David Gergen Stages Come Back
After 30 years in the Orthodontic Lab business. I have evaluated hundreds of designs. These are the appliances and opinions that define my career in Sleep Dentistry.
Herbst Telescopic Appliance
The Herbst Sleep Appliance has been proven to be effective on chronic snoring and mild to moderate obstructive sleep apnea sufferers. This appliance allows patients to move laterally and vertically without disengaging the appliance. Also, if it is determined that the initial position does not provide the anticipated relief of the condition, the mandible can easily be moved forward by the Telescopic version allowing the clinician to advance in 1/8 mm increments by making one full turn of the protrusion collar up to 4 mm from the start position. We start them at +1 so you can retrude 1 mm. The appliance can be fabricated from hard acrylic, thermoactive and soft materials and is tooth retained via friction grip or clasps.
The Herbst Sleep Appliance is a mandibular repositioner that has been in use many years for orthodontic and TMJ therapy prior to its modification for treatment of sleep disordered breathing.
The greatest advantage of the Herbst appliance is that it allows for very quick, easy and accurate mandibular protrusive adjustability. This is accomplished through simple manipulation of the rod/sleeve plunger mechanism. Vertical opening varies is 5 mm and there is limited freedom of movement for the mandible in a lateral direction. Bilateral interarch elastics are recommended to keep the jaw closed during sleep. There is no midline connection on the Herbst appliance. This helps extremely with claustrophobic patients.
NOTE: Some clinicians feel that limited lateral movement of the lower jaw during appliance use is beneficial for TMJ comfort while others believe it is of no benefit. Also, some clinicians find compromised effectiveness if the mandible is allowed to drop down even as much as a millimeter during appliance use while others find no difference. These are both areas that require more scientific study. We are presently unaware of the precise effect of these parameters on appliance effectiveness.
At Gergen’s Orthodontic Lab we make more of this appliance than all other appliances combined.
-David Gergen
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