herbst appliance

Bonded herbst appliance is certainly best treatment option in angle class II cases. Hence treatment with this orthodontic appliance is very common in german speaking countries as well as in the U.S.

Compared with other treatment options herbst appliance is the undisputed winner in angle class II treatment.

Herbst Scharnier Klassik

bonded herbst appliance – operating principle

In class II patients herbst appliance moves mandibula into a incisal edge to edge position or so called super class I. At any time of treatment it is possible to open mouth, do chewing procedures and speak as patient likes to.

As mandible is in this foward position posterior molars are in a open bite but in the next weeks of treatment this open bite will close again and stabilize the class I position.

Profile Herbst

herbst appliance – telescopical connection

Rods and sleeves allow to open, move forward and do excursion movements.
Nevertheless at all time of treatment it is possible to speak, eat, chew and open mouth.

Herbst attachment

What if my child needs a bonded herbst applaince?

If your child has an overbite – where the top teeth protrude beyond the underdeveloped lower jaw – braces may not fully correct the problem. Most often, the child will need additional treatment to move the lower jaw forward, and that means an herbst appliance.

In our office, we recommend the Herbst appliance for this condition. This device eliminates the need for cooperation e.g. elastics or headgear. Instead, in most cases herbst appliance is set in order to stimulate the lower jaw bone to grow forward as they hold the upper jaw back.

Some parents are surprised that braces alone cannot correct their child’s overbite or other bite issues.

Oberkiefer Herbstscharnier

When should my child start treatment for overbite?

Because your child will need a jaw adjustment as well as bite correction, the Herbst appliance is most effective while the jaw is still developing. herbst appliance are infrequently used past the teenage years. Adults who seek this type of correction usually must undergo surgery.

Kind mit Zahnspange verkleinert

bonded herbst appliance – How are rods and sleeves attached to the base?

In the upper jaw sleeves connect with a ball joint to the molar band. For the lower arch we designed a plug connection.

Insertion of herbst attachments

herbst appliance – Base of herbst appliance

Individually sintered base on top of upper and lower molars connected with all lingual arch.

UK Herbstscharnier

herbst appliance – Basement in the upper arch

Bands at upper molars with ball joints for sleeves

Herbst appliance one side

herbst appliance – Basement lower jaw

Lingual arch design is absolutely necessary in preventing the lower incisors from tipping.

Herbst Scharnier Unterkiefer

herbst appliance – Relation between discus and condylus

While setting the lower jaw into super class I position, the condylus / discus is heading into a anterior position as well. Finally after 12 weeks of treatment both move backwards into a slight retral position.

Kondylus Diskus

How do patients feel with herbst appliance

Patient report of a feeling of tension in the area of m. masseter. As a result of the mandible forward position some patients mention bad sleep in the first days of treatment due to the streched muscles.

 

Unterkieferrücklage

herbst appliance alternatives

After end of growth, around 16 years of age, it is possible to treat class II with several different treatment options.

  • Extraction treatment options in one or both jaws
  • NON extraktion treatment options
    • NON compliance options
      • herbst appliance
      • osteotomy in one or both jaws
      • Distalisation of upper teeth with temporary anchorage devices (TADs)
    • Compliance options
      • Use of elastics

While surgery is best choice in severe skelettal and dental class II cases, the other options (see above) are successful in moderate skelettal and dental class II cases.

In our office we prefer non compliance treatment options in order to meet patients expectations in the end of treatment and finally get a perfect and stabile orthodontic result.

Class II Corrector

herbst appliance for adults

herbst appliance isa treatment option especially for teenagers but as well as for younger adults.

 

Herbst appliance

herbst appliance pain

herbst appliance problems

Besides from muscular aching due to mandibular advancement in the first two days there is no other pain. Probably patient will have one bad night after placement of herbst appliance.

Impingements and irritations: If there are sharp edges on the metal herbst surface.

Nutrition ist limited due to posterior open bite in the beginning of treatment for a couple of days.

Rauhigkeiten werden fachmännisch geglättet

herbst appliance chewing

After application of herbst appliance the mandible is moved forward and the TMJ is moved downward. Thus results in a slight posterior open bite. For a couple of days it is not possible to chew in the molar area.

Herbst Scharnier Funktion

herbst appliance treatment time

is 7 month. After this period of time upper molars are distalized. Lower incisors should not be tipped forward. Angle class I should be established and the temporomandibular joint is stabile in the new position.

Herbst Scharnier

herbst appliance costs

Orthodontic lab costs of a herbst appliance is somewhere between 300 and 600€.

Lückenschluss

herbst appliance pain

Pain will occur in the first two nights after start of treatment due to the streched chewing muscles.

 

Zähneputzen Kind

herbst appliance treatment possibilities

  • treatment of class II malocclusions in children, young adults and adults
  • Space closure in agenetic lower premolars cases
  • ensure anchorage of maxillary molars in distalisation issues
  • treatment of asymmetric class II malocclusions with asymmetric herbst appliance
  • combine herbst with brackets
  • combine herbst with aligner treatment
  • combine herbst with treatment of non occlusion issues
  • combine herbst with crossbite issues
Herbst Scharnier Lückenschluss

herbst appliance cast

In the pre digital era herbst appliances were produced in a casting process

Nowadays we use selektive laser sinter techniques to save time and gain precision.

Herbst Scharnier Lückenschluss

herbst appliance – loose parts

Sometimes it is possible that the bonded herbst appliance comes off from your teeth. Please visit your orthodontic office in order to rebond it.

Zement

herbst appliance food

herbst appliance what to eat?

After engaging the herbst appliance chewing in the posterior is not possible (see Picture). Because the molars are in a slight open bite. During treatment open bite in the posterior will close again and chewing will be possible.

Your child may feel some pain initially. He will likely also find chewing and swallowing difficult at first.So soft foods – yogurt, mashed potatoes, macaroni and cheese, puddings – are best to eat for a couple of days. Your child should be able to return to normal eating in a short time, following his orthodontist’s few food restrictions.

Patient can eat what he likes to but mind, chewing in the posterior area is restricted due to the intial open bite.

Nahrung

herbst appliance or surgery

herbst appliance alternatives

In servere class II malocclusions there is no other choice in treating this patients with maxillofacial surgery options.

Depending of the kind of malocclusion surgery is performed in one of both jaws. And its done in general anasthesia.

Maxillofacial surgical treatment in case of class II takes about 2.5 hours and it is followed by a in patient stay for about 4 to 6 days in hospital. Soft food is required for a 2 weeks time.
Moderate swelling around the surgical area is normal and can last for 3 to 4 weeks.

Just as a reminder:
Treatment of class II malocclusions with herbst appliance in children and young adults can probably prevent surgery!

Unterkieferrücklage

herbst appliance orthodontics

Ask your orthodontics if she or he works with NON compliance treatment options as the herbst appliance!

Just a reminder:
Individual bonded herbst applaince is method of choice in treating class II malocclusions!

Lückenschluss Unterkiefer

herbst appliance- why its so successful?

It’s a NON compliance treament option, hence it’s working without patients cooperation – that’s the secret!

Herbst Scharnier

herbst appliance for maximum anchorage

The use of herbst appliance for maximum anchorage is recommended for special indications:

  • Angle class II molar relation with upper extraction planned- Herbst appliance provides a stable angle class II relation throughout the hole treatment. It provides hooks for canine retrusion and solves maxillary crowding and deep bite at the same time.
  • maximum anchorage for angle class I canine relation in lower molar mesialisation of lower premolars in aplasia of lower 5. It keeps canines stabile in angle class I.
HS Classic

Herbst appliance with braces

You will find a bunch of different way of herbst appliances.
You can distinguish two main groups of herbst appliances:

  • the individual bonded herbst appliance
  • the herbst appliance with is attached onto braces (light version)

Whats is the difference between the bonded and the light version of herbst appliance?

Lets start with the light version:
The aim of herbst treatment is to move teeth forward in the mandible and move teeth backward in the upper arch. In the light version herbst attachments are connected to the archwire in the upper and lower jaw. The archwire fits into the bracket slot and transfers the force to the tooth.
Unfortunately there is free play between the ligated arch wire and the bracket slot in the lower incisor teeth, thus the force of the herbst appliance tipps the lower incisal crowns forward as an unintended side effect.

Bonded version:
Individual herbst appliance is bonded to the lower arch. As there is no freedome of individual teeth movements, teeth cannot tip foward. One would speak of increasing anchorage in the lower jaw because of bonded herbst applaince. This leads to enhanced distalisation of the upper molars.

To cut a long story short:
using bonded herbst applaince results in a less proklined lower incisor finish, thus leads to a more stabile result in the end of treatment.

Lower incisor mit bracket
lower incisor bracket mit tip

herbst appliance sleep apnea

It is a fact that herbst appliance is a good choice in improving obstructive and central sleep apnea issues. Mandible moves forward to the desired position during nighttime. During daytime you can remove the attachments in order not to have relevant orthodontic tooth movements.

Ask your orthodontics if she or he works with NON compliance treatment options as the herbst appliance!

herbst appliance

Does herbst appliance require any special care?

First off all the child should not let his fingers or tongue fuss with the appliance or try to move his jaw out of its new position. If slurred speech is a problem at first, reading aloud can help retrain the pronunciation. It is possible that a rod on the appliance slips out of its sleeve, it this occurs it is not hard for you or your child to put it back in place – we demonstrate. Your child will need to brush more carefully because food can become trapped in the appliance. Above all it is important to brush with fluoride each day, and call our office with any questions or concerns.

Don’t despair for your child when your orthodontist tells you she needs a Herbst appliance. The discomfort is minimal. Finally the results will not only give him prettier teeth but a more perfect facial structure – and a healthier mouth for the rest of his life.

Zähneputzen Kind