Indications for Use:

The short haul Herbst (Herbst is a registered trademark of Dentarum, Inc.) appliance is intended mainly as a short-term anchorage appliance following Pendulum therapy (although many clinicians consider it the Herbst appliance of choice for its simplicity and its functional and growth benefits). It is utilized where headgear cooperation is questionable and the permanent dentition is either in place or almost erupted. The appliance is simplified greatly for comfort by attaching to the lower first bicuspids and upper molars only. This version of the classical Herbst appliance is easy to use, allows for adjunctive bonding and space closure of the upper arch and supplies some of the classical functional responses commonly attributed to this fixed functional appliance. In effect, it is like having a headgear on full time while the upper buccal segments are being retracted to the molars. Although there is some strain on the lower arch, we have found it to be minimal, as the Herbst appliance ultimately puts very little strain on the appliance itself once muscle memory has been altered.

Figure 27. Lower unit of the short-haul Herbst in place. An .050 lingual arch is soldered and Herbst hubs placed on the mesiogingival of lower first bicuspid crowns.

Figure 28. Components of the short-haul Herbst. This simplistic Herbst appliance is easy to fabri-cate and comfortable for the patient. Note small Peerless ® tubes on the upper molar crowns that can be used to retract the upper buccal teeth.

Figure 29. Frontal view of short-haul Herbst appliance in place following Pendex treatment and prior to full bonding in the upper arch. Patient in treatment for five months.

Technique:

To fit crowns on these teeth, the upper molars cannot be severely tipped distally. We commonly move the upper molar back into an ideal Class I relationship (don’t overcorrect it excessively), and although some distal tipping is allowable, it should be minimized. The Pendulum Appliance is removed and the slipcover is fabricated. Upper first molars and lower first bicuspids are fitted with stainless steel crowns. The upper hubs are welded to the distal of the upper molar crowns and impressions taken to fabricate the short-haul Herbst appliance. Small Mini-Peerless tubes are welded to the mesial of the upper molar stainless steel crowns in order to retract the upper buccal segments. A short lingual arch (.050 stainless steel) is soldered to the lower first bicuspids for stability. The upper arch is bonded and retracted to the upper molar, using the short-haul Herbst for anchorage. The Herbst appliance can be left in longer if needed for other functional and growth responses, but its main purpose is to work as an anchorage unit while retracting the upper arch.

Considerations:

Once the upper buccal segments have been retracted, there will be a large space between the upper lateral incisors and upper cuspids. The upper incisors will be in an ideal overbite and overjet relationship because the mandible is advanced to hold molar position. The upper incisors cannot be retracted until the Herbst appliance is removed and overjet recurs. The short-haul Herbst is often left in during the alignment and leveling phase in the lower arch. Then the upper incisors are retracted with a Reverse Curve TMA with "T" Loops closing arch to open the bite and consolidate upper spaces.