This document summarizes Nance appliances, transpalatal arches, and quad helix appliances. It describes the design, indications, and disadvantages of each appliance. For transpalatal arches, it notes they are used to prevent mesial migration of upper first molars and can provide anchorage, arch width stabilization, and be used as a retainer. Quad helix appliances are used to expand arches and derotate molars through a fan-like sweeping action. Nance appliances maintain posterior tooth positions and can be modified to provide an anterior bite plane.
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Introduction
History
Indications and contraindications
Timing of distalization
Second molar extraction
Mandibular molar distalization
Rickett’s criterion
Classification and various distalization appliances
References
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
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Ideal Security Provision to Embassies through Advanced Fencing SystemsGryffin
Gryffin is enviably trusted in context of providing security to all Embassies all over the world. Their ideal Palisade fence systems enable the requisition of anti-climb demarcation, dissuasion and penetration. Their Securifor and Fortis fences are powder coated in black and almost disappear amongst the environment. Their embassies specific Tigertape™ and less threatening Tangorail products are a proven solution. Security Gates are customized to fit risk management. Generally designed Anti ram barriers are even provisional. For more info visit: http://www.gryffin.com.au/
Introduction
History
Indications and contraindications
Timing of distalization
Second molar extraction
Mandibular molar distalization
Rickett’s criterion
Classification and various distalization appliances
References
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
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Ideal Security Provision to Embassies through Advanced Fencing SystemsGryffin
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Scania Year-end Report January-December 2016Scania Group
net sales rose to a record level of nearly SEK 104 billion. Total deliveries of trucks and buses and coaches reached all-time high levels. Service revenue amounted to a record of almost SEK 22 billion, an increase of 5 percent (7 percent in local currency).
Distributed stream processing with Apache Kafkaconfluent
A modern business operates 24/7 and generates data continuously. Shouldn’t we process it continuously too?
A rich ecosystem of real-time data-processing frameworks, tools and systems has been forming around Apache Kafka that allows data to be processed continuously as it occurs. Jay Kreps will introduce Kafka and explain why it has become the de facto standard for streaming data. He will draw on practical experience building stream-processing applications to discuss the difference between architectures and the challenges each presents. Jay will then outline the Kafka Streams API, which offers new stream processing functionality in Kafka, and explain how it helps tame some of the complexity in real-time architectures.
Visit www.confluent.io for more information
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Techniques for anchorage control in lingual orthodonticsParag Deshmukh
various techniques used in lingual orthodontics for anchorage control are described here.. and various cases of lingual orthodontics in which different techniques were used for anchorage control are discussed here..
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Hybrid appliances are specifically and individually tailored to exploit the natural processes of growth and development. Such an approach represents a departure from the practice of adopting a "named" appliance for the treatment of a class of malocclusion
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ocular injury ppt Upendra pal optometrist upums saifai etawah
Trans Palatal Arch
1. Nance Appliance, Trans Palatal Arch
& Quad Helix
Guided By :
Dr D.K. Agarwal (Prof & H.O.D)
Dr. Preeti Bhattacharya (Prof)
Dr. Ankur Gupta (Reader.)
Dr. Juhi Ansar (Senior Lect.)
Dr. Ravi Bhandari (Senior Lect.)
Presented By:
Asad Yusuf
P.G. Ist year
Department of
Orthodontic
3. Introduction
• Described by Nance in 1947
• It is simply a Modified maxillary lingual arch
that does not contact the anterior teeth, but
approximates the slope of anterior palate
The Transpalatal Arch: An Alternative to the
Nance Appliance for Space MaintenanceAri Kupietzky,Eli Tal,Pediatr Dent
2007;29:235-8
4. Design
• .036 SS wire running along palate connecting upper molars.
• The palatal portion incorporates an acrylic button resting on
slope of anterior palate that provides resistance to anterior
movement of the posterior teeth
6. 2.To maintain the position of the second molars where the first
molars have been extracted.
7. 3. 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.
9. 5. Offset Nance button to accommodate the palatally placed
lateral incisor with loops to allow adjustment.
10. Diadvantages
1. Oral hygiene difficulties: Nance appliances result in
deterioration of oral hygiene beneath the acrylic plate
leading to inflammation of the palate.
2.Poor patient tolerance in comparison to the standard
TPA
13. INTRODUCTION
Described by Robert Ara Goshgarian in 1972.Owing to the versatile
design TPAs can provide passive and active orthodontic forces in all 3
planes
14. Design
• .036 mm ss wire that goes across the palatal contour
from one molar or premolar to contralateral molar or
premolar
• Wire soldered to molar band at mesiolingual line
angles
• Or by insertion in the lingual sheath in molar band
(Wilson or Mershon attachments)
15. Major indication in mixed dentition is to prevent mesial
migration of upper first molar during transition from second
deciduous molar to 2nd premolar
Graber Vanarsdall Vig 5th ed. Pg 484
Rationale :
• When permanent maxillary molars move anteriorly, they
rotate mesiolingually around the large lingual root.
• TPA reduces anterior molar movement by coupling the right
and left permanent molars together and, thus, preventing
any possibility of rotations.
16. INDICATION in Transverse Plane
1. Anchorage and arch width stabilization during
orthodontic treatments or surgery
2. Retainer after active maxillary expansion
3. To Avoid Molar Tipping
4. Habit breaking appliance
5. Minimally expand dental arches
17. Transverse Plane :
1.Transverse anchorage and arch width stabilization when aligning
palatally impacted maxillary canines
Ref: 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
18. 2.TPA is also effective as a holding appliance or as a retainer after
active maxillary expansion
19. •
3. TPA & temporary anchorage devices (TADs) combination to
correct anterior open bites .
TPA is useful in controlling molar tipping during such clinical
situation
20. 4. Habit deterrent for persistent thumb and digit-sucking
habits. This requires the soldering/welding of a crib to the
TPA.
21. 5. Bilateral space maintenance following premature loss
of primary molars.
• Prevent loss of Leeway space and potential crowding
of the premolars where extractions of the deciduous
molars are planned.
22. 6. TPAs can be used actively to minimally expand dental arches.
• Expanded by 3−4 mm to provide a force of around 200 gm.
23. INDICATION in Anteroposterior Plane
Anteroposterior anchorage :The loop is directed posteriorly if the
TPA is to provide antero-posterior anchorage
25. Derotation of molars
• Bent-back end of the arch was gripped with pliers and
twisted relative to the main arch.
• If the moments on both sides are the same, the
Mesio-distal force will be zero.
Moments and forces delivered by transpalatal arches for symmetrical first
molar rotation Bengt Ingervall et al
26. Complications of TPA
1. Anchorage loss :
Type B Anchorage
2.5 mm of mesial movement of the upper first permanent molars in
TPA while the TADs group provided Absolute anchorage
Feldmann I, Bondemark L. Anchorage capacity of osseointegrated and
conventional anchorage systems: a randomized controlled trial. Am J Orthod
Dentofac Orthop 2008
2.Increase of risk of root resorption :
As TPA positions the root of anchor units against The cortical
bone plate
27. 3.Breakage and cementation failure is approximately 2% and 30%,
respectively
4.The loop of the TPA can cause palatal trauma
28. Quad helix
• Described by Ricketts in 1975
• Evolved from Coffin’s vulcanite expansion appliance
• He used with great success in the early treatment of those
patients with cleft palate in whom the lateral maxillary
segments had collapsed behind the premaxillary processes
• Wide range of continuous controlled force
29. • Frank et al: Forces in the range of 0.5 to 1.5 lbs (200 to
600 g).
• Palatal separation of .92 mm average intermolar
expansion was 5.88 mm.
• With the quad helix appliance there was a 6:1 ratio
between the orthodontic and the orthopedic expansion.
The Quad Helix Appliance Ruel W. Bench
30. Design
Pair of anterior helices
Pair of posterior helices
Anterior bridge.
Palatal bridge
Posterior loops should be 4-5mm distal to banded
molar but not extending to pterygomandibular raphe
31. Each of the helical loops adds an about additional 25
mm of wire to the appliance which lightens the force
magnitude, rendering a more continuous action due to
the greater range of activation provided by the longer
wire.
32. Types
• Custom made: 1 - 0·9mm stainless steel
• Preformed ready type
• Fixed : retained by bands cemented on the permanent first molars.
Adjustment ease with properties of .036 blue ELGILOY
(Co,Cr,Ni, Mo, Mn)
34. Action
Fan-like sweeping action :buccally expand and distally
rotate the maxillary molar teeth
Jones SP et al: Anterior arms of the appliance affect
both the forces produced by the appliance as well as
the force couples operating on the molar teeth. This
results from the fact that the anterior arms are a rigid
part of the whole appliance.
35. Importance of fan like action
• Parallel expansive force, larger amount of tensile strain was
recorded in the molar region.
• Fan type of expansive force by Quad helix, larger amounts of
tensile strain were observed in the canine region.
A reduction occurred as the strain was measured back toward
the molar teeth.
T. M. Graber. Jpn. Orthod. So. 42:442-453, 1983
36. • Parallel expansive force:
Frontal view: maxillary bones were expanded laterally
Occlusal view: palate and alveolar processes were expanded
laterally in the molar region.
• Fan type of forcer by quad helix: Palatal and alveolar
expansion was noted more in the canine region.
• Since many Class II malocclusions are characterized by
maxillary arches that are narrowest in the canine region, it
would follow that the fan type of appliance would be most
effective.
T. M. Graber. Jpn. Orthod. So. 42: 442-453, 1983
37. Fan like sweeping action for molar de rotation
• With this appliance,molar derotation is best
accomplished by leaving the arms of the quad helix
away from the lingual surfaces of the cuspid teeth. As
the molar teeth derotate, the arms will come to push
against the cuspid teeth and they will then expand
together with the rest of the maxillary teeth. The
advantage of activating the quad helix appliance in
this manner lies in the fact that the maxillary teeth are
expanded in a differential manner that "sweeps" them
into the ovoid arch form.
The Quad Helix Appliance Ruel W. Bench
38. Indications
1. Correct cross bites by Upper arch expansion
2. Case needing mild expansion with lack of space for
upper laterals
3. Molar Rotation correction
39. 4. Correction of mild class II Malocclusion in which upper arch
need to be widened & upper molar rotated distally
40. 5. Class III condition In which upper arch needs to be widened
&advanced with class III elastics
6. Habbit breaking aplpliance
Thumb sucking: Palatal bar forward & bended downward
Tongue thrusting: Spikes Soldered on bar & extending downward
41. 7. Unilateral & bilateral cleft palate: The quad helix
Expands the buccal segment
42. 8. With face mask
8.extension of .045" wire through the headgear tube of the molar band
enables the quad helix appliance to be used in conjunction with a
protraction face mask.
43. Sometimes advantageous to place a bi-helix appliance in the
mandibular arch to obtain and maintain a balance in the
dimensions of the maxillary and mandibular arches
44. Practical Application
• Bands are placed on upper second deciduous molar
for young case or 1st permanent molar . Particular
care is taken to adapt the lingual surface of bands
because this is strong purchase area of appliance
• Most appropriate size is selected
• Original cast is used & wire is formed with the
finger together with three pong plier to adapt wire
according to patients need
45. •Soldering spot is marked in front of posterior loops
depending on the adaptation of arms
•The band is picked up in the tong & approximated as
solder is flowed into position
•Desired activation is given
•Appliance is cemented making sure the bands are
well seated
47. (1) Anterior adjustments produce expansion in the posterior molar area
on both sides
(2) Lateral adjustment expands and rotates the molar on the activated
side. The molar on opposite side is distalized. Activation on both sides
causes the rotation & expansion to be on both sides
(3) Adjustments to the buccal arm expands the bicuspids and cuspids.
When held away from the teeth it allows the molars to rotate.
(4) Adjustments through the distal loop gives expansion to buccal arms.
The Quad Helix Appliance
Ruel W. Bench
48. Clinical Management
• Patients should be reviewed on a six-weekly basis for
activation.
• Intra Oral adjustment can be done in subsequent visits
• Widening of molars can be activated by pinching between
anterior loops.
• Care is taken to give only little activation is of anterior
arms and wire is left out of contact with anterior teeth
until molar rotation is achieved
49. Retention after the expansion
• At least three-month retention period
• Achieved expansion should be retained with an upper
removable appliance.
• If fixed appliances are being used, the quadhelix can
be removed and replaced by TPA.
50. Disadvantages
• The limited amount of skeletal change &
palatal relapse.
• Opening of the bite due to molar buccal
tipping.
• Outward positioning of upper buccal tooth by
an attempt of nature to upright the root.
• Downward Backward appliance posture
restrict tongue functions , so adaptation should
be 2-3 mm of palatal tissue
51. References
1.Ricketts : Bio Progressive therapy
2.Influence of’ arch, shape on the transverse eff’cts of
transpalatal arches of the Goshgarian type during
application ofbuccal root torque G. Baldini and H. ‘U.
Luder
3.The Transpalatal Arch: An Alternative to the Nance
Appliance for Space MaintenanceAri Kupietzky,Eli
Tal,Pediatr Dent 2007;29:235-8
52. • American Journal of Orthodontics and Dentofacial
Orthopedics hl memorianl 561 Volume 103, No. 6 Robert Ara
Goshgarian 1922-1992
• Transpalatal, Nance and Lingual Arch Appliances:Clinical
Tips and Applications Ortho Update 2015; 8: 92-100
53. Rationale :
When permanent maxillary molars move anteriorly, they rotate
mesiolingually around the large lingual root. The space between
the buccal and lingual cortical plates becomes narrow anterior to
the first molar roots.The large lingual root contacts the lingual
plate and acts as a pivot, allowing the 2 buccal roots to rotate
mesiolingually.
The TPA reduces anterior molar movement by coupling the right
and left permanent molars together and, thus, preventing any
possibility of rotations.
54. • In the treatment of narrow restricted maxillary arches,quad
helix tip the maxillary molar teeth bucally
To counter the tipping :buccal root torque is placed in the molar
bands before cementation & leaving the anterior arms of the
quad helix away from the lingual surfaces of the cuspid teeth.
As the molar teeth derotate, the anterior arms will come to
push against the cuspid teeth and they will then expand
together with the rest of the maxillary teeth, so the maxillary
teeth are expanded in a differential manner that "sweeps"
them into the ovoid arch form of the final occlusion.
55.
56. Expansion and derotation activation
placed in one side of the quad helix,
distalizes the molar on the opposite side
Modified to use one entire buccal
segment of the arch to a single molar
on the opposite side.
57. A quad helix can be activated to derotate a maxillary molar on
one side of the arch provides a distalizing force at the molar on
the opposite side of the same arch.
By extending the palatal arms of the appliance on one side, it can
involve more teeth on that side to act as anchorage in the distal
movement of a single molar on the opposite side of the arch.
58. VHA has intrusive effect on maxillary molar eruption.
Orthodontist must usually guard against further anterior
bite opening during leveling and aligning procedures in
patient with increased lower anterior facial height.
An ideal treatment goal for a patient with an acceptable
pretreatment overbite would be to at least maintain the
same amount of overlap throughout treatment.
Evaluation of the vertical holding appliance in treatment of high-angle patients Marc
DeBerardinis et al :Am J Orthod Dentofacial Orthop 2000;117:700-5)
59. INDICATION in Vertical plane
Positioned 4-5 mm away from the palate
Fabricated with banded maxillary permanent first molars with
connected acrylic button at the sagittal and vertical level of the
gingival margin of the molar bands.
Four helices were incorporated into the wire configuration for
flexibility.
60. Nance
• Provide anchorage during Alignment & levelling
Antero Posterior Anchorage in a case of canine retraction
• To maintain the position of the second molars where the
first molars have been extracted.
• 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.
61. TPA
1. Anchorage and arch width stabilization during
orthodontic treatments or surgery
2. prevent mesial migration of upper first molar during
transition from second deciduous molar to 2nd
premolar
3 Retainer after active maxillary expansion
4. Habit breaking appliance
5. Minimally expand dental arches
6. VHA
62.
63. A quad helix can be used to rotate an incisor tooth. In
this case, a cleft palate was present