Via Zis 1991

CLINICIANS' CORNER
The Triple-Loop Corrector (TLC): A new

thumbsucking habit control appliance
Anthony D. Viazis, DDS, MS*
Dallas, Texas
O n e of the most puzzling aspects of ortho- The purpose of this report is to introduce the triple-
dontic treatment is habit control, especially control of loop corrector (TLC) as a new and simple thumb suck-
the habit of thumb sucking that takes place at an un- ing habit control appliance (Fig. 1). It can be very easily
detected subconscious level during nocturnal hours. constructed by bending three consecutive loops on an
Various elaborate appliances have been introduced to 0.036-inch wire that is designed to fit into the lingual
correct this habit. Their construction in most cases re- sheaths of the upper first molar bands, just like a regular
quires substantial laboratory or chairside time. 1-3 transpalatal arch (TPA). This requires minimal chairside
In their article on the effectiveness of various meth- time (3 to 5 minutes) and can be adjusted to cover the
ods of treatment of thumb sucking, Haryett et al.4 sug- whole span of the patient's open bite to make insertion
gest that palatal crib treatments are more effective than of the thumb in the mouth very difficult.
psychologic treatment or palatal arch treatment. They
CASE REPORT
also found the majority of those treated with the crib
stopped the habit in 7 days, and mannerisms did not A t0-year-old girl had a 3 mm anterior open bite (Fig.
develop more frequently than in those subjects whose 2). According to the mother, the child had been sucking her
habit had remained active. It should be noted that good thumb "ever since I can remember." She had a full Class II
(100%) malocclusion with moderate upper and minor lower
rapport with the patient might reduce the incidence of
crowding. A two-phase treatment procedure was recom-
mannerisms and arrest other associated habits~ These mended. Initially, the habit would have to be controlled. The
findings are in accordance with Graber's view that second phase of the treatment would include extraction of the
thumb sucking is a simple learned habit (learning the- upper first premolars followed by fixed appliance therapy, to
ory) without an underlying emotional disturbance.t3 end up with a Class [ canine and a Class IF molar relationship
with a 2 to 3 mm overblte.
*Assistant Professor, Department of Orthodontics, B aylor College of Dentistry. After placement of the molar bands, the TLC appliance
Former Assistant Professor, Division of Orthodontics, Department of Diag-
nostic and Surgical Sciences, School of Dentistry, University of Minnesota. was fabricated within 5 minutes and was inserted in the
8/1/25174 sheaths of the upper molar bands. It was bent to cover the
Fig. 1. TLC appliance.

Fig. 2. Anterior open bite result of thumb-sucking habit.
91
92 Viazis Am. J. Orthod. Dentofac. Orthop.
July 1991
Fig. 3. Anterior view of TLC in mouth.

Fig. 4. Right buccal view.
Fig. 5. Left buccal view.
Fig. 6. After 4 months of treatment with TLC appliance.
lower incisors to increase its length in the vertical plane (Figs. treated with this appliance to prove its valid clinical
3 to 5). When the patient was asked to try to place her thumb application, the ease of fabrication o f the TLC is an
in her mouth, she could not open her mouth wide enough to advantage over appliances previously reported.
insert her thumb. Oral hygiene instructions, along with the
recommendation that the mother watch the patient on occasion REFERENCES
during her sleeping hours to make sure that she was not 1. Graber TM. The finger sucking habit and associated problems.
J Dent Children 1958;25:145-51.
sucking her thumb, were part of the therapy plan,
2. Graber TM, Swain BF. Orthodontics:current principlesand tech-
A month later the mother reported that the patient had niques. St. Louis: CV Mosby, 1985:3-100,369-483.
quit the habit. The appliance was left in place for 3 months 3. Graber TM, RakosiT, PetrovicAG. Dentofacialorthopedics with
to act as a reminder to the patient. After 4 months the open functional appliances. St. Louis: CV Mosby, 1985:412-25.
bi.te had decreased to 0.5 mm (Pig. 6). 4. Haryett RD, Hansen FC, DavidsonPO, SandilandsML. Chronic
thumb-sucking:the psychologiceffects and the relative effective-
It should be noted that this appliance will work if ness of variousmethods of treatment. AMJ O~THOD1967;53:569-
there is significant overbite and a marked overjet. 5 85.
5. GraberTM. Personal communication,1990.
There must b e enough that it will not interfere with
mandibular function. The clinician should be cautioned Reprint requests to:
Dr. Anthony D. Viazis
not to construct this design in any w a y that might allow
Department of Orthodontics
the lower incisors to i m p i n g e on the wire; otherwise a BayIor College of Dentistry
functional retrusion would be enhanced, s 3302 Gaston Ave.
Although m a n y more patients would have to be Dallas, TX 75246

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CLINICIANS' CORNER

The Triple-Loop Corrector (TLC): A new

Fig. 1. TLC appliance.

Fig. 3. Anterior view of TLC in mouth.

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