Pacific Coast Society of Orthodontists Bulletin Winter 2012 - (Page 23)

Practitioner’s Practitioner’s Corner Corner S E A S O NE D S E A S O NE D Dr. Terry McDonald Interviews Dr. Brian Hartman The Complexities of Successful Herbst Treatment DR. TERRY M c DONALD: Brian, When did you first use the Herbst appliance? Dr. McDonald Dr. Hartman T he Herbst appliance is widely used by many orthodontists to assist in their mechanics for class II correction. These practitioners incorporate a variety of diagnostic criteria when considering use of the appliance, and prescribe multiple methods for its construction. A downside of all functional class II correctors is lower incisor proclination, which creates the potential for future periodontal breakdown. It would seem that any means to avoid this undesirable impact would be welcome information for Herbst users.The interviewee for this issue of the Bulletin is Dr. Brian Hartman. By association with his father and through purchasing the practice of another orthodontist, both of whom had a high number of Herbst cases under treatment, Dr. Hartman gained extensive experience on the complexities of successful Herbst treatment. I chose him for this interview because I had the opportunity to review his cases for his Angle Society membership; one of those cases was treated with the Herbst appliance using his case selection criteria and appliance construction method. I was impressed with the finished occlusion and the control of lower incisor proclination (Figures 1-6; Table 1). I thought that it would be of interest to Bulletin readers — those who use the Herbst appliance as well as those who don’t — to learn of Dr. Hartman’s somewhat unique approach for maximizing his results with this appliance. DR. BRIAN HARTMAN: I only treated one case during my ‘99-’01 OHSU residency with a Herbst appliance. So in 2001, when I went into private practice, I had very little experience with the Herbst. At that time I did not even know there were different designs to the appliance. I joined my dad’s practice in June 2001 and was fortunate to have him provide me with some great experience with the Herbst appliance. At that time, he was treating about half of his class II cases with the Herbst. But it was not until later in the fall of 2001 that I was really exposed to Herbst treatment. Due to the tragic loss of Dr. Curtis Menard, I temporarily left my dad’s practice to cover Dr. Menard’s practice until a more permanent resolution could be determined. Dr. Menard was one of the most respected orthodontists in our state and had a very large, efficient practice with over 250 active Herbst patients. Dr. Menard had been using multiple designs of the Herbst in both Phase I & Phase II treatment. I ultimately bought Dr. Menard’s practice and thus took over the treatment of the 250-plus Herbst cases. Having been completely self-taught, I went through many ups and downs with the appliance. I believe there is a big learning curve difference when you do a treatment plan yourself, compared to jumping into the middle of an established treatment plan with an unfamiliar appliance. But it served as a great educational opportunity to learn what was and was not treating out well with the appliance. Once I became more comfortable in the practice, I revisited all the initial records Dr. Menard compiled, and compared them to how I had finished them. I think I taught myself not how to treat with the Herbst, but rather when not to use the appliance, based on a critical evaluation of my finished cases. WINTER 2012 • PCSO BULLETIN 23

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Winter 2012

Incremental Change
What a Time it Was!
AAO Trustee's Report
A need, A dream, A reality: A team approach produces an extraordinary outcome
PRECEDENT Orthodontists on Devices
The Complexities of Successful Herbst Treatment
Dr. Bryan Williams
Presentation Software
Treatment Planning: The Magic Step
Comprehensive Mixed Dentition Approach
Social Media 101 for Orthodontists
Update on Bonding 2012
Create the Future by Looking Back: 100 Years of PCSO
PCSO Business
Component Reports
AAOF Report
PCSO at a Glance
Case Report Pre-Treatment
Case Report Post-Treatment
In Memory

Pacific Coast Society of Orthodontists Bulletin Winter 2012