force of around 200 gm.
19
Furthermore, TPAs can be used for
distalization of the molars unilaterally or
bilaterally to correct a mild Class II molar
relationship. This is achieved by activating
the U-shaped bend in the TPA.20 Where
unilateral distalization is required, it is
better to reinforce the anchor side with Figure 18. (a, b) Nance arch. (c, d) TPA, for the management of palatally impacted canines.
headgear, place torque in the archwire
to make use of cortical anchorage, or use
temporary anchorage devices.20-23

Vertical dimension
A TPA positioned away from
the palate can produce a molar intrusive
effect by the tongue, which can help
in correcting or controlling any over
eruption of maxillary molars (Figure 15).1
In this situation, the TPA is constructed
5 mm away from the palate. Wise et
al found that, when compared with
controls, a TPA can control the maxillary
vertical growth although, as this was a
retrospective study, the results should be
treated with caution.14
Anteroposterior dimension
A Nance palatal arch can be
used to provide anchorage to distalize
the molars as in part of the pendulum
appliance,24 rapid molar distalization;
the distal jet (American Orthodontics®,
WI, Canada),25,26 Jones jig (American
Orthodontics®, WI, Canada)27-29 and the
Lokar distalizing appliance (Ormco®,
CA, USA).30,31 Once distalization has
been achieved, the Nance appliance
is replaced by a TPA to maintain the
molar position and the space gained.5
The most common use of
a TPA is to minimize loss of anchorage
during fixed appliance treatment. This
is done by preventing the roots of the
upper molars from rotating mesially as
they move mesially1 and by bringing the
buccal roots into contact with cortical bone
(cortical anchorage), which is resistant
to remodelling and therefore provides
additional anchorage (Figure 16). The loop
should be directed posteriorly if the TPA is
to provide antero-posterior anchorage.
Recent studies that have
investigated the effectiveness of the TPA for
anchorage reinforcement have found that
TPA is moderately successful for anchorage
reinforcement when compared with other
methods of anchorage reinforcement
(Table 1). Correction of molar rotations
to facilitate insertion of a headgear
inner bow can be achieved using a TPA.
 July 2015
a a
b b
Figure 19. Occlusal view of upper (a) and lower
(b) arches of a 14-year-old patient with delayed
eruption of all permanent canines mainly due to
severe arch crowding.
a TPA and activated to extrude a deeply
b In general, all these approaches
Figure 20. (a, b) TPAs providing an attachment
for lingual fixed appliance auxiliaries.
It is thought that derotation might
provide additional arch length. The
removable TPA can produce this
when the U-shaped bend is activated
(Figure 17).20 In some cases, with a
Class II molar and where premolar
extractions are undertaken, rotating
the molar mesiobuccally is required
to produce a good buccal segment
occlusion. The TPA may help to achieve
an optimal molar relationship due to
a
b
Figure 21. (a, b) TPA resulting in palatal trauma.
Figure 22. Nance appliance resulting in palatal
trauma.
the additional space resulting from
the removal of the upper premolars.
Similarly, mesial or distal tipping
to achieve ‘Andrew’s Class 1 molars
relationship’, or to correct molar distal
tipping following headgear, can be
achieved using a TPA.20
Contemporary
modifications of the TPA
Management of palatal canines
A recent development
of the traditional TPA is the
incorporation of finger or ballista
springs to aid eruption of impacted
maxillary canines.9 Figure 18 shows
several clinical applications in cases
with impacted canines. The acrylic
buttons in these cases are vertically
positioned in the palatal vault to
provide vertical anchorage and allows
a ballista spring to be embedded
and activated to extrude the canine
(Figure 18a, b). However, the spring
Orthodontics 97
Figure 23. (a, b) Combi/TPA/Nance appliance.
can be directly soldered on to the
impacted canine (Figure 18c, d).
Unerupted teeth
Lingual arches can be used
to provide attachments to extrude
multiple teeth after surgical exposure
(eg in cases of cleidocranial dysplasia)
using the Jerusalem approach,32-35
the Belfast–Hamburg approach36 and
the Toronto–Melbourne approach.37
co-ordinate the timing of extraction of
primary and supernumerary teeth, the
surgical exposure of the permanent
teeth and alignment. Figure 19 shows
a 14-year-old patient with delayed
eruption of multiple permanent teeth
mainly due to severe arch crowding.
A TPA and a lingual arch were used to
provide AP anchorage and preserve
the Leeway space, with the extraction
of second deciduous molars to allow
eruption of the second premolars.
Loops in the lingual arch were
incorporated to allow attachment of
the gold chains.
Incorporating bite planes
TPAs can provide an
attachment for other fixed appliance
auxiliaries (Figure 20). A modified
Nance appliance modified with an
anteriorly positioned acrylic button
can provide a fixed acrylic flat anterior
bite plane for the treatment of anterior
deep overbite.
July 2015 Orthodontics 99

Appliances Findings Authors uses in clinical orthodontic treatment.

Their uses range from interceptive
No appliance (control) Mean anchorage loss of 4.1 mm and 4.5 Zablocki et al38 applications to anchorage management
mm was found in association with the TPA for challenging malocclusions. They can
and the control group, respectively be custom-made, ready-made, fixed or
Onplant, TADs and Anchorage loss in the TPA group during the Feldmann & removable.
headgear initial alignment stage was approximately 2 Bondemark39
mm compared to 1.6 mm in the headgear
References
1. Goshgarian RA. Orthodontic
group while the anchorage was stable in
Palatal Arch Wires. United States
the Onplant group from the start until the Government Patent Office, 1972.
end of treatment 2. Tsibel G, Kuftinec MM. A bonded
Nance and TPA Both appliances are moderately effective Stivaros et al40 transpalatal arch. J Clin Orthod 2004;
38: 513−515.
appliances in preserving anchorage (anchorage loss
3. Moutaftchiev V, Moutaftchiev A. The
of around 1 mm over 6 months) and there individually prepared transpalatal
was no difference in anchorage support arch. Oral Hlth J 2009; 8: 13−16.
between the groups but TPA was well 4. Gill DS. Orthodontics at a Glance.
Oxford: Wiley-Blackwell, 2013.
tolerated by the patient
5. Prakash A, Tandur AP, Shyagali
TADs 2.5 mm of mesial movement of the upper Sharma et al41 T, Bhargava R. Post distalization-
first permanent molars in the TPA group methods of stabilization of molars.
while the TADs group provided absolute Orthod Cyber J [online] 2011.
6. Nance HN. The limitations of
anchorage
orthodontic treatment: I. Mixed
Nance, TADs and No statistical significance between the Sandler et al42 dentition diagnosis and treatment.
headgear three methods in providing anchorage Am J Orthod Oral Surg 1947; 33:
Table 1. Studies that have investigated the effectiveness of the TPA for antero-posterior anchorage. 177−223.
7. Owais A, Rousan M, Badran S,
Complication Comment Alhaija EA. Effectiveness of a lower
lingual arch as a space holding
Breakage and cement Breakage and cementation failure is approximately 2% and device. Eur J Orthod 2011; 33:
failure 30%, respectively, and common with large diameter wire 37−42.
wires43-46 8. Tzou TZ, Hansen JD. Orthodontic
separators. US Patent No 6,988,887,
Oral hygiene difficulties Nance appliances result in deterioration of oral hygiene
2002.
beneath the acrylic plate leading to inflammation of the 9. Fleming PS, Sharma PK, DiBiase
palate47 AT. How to… mechanically erupt a
Unwanted changes in lower Increase in intercanine width as the canines migrate palatal canine. J Orthod 2010; 37:
262−271.
arch width with the lingual distally and the proclination of lower incisors as a result
10. Harris M, Reynolds IR. Fundamentals
arch of the reciprocal force on the lingual surface of lower of Orthognathic Surgery.
incisors48-51 Philadelphia: WB Saunders
Poor patient tolerance Nance appliance in comparison to the standard TPA and Company, 1991.
11. Burstone CJ. The mechanics of the
other method of anchorage reinforcement40,42
segmented arch techniques. Angle
Impinging on the palatal The loop of the TPA can cause palatal trauma (Figures 21, Orthod 1966; 36: 99−120.
mucosa as the molars move 22) 12. Rothenberg J, Campbell ES, Nanda
mesially R. Class II correction with the twin
force bite corrector. J Clin Orthod
Increase of risk of root As TPA positions the roots of the anchor units against the 2004; 38: 232.
resorption cortical bone plate52 13. Baldini G, Luder H. Influence of
Frequent need for TPA In order to overcome this potential problem, a combi/ arch shape on the transverse
effects of transpalatal arches of the
removal and recementation TPA/Nance appliance can be used (Figure 23). The Nance
Goshgarian type during application
during space-closing button portion of the arch can be removed during space of buccal root torque. Am J Orthod
mechanics closure, whilst leaving the TPA portion in situ to provide 1982; 81: 202−208.
some A–P anchorage53 14. Wise JB, Magness WB, Powers JM.
Table 2. Common complications of transpalatal arches.
Maxillary molar vertical control with
the use of transpalatal arches. Am J
Orthod Dentofac Orthop 1994; 106:
Complications Conclusion 403−408.
These can be summarized in Transpalatal, Nance and
15. Cousley RR. A clinical strategy for
Table 2. lingual arch appliances have a variety of
100 Orthodontics
maxillary molar intrusion using
orthodontic mini‐implants and
a customized palatal arch.
J Orthod 2010; 37: 202−208.
16. Baccetti T, Sigler LM, McNamara
JA. An RCT on treatment of
palatally displaced canines with
RME and/or a transpalatal arch.
Eur J Orthod 2011; 33: 601−607.
17. Larsson E. Treatment of children
with a prolonged dummy or
finger-sucking habit. Eur J
Orthod 1988; 10: 244−248.
18. White L. Orthodontic Pearls: A
Clinician’s Guide. Dallas: Taylor
Publishing Co, 2012.
19. Ingervall B, Göllner P, Gebauer
U, Fröhlich K. A clinical
investigation of the correction
of unilateral first molar
crossbite with a transpalatal
arch. Am J Orthod Dentofac
Orthop 1995; 107: 418−425.
20. Rebellato J (ed). Two-Couple
Orthodontic Appliance Systems:
Transpalatal Arches. Elsevier:
Seminars in Orthodontics, 1995.
21. Ten Hoeve A. Palatal bar and
lip bumper in nonextraction
treatment. J Clin Orthod 1985;
19: 272−291.
22. Cooke MS, Wreakes G. Molar
derotation with a modified
palatal arch: an improved
technique. Br J Orthod 1978; 5:
201−203.
23. Dahlquist A, Gebauer U,
Ingervall B. The effect of
a transpalatal arch for the
correction of first molar
rotation. Eur J Orthod 1996; 18:
257−267.
24. Hilgers JJ. The pendulum
appliance for Class II non-
compliance therapy. J Clin
Orthod 1992; 26: 706−714.
25. Carano A, Testa M, Bowman S.
The distal jet simplified and
updated. J Clin Orthod 2002; 36:
586−590.
26. Carano A, Testa M, Siciliani G.
The Distal Jet for uprighting
lower molars. J Clin Orthod
1996; 30: 707−710.
27. Jones R, White J. Rapid Class II
molar correction with an open-
coil jig. J Clin Orthod 1992; 26:
661−664.
28. Patel MP, Janson G, Henriques
JFC, de Almeida RR, de Freitas
MR, Pinzan A et al. Comparative
distalization effects of Jones jig
and pendulum appliances.
View publication stats
Am J Orthod Dentofac Orthop 2009;
135: 336−342.
29. Paul L, O’Brien K, Mandall N. Upper
removable appliance or Jones Jig for
distalizing first molars? A randomized
clinical trial. Orthod Craniofac Res
2002; 5: 238−242.
30. Lokar RR. Orthodontic Appliance. US
Patent No 5299935, 1994.
31. McSherry P, Bradley H. Class
II correction-reducing patient
compliance: a review of the available
techniques. J Orthod 2000; 27:
219−225.
32. Becker A, Lustmann J, Shteyer A.
Cleidocranial dysplasia: Part 1 −
General principles of the orthodontic
and surgical treatment modality.
Am J Orthod Dentofac Orthop 1997;
111: 28−33.
33. Becker A, Shpack N, Shteyer A.
Attachment bonding to impacted
teeth at the time of surgical
exposure. Eur J Orthod 1996; 18:
457−463.
34. Becker A, Shteyer A, Bimstein E,
Lustmann J. Cleidocranial dysplasia:
Part 2 − Treatment protocol for the
orthodontic and surgical modality.
Am J Orthod Dentofac Orthop 1997;
111: 173−183.
35. Richardson A, Swinson T. Combined
orthodontic and surgical approach
to cleidocranial dysostosis. Trans Eur
Orthod Soc 1987; 63: 23.
36. Hall RK, Hyland AL. Combined
surgical and orthodontic
management of the oral
abnormalities in children with
cleidocranial dysplasia. Int J Oral Surg
1978; 7: 267−273.
37. Smylski PT, Woodside DG, Harnett BE.
Surgical and orthodontic treatment
of cleidocranial dysostosis. Int J Oral
Surg 1974; 3: 380−385.
38. Zablocki HL, McNamara JA, Franchi
L, Baccetti T. Effect of the transpalatal
arch during extraction treatment.
Am J Orthod Dentofac Orthop 2008;
133: 852−860.
39. Feldmann I, Bondemark L. Anchorage
capacity of osseointegrated and
conventional anchorage systems:
a randomized controlled trial. Am J
Orthod Dentofac Orthop 2008; 133(3):
339.e19−339.e28.
40. Stivaros N, Lowe C, Dandy N, Doherty
B, Mandall NA. A randomized clinical
trial to compare the Goshgarian and
Nance palatal arch. Eur J Orthod 2010;
32: 171−176.
41. Sharma M, Sharma V, Khanna B. Mini-
screw implant or transpalatal arch-
July 2015
mediated anchorage reinforcement
during canine retraction: a randomized
clinical trial. J Orthod 2012; 39:
102−110.
42. Sandler J, Murray A, Thiruvenkatachari
B, Gutierrez R, Speight P, O’Brien
K. Effectiveness of 3 methods of
anchorage reinforcement for maximum
anchorage in adolescents: a 3-arm
multicenter randomized clinical trial.
Am J Orthod Dentofac Orthop 2014;
146: 10−20.
43. Fathian M, Kennedy DB, Nouri MR.
Laboratory-made space maintainers: a
7-year retrospective study from private
pediatric dental practice. Pediatr Dent
2007; 29: 500−506.
44. Qudeimat MA, Fayle SA. The longevity
of space maintainers: a retrospective
study. Pediatr Dent 1998; 20: 267−272.
45. Moore TR, Kennedy DB. Bilateral space
maintainers: a 7-year retrospective
study from private practice. Pediatr
Dent 2006; 28: 499−505.
46. Rajab LD. Clinical performance
and survival of space maintainers:
evaluation over a period of 5 years.
ASDC J Dent Child 2002; 69: 156−160.
47. Singh R, Rockstuhl C, Lederer F, Zhang
W. Coupling between a dark and
a bright eigenmode in a terahertz
metamaterial. Phys Rev B 2009; 79(8):
085111.
48. Brennan MM, Gianelly AA. The use of
the lingual arch in the mixed dentition
to resolve incisor crowding. Am J
Orthod Dentofac Orthop 2000; 117:
81−85.
49. Villalobos FJ, Sinha PK, Nanda RS.
Longitudinal assessment of vertical
and sagittal control in the mandibular
arch by the mandibular fixed lingual
arch. Am J Orthod Dentofac Orthop
2000; 118: 366−370.
50. De Baets J, Chiarini M. The pseudo-
Class I: a newly defined type of
malocclusion. J Clin Orthod 1995; 29:
73−88.
51. Rebellato J, Lindauer SJ, Rubenstein
LK, Isaacson RJ, Davidovitch M, Vroom
K. Lower arch perimeter preservation
using the lingual arch. Am J Orthod
Dentofac Orthop 1997; 112: 449−456.
52. Topkara A, Karaman AI, Kau CH. Apical
root resorption caused by orthodontic
forces: a brief review and a long-
term observation. Eur J Dent 2012; 6:
445−453.
53. Yuan S, Tang L, Li T, Weng S. A study
on the combination of Nance arch and
TPA in the use of straight-wire arch
orthodontic treatment. Shanghai J
Stomatol 2012; 21: 350−353.