Complication of Trans-Palatal Arch (TPA) appliance placement: A case of palatal mucosa embedment

• Author Details:   
• Shubhangi Tanaji Suryawanshi ^*
• Vikram Pagar Patil
• Mrunal Shamrao Aley
• Mahesh Mansaram Ahire
• Madhura Milind Achwal
• Aditya Narasingha Das

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The Trans-Palatal Arch (TPA) is a fixed orthodontic appliance commonly used to reinforce posterior anchorage during orthodontic treatment. Despite its functional benefits, the TPA can lead to soft tissue irritation and mucosal lesions, including persistent discomfort and grooves on the tongue or palate due to its close proximity to the palatal tissues. In rare instances, the appliance may become embedded in the palatal mucosa.
This case report describes the embedment of a TPA in the palatal soft tissue of a 35-year-old female patient and describes a successful management approach. The embedded appliance was surgically removed by the Department of Periodontics using a diode laser (BioLase soft tissue laser). Postoperative healing was uneventful, with complete resolution observed within one month. A new TPA was fabricated with a 2.5 mm clearance from the palatal mucosa. Upon reinsertion, the modified appliance fit appropriately without further tissue involvement or adverse reactions.
The etiology of the TPA embedment was attributed to a fabrication error resulting in inadequate palatal clearance, added by vertical forces exerted by the dorsum of the tongue. This case highlights the importance of incorporating sufficient palatal clearance in TPA design and considering tongue posture during appliance fabrication to prevent similar complications.

Keywords: Trans-palatal arch (TPA), Palatal mucosa, Orthodontic appliance complications, Tongue Position, Laser surgery.