Structurally Modified Non-Compliant Transpalatal Arch to Correct an Anterior Open Bite with Fused Mandibular Right Incisors

During molar intrusion some of the problems commonly encountered are buccal tipping of the molars and relative anterior extrusion which may lead to a more gingival smile. Both of these can be effectively countered by the use of a low-placed Transpalatal arch. The patient reported to the clinic with an anterior open bite and fused mandibular right anterior central and lateral incisors. Utilizing the finite element model made using the patient’s scan, a pick-up impression of the maxillary arch was recorded with the bands in place on the maxillary first molars. The appliance was designed using the conventional .036 mm wire but the design was modified to include a moderately large U-loop in the middle to enhance the surface area in contact with the tongue and bring about intrusion. The palatal clearance was kept at 5mm and the U-loop was positioned anteriorly instead of the traditional posterior facing design. Maxillary molar intrusion was achieved leading to anti-clockwise rotation of the mandible causing the anterior open bite to close.