Preventing Accidental Removal of Lingual Arches

Making it difficult for the patient to accidentally dislodge a removable lingual arch usually results in an appliance that is difficult to remove for adjustments as well.

To circumvent this problem, I place 360° loops just anterior to the stopback bends in my individualized lingual arches, which are made of .030" or .032" stainless steel wire. The loops make the ends of the arches easy to insert into uncrimped .036" ×.072" lingual tubes^* (Fig. A).

Once inserted, the arch is tied in place with .010" ligature wire. For patient comfort, the ligature should be inserted through the loop from the lingual, in a gingivo-occlusal direction, and pulled across the occlusal surface of the tooth. The other end is then brought up in a gingival direction and hooked over the distal extension of the lingual arch, as it protrudes beyond the lingual tube. This end is brought forward over the occlusal surface of the tube to be tied with the other end of the ligature wire. After the ligature is clipped, the remainder is tucked gingivally between the loop and the mesiolingual surface of the tooth.