- What is the Maximum Incisal Opening (MIO)?
- How do I measure the MIO?
- What warrants starting a patient on Herbst treatment at an earlier age?
- What is the average treatment time for Phase I patients with the Herbst Appliance?
- What is the average age you start a patient in Phase II treatment?
- What changes occur when you place a Herbst on an adult?
- What procedure must you follow when you add an expander to the upper Herbst Appliance?
- What is the standard advancement you initially place a patient in for treatment?
- How long do you hold the patient in the corrected position?
- How do I know if the condyle is centered if I do not have a tomogram?
- Do you always add archwire tubes to the upper and lower arch?
- What is a common problem with the Herbst Appliance?
What is the Maximum Incisal Opening (MIO)?
The MIO is a measurement Specialty Appliances™ uses to size MiniScopes for each patient. The wrong sized MiniScope may allow the patient to pull off the lower crowns because they are not able to fully achieve their MIO. If Specialty Appliances™ has the MIO, we can provide you with the correct size MiniScope and the patient will not be able to dislodge their appliance.
How do I measure the MIO?
The MIO is the measurement of the distance from the upper to the lower incisal edges with the patient opening to the limit of their comfortable, pain free range. Add the amount of overbite to that dimension for an accurate MIO measurement.
What warrants starting a patient on Herbst treatment at an earlier age?
Phase I treatment is justified when a patient has a severe class II malocclusion or the patient experiences ridicule at school. The Herbst will usually change the patients' profile immediately and they will look more natural to their peers.
What is the average treatment time for Phase I patients with the Herbst Appliance?
Patients are treated from 9 to 16 months in Phase I depending on the severity of their class II malocclusion.
What is the average age you start a patient in Phase II treatment?
Patients are ideally started in Herbst treatment between the ages of 11 and 12. This allows for the maximum effect of the Herbst during their growth spurt. The age can vary depending on the maturity of the patient.
What changes occur when you place a Herbst on an adult?
It is believed that the main affects of the Herbst in adults is joint remodeling and dento-aveolar changes. We have made hundreds of Herbst for adults, some even in their fifties.
What procedure must you follow when you add an expander to the upper Herbst Appliance?
If patients are in a posterior cross-bite, the upper member of the Herbst appliance will often have to be expanded before the mechanism is attached. However, the new telescoping mechanisms with the AppleCore screws allow you to insert the complete appliance due to the flexibility they offer.
What is the standard advancement you initially place a patient in for treatment?
We normally will advance a Class II or a Class II Division II patient to an end to end advancement. This is only done if the distance is less than 8 millimeters. A Class II Division I patient will be advanced to Class I molars. However, your prescribed advancement will overrule our standards.
How long do you hold the patient in the corrected position?
Generally the patients are held in the corrected position for 9 to 12 months. This is determined by the severity of the class II.
How do I know if the condyle is centered if I do not have a tomogram?
An easy way to determine if the condyle is centered is to remove the Herbst mechanism and wait for one month. If the patient has relapsed, simply reattach the mechanism and continue treatment for 3 months.
Do you always add archwire tubes to the upper and lower arch?
We add archwire tubes to the upper and lower arch on 90% of all Herbst appliances we construct. This allows the clinician to tie the upper arch together to limit the "headgear effect" and level the lower arch during treatment.
What is a common problem with the Herbst Appliance?
The upper right screw tends to loosen and can fall out. To prevent this, add a few drops of Ceka Bond to the threads when seating the appliance.