Indications for Use:

The long-haul Herbst appliance is used to accomplish long-term functional responses common to Herbst appliance therapy and also to serve as the anchorage unit to hold the upper molars back following Pendulum therapy. This appliance is most commonly used in conjunction with the Pendex Appliance in Phase 1 therapy, long before the permanent upper buccal segments have erupted. The most typical case would be the brachyfacial Class II that has a short corpus length and retruded lower face. In these cases, it is not ideal to retract or orthopedically reduce the maxillary complex (à la headgear) and yet dental movements are acceptable and desirable.

Technique:

The cantilever Herbst appliance is most commonly used for this function. Following use of the Pendex appliance, where maxillary expansion is accentuated and distal tipping of the molars minimized, crowns are fitted and the cantilever Herbst appliance fabricated. A slipcover retainer is placed the day of Pendex removal to assure maintenance of the dental and expansive changes.

Considerations:

The long-haul Herbst appliance must be in place long term (over 12 months) to garner some of the orthopedic and orthodontic results attributed to this appliance. This combination of Pendex and long-term Herbst appliance is a very dynamic Phase 1 therapy that holds great potential in early treatment. The results to date have been very encouraging and improvements in technique come on almost a daily basis.