AN IMPROVED TRANSPALATAL BAR

DESIGN. CLINICAL
UPPER
MOLAR DEROTATION—CASE REPORT
(Angle Orthod 2003;73:244–248.)

Dr. Monojit Dutta

PG 1st Year
CONTENTS
Introduction
Zachrisson-type transpalatal bar [ZTPB]
Method
Results
Discussion
Critical Appraisal
References

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 INTRODUCTION

Angle (1899) - maxillary first permanent molars as the ‘‘key to occlusion,’

Henry (1956) – Angle between the median raphae and a line through the buccal cusps of molars.
Normal angle is 11.1 and passes 4.7mm to buccal surface of crown
Friel (1959) – median raphae as refrence and measured the angle between the raphae and a line
through mesiobuccal and mesiopalatal cusps of molars
Orton (1966) – Angle between the tangent to buccal surface of premolars and a line tangent to
buccal surface of molars
Andrews (1972) - ‘‘no rotations of the teeth in the dentition’’ One of the six keys

Henry RG. Relationship of the maxillary first molar normal occlusion and malocclusion. Am J Orthod 1956;42:288-306.
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 Ricketts RM. Occlusion – The medium of dentistry. J Prosthet Dent 1969;21:39-60.

de Oliveira Viganó Cd, da Rocha VE, Junior LR, Paranhos LR, Ramos AL. Rotation of the upper first molar in Class I, II, and III patients. Eur J Dent 2016;10:59-63
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Ricketts (1974)- In an ideal occlusion a line can be drawn between the mesiolingual
and the distobuccal cusps of the upper first molars, transecting the distal third of the
canine on the opposite side. The position of this line may indicate the need for molar
rotation. 5
Cetlin (1984) In an ideal occlusion the buccal surfaces of the upper first molars are usually
parallel to one another
Lamons and Holmes - molar rotations commonly exist in Class II malocclusions. The molars
are usually rotated around an axis lingual to their central fossae.
Ten Hoeve discussed the degree of Class II malocclusion in relation to maxillary first-molar
rotation, and the importance of examining the occlusion from the lingual aspect.
Liu and Melsen - The buccal molar relationships are not consistent with their corresponding
lingual relationship in 90% of the conventionally diagnosed Class II cases.

Ten Hoeve A. Palatal bar and lip bumper in nonextraction treatment.J Clin Orthod. 1985;19:272–291.
Liu D, Melsen B. Reappraisal of Class II molar relationships diagnosed from the lingual aspect. Eur J Orthod. 2001;23:457.
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Lamons FF, Holmes CW. The problem of the rotated maxillary first permanent molar. Am J Orthod 1961;47:246-72.
The space between the buccal and lingual cortical plates becomes narrow anterior to the first-molar
roots.

When the upper first molar drifts mesially, the large lingual root contacts the lingual plate and allows
the two buccal roots to rotate mesiolingually.

The occlusal surface of the first permanent molar is trapezoidal in shape, with the long diagonal from
distolingual to mesiobuccal.

Therefore, more mesiodistal space is used in the dental arch when this tooth rotates mesially with the
lingual root as the axis.

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(Angle Orthod 2003;73:244–248.)
 By correction of these rotations, one to two mm of
arch length per side and partial Class II correction can
be achieved.

Provide good intercuspation.

Transpalatal bar - Robert A. Goshgarian

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Orthodontic and Orthopedic Treatment in the Mixed Dentition James A., Jr. McNamara, William Brudon L. Brudon
The transpalatal bar is useful when the need for derotation is the same on both sides of the dental
arch.

If there are symmetrical upper molar rotations, equal and opposite moments of rotation can be
used to derotate the molars without creating mesiodistal forces.

If there are asymmetric molar rotations, the molar that is more mesiopalatally rotated will receive a
larger derotation moment and will move mesially.

The molar that is less rotated will have a smaller derotation moment and will move distally

The main differences between the design described by Zachrisson (Zachrisson-type transpalatal
bar [ZTPB]) and the traditional Goshgarian-type transpalatal bar (GTPB) are in the amount and
shape of the wire in the palatal loop. 9
(Angle Orthod 2003;73:244–248.)
ELGILOY

Cobalt-Chromium Nickel alloy

40% Co; 20% Cr; 15% Ni; 15.8% Fe
Elgiloy as initially manufactured by the Elgin, USA (1950)
Elgiloy has different forms: Blue (soft), yellow (elastic), green (half elastic) and red
(flexible).
The blue type is the most commonly used by orthodontists because of its
formability and the possibility to increase its durability by heat treatment.

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Orthodontic Materials William A Brantley
Properties
• Longer functioning as a resilient spring wire
• Fatigue resistance – More cycles than stainless steel without breakage
• Greater spring efficiency – Up to 20% more power than spring steel without an increase in
dimensions
• Corrosion resistance – Outperforms chrome stainless steel by 17%
• Non-magnetic – Non-magnetic through all temperature ranges
• Easy soldering without annealing
• Easy heat-treating to increase physical properties
• Simple electrolyte polishing
Orthodontic Materials William A Brantley 11
• Blue Elgiloy is initially the softest of the tempers.
•It can be welded with low heat, and soldered without embrittling.
•Recommended when the wire to be used is over .020” (0.508mm) or when the wire requires
considerable bending, welding or soldering.
•Excellent for edgewise arches, lingual arches, retainers and removables.

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https://www.rmortho.com/wp-content/uploads/2011/09/Wire-Elgiloy.pdf
Yellow Elgiloy is initially ductile and slightly harder than Blue.
Using caution, you can spot-weld and solder to large Yellow Elgiloy wires, .021” x
.025”; .030”; .036” (0.533mm x 0.635mm; 0.762mm; 0.914mm), without embrittling
them.
Heat treated if greater resiliency or spring performance is required.
After heat-treating, Yellow can be adjusted slightly, but should not be adjusted
sharply.
It is excellent for flat wire techniques.
Recommended where greater spring qualities are needed than those provided by
Blue Elgiloy.
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https://www.rmortho.com/wp-content/uploads/2011/09/Wire-Elgiloy.pdf
• Green Elgiloy is initially semi-resilient and will temper comparable to high spring
tempered steel wires. It can be shaped easily with the fingers and can be plier-
manipulated before heat-treating.
• Red Elgiloy is initially “hard” with exceptionally high spring qualities. It is not
recommended for heat-treating. Use where adjustments will not be required after
heat-treating.

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https://www.rmortho.com/wp-content/uploads/2011/09/Wire-Elgiloy.pdf
Elgiloy Blue alloy - can easily be manipulated into desired shapes and then heat
treated to achieve considerable increases in strength and resilience.
This heat treatment can be performed easily with the aid of an electrical resistance
welding apparatus, and the manufacturer provides a special paste that indicates when
the appropriate conditions of temperature and time have been achieved.
A furnace heat treatment for 10 minutes will achieve the same result.
Maximum YS for straight, 0.41 mm diameter, wire segments is obtained with a
heat-treatment temperature of about 500 °C.

Orthodontic Materials William A Brantley 15

Because of its “soft feel” (due to relatively low YS) during manipulation, orthodontists can
mistakenly believe that as-received Elgiloy Blue wires have substantially lower elastic force
delivery than stainless steel wires.
In reality, the values of modulus of elasticity for the Elgiloy Blue and stainless steel orthodontic
wires are very similar
Clinical use of Elgiloy Blue wires is fabrication of the fixed lingual quad-helix appliance,
which produces slow maxillary expansion for the treatment of maxillary constriction or crossbite
in the primary and mixed dentitions.

Orthodontic Materials William A Brantley 16

The force delivery from an 8 mm activation for appliances fabricated from stainless steel and
Elgiloy Blue wires of 0.032, 0.036, and 0.038 in (0.81, 0.91, and 0.97 mm) diameters was found
to vary significantly with appliance size and wire diameter but was independent of alloy type.
This result would be anticipated from the very similar values for the modulus of elasticity of the
two alloys

Orthodontic Materials William A Brantley 17

 18
Orthodontic Materials William A Brantley
 ZACHRISSON-TYPE TRANSPALATAL BAR [ZTPB]
The ZTPB has three loops
The middle loop is larger and longer than the single
round loop of the GTPB, is directed mesially, and the
additional loops are directed distally
The additional smaller loops are symmetrically
positioned on either side of the middle loop.
Optimal length of the ZTPB is about 89 mm.
Although adaptations are required for individual palatal
vault designs, the size of the central loop is generally
about 9 mm, and the distance from the two farthest points
is approximately 12 mm
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(Angle Orthod 2003;73:244–248.)
The ends of the ZTPB are longer than those of the standard GTPB, to secure
improved engagement to the lingual sheaths and make safe ligations possible.
Procedure :
 At the first appointment : Separators for the upper molars are placed.
 At the second appointment (about one week later), molar bands are fitted, and
alginate impression is taken with the bands in place.
 The ZTPB is then made indirectly, using a 0.036-inch (0.9 mm) Blue Elgiloy wire
The excellent formability of the Blue Elgiloy wire facilitates the making of the bar

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(Angle Orthod 2003;73:244–248.)
The bar is contoured in an optimal position, one to two mm above the palate on the
plaster model to avoid any soft-tissue impingement in both the vertical and the
horizontal planes.
After bending, the bar should be stress relieved by heat treatment with a memory
maker.
At the third appointment, the bands are cemented to the upper molars, and the bar is
placed in the lingual sheaths on the bands.

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(Angle Orthod 2003;73:244–248.)
 METHODS

Bilaterally rotated upper molars (mesial in, distal out) were derotated using ZTPBs.
Photographs of the patients were taken at the beginning of the treatment and after satisfactory derotation

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(Angle Orthod 2003;73:244–248.)
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Each occlusogram to evaluate the degree of rotation :
1. The angle between the line passing through the buccal
surface of the molar and the midsagittal line marked on the
median raphe

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(Angle Orthod 2003;73:244–248.)
2. The angle between the line through the mesiobuccal and
Mesiopalatal cusps of the molar and the midsagittal line
Marked on the median raphe.

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(Angle Orthod 2003;73:244–248.)
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(Angle Orthod 2003;73:244–248.)
RESULTS

Clinically satisfactory upper–first-molar rotations were obtained in both cases.

No intrusion of the molars was detected clinically at the end of derotation.
The measured overbite was the same before and after derotation.
The transpalatal bar was reactivated at each four-week control.

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(Angle Orthod 2003;73:244–248.)
 Angle 1 Angle 2
Treatment
Upper Post
Patient No. Time Pre Post Pre
Molar Treatment
(d) treatment treatment treatment

Left 18 2 60 79
1 90
Right 21 5 59 82
Left 36 4 63 72
2 73
Right 35 3.5 62 70

1. The angle between the line passing through the buccal surface of the molar and the midsagittal line
2. The angle between the line through the mesiobuccal and Mesiopalatal cusps of the molar and the midsagittal line

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(Angle Orthod 2003;73:244–248.)
 DISCUSSION

By enlarging the midline omega loop and directing the loop mesially, the force of the tongue can
produce intrusive forces on the teeth where the transpalatal bar is anchored.
However, in the short time span (three months) in the present cases, no intrusion of upper molars
was observed.
The time needed for derotation with ZTPB was shorter than the time taken by traditional GTPB.
The use of prefabricated transpalatal bars reduces the number of appointments.
However, fabrication of the ZTPB is not very time-consuming.

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(Angle Orthod 2003;73:244–248.)
The Blue Elgiloy wire has excellent formability and can be easily bent to the proper shape. After
bending and heat treatment (up to 480C), the Elgiloy wire has a slightly higher stiffness than
stainless steel.
With the ZTPB a greater length of wire is used over the same distance than for the routine
GTPB. This lowers the load deflection rate and allows greater flexibility to the bar, making the
forces more constant and predictable.
When the bar is fully engaged in the attachments, the middle bigger loop opens, and the
additional loops on either side of this big loop close.
The bar is active until the loops come to their original shape.

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(Angle Orthod 2003;73:244–248.)
The clinical use of the ZTPB for different treatment purposes, such as upper molar derotation,
expansion of the upper arch, maintaining arch widths, supporting anchorage, improving vertical
control, is found to be satisfactory by the present investigators.
A large number of patients who have received this custom made palatal bar design have been
treated by one of us during the last eight years.

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(Angle Orthod 2003;73:244–248.)
CRITICAL APPRAISAL

 No Patients Photographs were taken

 no mention of which method of occlusogram was used
 No Cephalometrical data regarding intrusion of molars are mentioned, pre and post
treatment.
 Low Sample Size

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REFERENCES
Orthodontic Materials William A Brantley
Orthodontic and Orthopedic Treatment in the Mixed Dentition Hardcover –James A.,
Jr. McNamara (Author), William Brudon L. Brudon
de Oliveira Viganó Cd, da Rocha VE, Junior LR, Paranhos LR, Ramos AL. Rotation
of the upper first molar in Class I, II, and III patients. Eur J Dent 2016;10:59-63

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