Article Data

  • Views 470
  • Dowloads 309

Case Reports

Open Access

Management of mandibular incisors crowding by using passive lower lingual holding arch: a case series and literature review

  • Ahlam Habib1
  • Ahmed Ghoneima1
  • Samira Diar-Bakirly1,*,

1Department of Orthodontics and pediatric Dentistry, Hamdan Bin Mohammed College of Dental Medicine, Mohammed Bin Rashid University of Medicine and Health Science (MBRU), 505055 Dubai, UAE

DOI: 10.22514/jocpd.2023.003 Vol.47,Issue 2,March 2023 pp.101-107

Submitted: 05 August 2022 Accepted: 09 November 2022

Published: 03 March 2023

*Corresponding Author(s): Samira Diar-Bakirly E-mail:


Mandibular incisor crowding is a frequently encountered problem in daily orthodontic treatment. Success of the treatment greatly depends on the orthodontist’s ability to manage the factors contributing to the existing crowding and implementing the proper interceptive means. The passive lower lingual holding arch (LLHA) helps maintain the position of the permanent first molars after the exfoliation of primary molars and canines. Thus, relieving the mandibular incisor crowding during transitional dentition. Four case reports age ranged from 11–13.5 years old were used to report the effect of using LLHA on mandibular incisor crowding. Little’s Irregularity Index (LII) was used to assess the severity of mandibular incisors crowding as well as to compare the severity of the crowding before and after the use of LLHA. Passive LLHA could be considered the appliance of choice for space maintenance during the mixed dentition. Mandibular incisor crowding was reduced as measured by LII after the use of the passive LLHA over a duration of twenty months.


Mandibular incisors crowding; Mixed dentition; Lower lingual arch; Little’s index

Cite and Share

Ahlam Habib,Ahmed Ghoneima,Samira Diar-Bakirly. Management of mandibular incisors crowding by using passive lower lingual holding arch: a case series and literature review. Journal of Clinical Pediatric Dentistry. 2023. 47(2);101-107.


[1] Law CS. Management of premature primary tooth loss in the child patient. Journal of the California Dental Association. 2013; 41: 612–618.

[2] Moshkelgosha V, Khosravifard N, Golkari A. Tooth eruption sequence and dental crowding: a case-control study. F1000Research. 2014; 3: 122.

[3] Bell RA, Sonis A. Space supervision and guidance of eruption in management of lower transitional crowding: a non-extraction approach. Seminars in Orthodontics. 2014; 20: 16–35.

[4] Moyers RE. Standards of human occlusal development. University of Michigan, Center for Human Growth and Development: Ann Arbor, Michigan, USA. 1976.

[5] Fleming PS. Timing orthodontic treatment: early or late? Australian Dental Journal. 2017; 62: 11–19

[6] Watt E, Ahmad A, Adamji R, Katsimbali A, Ashley P, Noar J. Space maintainers in the primary and mixed dentition—a clinical guide. British Dental Journal. 2018; 225: 293–298.

[7] Vyas M, Hantodkar N. Resolving mandibular arch discrepancy through utilization of leeway space. Contemporary Clinical Dentistry. 2011; 2: 115–118.

[8] Almeida RR, Oltramari-Navarro PV, Almeida MR, Conti AC, Navarro RD, Pacenko MR. The nance lingual arch: an auxiliary device in solving lower anterior crowding. Brazilian Dental Journal. 2011; 22: 329–333.

[9] Almasoud N, Bearn D. Little’s irregularity index: photographic assessment vs study model assessment. American Journal of Orthodontics and Dentofacial Orthopedics. 2010; 138: 787–794.

[10] Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. The International Journal of Adult Orthodontics and Orthognathic Surgery. 1998; 13: 97–106.

[11] Van der Linden FP. Theoretical and practical aspects of crowding in the human dentition. The Journal of the American Dental Association. 1974; 89: 139–153.

[12] Silva Filho OG, Garib DG, Freire-Maia BAV, Ozawa TO. Temporary and definitive primary crowding: differential diagnosis. Revista da Associacao Paulista de Cirurgioes Dentistas. 1998; 52: 75–81.

[13] Little RM. The Irregularity Index: a quantitative score of mandibular anterior alignment. American Journal of Orthodontics. 1975; 68: 554–563.

[14] Moorrees CF. Normal variation in dental development determined with reference to tooth eruption status. Journal of Dental Research. 1965; 44: 161–173.

[15] Baume LJ. Physiological tooth migration and its significance for the development of occlusion. I. The biogenetic course of the deciduous dentition. Journal of Dental Research. 1950; 29: 123–132.

[16] McDonald RE, Avery DR, Dean JA. Dentistry for the Child and Adolescent. 8th edn. Mosby: St. Louis Missouri, USA. 2004.

[17] Mullally RH. Space maintenance. Australian Dental Journal, 1962; 7: 155–159.

[18] Ritter F. Fixed lingual arch appliance for compliance-free unilateral molar distalization in the mandible. Journal of Orofacial Orthopedics. 2001; 62: 163–167.

[19] Drage K. A review of orthodontic videos available from suppliers in the UK. British Journal of Orthodontics. 1993; 20: 246–250.

[20] Kinzinger G, Fritz U, Diedrich P. Various anchorage approaches in unilateral mandibular molar distalization using a fixed lingual arch appliance. Journal of Orofacial Orthopedics. 2004; 65: 137–149.

[21] Santana LG, de Campos França E, Flores-Mir C, Abreu LG, Marques LS, Martins-Junior PA. Effects of lip bumper therapy on the mandibular arch dimensions of children and adolescents: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2020; 157: 454–465. e1.

[22] Julku J, Hannula M, Pirilä-Parkkinen K, Tolvanen M, Pirttiniemi P. Dental arch effects after early and later timed cervical headgear treatment—a randomized controlled trial. European Journal of Orthodontics. 2019; 41: 622–630.

[23] Brennan MM, Gianelly AA. The use of the lingual arch in the mixed dentition to resolve incisor crowding. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 117: 81–85.

[24] Gianelly AA. Leeway space and the resolution of crowding in the mixed dentition. Seminars in Orthodontics. 1995; 1: 188–194.

[25] Rebellato J, Lindauer SJ, Rubenstein LK, Isaacson RJ, Davidovitch M, Vroom K. Lower arch perimeter preservation using the lingual arch. American Journal of Orthodontics and Dentofacial Orthopedics. 1997; 112: 449–456.

[26] Owais AI, Rousan ME, Badran SA, Abu Alhaija ES. Effectiveness of a lower lingual arch as a space holding device. European Journal of Orthodontics. 2011; 33: 37–42.

[27] Ciftci V, Uzel A, Dogan MC. Evaluation of skeletal and dental effects of lower lingual arches. The Journal of Clinical Pediatric Dentistry. 2018; 42: 469–474.

[28] Almuzian M, Alharbi F, Chung LLK, McIntyre G. Transpalatal, nance and lingual arch appliances: clinical tips and applications. Orthodontic Update. 2015; 8: 92–100.

[29] Mershon J V. Band and lingual arch technic. International Journal of Orthodontia. 1917; 3: 195–203.

[30] Palazzo G, Ronsivalle V, Rustico L, Martina S, Fichera G, Campagna P, et al. Digital models for the analysis of little’s irregularity index in subjects with a different degree of crowding: a reproducibility study. Applied Sciences. 2020; 10: 7108.

[31] Chen CY, Hsu KLC, Marghalani AA, Dhar V, Coll JA. Systematic review and meta-analysis of passive lower lingual arch for resolving mandibular incisor crowding and effects on arch dimension. Pediatric Dentistry. 2019; 41: 9–22.

[32] De Baets J, Chiarini M. The pseudo-Class I: a newly defined type of malocclusion. Journal of Clinical Orthodontics. 1995; 29: 73–88.

[33] Viglianisi A. Effects of lingual arch used as space maintainer on mandibular arch dimension: a systematic review. American Journal of Orthodontics and Dentofacial Orthopedics. 2010; 138: 382.e1–382.e4

[34] Villalobos FJ, Sinha PK, Nanda RS. Longitudinal assessment of vertical and sagittal control in the mandibular arch by the mandibular fixed lingual arch. American Journal of Orthodontics and Dentofacial Orthopedics. 2000; 118: 366–370.

[35] Enlow DH, Harris DB. A study of the postnatal growth of the human mandible. American Journal of Orthodontics. 1964; 50: 25–50.

[36] Watanabe E, Demirjian A, Buschang P. Longitudinal post-eruptive mandibular tooth movements of males and females. European Journal of Orthodontics. 1999; 21: 459–468.

[37] Harrison SD, Park JH. A modified pontic appliance for missing maxillary incisors. Journal of Clinical Pediatric Dentistry. 2020; 44: 123–126.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

PubMed (MEDLINE) PubMed comprises more than 35 million citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full text content from PubMed Central and publisher web sites.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time