| Field | Value |
|---|---|
| ID | OA-0144 |
| Type | space maintainer |
| Category | space_maintainer |
| Fixed/removable | fixed |
| Primary function | bilateral space maintenance; anchorage; arch perimeter preservation |
| Malocclusion target | premature primary molar loss; Leeway space; anchorage |
| Inventor | various (mid-20th century) |
| First year | mid-1900s |
| Period | historical / current |
| Status | current |
| Wire gauge | 0.036″ (0.9 mm) SS standard |
| Uses TADs | no |
A lingual arch is a fixed wire appliance with bands cemented to the first permanent molars and a wire running along the lingual surfaces of the teeth connecting them. In the lower arch it is called a lower lingual holding arch (LLHA); in the upper arch it becomes a TPA (Transpalatal arch) or Nance (Nance button) when a palatal button is added. This entry covers the bilateral lower lingual arch used for space maintenance and anchorage. It is the standard bilateral mandibular space maintainer and is also used as anchorage reinforcement during comprehensive treatment to prevent lower molar mesial drift.
The wire contacts the cingulum of the lower anterior teeth and runs posteriorly to the molar bands. This continuous lingual contact prevents the lower molars from drifting mesially into the space left by missing primary teeth, and prevents the lower incisors from tipping lingually. The Leeway space (difference in mesiodistal width between primary canine, first molar, second molar and their permanent successors) is ~1.8 mm per side in the lower arch — a lingual arch preserves this space advantage for the permanent dentition.
Bilateral premature loss of mandibular primary molars; Leeway space preservation in late mixed dentition; anchorage reinforcement during lower arch space closure; prevention of lower incisor lingual collapse; as a passive holding device after lower molar distalization. The LLHA is the most commonly prescribed bilateral lower space maintainer because it is simple, durable, hygienic (open design vs. acrylic Nance button), and well-tolerated.
Requires accurate band fit — loose bands lead to appliance dislodgement. Wire must not impinge on the gingival papillae or lingual mucosa — improper contour causes tissue irritation. Not suitable if a unilateral appliance is needed (use band-and-loop Band and loop space maintainer). Like all fixed maintainers, must be monitored and removed when permanent teeth erupt.
mixed dentition)
posterior teeth
contact length for strength
The wire must be adapted so it contacts the cingulum of each anterior tooth at approximately the gingival third — too high interferes with occlusion, too low impinges on papillae. Keep the wire 1–2 mm off soft tissue posteriorly. The wire should be symmetric; asymmetry delivers unintended forces to one side. Solder joint strength is critical — the LLHA receives biting forces when patients inadvertently bite on it. 3D-printed lingual arches (CFL offers multiple for the printed version) are increasingly popular for their precision fit. CFL's 6-6 lingual series includes standard, omega loops, E extension, drop, and 3D variants.
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arch](OA-0160_transpalatal-arch.html) or Nance Nance button with palatal additions.
Labs](https://odlortho.com/lower-lingual-holding-arch-essential-guide-to-space-maintenance-in-mixed-dentition/)
PMC](https://pmc.ncbi.nlm.nih.gov/articles/PMC11293597/)
Update](https://www.orthodontic-update.co.uk/content/articles/transpalatal-nance-and-lingual-arch-appliances-clinical-tips-and-applications)
business notes.