pre herbst alignement

Pretreatment issues with herbst appliance

You can either aligne lower teeth with fixed orthodontics or realise a proper alignement with removable aligners. Both will work.
We prefer braces, because it´s our philosophy (NON compliance treatment).

Proklination of frontal mandibular incisors

Mind if there is a proklination of mandibiular front teeth prior to herbst treatment due to lower incisor crowding or small mandibular arch bow. To prevent excess frontal crowding do some stripping or extract teeth.

 

crowding in posterior teeth

Severe crowding in the posterior should be managed prior to herbst appliance treatment.
Rotated upper first molars are to align in order to insert the upper sleeve correctly.
Crowded or tipped premolars will impede sleeve and rod’s movements.

 

Separating rings

Use of separating elastics is benefical regarding bonding of upper herbst bands. There is absolutely no need for stripping when using this space gaining gadgets.

 

 

intraoral scan

As an aside:
Teeth are free of decay (fissures), not loose, there is no sign of parodontitis at any tooth.

Now teeth in the lower are aligned.

Make an appointment for intraoral scanning and a second appointment 5 working days later for placing and bonding of the herbst appliance.

After cleaning the teeths surface it´s time to do some intraoral scanning. Please try to scan all relevant areas besides the teeth. Full palate, gingiva lingually of the lower incisors, the area around upper 6. Scanning both arches takes about 10 minutes.

Occlusal scan.

 

separating elastics

Next appointment 1 week later:
Hopefully you already got our herbst appliance. It consists of two separate herbst bands in the upper with ball hook and slot and one big lower part.

In the same appointment place thick separating elastics mesial and distal to the upper 6. Instruct your patient not to floss inbetween those areas.

 

bonding

Next appointment 1 week later:
Hopefully you already got our herbst appliance. It consists of two separate herbst bands in the upper with ball hook and slot and one big lower part.

Clean, rinse and dry the enamel surface. Prior to bonding try if all parts of the herbst appliance fit perfectly to the teeth. If everything fits you can start the bonding procedure:

We use glasionomeric cement for bonding. In order to distinguish between cement colour and enamel surface during removing the cement we recommend to add a drop of plaque indicator liquid to the cement. It gives a bright blueish grey colour to the bonding. Believe, it helps a lot!

Paste the inner suface with a thin layer of cement, especially where there are small retention holes. Put it onto the teeth, remove excess bonding and light cure all for about 60 seconds.

 

intraoral herbst settings

Pull over the upper left sleeve to the ball hinge, watch the sleeves design. The is a outer “O” side and and inner “U” side. Take care that the “O” side shows buccaly. Don´t mix up the sides: the right sleeve is indicated with a white spot at the top!

Then insert the lower rod into the sleeve. Take the winegard plier and insert the lower forked end of the rod onto the lower canine bolt with a clicking sound.

A class I Canine relation  should now be established.
Same procedure on the right side.

Ask the patient to open wide, rods must not disengage. If they come off, please change them to longer ones.
It must be possible for the patient to make jaw movements with slight constraints.
Inform the patient that there is no contact in the molar region for a couple of days, thus eating of soft food is indicated.  Initial difficulties result in pain in both masseters muscle at the following day.

We set an “alibi” appointment for the next day, and recommend to the parents to give us a brief telephone call  in order to tell how the patients come along with the herbst. Most of the time they would cancel the set appointment.

appointments

We schedule herbst patients for the following appointments in a 10 weeks interval.

  • check disengagement of rods
  • jaw movements
  • Canine super class I
    • if not adjust the sleeves
  • look for impingements of the gingiva

we take the classic herbst appliance of after a 7 month treatment time.

post herbst treatment tips

You can either aligne lower teeth with fixed orthodontics or realise a proper alignement with removable aligners. Both will work.

We prefer braces, because it´s our philosophy (NON compliance treatment).

Mind if there is a proklination of mandibiular front teeth prior to herbst treatment due to lower incisor crowding. To prevent excess frontal crowding do some stripping or extract teeth to gain some space.