Tricks of the trade: Modified transpalatal arch for space maintenance in post distraction cases

Proper maintenance and utilization of space is an important criterion in orthodontics, especially in cases where space has been created by atypical methods. Here an innovative transpalatal arch has been suggested to maintain space created by anterio-posterior distraction. This method serves as an aesthetic pontic and, during subsequent space closure, the acrylic pontic attached to the transpalatal arch can be sequentially trimmed.

A space maintainer is an intra-oral appliance used to maintain arch length subsequent to premature loss or extraction of primary or permanent tooth/teeth until the space is utilized for the desired purpose. In the mixed dentition, the space created by loss of deciduous teeth needs to be maintained till the eruption of their successors. In the permanent dentition, the space may be utilized for desired tooth movement. Achieving the desired post orthodontic tooth positions is difficult if such space is lost.

Various space maintainers have been used for orthodontic purposes.1,2 The most commonly used ones include, the transpalatal arch (TPA), the nance palatal arch and the lingual arch. The transpalatal arch and nance palatal arch can be used in both mixed and permanent dentitions, but they do not control the vertical movement of the opposing dentition in asymmetrical extraction cases. In addition to this, the acrylic button of the nance palatal arch may cause tissue irritation. Both appliances do not control the distal movement of the anteriors in any extraction space.3