Herbst appliance in lingual orthodontics

Abstract

The aims of this article were to outline a technique for attaching Herbst telescopes to a customized lingual orthodontic (LO) appliance and to demonstrate the treatment phases and outcome with a case report. The interface between the LO appliance and the telescopes consists of a computer-aided design/computer-aided manufacturing (CAD/CAM), custom-made labial pivot base connected to the custom-made bands of the maxillary molars and mandibular canines. The individual CAD depiction of the interface ensures an optimal 3-dimensional tube-and-plunger position for correct and smooth function of the telescope mechanism. Because of the lingual location of the brackets, a small buccal tooth-to-telescope distance can be achieved, increasing patient comfort. Various options of anchorage are possible with only 1 device. After bite jumping, the telescopes and pivot bases can be removed easily without debonding the bands or removing the archwires. Experience from the first patient suggests that the Herbst-LO appliance facilitates treatment control during all phases, decreases the risk of interface breakage and mandibular incisor flaring, and might reduce overall treatment time. These initial clinical observations justify further research to provide evidence about the efficacy of Herbst-LO appliances.