Fig. 13 Fig. 11 Fig. 12 Fig. 14 How do I place buccal root torque in 6|6? With an Adam’s plier (triangular flat on flat) grasp the bayonet end of the NPE and rotate approximately 15 degrees to the buccal. Repeat on the other side (Fig. 12A). Why do I place buccal root torque in 6|6? We are expanding occlusal to the COR in the trans-verse plane. The possibility of tipping 6 | 6 to the buccal exists if buccal root torque is not programmed into the NPE. How do I re-activate the NPE? On a subsequent visit remove the NPE from the mouth. Squeeze one of the lateral ortholoy loops to flatten it slightly. Move the now buccally rotated ortholoy arm back toward the lingual to its original position (Fig 12-B) and repeat on the other side. Place buccal root torque as described earlier and re-insert into the lingual molar band sheaths. If more expansion is still required proceed to the next larger NPE at the next visit. Additional benefits of the NPE: If the skeletal vertical needs to be decreased, when measuring from the lingual of the 6 | 6’s add 2mm instead of 4mm to determine the appropriate size of NPE to use. The appliance will be flatter across the arch as opposed to following the contour of the palate. As the patient swallows the tongue will engage the NPE and help to intrude the molars. The patient may complain at first about the appliance position, but explain to them the benefits of a normal skeletal verti-cal. A patient with straight teeth but with a long face is not attractive. The NPE may also be used as a tongue thrust correct-ing appliance. Have the patient place and keep the tip of the tongue on the thermally activated Nitanium loop of the NPE and swallow 20 consecutive times twice daily. This exercise helps to convert an infantile swallow pattern to an adult one. Transpalatal Bar (TPB) The TPB that I use in my practice is the mesial loop PAB from Dentsply/GAC International, Inc. (Fig. 13A) www.orthodontics.com Fall 2014 17
Journal of the American Orthodontic Society Fall 2014: Page 17
