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Orthodontics/Advancsync functional appliance

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Question
Hi Dr Supan

I read from a previous that you have experience of the herbst type functional appliance, i was wondering in particular about Advancsync molar 2 molar.

1. Does this appliance just work to put the lower jaw in a forward position to gain growth or would you also expect to see any changes ie impacting/tipping to the pre molars on the lower jaw after a period of time in place.
2. If so can this be easily corrected during or after the functional appliance is removed?
3. Can there be any root damage to the pre-molar or loosening of molar that have crowns or when crowns are removed?

Thank you

Susie

Answer

Dear Susie,

I am getting so many interesting questions here.I will answer your questions in the order presented:

1. Does this appliance just work to put the lower jaw in a forward position to gain growth or would you also expect to see any changes ie impacting/tipping to the pre molars on the lower jaw after a period of time in place.

What an excellent question. There are various "flavors" of the Herbst Appliance, just like there are many ways of constructing a "cheese pizza" . The type of Herbst Appliance which  I employ uses small vented stainless steel crowns (caps) which are temporarily cemented to the upper left and right upper and lower first molars. The upper left and right "vented crowns" on the molars are connected using a palatal bar or connector which courses transversely along the roof of the mouth.  There is no banding of any premolars

The lower left and right first  molar crowns are furthermore connected with a stainless steel connector ( thick wire ) that is soldered to the inside aspect of the crowns and courses along the inside aspect of the anterior teeth (on the tongue side of the tooth ) This helps to fully reinforce the lower anchorage to the lower jaw and I have yet to ever see any tipping or for that matter significant root resorption in my 25+ years as an Orthodontist. I am not saying it is not possible, but given proper appliance design, not likely.  

Plunger like  pistons connect the upper molar "caps" to the lower molar caps. The lower left and right molars have forward extending arms  extending forwards on each side the the lower  left and right premolar ares. The net result is very secure anchorage, no tipping and on each side a plunger like pistons attached to a hinge on the upper molar coursing down diagonally towards a hinge soldered on the front end of the lower arm; the lower hinge point is located in the area of the premolar. In brief, I have not seen any tipping clinically or radiographically ( on Xray ).

2. If so can this be easily corrected during or after the functional appliance is removed?

I suppose tipped molars or premolars can be corrected, but with proper choice of appliance design, this issue can be largely avoided.

3. Can there be any root damage to the premolar or loosening of molar that have crowns or when crowns are removed?

Removal of the vented crowns, and the appliance as a whole is fairly uneventful  I use a zinc phosphate cement that has strength but is not too strong. Root resorption is an often  mysterious area and can often be due to genetic factors and unrelated to orthodontics or traumatic occlusion. I would agree that a poorly designed Herbst Appliance which laces unnecessarily high forces on a tooth could potentially bring about resorption.

Finally Susie, there s a field called Evidence based Dentistry which describes how good the evidence is for doing certain procedures. In a systematic review by the authors shown below, the Herbst was shown to have significant  success  in correcting malocclusions.

See the following reference  :

Evidence Based Dentistry: Systematic Review ( Very High Level of Evidence)
“Long-term Stability of Orthodontic Treatment and Patient Satisfaction”

Author: L. Bondemark, et al   Angle Orthod;  2007, 77(1):  181-191.

Overview: To evaluate morphologic stability and patient satisfaction at least 5 years after orthodontic treatment.

Findings:
   1004 abstracts or full-text articles; 38 met the inclusion criteria. Treatment of crowding ended in successful dental alignment.
   Treatment of Angle Class II Division 1 malocclusion with Herbst appliance normalized the occlusion.
   Relapse occurred but could not be predicted at the individual level (limited evidence).

Susie, if you have any questuons please feel free to resubit your question again

Paul Supan, DDS, MA, MPH
http://www.Leesburgbraces.com
http://www.braces.com  

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Paul Supan, DDS, MA, MPH

Expertise

First may I say please set your questions to Public so other readers can benefit from the response. Also, if you look at my comprehensive answers, they are not short 1 or 2 paragraph quickie replies that anyone can type out in < 5 minutes. Instead I often will ask other colleagues in other specialties for their advice in order to provide you the questioner with a more interdisciplinary perspective. This all takes time. I ask for readers to therefore allow 5-7 days. You will be rewarded with a very detailed response.

Because of the nature of Orthodontic questions, any pictures of the teeth and X-ray images would be very helpful. If you write to me and explain that you have crooked overlapping front teeth can be interpreted in many many ways, and my goal is to provide a specific response that meets your needs.

I hold double specialty credentials. I am Board Certified in Orthodontics and Board Eligible in Dental Public Health. I welcome questions regarding Braces, Invisible Braces, & Invisalign, as well as issues involving combination Cosmetic Dentistry and Orthodontic treatment. Orthodontics alone sometimes is not enough to achieve that perfect smile. Gingival (gum) re-contouring, tooth reshaping, bonding and other services are sometimes needed. I also have substantial experience in the areas of Infection Control and Sterilization in the Dental Environment. My personal websites braces.com and Leesburgbraces.com are non-commercial for information purposes only and may provide you with some background to more precisely frame your question for allexperts.com.

Please allow a week for a reply. I am in full time Private Practice, lecture on occasion, and am involved in many volunteer activities. I am therefore not always able to respond to questions straight away. Your understanding is appreciated.

Experience

Board Certified Orthodontist (ABO Diplomate) with over 25 years of Private Practice experience. Second Specialty Certificate in Dental Public Health with research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control (CDC) in Atlanta. Postgraduate Masters degree from the Harvard School of Public Health, as well as a Master of Arts Degree in Education.

Organizations
American Dental Association, American Association of Orthodontists, Academy of General Dentistry, College of Diplomates of the ABO, OSAP - Office Sterilization & Asepsis Procedures Organization, Others

Publications
Available upon Request.

Education/Credentials
BS College of William & Mary, DDS Medical College of Virginia, Masters of Public Health (MPH) Degree Harvard School of Public Health. Dental Public Health Specialty Certificate from NIH. Orthodontic Specialty Certificate from University of Rochester Eastman Dental Center. USPHS clinical research experience at NIH, and Epidemiology Training & Research at Harvard, NIH, and the Centers for Disease Control. Fellow of the Academy of General Dentistry (FAGD), and Fully Board Certified Diplomate of the American Board of Orthodontics. Board Eligible in Dental Public Health. Visiting Adjunct Associate Professor at the Meharry Medical College School of Dentistry, Nashville, Tennessee.

Awards and Honors
Available upon Request Please see my personal websites braces.com and Leesburgbraces.com for further personal background.

Past/Present Clients
Available upon Request

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