How do I deliver a Herbst appliance?

Four steps take a clinical assistant through the whole delivery appointment. The goals are being prepared, following the protocol, and instructing the patient on how to care for and use the appliance.

Step 1: Inspect and organize

• Pull the patient’s chart and appliance before they arrive. Verify all components were received as prescribed.
• Inspect each part for working order and smoothness (screws, crowns, rods and so on).
• Lay the Herbst out on tray paper as you would place it in the mouth, right on right and left on left. At this point the components are not interchangeable; they were prepared for this patient.
• Attach the upper rods to the upper member. Do not use Ceka Bond yet. Wrap a small elastic around the buccal attachment of the crown to the rod so it doesn’t hang down during fitting.
• Gather everything you need to prophy, pre-fit, cement, clean and assemble, plus the instructional tools for the patient.

Step 2: Pre-fit and adjust

• Remove spacers, prophy and floss.
• Fit the Herbst crowns. They should snap when seated. If they don’t, use a crown contouring plier to slightly undercut the border of the crown and refit.
• With the crowns in place, check the cantilever arms and occlusal rest for position. Make any adjustments before cementation. Use a 3-prong headgear plier for the cantilever arms.
• Place the lower rods into the upper rods and then onto the pivot. Check the rod length out of the distal, confirm the dental midline is on, and check the rod length is bringing the lower jaw forward to almost an end-to-end relationship.

Step 3: Cement, clean and bond

• Remove the crowns, take off the rods, and clean the components with alcohol using a cotton swab or pellet.
• Replace the upper member rods on the crowns, using Ceka Bond to secure the screws. Replace the elastic on the rod to make cementation and seating easier.
• Place toothpaste or wax anywhere you don’t want cement to seep. Do not use wax on the screw housing. Ceka Bond won’t adhere and the screw could loosen.
• Mix a glass ionomer cement as directed. Use a cold slab draped with freezer wrap to increase working time. Total working time is around 8 minutes.
• Load each crown with a generous amount of cement. Start with the mandibular arch: isolate the anchorage tooth, air-dry, and seat the crown with finger pressure followed by a band seater. Wipe excess adhesive with a cotton roll, then move to the next quadrant.
• Once all crowns are cemented, clean thoroughly with a scaler and floss the contacts. Use an intraoral mouth mirror to check the distal lingual and buccal areas. Residual cement causes tissue irritation and inflammation.
• Prepare to bond the occlusal rests, following the instructions for your bonding adhesive.

Cementation tips

Keep the upper Herbst attached to the mechanism. Attaching a piece of dental floss to the appliance guards against it being swallowed during fitting. Use Ceka Bond in the screws before final cementation.

Step 4: Assemble, instruct and reinforce

• Remove the elastic that held the upper rods to the crowns during fitting and cementation.
• Place the lower rods one at a time into the upper member. Ask the patient to move their lower jaw forward so the holes on the ends of the rods lay over the pivots.
• If you pre-checked all adjustments during the initial fitting, you can use Ceka Bond on the lower screw. If you’re not sure of the final fit, only lightly tighten the screw until the opposite side is attached and verified.
• Double-check the rod extension out the back of the upper tubes, the tightness of the screws, and the patient’s range of motion.
• Give the patient a Herbst Take-Home Packet: instructional guides, oral hygiene tools and an emergency kit.
• Review the instructional handout with the patient and their parent.
• Reinforce the patient’s part in successful treatment.

After the appointment

Call the patient in 2 to 3 days to see how they’re getting on and whether they have any questions. A handwritten note from you goes a long way too.

Need help?

Your Herbst experts at Specialty Appliances are a call or email away: 1-800-522-4636 or LabTech@SpecialtyAppliances.com.