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Oral Surgery/Herbst device and Orthodontics treatment

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QUESTION: Hi, I hope that I've chosen the most knowledgeable field to help answer this.  My son (17 yrs) is getting braces put on and prefers not to have 2 healthy teeth (bicuspids) removed.  He has an overbite and crowding.  He was given 4 choices:  remove the 2 teeth (typical for crowding), oral surgery after braces to break and reconstruct the jaw for aligning teeth, Herbst device in conjunction with braces, or do nothing.

I asked about the long & short term damage using a Herbst device to the jaw and hinge area.  Concern of TMJ and such things came to mind.  He said over the years it has become widely accepted treatment for alternative to pulling teeth in cases it applies to.  That, in fact, this is apparently one of the devices used to treat TMJ he said.  He's an Orthodontist (over 20yrs) but not a specialist for the jaws -- though I'm certain he continues his education and consults with that specialty (Oral & Maxillofacial Surgeons).

I trust my Orthodontist, but never having heard of this device I came home to research it.  I found this article (link below) from someone here in 2008.  Is this oral surgeon's information now archaic with improvements and updated information over the last 6 years?

http://en.allexperts.com/q/Dentistry-966/2008/7/Long-term-Effects-Herbst.htm

ANSWER: Jackie - This is a difficult question for me to answer without examining your son or reviewing xrays.  I am not a fan of the Herbst appliance.  I have reviewed many cases over the years of patients young and old wearing this appliance.  Your son is near the end of puberty and as such his continued growth is diminishing.  This decreasing of growth potential means that any changes attempted and forces applied by the Herbst has a much greater chance of putting excess pressure on the temporomandibular joint. This is one of the problems with using the Herbst on an adult. That could produce joint problems and difficulty with a normal jaw function.  

I cannot tell you if extractions of the bicuspids would be correct, nor can I tell you that surgery is the correct approach.  I just know that the Herbst is a potentially destructive appliance.  

If you have additional questions, feel free to contact me again.

---------- FOLLOW-UP ----------

QUESTION: Good evening.  Sorry to bother you again.  I wonder if there's a way that all of the experts that would have extensive training, knowledge, and experience with this device could weigh in from this site.  I think when I was setting up the initial question and choosing the "expert" that there were other Oral & Maxillofacial Surgeons with this group.  Can it be put as a group question to all of them?  Or is there another specialty that would also utilize this device that can also weigh in?

I just want to help my son with the best possible outcome (not just short term) and make sure he has what he needs to make the most informed decision here.  Again, I trust our Orthodontist -- but again, he's specialty trained in the teeth and not the jaw and areas affected long term with this device.

Again, thank you so much for your assistance in this matter.

Answer
Jackie - you are completely correct to make sure that whatever choice you do make is correct for your son.  My suggestion is for you to see a board certified oral and maxillofacial surgeon for a second opinion.  You are fortunate to be living in Oregon.  There is an oral and maxillofacial surgical residency program at Oregon Health and Science University in Portland.  
My suggestion is that you contact the Department of Oral and Maxillofacial Surgery at the University and ask to have you son evaluated by the director - Dr. Mark Engelstad-
Call - (503) 494-3259.  Call the residency and ask to be examined by Dr. Engelstad

I hope it all goes well and you can get an answer that gives you comfort in whatever decision you finally make.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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