Lower lingual holding arch (LLHA)


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Lower lingual holding arch (LLHA)

  2. 2. LOWER LINGUAL HOLDING ARCH (LLHA) Quinto, Jasmine Regalado, Liel Marie Salazar, Stefanie Vasquez, Czarina Alyssa
  3. 3. LOWER LINGUAL HOLDING ARCH (LLHA) DESCRIPTION: a space maintaining appliance is comprised of stainless steel rings (bands) around posterior teeth (usually molars) a stainless steel wire that passively contacts the lingual surfaces of the teeth. is designed to maintain the position of the lower molars as the baby teeth are lost.
  4. 4. PURPOSE to prevent your lower molars from moving. used to preserve and create space in the mandibular arch and to aid in uprighting of the molars designed for space management and rotation of molars if needed.
  5. 5. Lower Lingual Holding Arch Procedure • Place seperators for sufficient time • Band 26,36 • Weld lingual sheaths Lingualy. • Take impressions with bands in place. • Transfer the band to the impression. • Pour cast and send it to the lab. • When lower lingual holding Arch is used as a space maintainer the entire assembly can be fabricated in the lab itself. Only a clean stone impression is needed. But when it is used along with fixed appliance systems the procedure mentioned earlier important.
  6. 6. Fabrication (a laboratory processed appliance soldered to a molar band that requires two visits by the patient) • Bands are adapted to the most posterior tooth remaining on the arch (first permanent molar or second primary molar) • A pick up alginate impression is taken.
  7. 7. Fabrication • The appliance is fabricated in a laboratory. A 0.036” stainless steel wire is soldered to the bands. This wire must be 1.5 mm away from the soft tissues for gingival health. This wire should rest on the cingula of the incisors. • Cementation with appropriate cements (described earlier).
  8. 8. Indications: • Loss of second primary molar in the mandible • Bilateral loss of primary teeth in the mandibular arch during transitional dentition. • „ Maintenance of arch perimeter and incisor positions. • „ Contraindicated in primary dentition.
  9. 9. • Modification of LLA with omega loops. • „ Activation of loops help flare anteriors with some distalising of permanent molars.
  10. 10. Contraindications • Permanent mandibular incisors not yet erupted.
  11. 11. How Do We Fit The Lingual Arch? 1. If required, separators are placed between your back teeth to create space for the bands 2. The separators are removed approximately one week later or at the band fitting appointment. 3. Bands are chosen to specifically fit your teeth
  12. 12. How Do We Fit The Lingual Arch? 5. Once the bands have been fitted, an impression is taken to have the lingual arch constructed 6. Once the lingual arch has been constructed, an appointment will be scheduled to have the lingual arch inserted into your mouth
  13. 13. How Do I Clean My Lingual Arch?
  14. 14. How Do I Clean My Lingual Arch?  If food is not effectively removed from the lingual arch, it can cause dental decay and gum problems  Tilt your toothbrush on a 45 angle on the gum line, underneath the bands on your lower first molar teeth  Rotate your toothbrush ten times on both the left and right sides, inside and outside of the bands  A dental floss threader will be provided so that you are able to floss around the lingual arch
  15. 15. Instructions: • No hard or sticky foods (corn chips, hard candy, caramel, gum, taffy, peanuts, etc.) • 3-4 carbonated drinks (coke, root beer, 7-up etc.) per week • monitor highly sweetened foods (cake, pie, ice cream, cookies) brush after or rinse with water.
  16. 16. Proper Care • Brush teeth at least 3 times daily. • Use a water pick or floss, to remove food caught underneath the appliance. • Watch diet and contact office if bands come loose or anything breaks or wire gets bent. • Warm salt water rinses for sores. • 'Rescue' wax for bands until cheeks get used to new appliance
  17. 17. Advantages: • Maintains the tooth space and the leeway space • to prevent your lower molars from moving Disadvantages: • First permanent molars may be susceptible to decalcification • may be prone to breakage unless the patient is well-informed on maintenance
  18. 18. Prices As of June 1, 2012 by Ortho Dent Laboratory Inc. LLHA - 1361.26Php LLHA with loops - 1536.06Php
  19. 19. Sources • http://www.prescottortho.com/Treatment/Appliances.asp x • http://www.youtube.com/watch?v=JJTk5k8A3dY • http://www.bronskyorthodontics.com/assets/LLHA.pdf