Functional appliances are designed to modify growth and are used primarily for those patients with a deficient lower jaw. Success can only be achieved through consistent, full-time wear of the appliance. The Herbst appliance, unlike many other functional appliances, is fixed, or cemented, to the teeth. This means that the Herbst appliance is working 24 hours a day to maximize growth modification.
1. Why use the Herbst appliance?
The Herbst is an appliance that is used to correct the bite. In the past, orthodontists used head gear for the same purpose. However, head gear was difficult to wear and depended on patient compliance. The Herbst is cemented onto the teeth and requires little compliance. It allows for adequate range of motion of the jaws and minimally impacts speech. Most patients will find the Herbst appliance surprisingly easy to wear.
2. Why use this with younger children?
Growth modification is most effective during the greatest period of growth for children (9-14 years of age). When it is initially placed, it will move the lower jaw forward into a corrected bite position. In a growing child, the Herbst appliance enhances lower jaw growth, thereby correcting the bite by addressing the source of the malocclusion.
3. How is the appliance attached to the mouth?
The Herbst appliance is attached to the teeth by orthodontic bands that are placed on the first molars. Some appliances may have an expansion screw in the middle of the palate to help widen the jaw. Telescoping bars, or arms, are attached to the outside of the upper and lower bands of the appliance.
4. What happens after it is place?
It takes patients about 7 days to get use to the Herbst appliance. Initially, the patient’s bite will feel different and chewing will be affected. Occasionally, patients can develop sore spots where the appliance rests against the soft tissues of the cheeks and lips, but patients accommodate fairly quickly. The appliance is monitored closely until the proper amount of expansion has been obtained, and it is usually worn for a total of 9-12 months. Upper and lower braces may be used during Herbst treatment. The main goal, however, is the correction of the jaw discrepancy.
5. Do I have to clean the Herbst appliance?
It is durable and requires little maintenance, except for normal cleaning and slight modifications to diet (avoiding hard/sticky foods). Since the Herbst appliance lies in contact with the teeth, extreme care must be taken with regard to oral hygiene. The patient should use a daily fluoride mouth rinse and should avoid all sticky and sweet foods that could cause decay. Particular attention should be taken to clean the area of the appliance adjacent to the gum tissue.
6. Will the appliance need to be adjusted?
Depending upon the severity of the jaw discrepancy, it may be necessary to activate the Herbst appliance during treatment. This will usually be done every few months until the proper jaw position is achieved when the appliance is being worn. The activation of the appliance involves the placement of small pieces of tubing on the lower arms of the appliance. If the tubing comes loose from the appliance, this should be reported immediately to the office.
7. What if problems occur?
If a bonded part of the appliance becomes loose, this should be reported to the office immediately. In addition, if any irritation of soft tissues of the cheeks or lips occurs, or if there is an unpleasant smell or taste occurring in the mouth, this should also be reported. The fee for a replacement of the Herbst appliance is $300.00, which is in addition to the regular treatment fee. Please encourage your child to be very careful wearing and handling the appliance. Should replacement be necessary, new impressions would need to be taken.
8. What happens once the appliance is removed?
Following the removal of the Herbst appliance, comprehensive orthodontics will be initiated to finalize bite correction for the greatest stability and esthetics.