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Aim: The aim of the article is to describe the effect of Keles Trans Palatal Arch (TPA) on unilateral and bilateral molar rotation illustrated with two case reports. Method: Unilateral and bilateral maxillary first permanent molars de-rotation were performed in two cases using Keles appliance system which consists of the precision lingual hinge cap and TPA made of TMA wire. (0.032 × 0.032") (Ormco, Orange, CA). A 20 degree activation is given to the rotating part/terminal end(s) of the TPA every fourth week until rotation is completely corrected. The de-rotation achieved and change in the intermolar width are assessed using digital cast analysis performed by Ilexis FACAD (AB-2014 version 3.8.00) software and by comparing the pre and post maxillary occlusal radiographs with marker wires. Result: Pre and post values showed that the de-rotation is achieved in both cases. Inter-molar width showed no significant changes in both cases, suggestive of minimal/no expansion. Conclusion: The Keles TPA resulted in better transverse molar control during molar de-rotation owing to its superior precision self-locking design. When Keles TPA is used in correction of unilateral molar rotation, it causes successful de-rotation on the affected side and minimum or no changes on the unaffected side. Introduction Molar relationships have been a matter of major concern to orthodontist since the advent of Angle’s classification of malocclusion in 1899, with the maxillary first permanent molar referred to as the “key to occlusion”. Later in 1970’s Andrews highlighted the deficiencies in the molar relationship as described by Angle. One of the features in his six keys to normal occlusion is “no rotations”. (1) Today, the final goal to be achieved is ahead of the ideas proposed by Andrews, with more emphasis on mutually protected occlusion and incisal guidance. With these aims in mind, the upper first permanent molars are in limelight again. As proposed by Lamons and Holmes, (2) the position of maxillary first permanent molar is of importance to the clinical orthodontist since space gained by molar de-rotation measure to 1-2 mm. This plays a vital role in planning the treatment for borderline patients. In most situation Class II and a few Class I malocclusions manifest mesio-palatally rotated and constricted upper molars, which often results in mild to moderate malocclusion. Transpalatal bars introduced by Goshgarian, (3) as an anchorage appliance have been consistently used for bilateral and unilateral de-rotation of molars. The rigid wire and the method of activation brought about intermolar expansion. Variations from the conventional design have emerged either by bringing about a change in the appliance design or by altering wire material. A recently introduced design variation is the Keles Transpalatal Arch (4) (TPA) inspired from the Burstone lingual arch system. This article describes the effect of Keles TPA on unilateral and bilateral molar rotation using two case reports. Appliance Design and Construction The Keles appliance system consisted of the precision lingual hinge cap* and TPA made of TMA wire** (0.032 × 0.032′′) (Ormco, Orange, CA).The precision lingual hinge cap (5) attachments, designed to accommodate 0.032 × 0.032′′ beta-titanium alloy (TMA), are welded on to the selected preformed bands by placing them at the center of bands coinciding with the palatal groove on the upper first molars. The bands are then transferred to the impression and study cast is obtained. The Keles TPA is fabricated using 0.032 × 0.032′′ beta-titanium alloy. (4) A 20 degrees activation (4) is given to the rotating part/terminal end (s) of the TPA (on the side of the rotated molar) keeping the other end stable in one site, using symgrid as a template, with the help of a bird beak pliers. (Fig. 1) The bands are cemented on to the upper first molars and TPA is inserted into the precision lingual hinge cap (5) and locked. Unlike the conventional (removable) Goshgarian (3) TPA, Keles TPA selflocking lingual hinge cap does not need a ligature tie to secure the wire component to the lingual attachment. A maxillary occlusal radiograph is made to evaluate the amount of rotation in the molar with a marker wire (0.019 x 0.025” TMA, 15 mm) in the main slot (Fig. 2 (i)). The TPA is reactivated with 20 degrees every fourth week until rotation is completely corrected. Once the molar (s) is de-rotated, another maxillary occlusal radiograph is made with the marker Devaki Vijayalakshmi et al. “Keles transpalatal arch for molar derotation”Clinical discussion International Dental Journal of Student’s Research;5(4):109-112 110 wire in the buccal tube slot to appreciate and evaluate the correction achieved. (Fig. 2 (ii)) The derotation achieved and change in the intermolar width are assessed using digital cast analysis performed by Ilexis FACAD (AB-2014 version 3.8.00) software. (Fig. 2 (iii)) Fig. 1: Keles Transpalatal arch activated by 20 degrees at one arm by keeping the other arm stabilised at one

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