Many Doctors instruct their patient to adjust the gears at home, with the usual adjustment one-quarter turn or 90 degrees activation which is equal to ¼ mm. Arrows indicate direction of adjustment for each gear. When subsequent visits of the patient display lack of appliance retention, the gear should be reversed slightly. The patient is instructed to increase wearing time to keep pace with adjustments or reduce the frequency of adjustments.
Two or more anteriors can be moved to the labial by selectively sectioning the acrylic. A larger gear may be used depending on available space and number of teeth to be repositioned. The loops on the labial bow can be periodically opened to allow advancement of the anteriors and avoid restriction of movement. Typically, one millimeter of space is provided between the labial bow and the anteriors at each visit of the patient.