Fig. 10 Fig. 12 proclined and need retraction, place the labial bow level below the CEJs of the labial surfaces of the incisors (Level 3) (Fig. 13). 4 The lip fully engages the incisors and they move to the lingual. The mandibular molars distalize and slightly intrude (Fig. 13). If there is any concern that the second molars may become impacted as the first molars distalize, place the lip bumper in the level 3 position. Second molar impaction will not occur. How Is the Lip Bumper Activated? To advance the lip bumper such that it is 2 mm labial to the mandibular incisors, flatten the Omega loops equally on both sides at each visit (Fig. 4-A). The terminal ends will then need to be bent to the correct horizontal level. To place the lip bumper vertically in the Level 1, 2 or 3 position, bend the terminal ends up or down equally on both sides. If the terminal ends are bent upward, the labial bow will be positioned more incisal (Fig. 14-A). If the terminal ends are bend downward, the labial bow will be positioned more apically (Fig. 14-B). After the lip bumper has been activated, bilaterally secure it with three loop power chains from the first molar band gingival hooks to the hooks on the lip bumper. The power chains should be positioned behind the Omega loops (Fig. 14-C). Fig. 11 buccal and arch length will be gained. The goal is to have the mesial surfaces of the mandibular first molars parallel to one another (Fig. 9-B). If toe-in is placed in only one terminal end, that molar will rotate and the opposite molar will slightly distalize (Fig. 10). 4 The labial inclination of the mandibular incisors determines the vertical position of the labial bow. If the mandibular incisors are retroclined and need advance-ment, place the labial bow level at the middle third of the labial surfaces of the incisors (Level 1) (Fig. 11). 4 The lip cannot engage the incisors and they advance forward. The mandibular first molars extrude and distalize, thus opening the dental bite anteriorly and increasing the skeletal vertical dimension (Fig. 11). If the mandibular incisors are inclined properly, place the labial bow level at the CEJs of the labial surfaces of the incisors (Level 2) (Fig. 12). 4 The lip slightly engages the incisors and they maintain their position. The mandibular molars slightly extrude and distalize (Fig. 12). If the mandibular incisors are Nitanium Palatal Expander 2 (NPE) The following information on the NPE originally appeared in the Fall 2014 issue of the JAOS: 8 The following is a brief overview of how to size, use and reactivate the Nitanium Palatal Expander 2 (NPE). For a technique guide about the NPE, refer to the Ortho Organizers Instructions for Use Sheet REF 1010-760/101-770.9 Another excellent source is the Gerety Orthodontic Seminars titled, Palatal Expansion With the Nitanium Palatal Expander (NPE), pages 277-285. 3 Figure 5 shows the NPE in a patient’s mouth with the components labeled. NPE features: 18 Summer 2016 JAOS
Journal of the American Orthodontic Society Summer 2016 / Buyer's Guide: Page 18
