herbst appliance

The Patient’s Guide to the Herbst Appliance

By  Dr. Tyler Coles – Premier Orthodontics

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If your child has an overbite, you may have heard an orthodontist mention a Herbst appliance. But you may be wondering what that is. In this article we will discuss what a Herbst appliance is, how it works, and go over all the details that you may need to know if your child needs a Herbst appliance.

What is a Herbst Appliance?

A Herbst appliance is an orthodontic appliance that is used to help fix overbites. However, not all Herbst appliances are the same. There are many different designs of Herbst appliances.  Some appliances are removable and can be taken out of the mouth while eating, but most Herbst appliances are designed to be cemented on the teeth.

While the design of Herbst appliances may vary a bit, most that are cemented on the teeth will have certain key features:

  1. Metal bands or caps that are cemented to the upper molars using orthodontic cement. 
  2. Metal bands or caps that are cemented on the lower molars (or sometimes the lower bicuspid teeth).
  3. Metal arms that are attached from the upper part of the appliance to the lower part of the appliance.  

 

Depending on the design of the Herbst appliance, there may be some other features built into the appliance, including supporting wires to help stabilize the metal bands or possible expansion appliances to help widen the upper teeth.

Herbst Appliance Diagram

What is a Herbst Appliance Used For?

A Herbst appliance is used to fix overbites, typically meant for younger, growing patients. When a child has an overbite, (meaning that the top teeth stick out too far compared to the lower teeth) a Herbst appliance might be the recommended option for treatment.

A Herbst appliance is most effective when:

  • A patient is still growing. (usually during the pre-teen or early teen years)
  • A patient has a retrusive lower jaw. (the lower jaw is set back too far compared to the upper jaw)
  • A patient doesn’t have extreme crowding of the teeth.

 

Keep in mind that there are many different types of overbites, and many different treatment options. Just because your child has an overbite does not necessarily mean that the Herbst appliance is the best treatment option. An orthodontist will consider all these factors when determining if a Herbst appliance is the best option for your child.  

Want to see what a Herbst appliance actually looks like?  Watch this video to see an animation of a young patient wearing a Herbst appliance.

How is the Herbst Appliance Installed?

Some parents may be worried that getting a Herbst appliance installed will be painful or uncomfortable, however, installation of a Herbst appliance is a routine procedure that is relatively simple with very little discomfort.

Prior to having a Herbst appliance installed the orthodontist may place spacers between the teeth. These spacers are designed to make room for the bands of the Herbst appliance to easily slide between the teeth.

orthodontic separator

Example of orthodontic separators that may be placed before a Herbst appliance is installed.

If the teeth already have sufficient space then spacers may not be necessary prior to installing the Herbst appliance.

 

At the appointment that the Herbst Appliance is installed the orthodontist or orthodontic technician will first verify that the appliance fits properly. (This simply means that the appliance fits the teeth and is comfortable) Once the fit has been verified orthodontic cement will be placed into the bands, and then the bands will be placed over the teeth.

Once the orthodontic cement is set completely, the orthodontist or orthodontic technician will then insert the arms of the herbst appliance. These are usually attached using a small wrench that securely attaches the Herbst appliance arms to the bands.

Does a Herbst Appliance Hurt?

A Herbst appliance generally doesn’t hurt when it is placed. During the first week, you may feel a bit of discomfort on your teeth and cheeks as you first get adjusted to the Herbst appliance. The most common problem with a Herbst appliance is that it may make your cheeks sore for a time. . This especially happens if you sleep on one side and put pressure on your cheek all night long. If you have trouble with your cheek getting sore, you can ask your orthodontist for a small cotton triangle that will act as a barrier and hold your cheek away from the appliance while you sleep.  These cotton triangles are called “dry angles.”
Dry angles
Dry angles

Dry angles are used in dentistry to help keep the teeth dry while dentists perform different procedures. These small cotton triangles can also be used to keep the cheek away from the Herbst appliance at night time in the event that any irritation occurs.

Usually after the first week or two, patients get used to their Herbst appliance and generally don’t have any problem to speak of. Your cheeks adapt quickly and most patients don’t have any long term problems with a Herbst appliance.

How Long Do You Need to Wear a Herbst appliance?

Treatment length with a Herbst appliance will vary depending on each patient’s age and the severity of bite correction needed. Generally speaking, most patients will wear a Herbst appliance between 8 and 12 months.

At Premier Orthodontics, our usual protocol is to:

  1. Place a Herbst appliance by itself for 3-6 months.
  2. Add top braces (while keeping the Herbst appliance in place).
  3. Remove the Herbst appliance somewhere between month 8 and 12 (or when the bite correction is completed). Place lower braces.
  4. The patient will then continue upper and lower braces for 12-18 months

Does the Herbst Appliance Really Work?

Yes – and it has been used for over a century now. Let’s take a look at the history.

The Herbst appliance was first invented in 1909 by Dr. Emil Herbst, a German orthodontist. In the past 100+ years, thousands of patients have been treated with his appliance. There are hundreds of patient images that can be found that show the before and after changes that can happen with a Herbst appliance.  

Dr. Emil Herbst

Dr. Emil Herbst – the inventor of the Herbst Appliance in 1909

Additionally there have been scientific journals outlining studies that have demonstrated that the Herbst appliance is effective at correcting overbites in growing children. 

With such a successful track record of successful treatments, all verified by professionals and researchers, you can be confident that the Herbst appliance definitely works. 

Herbst Appliance - Before and After

Below are a few patients treated at Premier Orthodontics using a Herbst appliance…

before herbst appliance
before herbst appliance
after herbst appliance
after herbst appliance
before herbst appliance
unnamed (4)
after herbst appliance
unnamed (6)

Herbst Appliance - The Pros and Cons

Like any other orthodontic treatment out there, there are pros and cons to a Herbst appliance. Below are some of the details one should be aware of.

Benefits of the Herbst Appliance

  1. A Herbst appliance helps correct large overbites.
  2. A Herbst appliance has been proven to be effective and has been used by orthodontists for over 100 years.
  3. A Herbst appliance may help to avoid the need to extract permanent teeth to fix overbites.
  4. A Herbst appliance can’t be lost or misplaced by a young child and doesn’t require as much patient cooperation as it is permanently cemented to the teeth.

Drawbacks of the Herbst Appliance

  1. It may cause some initial discomfort. 
  2. Eating with a Herbst appliance can be difficult during the first couple of weeks. 
  3. The appliance can sometimes cause irritation to the cheeks, especially in the initial two weeks after placement. 
  4. A Herbst appliance takes 8-12 months to be effective. 
  5. Herbst appliances are generally most effective in young growing children and may not be the best treatment for older teens or adults with overbites..

Herbst Appliance With Braces and Without Braces

A Herbst appliance may be used at the same time as braces, but there are times that a Herbst appliance may be best used before braces are placed on the teeth. This is usually dependent on how old the child is, how many baby teeth are remaining, and the severity of the overbite.

The orthodontist will determine the best timing for when a Herbst appliance should be placed and when braces will be most effective.

How Much Does a Herbst Appliance Cost?

Prices may vary depending on each situation and each office but at Premier Orthodontics the cost of the Herbst appliance is included with the cost of braces

How Do I Clean a Herbst Appliance?

Thanks to modern orthodontic technology, the Herbst appliance is now a small appliance.  The downside is that it has several small parts that may lead to many places for food particles to get stuck. It will require a little more cleaning maintenance than your child may be used to.  Below are the steps one should take to make sure the Herbst Appliance stays clean.

  1. Brush thoroughly and regularly – The tooth brush is still the best tool when it comes to cleaning. Make sure to scrub the teeth as well as the appliance itself. After brushing, look closely at the appliance and see if there are any food particles remaining.
  2. Floss around the bands of the appliance – There are several metal bands that will be placed on the teeth, so do your best to floss between these teeth. It might feel a bit awkward at first with the different parts of the appliance, but with practice you should be able to effectively floss around these teeth.
  3. Use a Waterpik to thoroughly clean around the appliance – A Waterpik is a great tool to clean around any hard-to-reach areas and to clean between the teeth. The Waterpik is nearly as effective as floss when it comes to cleaning the gums. If you’re going to be wearing a Herbst appliance for several months, a Waterpik is a good investment to make.

 

Want to learn more about how to brush and floss with braces?  Check out our video below

What if a Problem Occurs With the Herbst Appliance?

Some problems that may occur with a Herbst Appliance include:

  1. One of the bands becomes loose.
  2. One of the Herbst appliance arms becomes loose.
  3. Your cheek begins to feel sore due to the pressure.

 

Solution to #1 and #2 – In the event that one of the Herbst appliance bands or arms comes loose, you should call your orthodontist office right away to have it repaired. 

Solution to #3 – If you are having discomfort from the appliance on your cheeks your orthodontist may be able to give you dry angles to place between the appliance and your cheek that should help your cheek to recover and begin feeling better.

What Happens After a Herbst Appliance is Removed?

When a Herbst appliance is removed a patient may begin braces. The patient may immediately receive braces, or the patient may go for a period without any orthodontic appliances on their teeth.

Depending on the stage of development of the child, as well as how many baby teeth are remaining, the orthodontist will decide if a patient should immediately begin braces when the Herbst appliance is removed, or if it would be best to wait for a period of time before starting braces.  

How Can I Tell if My Child Needs a Herbst Appliance?

If you think your child may need a Herbst appliance the best place to start is by getting a free consultation with an orthodontist in your area.  If you live in or around the Phoenix, Arizona area we would love to provide you and your child with a free consultation for braces and to determine if the Herbst appliance would be the best choice for your child. As you can see, we have a deep understanding of the Herbst appliance and are ready to answer any and all of your questions about it.

Orthodontic Offices in Phoenix, Chandler, Maricopa, Anthem, and Casa Grande

Premier Orthodontics has 7 locations  providing braces in Phoenix, Chandler, Gilbert, Maricopa, Casa Grande, Glendale, and Anthem/Carefree as well as the surrounding areas. 

You can schedule your free consultation for braces below and we can determine if a Herbst appliance is the best choice for your child.  You can also  click here to see our comprehensive guide to the cost of braces. (We are very transparent about our process and our pricing, as you’ll see in this guide.)

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