The transpalatal arch: an alternative to the Nance appliance for space maintenance.

Department of Pediatric Dentistry, New Jersey Dental School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
Pediatric dentistry (Impact Factor: 0.56). 29(3):235-8.
Source: PubMed

ABSTRACT The loss of multiple primary molars in the primary or transitional dentition will, in many instances, lead to disturbances of the developing dentition. To prevent this, an appliance can be constructed to maintain the relationship of the remaining teeth and to guide the eruption of the developing teeth. Traditionally, the treatment of choice for maxillary loss is the placement of a Nance appliance. An alternative appliance that may be considered for use is the transpalatal arch or bar. The purpose of this clinical report was to describe the transpalatal arch appliance and present its advantages over the more common Nance appliance, thus encouraging clinicians to prescribe its use in certain clinical situations.

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    ABSTRACT: The use of a space maintainer appliance, or restoration of a carious primary tooth that can then act as a natural space maintainer, may potentially obviate the consequences of loss of arch length and the need for complex orthodontic treatment at a later stage. Nevertheless, all space maintainer appliances are plaque retentive and may predispose to dental caries and gingival inflammation. Space maintainer appliances may also impinge on the soft tissues, interfere with eruption of adjacent teeth, fracture, and become dislodged or lost. This review article provides a summary of the available evidence, and considers the indications for space maintenance. Medline and Ovid Medline were scanned, and additionally a hand-search of non-listed peer-reviewed papers written in English was performed. A total of 16 pertinent papers published between 1987 and 2007 that satisfied the inclusion criteria were selected for discussion. There is limited evidence to recommend either for or against the use of space maintainers to prevent or reduce the severity of malocclusion in the permanent dentition. Decisions regarding the use of space maintainers should be guided by balancing the occlusal disturbance that may result if one is not used against the potential plaque accumulation and caries that the appliance may cause.
    International Journal of Paediatric Dentistry 06/2009; 19(3):155-62. · 1.54 Impact Factor
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    ABSTRACT: Premature loss of primary teeth can result in a loss of arch length and have a negative effect on occlusion and alignment, often increasing the need for orthodontic treatment. Use of space maintainers can reduce the severity of problems such as crowding, ectopic eruption, tooth impaction and poor molar relationship. This article presents a review of the consequences of premature tooth loss and discusses the appliances commonly used for space maintenance.
    Journal of the California Dental Association 08/2013; 41(8):612-8.


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