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-
dontic treatment is habit control, especially control of
the habit of thumb sucking that takes place at an un-
detected subconscious level during nocturnal hours.
Various elaborate appliances have been introduced to
correct this habit. Their construction in most cases re-
quires substantial laboratory or chairside time. 1-3
In their article on the effectiveness of various meth-
ods of treatment of thumb sucking, Haryett et al.4 sug-
gest that palatal crib treatments are more effective than
psychologic treatment or palatal arch treatment. They
also found the majority of those treated with the crib
stopped the habit in 7 days, and mannerisms did not
develop more frequently than in those subjects whose
habit had remained active. It should be noted that good
rapport with the patient might reduce the incidence of
mannerisms and arrest other associated habits~ These
findings are in accordance with Graber's view that
thumb sucking is a simple learned habit (learning the-
ory) without an underlying emotional disturbance.t3
*Assistant Professor, Department of Orthodontics, B aylor College of Dentistry.
Former Assistant Professor, Division of Orthodontics, Department of Diag-
nostic and Surgical Sciences, School of Dentistry, University of Minnesota.
8/1/25174
Fig. 1. TLC appliance.
Fig. 2. Anterior open bite result of thumb-sucking habit.
The purpose of this report is to introduce the triple-
loop corrector (TLC) as a new and simple thumb suck-
ing habit control appliance (Fig. 1). It can be very easily
constructed by bending three consecutive loops on an
0.036-inch wire that is designed to fit into the lingual
sheaths of the upper first molar bands, just like a regular
transpalatal arch (TPA). This requires minimal chairside
time (3 to 5 minutes) and can be adjusted to cover the
whole span of the patient's open bite to make insertion
of the thumb in the mouth very difficult.
CASE REPORT
A t0-year-old girl had a 3 mm anterior open bite (Fig.
2). According to the mother, the child had been sucking her
thumb "ever since I can remember." She had a full Class II
(100%) malocclusion with moderate upper and minor lower
crowding. A two-phase treatment procedure was recom-
mended. Initially, the habit would have to be controlled. The
second phase of the treatment would include extraction of the
upper first premolars followed by fixed appliance therapy, to
end up with a Class [ canine and a Class IF molar relationship
with a 2 to 3 mm overblte.
After placement of the molar bands, the TLC appliance
was fabricated within 5 minutes and was inserted in the
sheaths of the upper molar bands. It was bent to cover the
91
92 Viazis
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.
3 to 5). When the patient was asked to try to place her thumb
in her mouth, she could not open her mouth wide enough to
insert her thumb. Oral hygiene instructions, along with the
recommendation that the mother watch the patient on occasion
during her sleeping hours to make sure that she was not
sucking her thumb, were part of the therapy plan,
A month later the mother reported that the patient had
quit the habit. The appliance was left in place for 3 months
to act as a reminder to the patient. After 4 months the open
bi.te had decreased to 0.5 mm (Pig. 6).
It should be noted that this appliance will work if
there is significant overbite and a marked overjet. 5
There must b e enough that it will not interfere with
mandibular function. The clinician should be cautioned
not to construct this design in any w a y that might allow
the lower incisors to i m p i n g e on the wire; otherwise a
functional retrusion would be enhanced, s
Although m a n y more patients would have to be
Am. J. Orthod. Dentofac. Orthop.
July 1991
treated with this appliance to prove its valid clinical
application, the ease of fabrication o f the TLC is an
advantage over appliances previously reported.
REFERENCES
1. Graber TM. The finger sucking habit and associated problems.
J Dent Children 1958;25:145-51.
2. Graber TM, Swain BF. Orthodontics:current principlesand tech-
niques. St. Louis: CV Mosby, 1985:3-100,369-483.
3. Graber TM, RakosiT, PetrovicAG. Dentofacialorthopedics with
functional appliances. St. Louis: CV Mosby, 1985:412-25.
4. Haryett RD, Hansen FC, DavidsonPO, SandilandsML. Chronic
thumb-sucking:the psychologiceffects and the relative effective-
ness of variousmethods of treatment. AMJ O~THOD1967;53:569-
85.
5. GraberTM. Personal communication,1990.
Reprint requests to:
Dr. Anthony D. Viazis
Department of Orthodontics
BayIor College of Dentistry
3302 Gaston Ave.
Dallas, TX 75246