Instructions for Use

The Herbst^® Bite Jumping Hinge was first invented by Emil Herbst in 1909 and further developed by Pancherz in 1979. Today it is available on the market in many different versions.

1. Clinical use of the Herbst^® Bite Jumping Hinge

The Herbst® is used in cases of distal occlusion (angle class II, 1) in order to keep the mandible permanently in an advanced position.
The Herbst® consists of a telescopic hinge on both sides, which is attached to the distal part of the maxilla and the mesial part of the mandible. The length of the telescopic tube prevents the mandible from returning to its previously retracted position. The appliance permits movement in all directions.
The use of the Herbst^® creates a backwards directed force on the maxilla, similar to that of high-pull headgear. The more advanced position of the mandible encourages additional growth. Depending on the shape of the appliance, it is possible to achieve retrusion of the front of the maxilla and protrusion of the front of the mandible.

The Herbst^® has a number of advantages compared to other bimaxillary methods of adjustment in cases of distal occlusion:

• its effect is continuous, 24 hours per day
• the duration of active treatment is short (6 - 8 months)
• it requires no active co-operation on the part of the patient
• it can be worn at all times
• it can be given an acceptable design from the point of view of hygiene and appearance
• the appliance is in a fixed position.

Considerable forces are exerted on the fastening elements by the chewing function.
Therefore, these have to be strong in order to avoid fractures. The joints require regular checking by the doctor, and the patient must be able to detect any loosening of the parts at an early stage.

The most favourable age for beginning treatment is in the middle of the adolescent growth phase. A neutral relation is achieved after 6–8 months. The retention period with a removable appliance (e. g. Bionator) which is worn only at night up to the end of the main growth period, is short when the treatment is begun relatively late. However, in serious cases of distal occlusion in young children, there may be psychological or trauma-prophylactic indications for early treatment.

In the case of adults with problems in the maxilla joint, the Herbst^® Bite Jumping Hinge can prevent the joint heads from moving too far in the dorsal direction.

A number of variations in the Herbst^® Bite Jumping Hinge are now available, e. g.:

• bands on the sixth and fourth tooth with lingual arch wire as anchoring aid
• steel crowns on the upper sixth tooth and a removable plastic bar in the mandible
• two cast cobalt-chromium frames, fixed or removable
• combinations with multiple band appliances (Herbst^® II).

2. Treatment

(The following treatment applies to a typical patient of angle class II 1)

The patient is 13 years old and has just completed the growth maximum. She has a premolar-wide distal occlusion, protrusion of the maxilla front with narrow spacing*,overeruption* of the mandible front with deep occlusion*.


Phase 1: Shaping the rows of teeth with a multiple band appliance.
Transversal expansion of the maxilla as preparation for the coming neutral relation.
Correction of the Spee curve.
Retention of the maxilla front, e. g. using a twisted wire with a palatal curve Dentaflex^®).

Phase 2: Occlusion adjustment with the Herbst^®
In this case, the Herbst® consists of two standard steel crowns on the upper sixth tooth connected by a palatal arch. In the buccal zone, the fastening elements for the Herbst^® tubes are soldered into position.
The mandible is fitted with a removable plastic bar with an occlusal wall approx. 1– 2 mm in thickness and articulated against the maxilla. The interior of the bar has a frame of steel wire to allow soldering of the fastening elements for the Herbst^® sliding pins.
The occlusion is constructed with a support of 5 and 6 mm. The crowns are cemented. The patient is requested to keep the bar in position permanently (except when cleaning the teeth).
Patient co-operation and occlusion shift are checked once per month. If required, the telescopic tubes are extended by spacer rings to increase the forward thrust.

Phase 3: Fine adjustment of permanent dentition and retention
After 6 - 8 months the Herbst^® is replaced by a Bionator in the head-occlusion* position. In the occlusal zone, the plastic is ground off the lateral teeth to allow eruption of good teeth*. The Bionator is worn at night for 1– 2 years. An alternative to the Bionator would be a positioner which also permits fine adjustment of the teeth.

Herbst^® I Bite Jumping Hinge

Manufacture of the Herbst^® I Bite Jumping Hinge (Magnusson system)

• Adjustment of models in fixator with constructed occlusion.
• Mandible:
  Bend a connecting element of Remanium® wire (Ø 1.0 mm, hard) at mid level from centre tooth 4 mandible to centre tooth 6 maxilla (if tooth 4 is extracted, then possibly to mandible 3 depending on occlusal conditions. Then both elements are joined and soldered to the Remanium^® wire from the lingual side.
• Maxilla:
  The standard steel crowns (e. g. 3M) selected by the doctor on the 1st molars of the maxilla are joined by means of a Goshgarian palatal arch wire. The arch wire should be at a distance of 2 mm from the gingiva.
  The bases for the hinge joint are now spot welded and soldered to the outermost buccal point of the steel crowns. Ensure that the thread is not contaminated with solder. If necessary, use flux.
• Mandible:
  Weld and solder base to wire in the area of the 4th tooth. Ensure that the hinges between maxilla and mandible are parallel.
• Soak the models and insulate if necessary.
  Mix Orthocryl® acrylic as stated in the instructions included with the acrylic and model it onto the mandible.
  Close fixator.
  Polymerize in autoclave (25 minutes at 2.2 bars)
  Work as required, allowing plastic to flow to the tooth mid point from 3 to 3 in the mandible for support. This increases the stability of the bar.

The guide tubes and slide pins are now fitted:
The sleeves are shortened to fit the occlusal structure, followed by the slide pins (which should be approx. 2 mm longer). If the slide pins are too short, they may emerge from the guide tubes. If the pins are too long, they may cause irritation of the mucous membrane and injury. It is therefore advisable to check the exact length on the patient himself.

The bases for the hinge joints are now spot welded and soldered to the bands. It must be ensured that the direction of the screws is at the correct angle to the connecting line between the maxilla + mandible. It is also important that these joints between are free of friction to allow unrestricted functioning of the telescope mechanism. If friction exists, the appliance (especially the bands) may be irreparably damaged.

The guide tubes and slide pins are now fitted:
The sleeves are shortened to fit the occlusal structure, followed by the slide pins (which should be approx. 2 mm longer).
If the slide pins are too short, they may emerge from the guide tubes. If the pins are too long, they may cause irritation of the mucous membrane and injury. It is therefore advisable to check the exact length on the patient himself.

Fitting in the mouth:
The bands are fixed in the mouth with normal band cement. It is recommended to coat the bases of the joints with wax to prevent cement from penetrating the thread. When the cement has hardened, the guide tubes and slide pins (already shortened) are attached to the bases. For the Herbst^® I, a special screwdriver is used for this purpose.

For use on the maxillary and mandibular arch wire of a multiple band appliance.

The Herbst^® II is fitted with a special connecting element for fastening the Herbst^® II to the existing arch wire of a multiple band appliance. This assures maximum anchoring effect without the co-operation of the patient (e. g. headgear).
However, this requires that the strongest steel arch wire is used for this treatment technique.
The connecting element (pivots) has a slot which is inserted into the existing arch wire of the multiple band appliance and then fixed to the arch wire with the screw provided.
In this way the hinges are fastened mesially to the 6th tooth of the maxilla, and between the 3rd and 4th tooth on the arch wire of the mandible.

Procedure with patient:
After fixing the pivots to the steel arch wire, the distance between the upper and lower pivots is measured and the hinges shortened accordingly. The hinges are then fixed to the pivots with the screws. If the arch wire of the multiple band appliance has to be changed, the pivots must first be unscrewed. The hinge is then mounted as described.

Safety note:
Regular checks are necessary to ensure that the Herbst^® is securely seated and the screws are tight to prevent these from being swallowed or inhaled.
If necessary, the Herbst® can be activated with spacer rings 1, 2 or 3 (see delivery program).

For the Herbst^® IV, we recommend using Weingart or How pliers to hold the C-clips more securely.



After fitting the Herbst® IV always check to ensure that the C-clips are accurately positioned.
They lose their tension after being removed and replaced several times. New ones should then be used.

Safety note:
Ensure that the C-clip is pushed up parallel to the slot in the ball hinge. If it is not located straight, the clip may bend and work loose in the mouth, causing danger of injury or inhalation.

The appliance should be checked for the first time no later than a week after fitting.
After being worn for some time, the Herbst® IV can be activated with spacer rings.