What are the possilbe long term effects of a herbst appliance used in orthodontics? My stepdaugher had the herbst appliance and it seemed very invasive. Her mom had the braces put on her. Her dad and I were going with another treatment plan that was not a
Answer: . Answer: the herbst appliance is one type of orthopedic (as opposed to orthodontic) treatment appliance. These type of appliances are used in situations where the upper teeth are biting too far "forward" relative to the lower teeth. About 80% of the time that this type of bite problem exists it is the result of the lower jaw not growing far enough forward to allow the lower teeth to occlude (bite) in the proper position relative to the upper teeth. The purpose of an orthopedic appliance, like the herbst appliance, is to create change in the upper and lower jaw bone relationships, typically by helping the lower jaw bone grow to a more forward position relative to the upper jaw bone. As the lower jaw bone comes forward the teeth are carried with it and the biting discrepancy is resolved. The herbst appliance is one type of many orthopedic appliances which are used to encourage improvements in jaw bone growth and relationship. These appliances can be fixed/cemented, like the herbst or removable like a bionator appliance. There are many other specific appliances which are variations on both of these themes. The use of a headgear appliance in conjunction with braces is an attempt to accomplish the same goals as the herbst appliance (correcting the bite), however the orthopedic appliances tend to be a little more proactive in their ability to potentate forward lower jaw re-positioning through growth than the headgear. Usually the forward re-positioning of the lower jaw also has the advantage of improving the overall facial profile (giving the individual a "stronger" looking chin). The advantage to the herbst appliance is that it is cemented in place, so compliance in appliance wear is less a problem. The trade-off is that the herbst appliance is cemented in and the hygiene demands on the patient are significantly more than presented by a removable appliance such as the bionator. An additional problem with the herbst appliance is that it is fairly bulky and will intrude on the soft tissue inside the check - comfort can be a problem. Removable appliances such as the bionator are extremely comfortable to wear and, with a little effort learning to talk with it in, can be quite easy to acclimate to. With the bionator there is nothing cemented on the teeth so there are really no hygiene problems to deal with. An additional advantage to a removable appliance is that it can be removed for sports and other activities. However the bionator is removable and requires significant wear time, typically 20 hours per day, and thus requires excellent patient cooperation in it's use. For any orthopedic appliances, fixed or removable, the patient must be growing. If the patient has completed their growth time orthopedic appliances will not be effective. The only way to resolve jaw position/relationship problems in the non-growing individual is through jaw surgical procedures, usually referred to as orthognathic surgery.
Apples and oranges. Of greater importance is the background, skill, education, and experience of the orthodontic specialist, not the kind of appliance that they choose. Put 2 dentists in a room and you will get 10 different opinions. Make your choice based on the practitioner, not the gadget.
Lower teeth flared. Dr. Lysle johnston the past chairman at the u. Of michigan and internationally acclaimed researcher showed all functional appliances gain only 1mm of additional jaw growth compared to traditional orthodontics from a sample size over 5000 cases. The herbst appliance utilizes the lower teeth to pull the uppers back. The reaction is tipping forward of the lower teeth into a less than ideal position.
Herbst Effects. I have been using the herbst for the last 15 years. When used appropriately and growth is favorable, it is a very effective appliance with results that show great long term stabilty. Dare i say that most orthodontist that use the herbst would agree that there are few untoward long term effects.
Herbst Rocks!! I routinely use herbst appliances for weak chins and associated bites. It helps the upper and lower jaws to come together with out removal of teeth, which in my opinion is more invasive. Facial profile is enhanced by increasing relative prominence of chin and reducing nasal prominence, which can be increased with removal of teeth.
Position. It has been pointed out that herbst therapy re-positions the lower jaw forward. It does do that when in place. Long term there are no significant long term studies that prove that it increases lower jaw growth beyond the genetic potential. I do not personally like it, as it distracts the head of the lower jaw out of its "socket" stretching ligaments. Other treatments are available. Genetics rule!