Two-Couple Orthodontic Appliance

Systems: Transpalatal Arches

Joe Rebellato
The transpalatal arch (TPA) can be activated to deliver a clinically useful
array of forces and couples to move and/or rotate maxillary molars in all
three planes of space. Changing the palatal arch form can produce expan-
sion or constriction of intermolar width and activation of the inserts of the
TPA will produce couples at the molar sheaths. Activations of the inserts to
generate couples is possible in all three planes of space in the form of
symmetrical V-bends, asymmetrical V-bends, and step bends. Although the
associated equilibrium forces of a couple can be the source of clinical sur-
prises, they can also be harnessed to produce favorable tooth movements.
Copyright © 1995 by W.B. Saunders Company

he transpalatal arch ('FPA) has tradition- be m e a s u r e d clinically and are t h e r e f o r e very

T ally been used as a soldered, passive orth-
odontic appliance, its m a n y uses have included
m o l a r a n c h o r a g e , space m a i n t e n a n c e , and re-
tention after r a p i d maxillary expansion. T h e
r e m o v a b l e T P A , also k n o w n as the Palatal
Arch Bar or T r a n s p a l a t a l Lingual Arch, allows
for m o r e versatile t r e a t m e n t applications than
does its soldered c o u n t e r p a r t . ~''
T h e biomechanical u n d e r s t a n d i n g o f the re-
movable T P A is c o m p l e x because it is a two-
bracket system that is constrained at both ends.
It is, in a way, cinched so that the wire can
m o v e neither in n o r out o f the m o l a r sheaths
on either side. C o n s t r a i n i n g forces that cannot
be intuitively predicted are i n t r o d u c e d into the
system caused by the rigidity and fixed length
o f the transpalatal wire. T h e addition o f these
new forces m a y affect tooth m o v e m e n t in such
a way as to alter the anticipated response o f the
teeth. It is difficuh to accurately account for all
o f these forces so they will only be discussed in
certain instances w h e r e they play a significant
role in tooth m o v e m e n t .
O n e - b r a c k e t systems deliver forces that can
From the Department of Orthodontics, School of Dentistry,
Medical College of Virginia, Virginia Commonwealth University,
Richmond, VA.
Address reprint requests toJoe Rebellato, DDS, Department o)c
Orthodontics, School of Dentistry, Medical College of Virginia,
Virginia Commonwealth University, PO Box 980566, Rich-
mond, VA 23298-0566.
Copyright © 1995 by W.B. Saunders Company
1073-8746/95/0101-000655.00/0
predictable. T w o - b r a c k e t systems w h e r e the
appliance is e n g a g e d in the brackets/sheaths o f
both teeth have force systems that are statically
indeterminate. 3'4 This is to say that it is diffi-
cult to m e a s u r e clinically the forces that are
present in the wire. H o w e v e r , static analysis
still provides a clinically useful prediction o f
the direction a n d relative m a g n i t u d e o f the
forces and m o m e n t s p r e s e n t in the T P A sys-
tem at time point zero (ie, b e f o r e the teeth be-
gin to move).
F o r m i n g a Passive T P A
A set o f models can be used as a guide in in-
directly f o r m i n g the a p p r o x i m a t e s h a p e o f the
TPA, or it may be fabricated directly f r o m the
patient's mouth. T h e T P A can either be m a d e
f r o m stainless steel r o u n d w i r e o f p r o p e r
gauge to fit into the m o l a r sheaths (Figs 1-3) or
a p r e f o r m e d T P A may be chosen.
It is very i m p o r t a n t to always have the T P A
tied to some string or floss while holding it or
inserting it inside the m o u t h to p r e v e n t acci-
dental swallowing or aspiration o f the appli-
ance.
T h e next step is to m a k e the T P A passive,
ie, the T P A should effect no forces, couples, o r
tooth m o v e m e n t once inserted. T h i s can be
d o n e by placing an insert into o n e o f the
sheaths and checking if the contralateral insert
lies adjacent to a n d parallel to its sheath. It is
impossible to tel1 if a T P A is passive with b o t h

44 Seminars in Orthodontics, Vol 1, No 1 (March), 1995: pp 44-54

 Transpalatal Arches
,w I
..¢...
Figure 1. Fabrication of TPA on a model. The pal-
atal loop and tissue offset bends are modifications
that help in adjustments to prevent soft tissue im-
pingement.
inserts placed into their sheaths simuha-
neously. Only one insert m u s t be in a sheath at
any given point in time to d e t e r m i n e if the
T P A is passive.
All a d j u s t m e n t s should be d o n e outside the
m o u t h and to the side that was inserted to al-
low the contralateral insert to lie adjacent and
parallel to its s h e a t h . O n c e this is a c c o m -
plished, r e m o v e the first insert f r o m its sheath,
place the c o n t r a l a t e r a l i n s e r t into its o w n
sheath and r e p e a t the process. Again, adjust-
ments should be m a d e only on the side that
was just inserted. T h e process may have to be
r e p e a t e d several times to get a completely pas-
sive TPA.
It is i m p o r t a n t to secure the T P A into the
sheaths with elastomeric or steel ligatures be-
fore dismissing the patient (Figs 4 to 8). T h e
friction between the inserts of the T P A a n d the
sheaths o f the molars bands should not be as-
Figure 2. Lingual arch (lingual lock) pliers are used
to form the inserts of the TPA. The inserts should
be made slightly longer than the molar sheaths if
there is no gingival bar on the sheaths to help tie in
the TPA.
45
Figure 3. A final bend to tuck the end of the wire
out of the way is made. The fit of the TPA can be
checked on the model and the inserts can be ad-
justed to the approximate location and orientation
of the molar sheaths.
s u m e d to be sufficient to k e e p the T P A f r o m
b e c o m i n g dislodged between a p p o i n t m e n t s .
Activating the TPA
T h e same biomechanical principles a p p l y to
activating the T P A as a p p l y to all o t h e r orth-
odontic appliances. Forces a n d couples can be
g e n e r a t e d by the T P A , resulting in m o m e n t s
o f the couples and m o m e n t s o f the forces. Un-
d e r s t a n d i n g the a p p l i c a t i o n o f couples a n d
forces with the T P A is a little m o r e c o m p l e x
because it is a constrained two-bracket system.
G e n e r a t i n g forces to e x p a n d or constrict in-
t e r m o l a r width can be easily d o n e by widening
or n a r r o w i n g the palatal arch f o r m o f the T P A
b e f o r e insertion. Adjusting the palatal loop will
help to k e e p the T P A an a p p r o p r i a t e distance
f r o m the palate.
Figure 4. An elastic ligature can be hooked around
the gingival bar of the molar sheath to help secure
the TPA.
46
Figure 5. An elastic ligature can t)e hooked around
the end of the insert to secure the TPA if the molar
sheath does not have a bar. The insert of the TPA
must be made long enough at the time o[ fabrica-
tion.
G e n e r a t i n g couples using a T P A can be ac-
complished in one of t h r e e activation types:
symmetrical V-bends, asymmetrical V-bends,
and step bends. T h e T P A creates V-bends or
step bends by activations o f the inserts. This
creates the relative couples d e t e r m i n e d by the
angle o f insertion .just as V-bends a n d step
bends in an arch wire.
S y m m e t r i c a l V - b e n d s will create o p p o s i t e
and equal couples whose associated equilib-
r i u m forces will cancel out. A s y m m e t r i c a l
V-bends will create opposite but unequal cou-
ples whose equilibrium forces will be subtrac-
tive but not cancel each o t h e r out. Step bends
will create couples in the same direction whose
equilibrium forces will always be additive.
T h e T P A is acting u p o n two similar teeth
Figure 6. The TPA fully secured with an elastic lig-
ature,
Joe Rebellato
Figure 7. A heavy wire ligature can be used instead
of an elastic ligature to secure the TPA in place.
a n d theoretically, a s y m m e t r i c a l V-bend (oppo-
site a n d equal angles o f entry) should result in
s y m m e t r i c a l tooth m o v e m e n t . Clinical diffi-
culty in o b t a i n i n g a p e r f e c t l y s y m m e t r i c a l
V-bend and differences in biological response,
even between contralateral molars, will k e e p
this f r o m precisely occurring. H o w e v e r , fairly
p r e d i c t a b l e m o l a r m o v e n l e n t s should o c c u r
with a symmetrical V-bend.
Bilateral Expansion/Constriction
Expansion o f i n t e r m o l a r distance can be easily
a c c o m p l i s h e d by w i d e n i n g the palatal a r c h
f o r m o f the T t ' A , thereby increasing the dis-
lance between the inserts o f the T P A . W h e n
placed into the m o l a r sheaths, the T P A will
deliver an expansive force that will be acting in
a facial direction at a level occlusal to the cen-
Figure 8. The TPA fully secured with a wire liga-
ture.
 Transpalatal Arches 47

ters of resistance (CRew) of the teeth (Fig 9).

T h e CRe s will have a tendency to move facially
=.,,£
along a direction that is parallel to the line of :'==F ="=F
force acting on the teeth. T h e teeth will also
have a tendency to rotate around their CRes in
a c r o w n - f a c i a l / r o o t - l i n g u a I f a s hi on. T h i s
Figure 10. Bilateral constriction of intermolar
ten d en cy to rotate caused by the m o m e n t width.
(g • mm) of the force, can be represented as a
mathematical product of the magnitude of the
strained by the TPA, the CRot will be closer to
expansive force (g) acting on the tooth mul-
the sheath and some expansion may be neces-
tiplied by the shortest perpendicular distance
sary to maintain intermolar width. No antero-
(mm) from the force vector to the CR~ of the
posterior movement of the CRes will occur be-
tooth it is acting on. Similar molar movements
cause the associated equilibrium forces (which
should occur bilaterally. T h e instantaneous
in this case act in an anteroposterior direction)
centers of rotation (CRot) will be apical to the
are equal and opposite and will cancel each
CR~s of the molars.
other out.
Constriction of intermolar distance can be
easily accomplished by narrowing the palatal
Clinical Uses
arch form of the TPA, thereby decreasing the
distance between the inserts of the TPA. Once M-Fa rotations are frequently required in non-
activated by inserting the TPA into the molar extraction treatments to gain arch perimeter.
sheaths, the CR~ of the molars will tend to Because of the rhomboidal shape of molar
move lingually toward each other, and the crowns and the fact that the CRe~ has been pos-
teeth will have a tendency to rotate in a crown- tulated to be lingual to the central fossa (as
lingual/root-facial fashion (Fig 10). O nce seen from an occlusal view), space may open
again, the instantaneous CRot will be apical to mesiai to the molars giving the illusion that
the CR~ of the molars, but the rotation will be both molars are moving distally. 5 This molar
in the opposite direction to expansion. characteristic becomes an important factor in
T h e analysis of these force systems does not defining arch perimeter during first-order ro-
take into account the couple that may be gen- tations. M-Fa rotations are also useful during
erated between the insert of the TPA and the extraction treatment to counter the mesiolin-
molar sheath as the teeth begin to move. guaI (M-Li) moments produced by the space
closing forces acting facial to the CRes of the
teeth.
Symmetrical V Bends Patients often also present with u p p e r first
Bilateral First-Order Activations
(Mesiofacial Rotations)
First-order symmetrical activations of the in-
serts as shown in Figure 11 will result in equal
and opposite couples applied to the molars.
T h e tendency will be for each molar to rotate
around its CR~s in a mesiofaciaI (M-Fa) direc-
tion. However, because arch width is con-
Mc Mc

M F ~
~.'
MF
".~

Figure 11. Bilateral toe-ins in the occlusal plane will

Figure 9. Bilateral expansion of intermolar width. produce bilateral mesiofacial rotations.
48
molars that are rotated M-Li and require M-Fa
rotations b e f o r e initiating h e a d g e a r therapy to
allow easier insertion of the inner bow into the
h e a d g e a r tube. T h e removable T P A can easily
do this, obviating the need for brackets and
wires to rotate the molars M-Fa.
Bilateral First-Order Activations
(Mesiolingual Rotations)
First-order symmetrical activations o f the in-
serts as shown in Figure 12 will result in equal
and opposite couples applied to the molars,
but this time the tendency is for mesiolingual
(M-Li) rotations about the CR~ o f the molars.
T h e arch width is constrained by the T P A so
the CRo~ will be close to the sheath and some
expansion may be necessary to maintain inter-
molar width. Once again, the equal and oppo-
site associated equilibrium forces cancel out
and no a n t e r o p o s t e r i o r m o v e m e n t of the CR~~
will occur. This situation is similar to the bilat-
eral M-Fa rotations, except all forces, couples,
and m o m e n t s are reversed.
Clinical Uses
Bilateral M-Li molar rotations are often re-
quired in finishing cases o f u p p e r extractions
for camouflage o f Class II malocclusions. T h e
M-Li molar rotation takes advantage o f the
rhomboidal shape o f the molar crown and the
location of the CRy, to decrease arch perimeter.
This may help to close any remaining posterior
spaces that resulted f r o m tooth size discrepan-
Mc ~
~j ~ ~
Mc
...j,~
r 1~
II
I distal/root-mesial couple at the molar sheath. (C) A
Figure 1:l. Bilateral toe-outs in the occtusal plane
will produce bilateral mesiolingual rotations,
Joe RebelIato
cies and to seat the molar cusps p r o p e r l y for a
Class II molar finish.
Bilateral Second-Order Activations
(Mesiodistal Tipping)
S e c o n d - o r d e r activations o f the inserts as
shown in Figure 13 will result in a torsional
activation o f the palatal wire when the inserts
are placed into the molar sheaths. Equal and
opposite couples will be applied to the molars
in the sagittaI plane. One molar will have a
tendency to rotate clockwise and the o t h e r mo-
lar will tend to rotate counterclockwise a r o u n d
their respective CRe~.
H o w e v e r , the palatal arch will i n t r o d u c e
constraining forces into the system and will
move the instantaneous Caot occlusally and
closer to the molar sheaths (Fig 14). T h e molar
with the crown-distal/root-mesial couple will
u n d e r g o mesial root m o v e m e n t and the CReS
will move mesially because the stiffness o f the
palatal arch will p r e v e n t the crown f r o m mov-
ing distally. T h e contralateral molar with the
crown-mesial/root-distal couple will u n d e r g o
distal root m o v e m e n t and the CR~S will move
distally for similar reasons.
T h e r e are no associated equilibrium forces
,.Q
F,gure 13 Acuvatton of a TPA for second-order
mechanics. (A) A side view of a TPA with bilateral
second-order activations. (B) A toe-up of the insert
at the upper right first molar will produce a crown-
toe-down of the insert at the upper left first molar
will produce a crown-mesial/root-distal couple at the
molar sheath.
 Trampalatal Arches 49

Clinical U s e s

Mc Mc This activation o f the T P A is useful in the cor-

rection o f a unilateral Class II dental malocclu-
sion. This works most effectively when no arch
wires are in place or may be used in combina-
tion with a headgear. T h e molar with the distal
root m o v e m e n t also has its CR~ moving distally
and this will help toward correcting the Class
II molar relationship.

Bilateral Third-Order Activations (Facial

Root Torque)

\ Symmetrical t h i r d - o r d e r activations o f the in-

serts as shown in Figure 15 will result in equal
and opposite couples applied to the molars in
the frontal plane. T h e associated equilibrium
forces will cancel out, and tile tendency will be
for the molars to rotate a r o u n d their Cm. S in a
crown-lingual/root-facial direction and for the
molar sheaths to come closer together.
However, tile system is constrained and the
stiffness o f the palatal arch will help to main-
tain the intersheath distance. T h e stiffness o f
Figure 14. Constraint from the wire of the TPA will the wire imposes a facially directed force acting
prevent second-order rotations of the molars
around their respective CR~~. In effect, mesial and at the molar sheaths and the Cr,.s o f the teeth
distal root torque of the molar roots will result. will move facially because o f this force. T h e
instantaneous CRot are in this situation m o v e d
occlusally and closer to the molar sheaths.
present in this case. One couple and its mo-
ment will be equal and opposite to the o t h e r Clinical U s e s
couple and its m o m e n t and the whole system
W h e n p e r f o r m i n g a r c h e x p a n s i o n using a
will be in equilibrium. 6'7 Torsional activations
TPA, facial root t o r q u e activations can be in-
in wires create equal and opposite couples on
c o r p o r a t e d along with the expansive c o m p o -
the inwflved tooth pair. This is similar to third-
nent to simultaneously u p r i g h t the roots as the
o r d e r t o r q u e activations in c o n t i n u o u s arch
intermolar width increases (Fig 16). This third-
wires where the adjacent teeth will feel equal
o r d e r t o r q u e may help control transverse re-
and opposite torquing moments (see T o r q u i n g
lapse and create better occlusal interdigitation
Arch section). It is the stiffness o f the contin-
and fewer balancing interferences by upright-
uous arch wire that introduces constraining
ing the molar roots. A T P A can also be placed
forces and prevents the teeth f r o m rotating
a r o u n d t h e i r CR~ ~, leading to g r e a t e r r o o t
m o v e m e n t than crown m o v e m e n t .
Equal and opposite activation o f the inserts
is not r e q u i r e d because with torsional activa- ac
tions, the angle o f entry is always equal and
opposite between the two paired teeth creating
opposite couples o f equal m a g n i t u d e . T o r -
sional activations o f arch wires are closely re-
lated to V-bends because o f the fact that the Figure 15. Bilateral toe-ins in the frontal plane will
angles o f entry are always equal and opposite. produce bilateral facial root torque.
50
I
I
•
~ Mc
4, , t h o u g h present, the m a g n i t u d e o f the m o m e n t
Figure 16. Bilateral toe-ins in the frontal plane
along with expansion in the palatal arch form will
result in an increase in intermolar width and molar
translation.
after rapid maxillary expansion (RME) to not
only retain the transverse molar width, but to
also upright the molars that may have tipped
out facially with the RME appliance.
Asymmetrical V-Bends
Unilateral First-Order Activations
(Mesiofacial Rotation)
F i r s t - o r d e r activation o f only o n e insert as
shown in Figure 17 will p r o d u c e a unilateral
couple and result in a M-Fa m o m e n t o f the
couple on that molar and an associated equi-
librium force on the o t h e r molar. T h e associ-
ated equilibrium forces will be in anteroposte-
rior direction. T h e s e equilibrium forces will be
felt by the teeth at their point o f application by
the T P A , ie, at the sheaths.
T h e molar with the large M-Fa m o m e n t o f
the couple will also feel a mesially directed as-
MC
<.,,
! 1
Figure 17. A unilateral toe-in in the occlusal plane
will produce a M-Fa moment on one molar and an-
teroposterior equilibrium forces.
Joe Rebellato
'='F
sociated equilibrium force being applied at the
sheath that will tend to move the CRe~ o f the
molar mesially. This mesially directed force,
acting lingual to the CRes o f the tooth, will gen-
erate a m o m e n t o f the force that will be addi-
tive to the M-Fa m o m e n t o f the couple. Al-
o f the force is very small and clinically negligi-
ble c o m p a r e d with the effects o f the m o m e n t
o f the couple. This is because the m o m e n t o f
the force is a p r o d u c t o f two small factors; the
m a g n i t u d e o f the equilibrium force multiplied
by the smallest p e r p e n d i c u l a r distance f r o m
the force vector to the CRe s o f the molar.
T h e equilibrium force acting on the contra-
lateral molar will apply a distally directed force
at the sheath. T h e CRes will move distally in a
direction parallel to the vector o f the line o f
force acting o n the tooth. T h e force is acting
lingual to the CRes o f the molar and for reasons
previously mentioned, the resultant m o m e n t
o f the force is small and can be clinically dis-
regarded.
Clinical Uses
A unilateral first-order activation o f the T P A
resulting in a unilateral M-Fa m o m e n t o f the
couple is useful in the correction o f a unilateral
Class II dental malocclusion. This works most
effectively when no o t h e r arch wires are in
place. A h e a d g e a r can be used to keep the
M-Fa rotation o f the molar f r o m fully express-
ing itself.
T o minimize the side effect o f the molar
M-Fa rotation, the T P A can be used with a
full-bonded/banded appliance system (Fig 18).
This allows the molar moving distally to slide
back along the wire while at the same time the
arch wire minimizes the M-Fa rotation o f the
o t h e r molar as the wire would have to b e n d or
the whole arch would have to skew over to al-
low the M-Fa rotation to express itself.
Unilateral First-Order Activations
(M esiolingual Rotation)
F i r s t - o r d e r activation o f only o n e insert as
shown in Figure 19 will p r o d u c e a unilateral
couple and result in a M-Li m o m e n t o f the
couple on that molar and an associated equi-
librium force on the o t h e r molar. This is sim-
 Transpalatal Arches
Figure 18. A unilaterally-activated TPA has moved
the upper left buccal segment distally. The insert
with the toe-in is in its sheath to show the degree of
activation of the appliance. Note the floss to prevent
accidental swallowing or aspiration of the TPA.
ilar to the previously discussed T P A except
that all m o m e n t s and forces are reversed.
T h e associated equilibrium forces will be in
an a n t e r o p o s t e r i o r direction. A distally di-
rected equilibrium force will be acting on the
molar with the M-Li m o m e n t o f the couple and
the CRes will have a tendency to move distally.
This distally directed force is acting lingual to
the CRes o f the molar but the resultant m o m e n t
o f the force is small and can be disregarded.
T h e contralateral molar will feel a mesially
directed equilibrium force that is acting at the
Mc
! 1
Figure 19. A unilateral toe-out in the occlusal plane
will produce a M-Li moment on one molar and an-
teroposterior equilibrium forces.
51
sheath and lingual to the CRes o f the molar.
T h e CRes o f the molar will tend to m o v e me-
sially f r o m the force and the small m o m e n t o f
the force that is g e n e r a t e d can be disregarded.
Clinical Uses
A unilateral first-order activation o f the T P A
resulting in a unilateral M-Li m o m e n t o f the
couple is ideal when the situation requires loss
o f molar a n c h o r a g e on one side. Again, the
side effect o f molar rotation is minimized in a
f u l l - b o n d e d / b a n d e d a p p l i a n c e system. T h e
molar moving mesially slides f o r w a r d along
the wire while the arch wire minimizes the
M-Li rotation o f the o t h e r molar as the wire
would have to bend or the whole arch would
have to skew over to allow the M-Li rotation to
express itself. Although there is a t e n d e n c y for
the molar with the M-Li m o m e n t to move dis-
tally, Class III elastics can be used to counter-
act this m o v e m e n t .
Unilateral Second-Order Activations
A s e c o n d - o r d e r activation o f only one insert
will result in a torsional activation o f the palatal
wire w h e n the inserts are placed into the molar
sheaths. Equal and opposite couples will be ap-
plied to the molars in the sagittal plane because
with torsional activations, the angle o f entry is
always equal and opposite between the two
paired teeth. It is t h e r e f o r e impossible to cre-
ate asymmetrical torsional activations because
the paired teeth will always feel opposite cou-
ples o f equal magnitude.
Unilateral Third-Order Activations
(Facial Root Torque)
A t h i r d - o r d e r activation o f only o n e insert as
shown in Figure 20 will p r o d u c e a unilateral
couple and result in a facial root t o r q u e mo-
m e n t o f the couple on that molar and an asso-
ciated equilibrium force on the o t h e r molar.
This is similar to the first-order activations ex-
cept the m o m e n t s in this case are o r i e n t e d in
the frontal plane.
T h e associated equilibrium forces will be in
a vertical (intrusive-extrusive) direction. T h e s e
equilibrium forces will be felt by the teeth at
their point o f application. T h e molar with the
large facial root torque m o m e n t will also feel
52 Joe RebelIato
Mc
Figure 20. A unilateral toe-in in the frontal plane
will produce a facial root torque moment on one
molar and intrusive-extrusive equilibrium forces.
an intrusively directed equilibrium force ap-
plied at the sheath and the CR~~ will have a
tendency to i n t r u d e in a direction parallel to
the intrusive force vector. T h e small m o m e n t
o f the force g e n e r a t e d by this lingually posi-
tioned force may be clinically disregarded.
T h e contralateral molar will have an extru-
sive equilibrium force acting at the sheath and
lingual to the Cae~ o f the tooth. T h e CR~~of the
molar will have a tendency to e x t r u d e in a di-
rection parallel to the force vector. T h e r e will
also be a m o m e n t o f the force generated, but
once again it is not clinically relevant.
Clinical Uses
T h e differential m o m e n t s in the above T P A
can be used in conjunction with expansion in
the TPA's palatal wire to correct unilateral
crossbites (Fig 21). T h e facial root torque gen-
erated on one molar can be used as anchorage
to p r e v e n t expansion o f the molar crown on
one side, although the CRe~ will still have a ten-
dency to move facially. T h e CRes o f the molar
in crossbite will also have a tendency to move
i m
:":F
Figure 21. A unilateral toe-in in the frontal plane
along with expansion in the palatal arch form will
result in a facial translation of the molar with the
moment of the couple and a facial tipping out of the
molar in crossbite. Note that more crown movement
has occurred with the molar that is tipping facially.
facially because o f the expansive force, and the
m o m e n t o f the force will tend to make the
tooth rotate in a crown-facial/root-lingual di-
rection.
Once the molar is tipped out o f crossbite,
the expansive c o m p o n e n t to the T P A can be
inactivated. T h e insert bends are reversed so
that the molar that was tipped out o f crossbite
will now be u n d e r g o i n g facial root torque to
upright the roots. T h e molar that previously
had the large m o m e n t o f the couple with the
intrusive equilibrium force now has the extru-
sive equilibrium force acting at its sheath.
Step Bends
T h e previous asymmetrical V-bend examples
have described a unilateral couple and its mo-
ment on one molar, and no couple (angle o f
entry = zero degrees) on the o t h e r molar. In-
creasing the angle o f entry of the insert on the
couple side increases the m a g n i t u d e o f the mo-
m e n t felt by that molar and concomitantly, the
magnitude of the associated equilibrium forces
felt by both molars. However, this creates a
very high angle of entry o f the insert at one
sheath and may make insertion o f the appli-
ance difficult or possibly painful to the patient.
Step bends are essentially two-bracket sys-
tems that have couples at the brackets that are
always in the same direction. T h e associated
equilibrium forces will also be additive and so,
step bends can be an efficient way o f increasing
the m a g n i t u d e of the equilibrium forces with-
out greatly increasing the angle o f entry at a
sheath.
First-Order Step Bend Activations
First-order step bend activations o f the inserts
as shown in Figure 22 combines the two pre-
vious unilateral first-order activations (Figs 17
and 19). T h e step bend generates couples on
the molars that are in the same direction and
so, the associated m o m e n t s that make u p the
equilibrium will both be in the opposite direc-
tion. T h e associated equilibrium forces will be
additive and the forces will be felt by the mo-
lars at their point of application, ie, at the
sheaths.
 Transpalatal Arches
M Figure 23. A toe-in of one insert and a toe-out of
"-'C --r--C
M.~ ~ ~
F I
Figure 22. A toe-in of one insert and a toe-out of
the other in the occlusal plane will produce mo-
ments of the couple that are hoth in the same direc-
tion with anteroposterior equilibrium forces that are
additive.
Additionally, the m o m e n t s of the force will
be additive to the m o m e n t s o f the couple in
this situation. This is because o f the lingual po-
sition of the sheaths on the molar bands. Al-
t h o u g h the equilibrium forces are greater than
in the asymmetrical V-bend examples, the mo-
ments of the force can still be disregarded.
Once again, this is because the m o m e n t s o f the
fbrce are very small coinpared with the mo-
ments of the couple.
Clinical U s e s
This step bend activation of the T P A is useful
in the correction of a unilateral (;lass II dental
malocclusion where a distally directed force o f
greater m a g n i t u d e is required. As previously
mentioned, arch wires or headgears are useful
in minimizing the side effect (3t molar rotation.
Third-Order Step Bend Activations
Step bend activations o f the inserts (Fig 23)
combines the previously discussed unilateral
facial root torque T P A with a unilateral lingual
root torque T P A (not previously discussed be-
cause of lack of clinical application). T h e cou-
ples g e n e r a t e d are in the same direction and
so, the associated equilibrium forces will be ad-
ditive.
T h e equilibrium forces are acting in a ver-
tical r a t h e r than an a n t e r o p o s t e r i o r direction
53
..t~.C
the other in the frontal plane will produce moments
of the couple that are hoth in the same direction
with intrusive-extrusive tortes that are additive.
and so, the CR,.~ o f the molars will tend to move
in an apico-occlusal direction. T h e CR,.,~ o f the
molar with the facial root torque m o m e n t will
tend to intrude, a n d the CR~~ o f the m o l a r with
the lingual root t o r q u e m o m e n t will have a ten-
dency to extrude. T h e m o m e n t s o f these asso-
ciated equilibrium forces are present, but are
clinically insignificant.
Clinical Uses
This step b a n d activation o f the T P A , if com-
bined with expansion in the T P A ' s palatal wire,
is useful in correcting unilateral crossbites (Fig
24). This application is similar to the one dis-
cussed in the unilateral t h i r d - o r d e r activations
section, except the additional crown-buccal/
root-lingual couple helps to quickly get the mo-
lar crown out o f crossbite.
As with the unilateral t h i r d - o r d e r activation
TPA, the expansive c o m p o n e n t can be inacti-
vated once the m o l a r is out o f crossbite. T h e
inserts are now adjusted so that the molar that
was b r o u g h t out o f crossbite will now be un-
Mc~ Mc
"-11
"-'F
I',
Figure 24. A step-bend activation of the inserts in
the frontal plane along with expansion in the palatal
arch form will result in translation of the molar with
the facial root torque couple. The contralateral mo-
lar will tip out facially from the expansive force and
the lingual root torque couple.
54
d e r g o i n g facial root torque to u p r i g h t the
roots. T h e angle of entry of the other insert is
now adjusted to zero degrees or passive entry
and this molar will now have the extrusive
equilibrium force acting on it.
Conclusion
Several cIinical applications of the removable
TPA have been presented. This section is not
complete with regard to all the possible uses
and activations of this appliance. Unilateral lin-
gual root torque activations and bilateral lin-
gual root torque activations have not been dis-
cussed because of their lack of clinical applica-
tion but are nonetheless possible to obtain. As
with any other orthodontic appliance, under-
standing the basic biomechanics leads to un-
derstanding the full range of treatment op-
Joe Rebellato
tions with the appliance, even if only a few of
the possible activations are routinely used.
References
1. Burstone CJ, Manhartsberger C. Precision lingual
arches-Passive appiications. J Clin Orthod 1988;22:
444-451.
2. Burstone CJ. Precision lingual arches-Active applica-
tions. J Clin Orthod 1989;23:101-109.
3. Burstone CJ, Koenig HA. Precision adjustment of the
transpalatal lingual arch: Computer arch form prede-
termination. Am J Orthod 198I ;79:115-133.
4. Burstone CJ, Koenig HA. Force systems from an ideal
arch. Am J Orthod I974;65:270-289.
5. *Iulligan TF. Common sense mechanics. Phoenix,
CSM, 2122 East Kaler Drive, I989.
6. Isaacson RJ, Lindauer SJ, Rubenstein LK. Moments
with the edgewise appiiance: Incisor torque control.
Am J Orthod Dentofacial Orthop 1993;103:428-438.
7. Nikolai RJ (Ed). Delixery of torque by the orthodontic
appiiance, In: Bioengineering analysis of orthodontic
mechanics. PhiladeIphia, PA: Lea & Febiger, 1985:
272-321.