A Herbst® journey

Dr. Bill Dischinger discusses how his personal Herbst experience led to development of a comfortable and efficient appliance

I had a Herbst^® as a teenager. How are my memories of that time in my life? Well … not exactly great. Although as an adult, I look at the results it gave me compared to the upper bi extraction cases that were the norm back then, and I know it was worth it. But …

The second Dischinger to have a Herbst was none other than Terry Dischinger himself. We treated him when he was in his late 50s. He had always been a Class II open bite that would have required surgery. Eventually, he developed a modified Herbst appliance that intruded the maxillary molars while the Herbst was correcting the Class II. The results are similar to what we see in today’s technology using TADs to intrude the maxillary molars and autorotate the mandible. He claims his experience was an easy process, but my dad is kind of that way. It sure beat surgery though, but in watching from the other side, it didn’t look all that comfortable.

Shortly after finishing his treatment, we decided to see if we could make a smaller Herbst appliance. Our purpose in attempting this design change was to improve the comfort of orthopedic Class II treatment for our patients. I was two boys into my now current four-boy family, and it was obvious they were following the Dischinger growth pattern and would require Class II correction. Selfishly speaking, I wanted my kids’ experience to be better than mine, my dad’s, and all my previous and current patients. So we set off on a journey, and let me tell you, it was a journey much harder and more frustrating than we had dreamed. When I was in my residency, I had a classmate that sat down at the bar with me one night, grabbed a napkin and pen, and said, “Let’s invent an appliance.” Well, it isn’t quite that easy. We had the design idea, but making that work from an engineering perspective is a little harder than most people would think. Thanks to the hard work of some amazing engineers at Ormco, we slowly started putting out some prototypes. We worked with these prototypes for a few years until we felt we had a design that worked consistently with great results.

AdvanSync™ was launched shortly thereafter. Early on, it was widely adopted by many based on the features that other doctors also recognized were beneficial to their practices and patients. Like many initial concepts, once the product was mass-produced, we began to see several flaws surface. We then went to work on the second generation with manufacturing and design changes that would resolve the issues. Thus came AdvanSync 2 with modified enhancements, and this is the product we are still using today and have been for nearly 5 years.

As stated, our goal was to improve the comfort of orthopedic Class II treatment for our patients. AdvanSync™ 2 is almost half the size of the miniscope appliance that we had been using and half of the size of the flip-lock design we used prior to that. It is well over half the size of what I had as a kid, which I can assure you. Because of the smaller size, it fits more in the posterior of the mouth. Most of the sores we saw patients experiencing were in the lower premolar area from the screw housings. This has been minimized with the enhancements of AdvanSync 2. The appliance also does not show in the mouth like previous Herbst designs, so patients are more accepting to wear it.

A bonus that came out of the smaller design was the ability to bracket every tooth forward of the appliance. In the past, we were unable to bracket the lower premolars, and at times, we would not bond the maxillary premolars either. With this new design, we bond all the teeth, and sometimes the mandibular second molars as well. When we are finished with the Class II correction and the appliance is removed, most of the Class I orthodontics has been accomplished as well, which allows us to quickly move to the end of treatment making our orthopedic Class II cases much more efficient. Since moving to the AdvanSync 2 appliance, we have dropped our average treatment time by over 6 months.

Over the years of using the AdvanSync, I have modified my treatment protocols on most of my patients. I used to place the crowns, place the braces, and hook up the AdvanSync arms on every new patient the first day of his/her treatment. Today, with most of our current patients, I am waiting 2 to 4 months before hooking up the arms. For younger patients, this helps them ease into treatment with less to adjust to. For some patients, I like to get the lower arch leveled, particularly in Class II, division 2 patients. Although this postpones the Class II correction by 2 to 4 months, the end result is that less orthodontics needs to be done after removal of the appliance. Because of this, the Class II correction occurs smoothly without vertical issues, and thus, the overall treatment time is lessened.

Since starting my Herbst journey over 35 years ago, I have seen a great progression in the comfort and efficiency of treating skeletal Class II patients. It has been rewarding to see my patients, especially my own children, go through a better experience than I did.

Herbst^® is a registered trademark of Dentaurum, Inc., and AdvanSync™ is a trademark of Ormco Corporation.