Phoenix Orthodontist Herbst Treatment Protocol
The Phoenix orthodontist in the growing patient as a means to correct a Class II malocclusion can use the stainless steel crown Phoenix orthodontist Herbst. Typically, the Phoenix orthodontist Herbst would be used in a patient with a retrognathic mandible. The appliance may also be indicated in the patient with a prognathic maxilla as the Phoenix orthodontist has also noted a headgear effect with the Phoenix orthodontist Herbst appliance.
Treatment Protocol:
- Preparation of the dentition – Some Phoenix dental decompensation may be necessary prior to Phoenix orthodontist Herbst treatment. Proclined mandibular incisors should be uprighted while lingually tipped maxillary incisors should be proclined. Extruded incisors should be intruded using a Phoenix orthodontist. Problems in the transverse dimension can be corrected by adding an expansion screw to the Phoenix orthodontist Herbst.
- Impressions – Separators are placed on the maxillary 1st molars and mandibular 1st premolars. At the impression appointment, the separators are removed and orthodontic technicians employed by the Phoenix orthodontist take alginate impressions.
- Bite registration – If the overjet is 7mm or less, the bite registration is taken at an incisal edge to edge position. If the overjet is greater than 7mm, the bite registration is taken at a halfway point. The appliance is then advanced to an edge-to-edge position after 2-4 months. Either a centric occlusion bite registration advanced by the laboratory or a protrusive bite using a Projet bite fork is acceptable.
- Maintaining space for crowns – Bands are cemented on the teeth that will have stainless steel crowns. Separators are also placed to create a larger space to seat the crowns.
- Preparation and delivery – The bands and separators are removed. The individual parts of the appliance are tried in. Once both arches are fully seated, the plungers are reinserted into the tubes to advance the mandible. Opening, closing, and lateral movements should be carefully evaluated. Crown margins should be evaluated and crimped if necessary by the Phoenix orthodontist. The bite advancement and midlines should be evaluated.
The appliance is removed and a notch is cut in the mesiofacial line angle of each crown. Usually the upper member of the Phoenix orthodontist Herbst is cemented with the tubes attached and the lower member without the plungers attached. Petroleum jelly is placed on the occlusal surfaces of the teeth to be crowned. The appliance is then cemented with Blue CrownLok. The plungers are reattached to the lower unit.
- Subsequent advancement – The Phoenix orthodontist Herbst can be reactivated every other appointment as necessary.
- Discontinuation – The Phoenix orthodontist Herbst is typically worn for 9-12 months. It is left in place at least 5-6 months after the last activation.
- Removal – The first step is to remove the plunger mechanism. The notches on the crowns are located and a fissure bur is used to cut through the crown and cement without cutting the tooth on the mesiofacial line angle. Crown removal pliers are used to remove the crown.
