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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Functional Lingual Arch with Hinge-type Lockable Dentulous Component</title>
<author><name sortKey="Chalakkal, Paul" sort="Chalakkal, Paul" uniqKey="Chalakkal P" first="Paul" last="Chalakkal">Paul Chalakkal</name>
<affiliation><nlm:aff id="aff1">Assistant Professor, Department of Pedodontics and Preventive Dentistry, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="N Ferreira, Amanda" sort="N Ferreira, Amanda" uniqKey="N Ferreira A" first="Amanda" last="N Ferreira">Amanda N Ferreira</name>
<affiliation><nlm:aff id="aff2">Postgraduate Student, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="C Da Costa, Godwin" sort="C Da Costa, Godwin" uniqKey="C Da Costa G" first="Godwin" last="C Da Costa">Godwin C Da Costa</name>
<affiliation><nlm:aff id="aff3">Lecturer, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="A Aras, Meena" sort="A Aras, Meena" uniqKey="A Aras M" first="Meena" last="A Aras">Meena A Aras</name>
<affiliation><nlm:aff id="aff4">Professor and Head, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">29104394</idno>
<idno type="pmc">5661048</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5661048</idno>
<idno type="RBID">PMC:5661048</idno>
<idno type="doi">10.5005/jp-journals-10005-1455</idno>
<date when="2017">2017</date>
<idno type="wicri:Area/Pmc/Corpus">001D12</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Functional Lingual Arch with Hinge-type Lockable Dentulous Component</title>
<author><name sortKey="Chalakkal, Paul" sort="Chalakkal, Paul" uniqKey="Chalakkal P" first="Paul" last="Chalakkal">Paul Chalakkal</name>
<affiliation><nlm:aff id="aff1">Assistant Professor, Department of Pedodontics and Preventive Dentistry, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="N Ferreira, Amanda" sort="N Ferreira, Amanda" uniqKey="N Ferreira A" first="Amanda" last="N Ferreira">Amanda N Ferreira</name>
<affiliation><nlm:aff id="aff2">Postgraduate Student, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="C Da Costa, Godwin" sort="C Da Costa, Godwin" uniqKey="C Da Costa G" first="Godwin" last="C Da Costa">Godwin C Da Costa</name>
<affiliation><nlm:aff id="aff3">Lecturer, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
<author><name sortKey="A Aras, Meena" sort="A Aras, Meena" uniqKey="A Aras M" first="Meena" last="A Aras">Meena A Aras</name>
<affiliation><nlm:aff id="aff4">Professor and Head, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">International Journal of Clinical Pediatric Dentistry</title>
<idno type="ISSN">0974-7052</idno>
<idno type="eISSN">0975-1904</idno>
<imprint><date when="2017">2017</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
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<front><div type="abstract" xml:lang="en"><p>The conventional lingual arch is a nonfunctional fixed space maintainer used in the mandibular arch to maintain arch length by the prevention of mesial movement of the permanent first molars. This study highlights a functional lingual arch with a hinge-type lockable dentulous component that incorporates molar tubes, with various advantages over the conventional lingual arch.</p>
<sec><title>How to cite this article</title>
<p> Chalakkal P, Ferreira AN, Da Costa GC, Aras MA. Functional Lingual Arch with Hinge-type Lockable Dentulous Component. Int J Clin Pediatr Dent 2017;10(3):302-308.</p>
</sec>
</div>
</front>
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<pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Int J Clin Pediatr Dent</journal-id>
<journal-id journal-id-type="iso-abbrev">Int J Clin Pediatr Dent</journal-id>
<journal-id journal-id-type="publisher-id">IJCPD</journal-id>
<journal-title-group><journal-title>International Journal of Clinical Pediatric Dentistry</journal-title>
</journal-title-group>
<issn pub-type="ppub">0974-7052</issn>
<issn pub-type="epub">0975-1904</issn>
<publisher><publisher-name>Jaypee Brothers Medical Publishers</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">29104394</article-id>
<article-id pub-id-type="pmc">5661048</article-id>
<article-id pub-id-type="doi">10.5005/jp-journals-10005-1455</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject>
</subj-group>
</article-categories>
<title-group><article-title>Functional Lingual Arch with Hinge-type Lockable Dentulous Component</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Chalakkal</surname>
<given-names>Paul</given-names>
</name>
<xref ref-type="aff" rid="aff1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>N Ferreira</surname>
<given-names>Amanda</given-names>
</name>
<xref ref-type="aff" rid="aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>C Da Costa</surname>
<given-names>Godwin</given-names>
</name>
<xref ref-type="aff" rid="aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>A Aras</surname>
<given-names>Meena</given-names>
</name>
<xref ref-type="aff" rid="aff4">4</xref>
</contrib>
<aff id="aff1"><label>1</label>
Assistant Professor, Department of Pedodontics and Preventive Dentistry, Goa Dental College & Hospital, Bambolim, Goa, India</aff>
<aff id="aff2"><label>2</label>
Postgraduate Student, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</aff>
<aff id="aff3"><label>3</label>
Lecturer, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</aff>
<aff id="aff4"><label>4</label>
Professor and Head, Department of Prosthodontics & Crown and Bridge, Goa Dental College & Hospital, Bambolim, Goa, India</aff>
</contrib-group>
<author-notes><corresp id="cor"><bold>Corresponding Author:</bold>
 Paul Chalakkal, Assistant Professor Department of Pedodontics and Preventive Dentistry, Goa Dental College & Hospital, Bambolim, Goa, India, Phone: +919960583896, e-mail: atomheartpaul@yahoo.com</corresp>
</author-notes>
<pub-date pub-type="ppub"><season>Jul-Sep</season>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub"><day>27</day>
<month>2</month>
<year>2017</year>
</pub-date>
<volume>10</volume>
<issue>3</issue>
<fpage>302</fpage>
<lpage>308</lpage>
<history><date date-type="received"><day>17</day>
<month>1</month>
<year>2017</year>
</date>
<date date-type="accepted"><day>28</day>
<month>2</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.</copyright-statement>
<copyright-year>2017</copyright-year>
<license license-type="open-access"><license-p>This work is licensed under a Creative Commons Attribution 3.0 Unported License. To view a copy of this license, visit
<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/3.0/">http://creativecommons.org/licenses/by/3.0/</ext-link>
</license-p>
</license>
</permissions>
<abstract><p>The conventional lingual arch is a nonfunctional fixed space maintainer used in the mandibular arch to maintain arch length by the prevention of mesial movement of the permanent first molars. This study highlights a functional lingual arch with a hinge-type lockable dentulous component that incorporates molar tubes, with various advantages over the conventional lingual arch.</p>
<sec><title>How to cite this article</title>
<p> Chalakkal P, Ferreira AN, Da Costa GC, Aras MA. Functional Lingual Arch with Hinge-type Lockable Dentulous Component. Int J Clin Pediatr Dent 2017;10(3):302-308.</p>
</sec>
</abstract>
<kwd-group><title>Keywords</title>
<kwd>Functional</kwd>
<kwd>Hinge</kwd>
<kwd>Lingual arch</kwd>
<kwd>Molar tube</kwd>
<kwd>Sticker.</kwd>
</kwd-group>
</article-meta>
</front>
<body><sec sec-type="intro"><title>INTRODUCTION</title>
<p>Space maintainers are fixed or removable appliances used to preserve arch length, following the premature loss or elective extraction of a tooth/teeth.<sup><xref rid="B1" ref-type="bibr">1</xref>
</sup>
 The lingual arch is a bilateral fixed space maintainer, consisting of a single heavy-gauge stainless steel wire adapted anteriorly to the lingual aspect of mandibular arch and posteriorly to bands on the first permanent molars.<sup><xref rid="B1" ref-type="bibr">1</xref>
</sup>
 Lourie had been credited for inventing the lingual arch in 1904,<sup><xref rid="B2" ref-type="bibr">2</xref>
</sup>
 although Mershon<sup><xref rid="B3" ref-type="bibr">3</xref>
<xref rid="B4" ref-type="bibr">4</xref>
</sup>
 and Burstone are known to have popularized it.<sup><xref rid="B1" ref-type="bibr">1</xref>
</sup>
 Nance, who used it extensively during the mid-1940s, indicated the lingual arch for treatment during the mixed dentition for maintenance of distance between the permanent incisors and molars.<sup><xref rid="B5" ref-type="bibr">5</xref>
<xref rid="B6" ref-type="bibr">6</xref>
</sup>
</p>
<p>Arch length deficiency due to the early loss of primary teeth may result in crowding, impaction, and irregularity of the permanent dentition.<sup><xref rid="B7" ref-type="bibr">7</xref>
-<xref rid="B9" ref-type="bibr">9</xref>
</sup>
 These in turn result in loss of structural balance and functional efficiency.<sup><xref rid="B10" ref-type="bibr">10</xref>
</sup>
 The greatest space loss has been attributed to the mesial movement of the permanent molars after the loss of the second primary molar.<sup><xref rid="B11" ref-type="bibr">11</xref>
-<xref rid="B13" ref-type="bibr">13</xref>
</sup>
 About 51% of first primary molars and 70% of second primary molars lost prematurely result in space loss and subsequent malposition of permanent teeth.<sup><xref rid="B14" ref-type="bibr">14</xref>
</sup>
</p>
<p>The lingual arch prevents mesial migration of the permanent first molars,<sup><xref rid="B8" ref-type="bibr">8</xref>
<xref rid="B15" ref-type="bibr">15</xref>
-<xref rid="B17" ref-type="bibr">17</xref>
</sup>
 sometimes at the expense of mandibular incisor proclination.<sup><xref rid="B18" ref-type="bibr">18</xref>
-<xref rid="B21" ref-type="bibr">21</xref>
</sup>
 Reduction in arch length by the use of the lingual arch has also been reported,<sup><xref rid="B22" ref-type="bibr">22</xref>
</sup>
 sometimes due to the lingual tipping of inci-sors.<sup><xref rid="B15" ref-type="bibr">15</xref>
<xref rid="B16" ref-type="bibr">16</xref>
<xref rid="B20" ref-type="bibr">20</xref>
</sup>
 However, certain studies have reported that the lingual arch prevents lingual collapse of the mandibular incisors.<sup><xref rid="B8" ref-type="bibr">8</xref>
<xref rid="B15" ref-type="bibr">15</xref>
-<xref rid="B17" ref-type="bibr">17</xref>
</sup>
</p>
<p>This case report highlights a new functional lingual arch design that incorporates a hinge-type openable dentulous component with a locking mechanism, with various advantages over the conventional lingual arch design.</p>
</sec>
<sec><title>CASE REPORT</title>
<p>A 10-year-old boy visited the Department of Pedodontics with the complaint of being unable to chew on his right side. Upon examination, the lower arch contained the following teeth: 36, 35, 34, 73, 32, 31, 41, 42, 83, and 46 (<xref ref-type="fig" rid="F1">Fig. 1</xref>
). The upper arch contained teeth consistent with the intertransitional period, except that 14 had erupted (<xref ref-type="fig" rid="F2">Fig. 2</xref>
). Upon history taking, it was gathered that 84 and 85 had been extracted a year ago due to extensive caries and severe pain. An orthopantomograph (OPG) revealed half root completion of the unerupted 44 and 45 (<xref ref-type="fig" rid="F3">Fig. 3</xref>
). It was decided to construct a LHLD (functional lingual arch with hinge-type lockable dentulous component) in order to maintain the edentulous span until the eruption of 44 and 45, and to relieve the child of his chewing disability. After band adaptation on 36 and 46, alginate impressions were made of both the arches, into which the prepared bands were placed (<xref ref-type="fig" rid="F4">Figs 4</xref>
 and <xref ref-type="fig" rid="F5">5</xref>
). Casts were poured with dental stone. A lingual arch incorporated with two molar tubes (on the edentulous side) was fabricated using 0.9 mm wire on the lower cast (<xref ref-type="fig" rid="F6">Fig. 6</xref>
). Wax up was done on the edentulous span containing artificial molar teeth (to replace 84 and 85), such that the molar tubes were incorporated into the wax up in order to later serve as hinges for the dentulous component. On the buccal side of the dentulous component, another molar tube was placed, such that it was parallel and in alignment with another buccal tube welded on the buccal surface of the molar band (<xref ref-type="fig" rid="F7">Figs 7</xref>
 to <xref ref-type="fig" rid="F10">10</xref>
). The lingual arch was then soldered to the bands (<xref ref-type="fig" rid="F11">Fig. 11</xref>
).</p>
<fig id="F1" orientation="portrait" position="float"><label>Fig. 1:</label>
<caption><p>Lower arch</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g001"></graphic>
</fig>
<fig id="F2" orientation="portrait" position="float"><label>Fig. 2:</label>
<caption><p>Upper arch</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g002"></graphic>
</fig>
<fig id="F3" orientation="portrait" position="float"><label>Fig. 3:</label>
<caption><p>Orthopantomograph</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g003"></graphic>
</fig>
<fig id="F4" orientation="portrait" position="float"><label>Fig. 4:</label>
<caption><p>Banded 36 and 46</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g004"></graphic>
</fig>
<p>Plaster blockout of the undercuts and buccal tubes was done (<xref ref-type="fig" rid="F12">Fig. 12</xref>
). Acrylization was carried out using self-cure acrylic by the putty method. An index was made of the wax up (<xref ref-type="fig" rid="F13">Fig. 13</xref>
) using addition silicone (Elite HD, Zhermack, Germany), following which the cast was dewaxed (<xref ref-type="fig" rid="F14">Fig. 14</xref>
). Artificial teeth were incorporated into the index (<xref ref-type="fig" rid="F15">Fig. 15</xref>
) and self-cure acrylic was mixed with monomer and placed into the index. The index was reseated on the edentulous ridge on the cast until the acrylic mixture had completely polymerized (<xref ref-type="fig" rid="F16">Fig. 16</xref>
). An "Angry Birds" sticker was laminated and placed on the buccal surface of the dentulous component and covered with a thin layer of clear acrylic. The appliance was then gently removed from the cast (<xref ref-type="fig" rid="F17">Figs 17</xref>
 and <xref ref-type="fig" rid="F18">18</xref>
).</p>
<fig id="F5" orientation="portrait" position="float"><label>Fig. 5:</label>
<caption><p>Alginate impressions after placement of bands</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g005"></graphic>
</fig>
<fig id="F6" orientation="portrait" position="float"><label>Fig. 6:</label>
<caption><p>Lingual arch incorporating molar tubes</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g006"></graphic>
</fig>
<fig id="F7" orientation="portrait" position="float"><label>Fig. 7:</label>
<caption><p>Lingual arch with wax up</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g007"></graphic>
</fig>
<fig id="F8" orientation="portrait" position="float"><label>Fig. 8:</label>
<caption><p>Wax up (lingual view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g008"></graphic>
</fig>
<fig id="F9" orientation="portrait" position="float"><label>Fig. 9:</label>
<caption><p>Wax up (buccal view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g009"></graphic>
</fig>
<fig id="F10" orientation="portrait" position="float"><label>Fig. 10:</label>
<caption><p>Wax up (superior view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g010"></graphic>
</fig>
<fig id="F11" orientation="portrait" position="float"><label>Fig. 11:</label>
<caption><p>Soldering</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g011"></graphic>
</fig>
<fig id="F12" orientation="portrait" position="float"><label>Fig. 12:</label>
<caption><p>Plaster blockout of wax up</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g012"></graphic>
</fig>
<p>The tubes on the buccal surface were incorporated in order to pass the locking wire (0.64 mm) that formed the locking component of the appliance (<xref ref-type="fig" rid="F19">Figs 19</xref>
 and <xref ref-type="fig" rid="F20">20</xref>
). The efficacy of the hinge (molar tubes attached to the lingual arch) was verified by rotating the dentulous component around its hinge axis (<xref ref-type="fig" rid="F21">Figs 21</xref>
 and <xref ref-type="fig" rid="F22">22</xref>
). Finishing and polishing was carried out for the acrylic and metal components. The appliance was evaluated for any mucosal interferences or occlusal disharmonies, following which the appliance was inserted intraorally by cementing the bands onto 36 and 46 using luting glass-ionomer cement (<xref ref-type="fig" rid="F23">Figs 23</xref>
 and <xref ref-type="fig" rid="F24">24</xref>
). The patient was recalled the next day for a check-up, following which another general evaluation was done after a week.</p>
<fig id="F13" orientation="portrait" position="float"><label>Fig. 13:</label>
<caption><p>Index of wax up</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g013"></graphic>
</fig>
<fig id="F14" orientation="portrait" position="float"><label>Fig. 14:</label>
<caption><p>After dewaxing</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g014"></graphic>
</fig>
<fig id="F15" orientation="portrait" position="float"><label>Fig. 15:</label>
<caption><p>Artificial teeth placed in the index</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g015"></graphic>
</fig>
<fig id="F16" orientation="portrait" position="float"><label>Fig. 16:</label>
<caption><p>After acrylization</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g016"></graphic>
</fig>
<fig id="F17" orientation="portrait" position="float"><label>Fig. 17:</label>
<caption><p>Appliance (buccal view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g017"></graphic>
</fig>
<fig id="F18" orientation="portrait" position="float"><label>Fig. 18:</label>
<caption><p>Appliance (lingual view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g018"></graphic>
</fig>
</sec>
<sec sec-type="discuss"><title>DISCUSSION</title>
<p>Leeway space represents the difference between the sum of the mesiodistal diameter of the primary canine and molars and the sum of the mesiodistal diameter of the permanent canine and premolars<sup><xref rid="B22" ref-type="bibr">22</xref>
</sup>
 and can measure up to 4.3 mm.<sup><xref rid="B23" ref-type="bibr">23</xref>
</sup>
 As much as 4.8 mm of space becomes available after the permanent canines and premolars replace their primary successors.<sup><xref rid="B24" ref-type="bibr">24</xref>
</sup>
 Normally, the first molars move mesially into the leeway space, decreasing the arch length.<sup><xref rid="B23" ref-type="bibr">23</xref>
</sup>
 This space can be preserved by maintaining the arch length with passive appliances, such as the lingual arch.<sup><xref rid="B8" ref-type="bibr">8</xref>
/15/16/21/22/25/26</sup>
 In the current case, although extraction of 84 and 85 was carried out a year ago, there was no resultant loss in arch length when the distances between permanent molars and primary canines were measured on both the mandibular quadrants and compared. Moreover, space analysis had shown the presence of sufficient space for the eruption of 44 and 45. There was no loss in arch length probably because the extraction of 84 and 85 were carried out during the second transitional period, rather than the first or intertransitional periods.</p>
<fig id="F19" orientation="portrait" position="float"><label>Fig. 19:</label>
<caption><p>Appliance (with wire passed into locking component)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g019"></graphic>
</fig>
<fig id="F20" orientation="portrait" position="float"><label>Fig. 20:</label>
<caption><p>Appliance (superior view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g020"></graphic>
</fig>
<fig id="F21" orientation="portrait" position="float"><label>Fig. 21:</label>
<caption><p>Appliance (with dentulous fragment opened)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g021"></graphic>
</fig>
<fig id="F22" orientation="portrait" position="float"><label>Fig. 22:</label>
<caption><p>Appliance (with dentulous fragment opened)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g022"></graphic>
</fig>
<fig id="F23" orientation="portrait" position="float"><label>Fig. 23:</label>
<caption><p>Appliance (intraoral occlusal view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g023"></graphic>
</fig>
<fig id="F24" orientation="portrait" position="float"><label>Fig. 24:</label>
<caption><p>Appliance (intraoral buccal view)</p>
</caption>
<graphic xlink:href="ijcpd-10-302-g024"></graphic>
</fig>
<p>Early loss of primary molar teeth can eventually cause narrowing in the dental arch.<sup><xref rid="B13" ref-type="bibr">13</xref>
</sup>
 Although the extraction of primary molars had been carried out a year ago, narrowing of the corresponding region of the arch was observable.</p>
<p>Space maintenance is indicated when the succeeding tooth has < 75% of root formation, or when there is >1 mm of alveolar bone above it.<sup><xref rid="B7" ref-type="bibr">7</xref>
</sup>
 Such was the situation in the patient as per the OPG with regard to 44 and 45. The thickness of wire used for the construction of the LHLD was 0.9 mm. Lingual arches made with 0.9 mm stainless steel wire are superior in terms of arch length preservation.<sup><xref rid="B18" ref-type="bibr">18</xref>
</sup>
 Owais et al<sup><xref rid="B18" ref-type="bibr">18</xref>
</sup>
 showed that 1.25 mm wire increased the stiffness, resulting in increased forces on the lower incisors and first molars, as compared with 0.9 mm wire. This resulted in greater proclination of the incisors and loss of the Leeway space. Additionally, increased wire stiffness resulted in higher cementation failure and wire/band breakage.</p>
<p>A conventional lingual arch has the following drawbacks: (1) Risk of extrusion of antagonist teeth into the lower edentulous space and (2) nonfunctional (does not bear artificial teeth).<sup><xref rid="B27" ref-type="bibr">27</xref>
</sup>
 However, the LHLD does not have any of the above disadvantages. Never before in dental literature has a similar appliance been fabricated. It has the following advantages:</p>
<list list-type="bullet"><list-item><p> The hinge-type design provides easy visualization of the ridge by opening the dentulous component around its hinge axis without having to deband the lingual arch, after the locking component is opened. Periodic inspection of the ridge is required to check for any mucosal alterations and to check for eruption of the premolars. The locking component can be opened by cutting and removing the wire that passes through the molar tubes on the buccal aspect. After inspection, a new wire can be passed through the tubes and turned into a loop mesially and distally, in order to lock the dentulous component.</p>
</list-item>
<list-item><p> The appliance helps in mastication since it is functional.</p>
</list-item>
<list-item><p> The underside of the dentulous component can be cleaned upon opening the dentulous component.</p>
</list-item>
<list-item><p> There is prevention of overeruption of antagonist teeth</p>
</list-item>
</list>
<p>It also satisfies all the requirements of an ideal space maintainer, such as: (1) preservation of space; (2) allows for eruption of adjacent, succedaneous, and abutment teeth; (3) restoration of masticatory function; (4) prevention of over eruption of antagonist teeth; (5) compatibility with soft tissues; (6) effective hindrance of torquing forces on abutment teeth; (7) economy of construction and resistance to distortion; (8) allowance for adjustment or minor repair; and (9) universal application.<sup><xref rid="B28" ref-type="bibr">28</xref>
</sup>
</p>
<p>However, since it is a fixed appliance with an acrylic component, maintenance of oral hygiene would often be difficult. This remains the disadvantage of the appliance.</p>
</sec>
<sec sec-type="cocnlu"><title>CONCLUSION</title>
<p>The LHLD has various advantages over the conventional lingual arch for being a functional space maintainer for use in the lower arch.</p>
</sec>
</body>
<back><fn-group><fn id="n1" fn-type="COI-statement"><p><bold>Source of support</bold>
: Nil</p>
<p><bold>Conflict of interest</bold>
: None</p>
</fn>
</fn-group>
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