Herbst appliance in lingual orthodontics

Introduction: 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. Methods: 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. Results: 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. Conclusions: These initial clinical observations justify further research to provide evidence about the efficacy of Herbst-LO appliances.