Pacific Coast Society of Orthodontists Bulletin Fall 2021 - 50

Clinical Practice
Pearls of the Pacific
Instructions for Removing a Lower
Lingual Holding Arch
In the mixed dentition period, a lower lingual
holding arch (LLHA) can be useful to maintain
the arch length, preserve leeway spaces, and help
prevent future crowding. The lingual arch is held
in place by being inserted into horizontal or vertical
lingual sheaths on bands that are cemented
on the lower permanent first molars. The arch is
meant to be passive, and the patient should not
feel any pressure on their incisors.
Dr. Bianca Lau
San Francisco, CA
PCSO Bulletin Contributor
A lower lingual arch should be removed routinely
to adjust for passivity or if there is no longer a
need for it as the permanent dentition erupts.
It can be difficult to not cause discomfort to the
patient while removing a lingual arch, because
the clinician may accidentally hit the anterior
of the arch against the patient's mandibular
incisors while removing it. In this pearl, we want
to discuss a method for removing a lower lingual
arch while ensuring patient comfort during the
process.
First, use a Weingart plier to pinch the mesial of
the lingual sheath and the loop of the LLHA that
is extending out the distal end of the sheath
(Figure 1). This will unlock the LLHA from the
sheath. Repeat on the other side. Once the LLHA
is unlocked, use the Weingart plier to grab the
portion of the LLHA that is extending mesial to
the sheath, and fulcrum off of the molar to rotate
the end of the LLHA out of the sheath (Figure 2).
The key pearl is that as you are fulcruming and
removing the LLHA out of the sheath, gently lift
the anterior incisor portion with your finger so
the LLHA does not hit the incisors as you remove
it (Figure 2).
Dr. Gabrielle Wainwright
San Francisco, CA
PCSO Bulletin Contributor
Dr. Kyle Cuenin
San Francisco, CA
PCSO Bulletin Contributor
Figure 1
Figure 2
50
PCSO Bulletin
Fall 2021

Pacific Coast Society of Orthodontists Bulletin Fall 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Fall 2021

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Pacific Coast Society of Orthodontists Bulletin Fall 2021 - 50
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