Herbst appliance or Mara appliance

Herbst appliance versus Mara appliance

Herbst appliance and the Mara appliance are both in use by orthodontists across the country, so why one over the other?  Personal preference of the orthodontist to a large extent.  The Mara appliance is slightly smaller but both are large enough that they take some time for a patient to adjust to.  The Mara appliance, being smaller, has more complications, like breaking.  We almost exclusively utilize Herbst appliances over the mara appliance.

Why the Herbst appliance over the Mara appliance?

herbstOne of the most common problems presented to an orthodontist is the upper teeth being further forward relative to the lower teeth.  In most cases, this is the result of the lower jaw being set back relative to the upper jaw, as opposed to the upper jaw being too far out.

Traditionally headgear would be used to correct this issue.  The Herbst appliance accomplishes the same thing and is actually more effective.  While it has the same “headgear effect” of holding the top jaw from continuing to outgrow the bottom jaw, it also pushes the bottom jaw forward, helping it “catch up”.  The growth center of the bottom jaw is near the lower jaw joint and the Herbst appliance works to “remodel” this area.  Additionally, the Herbst appliance is a great “tooth mover”, helping to move the lower teeth move forward.  An orthodontist will cement the Herbst in place, so it cannot be removed by the patient and does not rely on patient compliance.

By utilizing the Herbst while your child is growing, we can maximize their growth potential and eliminate the need for a jaw advancement surgery to fix the bite later in life.  Although positive esthetic changes to the jaw line and face will occur, the purpose of correcting their bite is not just for cosmetics.  It is important to have a proper bite where the teeth can work efficiently to aid in digestion and avoid future issues with the teeth and jaw muscles.

herbst appliance, mara appliance

Herbst appliance before and after photos

herbst before and after

herbst applaince before and after

How will it feel? Is there pain?

It will feel like a mouthful at first!  Within the first 1-2 weeks the patient should adapt to the herbst appliance and it should not be too uncomfortable.  It may irritate the inside of your child’s cheek at first, but soon the tissue will toughen up and the herbst appliance will not be a problem.  You should report any prolonged cheek or tongue irritation to your orthodontist.  We utilize the “telescoping” Herbst; the arms are shorter and less bulky, so it is easier to adapt to. Additionally, the telescoping feature allows for better side-to-side movement of the jaw.  This reduces jaw limitations that traditional herbst appliances had.

What is the cost of a Herbst appliance?

Offices often include the cost of a Herbst appliance into the orthodontic fee and thus cost varies depending on your particular orthodontic situation. Adding miniscrews will increase the cost, but also increases the effect, according to Manni AJO 2019. In our Wheaton orthodontic office the Herbst appliance has no additional cost.  It is to our benefit, as well as yours, to utilize a Herbst appliance.  A Herbst appliance allows the orthodontic treatment to be completed much more quickly.  We recommend going to fairconsumerhealth.org for dental codes.  However, they do not have orthodontic codes.  Braces info does though.  Go there and click your area and orthodontics for a fee for your area.  Herbst appliance along with braces in our office typically runs about $6,500.

What about eating with a Herbst?

You may hear your child say “I cannot eat with this in my mouth.”  This is not true – they just can’t eat like they used to.  The bite will be different and some teeth will not touch initially.  We recommend a soft diet for the first few days.  This will allow for a transition period will the child adapts to their new chewing style.  Frustration while first wearing a herbst appliance is normal, so stick in there!  After a few weeks the child should be back to a normal orthodontic diet.

What is the best way to adapt to a herbst?

It will be natural for your child’s tongue and mouth to be curious to this new appliance.  Try to encourage them NOT to play with it with their fingers or tongue.  Encourage them to allow it to work and not fight it!  Tell them not to try to force the jaw into positions that are hard to get to.  In short, DON’T MESS WITH IT!

What problems may arise while wearing a herbst appliance?

There are a few problems which may arise from the Herbst appliance.  The first is ulcer formation on the inside of the cheek, which usually occurs from sucking on the appliance arms.  Since we use a telescoping herbst appliance, the arms will pinch the cheek if the patient sucks their cheeks in.  A child must make a conscious effort to not start or to stop this habits.

The second problem is the appliance becoming loose or uncemented from the teeth.  Your child should be able to open wide enough to eat anything large or yawn when sleepy.  However, if they “pop” the herbst appliance by popping their jaw, it will become loose as the muscles are much stronger than the orthodontic glue!  This should not happen with proper care and attention and following the appropriate orthodontic diet.

Another issue is a screw coming unscrewed. We can easily fix this for you but you be capable of doing it yourself.

How long will the Herbst be worn?  Do children wear braces with a Herbst?

12 months is a typical amount of time for a Herbst.  The appliance needs to be active for a full year of growth.  Your child will most likely get the Herbst appliance without any braces initially.  This is to allow plenty of time for them to adapt to the appliance without overwhelming them.  They will typically get their braces about 8 weeks later.  The effects of the Herbst appliance occur slowly over time as we activate the appliance in 1-2 mm increments as your child grows.

Herbst appliance problems that you should report to the orthodontic office immediately:

  • Bands that become loose
  • Irritations that don’t improve within 7-10 days.  Ulcers normally take a week to heal.  Encourage your child to use wax as necessary to help it heal.
  • Any breakage or something that limits jaw movement.