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January 6, 2017

How OrthoDenco Makes Herbst Appliances

Herbst ©

When we go about our Herbst, the first thing we ask is to get upper and lower models or impressions. Of course, the quality of those needs to be superb because the Herbst is a big deal for the patient and the practice. A lot of times parents are advised ahead of time when the Herbst is required for the treatment plan so they have a lot of notice and there’s a lot of angst and expectation about the appliance. From the moment we start, we want to make sure that we’re going to be able to deliver on that expectation for the practice and the patient.

Once we have those models, we then look at the prescription and we start looking at things that are important for the startup of the case. One very important thing is how is the jaw going to be positioned when we start manufacturing the appliance? Does the orthodontist want the jaw at its natural position and wants to advance it gradually throughout the wearing time of the appliance, or does your orthodontist want full advancement of the jaw from day one? Those are considerations that we take into account when we start articulating the appliance and looking at the function that it’s going to have in the patient.

Once all that is taken care of we start building our framework. Certain considerations are taking place when we do that. Where are the molar crowns going to be, are we going to have crowns on the first permanent molars, are we going to have crowns on the first bite cuspids? Where are we going to have molar rests? Is there clearance for the appliance? Do we need to have an upper expansions crew because the palate is a little bit narrower than the jaw, in which case we’re not going to have enough clearance for the Herbst to function?

Once all that’s taken care of and we build our framework then we start measuring the arms from the Herbst. Those basically will dictate how far forward are the Herbst pivots going to be positioned and what type of force are they going to allow the Herbst to apply so that the patient can move forward. That’s very important because we need to strike balance between function and also comfort for the patient. Remember, we want to meet that expectation that the parents have and so we want the patient to definitely feel comfortable but at the same time we want the appliance to do its thing so that within a year’s time the patient and the orthodontist can see their results.

When we have everything laid out we do soldering. We do two types of soldering, we do
laser welding and conventional soldering. Once that’s taken care of we polish the appliance, check it for quality, do another clearance check just to make sure that everything is going to have enough room to work and then we ship it to our customer.