Fig. 16 “The NPE may also be used as a tongue thrust correcting 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.” Fig. 17 Fig. 19 at first about the appliance position, but explain to them the benefits of a normal skeletal vertical. 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. Fig. 18 Place root torque as described earlier and re-insert into the lingual molar band sheaths. If more expan-sion is still required, proceed to the next larger NPE at the next visit. Case #1: Conditions (Fig. 16) • Narrow mandibular arch • Severe crowding • Premature loss of C C • Mesial drifting of the posterior segments • 1 to mandibular plane angle is 81° (90-100° is normal) • The distance between the MB cusp tips of 6 I 6 is 42 mm. • At each visit, the lip bumper was widened posteri-orly 2 mm, advanced anteriorly 2 mm, and main-tained in the Level 1 position. Additional Benefits of the NPE: If the skeletal vertical needs to be decreased, when measuring from the lingual of the first molars add 2mm instead of 4 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 20 Summer 2016 JAOS
Journal of the American Orthodontic Society Summer 2016 / Buyer's Guide: Page 20
