Oral and Maxillofacial Question Regarding my Open Bite

I was administered a Herbst appliance while I was wearing braces when I was 12 until I was 14, for a period of 22 months or so. The open bite isn't severe, but I was wondering if there's anything I can do about it. The only thing that really bothers me about it is that my jaw is slightly receded which causes my lips to be slightly unaligned, causing the pout of my lower lip to look awkward. Is it possible that my jaw slightly receded after removing the appliance? I'm willing to try it again

Doctor Answers 6

Herbst appliances

Herbst. and other "functional" appliances are not all that great....Orthodontist use them for patients with severe skeleletal problems, but the studies have shown that they have only minimal effects on the bone structure (many orthos would disagfree with this statement but ask them to show you studies that back up their opinion!)

Bottom line, you probably had a severe skeletal problem and still do,  At this point either try to fix it with braces, do jaw surgery, or live with it

Saint Louis Orthodontist

Open bite after a Herbst Appliance

Tough question.  One would need to know if you started with an open-bite to begin with and how "recessive" your chin was before treatment started.  In general, a Herbst appliance is prescribed in growing individuals to help move the lower jaw forward, hold the upper jaw in its current position (much like a head-gear does) and move the teeth.  In lay terms, this reduces "overbite" -- meaning that the distance between the top and bottom front teeth gets smaller.  In orthodontic terms, we call this a reduction in "overjet".  After Herbst appliance treatment, we generally expect a small degree of rebound, meaning that the "overjet" could increase slightly.  When using the Herbst in conjunction with braces, the braces and rubber bands (elastics) can be used to counteract both the rebound effect and any small openbite which exists.  An openbite, however, can also be caused by a variety of other things -- including jaw joint changes.  Your Orthodontist is in the best position to determine the cause of your existing openbite and how best to treat it.  It might be a good idea to take some new records (photos, x-rays and models) as well as an updated health history and evaluation of tongue posture to determine how best to proceed.  With regard to the chin position, you should also inquire about cosmetic surgical procedures that can be a very simple and effective way to improve chin position.

Kara J. McCulloch, DMD
Mercer Island Orthodontist

Open bite may be rebound from herbst of related to "tongue thrust"

It is not uncommon for there to be "rebound" from Herbst treatment - particularly if there was major difference in jaw size the was responsibel for the bite imbalance. On the other hand, the open bite may be completely independent of the treatment you received but rather response to abnormal balance between lip and tongue pressures on the teeth. The orthodontist who did your treatment is probably n the best position to evaluate your circumstances and outline options for re-correction. I suggest you return for re-evaluation and discussion of your concerns.

R. William McNeill, DDS, MS
Mercer Island Orthodontist

Herbst appliance relapse may be do to adverse habits.

The Herbst can be effective in repositioning and stimulating the lower jaw to come more forward during treatment.  The relapse that you are experiencing can be the result of unrecognized adverse oral habits, such as mouth breathing or improper tongue posture.  The question should always be asked as to why the relapse occurred.  The solution should be addressed before or during treatment so that relapse does not occur again.  Having the lower jaw recede could  be the result of the upper jaw being constricted (likely the case since you have an open bite) and/or the TMJ going out of alignment.  All ot these types of things should be checked out before proceeding with treatment.  If these adverse conditions are corrected, then I see no reason you can not have a successful retreatment.   I personally prefer other types of orthopedic appliances to the Herbst, as the Herbst is not very effective in expanding the upper jaw, which is probably needed in your case.  Good luck with treatment.

Kent Lauson, DDS, MS
Denver Orthodontist

Open bite after Herbst treatment

If your jaw receded after the Herbst was removed it may not have much effect to do Herbst treatment again.  I would want to know the answers to several questions in a case like yours such as:  did you have an open bite before Herbst treatment, how much correction was there during Herbst treatment, and how much has your jaw position changed since getting your braces off?  Revisiting your old orthodontist might provide answers to these questions.  For a non-growing adult, significant openbite and a receding lower jaw sometimes need braces plus jaw surgery for a complete correction.

Brian Povolny, DDS, PhD
Seattle Orthodontist
5.0 out of 5 stars 2 reviews

Openbite post Herbst Treatment

The Herbst appliance is intended to stimulate mandibular (lower jaw) growth. After the Herbst appliance, most orthodontists put on braces to make the teeth fit the existing post-Herbst jaws.If you still have a small openbite, I would advise that you see your or another orthodontist for an re-evaluation. 

Gary Kloberdanz, DDS, MS
Greeley Orthodontist

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.