September 1, 2000
by Michael W. Scott, DDS., MSD
Orthodontists have used lip bumpers for years as a usual part of their Phase One treatment regimen and clinical research has repeatedly proven their effectiveness. What we have needed is a patient-friendly lip bumper that is easy to seat, easy to adjust and improves our clinical efficiency. Now we have it: the Orthos Lip Bumper, manufactured by Ormco Corp.
I use hundreds of lip bumpers every year. When I first got into lip bumper therapy, I made the things myself from straight lengths of .045 stainless steel wire. When commercial lip bumpers became available, the same problems I had with my homemade versions still existed plus other problems that were manufactured into the product. Those problems included:
Constricted arch form.
Tissue impingement that causes ulcers.
Inadequate range of sizes.
No way to measure accurately for correctly sizing individual patients.
Extensive wire bending needed to seat.
Incorrect placement of adjustment loops for patient comfort.
Lack of tie-in hooks.
– Without tie in, the lip bumper would often become passive in the buccal tubes and slide out, thus creating emergency visits to reseat it.
– Because the patient could remove the lip bumper, patient compliance suffered.
– The only way to get a lip bumper to stay seated for any length of time was to create friction between it and the buccal tube, either by expanding the lip bumper (a bad idea) or by toeing in the distal end of the lip bumper and adversely rotating the first molar.
I solved the last two problems myself by soldering hooks on each lip bumper when I received them. The other problems were just going to be there so I resigned myself to dealing with them as we treated each patient. While hooks finally became commercially available, the other problems persisted.
As my experience using lip bumpers grew, I found that I was going through the same motions, making the same bends every time I seated one. Also, when I observed bumpers at the end of their use, I found they all had a similar look in terms of arch form. It was logical to think that the repetitive bends I was making manually to seat a lip bumper could easily be manufactured into the product, thereby making it more clinically efficient; thus, the Orthos Lip Bumper was developed.
APPROPRIATE MANDIBULAR ARCH FORM
One of the desired effects of lip bumper therapy in Phase I treatment is the development of an appropriate mandibular arch form. The Orthos Lip Bumper is manufactured to fit the Orthos mandibular large arch form. The mandibular large arch form was chosen because the tip bumper sits outside the mandibular arch. (As most everyone using the Orthos arch forms knows, the Orthos archwire shape is uniquely derived from actual skeletal and dental anatomy rather than from a theoretical concept of an ideal arch shape.) Figure I shows the correct fit of the Orthos Lip Bumper to the Orthos arch form as compared with the constricted arch form of another manufacturer’s lip bumper (Fig. 2).
MINIMAL TISSUE IMPINGEMENT
Efficiency and profitability demand that there be as few emergency visits as possible throughout treatment. Emergency visits associated with lip bumpers are usually due to irritations of the soft tissue. The Orthos Lip Bumper has greatly reduced these problems. Figure 3 shows the smooth, clean edges of the plastic part of this appliance, the smooth round solder joint where the hook is attached and the large ball on the hook – all of which serve to lessen soft tissue problems. Figure 4 shows the other manufacturer’s lip bumper with a small ball hook and the solder joint with a corner – both of which often cause irritation. This appliance often has a plastic tag that can create ulcerations as well.
Pearl. Even with the improved design of the Orthos Lip Bumper, there will still be times when a patient’s soft tissue will wrap itself around the lip bumper wire and become inflamed and tender. When this occurs, I simply cover the wire with a light-cured composite. To apply the composite, moisten your gloved fingers with a small amount of sealant and shape a mass of composite around the wire. Smooth the composite with your wet finger making sure to keep the hook accessible for connecting the power chain. Light cure for 20 seconds (Fig. 5).
REDUCED APPLIANCE REWORK
One of the repetitive motions that I found myself going through as I seated lip bumpers was bending the hooks lingually in order to prevent them from sticking into the buccal soft tissue. Hooks of the Orthos Lip Bumper come with a lingual inclination (Figure 6). Figure 7 shows an occlusal view of the same manufacturer’s lip bumper shown previously. You cannot see the hook because it is directly under the wire. Notice again the plastic tag that is a potential tissue irritant. Figure 8 shows a side-by-side comparison of the two lip bumpers.
You might ask why the hook is in front of the adjustment loop. The answer is simple. All adjustments are made from the loop distally. The hook is never in the way of adjusting the lip bumper. Placing the hook anterior to the loop also allows the loop to be positioned to the buccal of the second bicuspid or second primary molar. This keeps the loop away from the frenum that attaches to the buccal of the first bicuspid. If the hook were distal to the loop, the loop would have to be more mesially positioned and would impinge on that frenum.
Another repetitive and time-consuming task, with previous lip bumpers was accentuating the bayonet bend. The bayonet bend creates a positive stop to prevent the bumper from sliding through the buccal tube and impinging on the soft tissue distal to the first molar. If the bayonet bend does not create a solid stop when adjusting the lip bumper, one might think the bumper is correctly positioned 2 to 3 mm in front of the mandibular incisors, only to discover that it has actually slid back through the buccal tube, requiring removal and adjustment. Figure 9 shows a comparison between the bayonet bend of the Orthos Lip Bumper (top) and that of a competitor’s (bottom). Figure 10 shows how the accentuated bayonet bend in the Orthos Lip Bumper prevents the wire from sliding through the buccal tube. Figure 11 shows how an indistinct bayonet bend allows the wire to protrude through the buccal tube and cause the problems previously mentioned.
ACCURATE MEASUREMENT FOR PROPER SIZING
With previous lip bumpers, there was no accurate way to determine the correct size. Many times our “clinical experience” proved wrong. More often than we liked to admit, we’d work to make a particular size fit only to discover that we needed a different size. We’d then have to sterilize the original, mangled appliance to return it to stock, but with no clue about what size it now was. The Orthos Lip Bumper completely solves this problem by providing a ruler and conversion table to determine the correct size. The measurements are printed on both sides of the ruler to accommodate right and left sides, and the conversion table is accurate.
SIZING THE ORTHOS LIP BUMPER
Place the tooth on the ruler at the midline. (Fig. 12)
Measure to the mesial of the buccal tube of the right quadrant.
Flip the ruler and measure to the mesial of the buccal tube of the left quadrant.
Average the two measurements to account for midline discrepancy.
Use the Conversion Table to find the appropriate size (Fig. 12). The table is printed on each Orthos Lip Bumper Introductory Pack.
You will find that the Orthos Lip Bumper virtually seats “right out of the package” and there is very little chair time needed; however, your clinical judgment must still enter into the final decision. For example, an average measurement of 44 mm would indicate a size 3 lip bumper, but in a severely crowded case, you might choose a size 4 and initially close the adjustment loop in order to have more room to adjust the lip bumper as space is created.
TYING IN THE ORTHOS LIP BUMPER
After cementing the bands, connect two 3-unit power chains to the lip bumper tube (Fig. 13a). Pearl. Two pow
er chains substantially reduce emergency visits. Do not tie with steel ligatures. Doing so is far too difficult and unnecessary.
Connect the dual power chains to the hook (Fig. 13b).
Figure 13c shows an occlusal view of the Orthos Lip Bumper tied in. Notice that the hooks are bent to the lingual of the lip bumper and that the distal ends of the bumper wire do not protrude past the distal end of the molar tubes.
FOLLOW-UP LIP BUMPER ADJUSTMENTS
I typically see patients at 9-week intervals and, by then, the lip bumper will be touching the lower anterior teeth, requiring adjustment. Adjustment is easy and chair time is minimal.
To advance the lip bumper 2 to 3 mm in front of the anterior teeth, hold the anterior leg of the adjustment loop as shown. Bend the part of the lip bumper wire anterior to the loop upward (occlusally) about 15 (Fig. 14a).
Bend the part of the wire with the bayonet bend downward (gingivally)15 as shown (Fig. 14b). The net effect of these two bends is to open the loop.
Hold the posterior leg of the adjustment loop as shown and bend the bayonet bend upward (occlusally) about 15 (Fig. 14c). This bend serves to level the lip bumper in the mouth so that the anterior part is not too low in the vestibule. This bend does NOT negate the second bend. Because the plier is moved to the posterior part of the adjustment loop, the loop stays open and the lip bumper stays advanced. This final bend simply gets the lip bumper back to the correct horizontal plane in the mouth.
I delegate seating and adjusting lip bumpers to my staff. When I check a lip bumper seating, it is already in place with the power chains ready to be connected to the hooks. I remove one side from the buccal tube to see that it is not constricted or expanded, check to make sure it is advanced the correct amount in front of the anterior teeth, then use a hemostat to secure the power chains to the hooks. My total time involved in the procedure is mere seconds.
Case I demonstrates the typical use of the Orthos Lip Bumper in the late mixed dentition.
The goal of this article was to introduce the reader to the Orthos Lip Bumper and to show why I consider this product to be superior to any other lip bumper now available. I believe the Orthos Lip Bumper will significantly improve clinical efficiency in Phase I cases.
|39 mm or less is a size 1 lip bumper 39 – 43 mm is a size 2 lip bumper|
|43 – 46 mm is a size 3 lip bumper|
|46 – 48 mm is a size 4 lip bumper|
|48 mm or more is a size 5 lip bumper.|
Dr. Michael Scott maintains a private orthodontic practice in Longview, TX.