Herbst Appliance: The Timing of Treatment

In recent years one of the more challenging and investigated areas of orthodontia is the phenomena of growth stimulation. This area has received increased attention in the last 15 years with regards to the Herbst appliance. The Herbst appliance which is a bite jumping appliance (1) has received both praise and criticism in the literature. This bite jumper actually positions the mandible in a forward position with no reliance on patient compliance (2). The use of this appliance was first introduced by Emil Herbst in 1905(3) for the correction of Class II anteroposterior relationships. There have been several papers that have evaluated this appliance in the past 2 decades (4-10). The Herbst appliance corrects Class II malocclusion by (11): 1) decreases maxillary growth (headgear effect) 2) stimulation of mandibular growth 3) stimulation and/or redirection of condylar growth 4) adaptive changes in the glenoid fossa 5) dentoalveolar changes. With an emphasis on controlling the growth of an individual to correct transverse, anteroposterior and vertical problems as we enter the 21st century it only seems logical to attempt to determine the best time to treat. We have the ability to quantify an individual's growth and maturational level (12) but we often disregard these factors in our treatments. We already know that there are certain timings of craniofacial growth, this paper will attempt to determine and take advantage of these certain timings.