Herbst-02(2)

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G O O D P R A C T I C E 1
VOLUME 4 NO. 1
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Page 2
Herbst Therapy: Trying to get out
of the 20th Century
Dr. Stephen D. Hanks, DMD, MSD
Page 5
Indirect Bonding Custom Base - A Vehicle for Change
Dr. William C. Machata, DDS
Perspectives and Insights for the Orthodontic Profession
2 G O O D P R A C T I C E
Herbst Therapy: Trying to get out
of the 20th Century Stephen D. Hanks, DMD, MSD
Before the x-ray, the refrigerator, or the zipper,
there was the HerbstTM appliance. At the begin-
ning of the 20th century, Emil Herbst envisioned
a new appliance that would later bear his name.
Today’s Herbst appliance looks strikingly simi-
lar to the original drawings published by Emil
Herbst in 1910. The author’s intent is to intro-
duce a significant advancement in the Herbst
appliance. A discussion of the limitations of
the modern Herbst appliance and the improve-
ments introduced by the author will serve no-
tice that the Herbst appliance is finally ready
to get out of the 20th Century.
A Historical Perspective
Emil Herbst introduced the world to his inno-
vative concept in 1910 with the publication of
his text entitled, ATLAS UND GRUNDRISS
DER ZAHNÄRTLICHEN ORTHOPADIE
(Translation: Atlas and Compendium of Den-
tal Orthopedics). Although the textbook con-
sisted of 392 pages of text with 441 illustra-
tions, Herbst dedicated just 10 pages to ex-
plain the basis for his new appliance and how
to construct it. Emil Herbst included two litho-
graphs illustrating his design (Figs. 1, 2Figs. 1, 2Figs. 1, 2Figs. 1, 2Figs. 1, 2). Re-
markably, these lithographs demonstrate the
similarity of his original appliance to those
used today. On the one hand, that similarity is
a testament to Herbst’ extreme foresight; but on
the other hand, it may be interpreted as a con-
demnation of our own lethargy and inability to
refine what he started almost a century ago.
In the concluding paragraph of his description
of this appliance, Herbst stated with an excla-
mation of optimism, “That this guide can be
improved is beyond doubt. For the time being
though it is a given that it [the guide] is a
device that promises a simpler and more com-
fortable result, as compared to the up-until-
now-used inclined planes. We still stand so
very much in the infant shoes of orthodon-
tics—who knows what progress this science
will have made in 20 years—but the improve-
ment will come, and it would only take a small
stimulus of enthusiastic investigation, and
where possible, scientific and practical im-
provement, and although not easy, that is our
assignment; that is our responsibility” (English
translation of the original German). There have
been significant contributors to Herbst’ origi-
nal concept of a mandibular guide: Langford,
Dischinger, and Mays, etal. But, the improve-
ments to Herbst’ original appliance design have
not progressed as the wise doctor had envisioned.
Indeed, the modern Herbst design is still cause
for frustration and, at times, contempt.
The design modifications introduced in this
text are the result of three established goals: to
reduce the number of emergency appointments,
to increase patient comfort, and to transform
the Herbst into a more user-friendly appliance.
Goal One:
Reduce Emergency Appointments
The first and primary goal for creating an
improved Herbst design is to reduce, if not
eliminate, emergency appointments. Inevitably,
many of these emergencies fall on a day when
the office is closed. When a Herbst appliance
bends, locks up, disengages, or breaks, the
patient needs immediate attention, creating
countless hassles for the clinician and staff,
not to mention the patient and parents. Under-
standing the causes for emergency appoint-
ments is the first step toward improving the
Herbst design.
The modern Herbst appliance experiences a
limited range of motion with regard to man-
dibular lateral excursion. Most emergency vis-
its result from repeated or traumatic abuse of
the appliance when taken to its sagittal or fron-
tal limits. Ideally, the patient should be afforded
a full range of motion in the sagittal plane (open-
ing and closing) as well as the frontal plane
(mandibular lateral excursion). Some designs
have incorporated ball and socket features to
minimize binding during lateral excursion of
the mandible, but the common axle-post-eye
design (Fig. 3Fig. 3Fig. 3Fig. 3Fig. 3) significantly restricts lateral
movement, which leads to many bent and bro-
ken appliances. Both designs suffer from limi-
tations on the sagittal plane, which lead to
emergency appointments to re-engage the rod/
tube assembly.
Ideally, all forces brought to bear on the rod/
tube assemblies should be parallel to the rod
and tube long axis. From a metallurgic consid-
eration, rods and tubes exhibit their greatest
strength along their length, but are suscep-
tible to failure when stress is applied perpen-
dicular to the long axis. When a rod or tube
attachment binds prior to completion of the
lateral excursion, perpendicular forces are in-
troduced to the appliance, potentially weaken-
ing, bending or breaking the rod/tube assem-
bly or its attachment to the metal crown.
Generally speaking, patients exhibit three
Dr. Hanks maintains a private orthodontic
practice in Las Vegas, Nevada. He holds two
patents on fixed functional appliances and has
lectured and published articles about the
Herbst appliance over the last five years.
FIG 3
FIG 1 FIG 2
G O O D P R A C T I C E 3G O O D P R A C T I C E 3
types of responses when binding occurs. If
patients are passive by nature, they do not con-
tinue the excursion, develop a subconscious
memory of the limitation, and henceforth avoid
the conflict, maintaining appliance integrity.
Patients that are less passive exhibit the sec-
ond type of response. These patients find the
limitations and continue to test them until the
assembly experiences metal fatigue resulting
in bent, binding or broken rod/tube assem-
blies. The third response comes from patients
that are receiving treatment against their will to
satisfy a parent. These patients, out of aggra-
vation and frustration, aggressively stress the
appliance leading to failure at either the rod/
tube assembly or, more likely, at the soldered
attachments. To minimize or eliminate emer-
gency appointments, a new Herbst design must
provide a remedy for all three types of patient
responses to Herbst therapy.
Goal Two:
Increase Patient Comfort
The second design goal addresses patient com-
fort. A common source of patient discomfort
arises from ulceration of the mucosa covering
the super oblique ridge of the coronoid process.
Interestingly, all Herbst mechanisms utilize a
single rod and tube actuating assembly. Of ne-
cessity, the rod must be long enough so that it
does not disengage from the tube upon extreme
opening (yawning). Unfortunately, when the rod
is set at its maximum length to avert disengage-
ment, the distal end of the rod impinges the mu-
cosa when the patient closes his/her bite result-
ing in the all too familiar ulcerations that Herbst
users have experienced (Fig. 4Fig. 4Fig. 4Fig. 4Fig. 4).
Another contributing factor to mucosa ulcer-
ation with traditional Herbst appliances is the
fixturing location of the upper axle assembly.
In most cases, the upper axle fixture is located
near the disto-buccal line angle of the first per-
manent molar, which maximizes the length of
the tube to insure against rod/tube disengage-
ment. Unfortunately, fixturing on the disto-buc-
cal line angle only exacerbates the ulceration
problem once the appliance is activated, for-
ward posturing the mandible. To minimize
ulceration, the rod must remain short enough
to preclude it from extending too far past the
distal opening of the tube; yet, shortening the
rod increases the likelihood of disengagement
from the tube. Thus, clinicians are caught in a
Catch 22 situation where they must choose
between ulceration or disengagement—acom-
promise that is frustrating to both patient and
clinician.
Goal Three:
A More User Friendly Appliance
The third goal centers on making the Herbst
appliance more user friendly. Gaining access
to the posterior region during insertion and
removal of the rod/tube assembly creates a
moderate amount of patient discomfort. As
stated previously, many current Herbst designs
specify that the rod/tube assembly be attached
on the extreme disto-buccal line angle, thus
reducing the risk of disengagement by the pa-
tient. To affect such access, the lip commis-
sure must be so extremely retracted that the
patient squirms with discomfort, limiting clini-
cal access to the posterior region. As a conse-
quence, it is not uncommon practice to insert
or remove the entire assembly with the rods
and tubes pre-attached to the molar crowns.
Cementing crowns on molars and bicuspids is
always challenging, but when a rod or tube is
dangling from the buccal surface of the crown,
the challenge becomes even more vexing. While
some clinicians may not find this altogether dis-
advantageous, there are many that want to ac-
complish some arch development prior to Herbst
activation or, rather, may just want to ease their
patient into the appliance (attach the rod/tube
assembly at a later appointment).
The desire to place the rod/tube assembly to-
ward the mesial and improve clinical access
must be balanced with the risk of disengage-
ment. Achieving the aforementioned goal of
delivering a more user-friendly appliance while
maintaining clinical objectives requires the
development of a new Herbst design that elimi-
nates the possibility of disengagement, regard-
less of the mesio-distal positioning of the sol-
dered attachment.
A New Herbst Design
Achieving all three goals with a new Herbst
design provided a significant challenge for the
author. No Class II appliance garners such a
strong following or has such a vibrant history
as does the Herbst. Despite the enormous
manufacturing challenges, the Hanks Tele-
scoping Herbst Appliance® (HTH) was devel-
oped to meet the challenging goals previously
discussed (Fig. 5Fig. 5Fig. 5Fig. 5Fig. 5).
The HTH offers three major improvements
over modern Herbst appliance designs: the
telescoping axle assembly will not disengage,
the axle assembly incorporates the rod, tube,
and screw components into a one-piece de-
sign, and a patented ball and socket joint of-
fers unlimited excursion of the mandible.
The telescoping axle consists of two tubes
and a rod, and functions similar to a free-slid-
ing radio antenna (Fig. 6Fig. 6Fig. 6Fig. 6Fig. 6). The outer tube of
the axle captures the middle tube, yet the middle
tube slides inside the outer tube until it is
stopped at the mesial end of the outer tube.
The rod, which attaches to the lower bicuspid
or cantilever arm, is captured by the middle
tube and slides inside the middle tube until it
is stopped at the mesial end of the middle tube.
Thus, the axle assembly functions similar to
modern Herbst designs yet will not disengage
due to the stops built into the free-sliding rod
and tubes. Additionally, the expansion length
of the HTH axle assembly greatly exceeds the
expansion length of modern Herbst’ designs—
FIG 4 FIG 5 FIG 6
4 G O O D P R A C T I C E
FIG 2
even to the extent that it exceeds the maximum
length a patient can open his/her jaw (Fig. 7Fig. 7Fig. 7Fig. 7Fig. 7).
The second improvement to the Herbst appli-
ance is a patented, one-piece design. The one-
piece design of the HTH appliance provides
many time saving opportunities for the prac-
tice not afforded by modern Herbst appliances.
First, because the axle assembly is one piece, it
does not require a clinician or laboratory tech-
nician to measure and trim the appropriate
length for the rod and tube. Rather, one of the
four basic telescoping units is selected: 20mm,
24mm, 27mm, and 31mm. The telescoping axle
cannot come apart regardless of the length se-
lected; even if the patient opens wide while
yawning and maximizes the HTH axle’s travel
length, the appliance will not disengage. After
selecting the appropriate length, any adjust-
ment to refine length more precisely at the time
of insertion is performed chairside using a
FIG 9b
crimpable shim (Fig. 8Fig. 8Fig. 8Fig. 8Fig. 8). The crimpable shim
offers time savings throughout Herbst treat-
ment because the one-piece axle does not re-
quire removal from the soldered attachments
to adjust mandibular advancement.
The one-piece design also solves the ulcer-
ation dilemma because the increased expan-
sion length of the axle allows maxillary molar
attachments to move mesially on the molar
crown (Fig. 9a, 9bFig. 9a, 9bFig. 9a, 9bFig. 9a, 9bFig. 9a, 9b). By locating the maxillary
molar attachments mesially away from the su-
perior oblique ridge, ulceration no longer re-
mains a concern and clinical access is im-
proved. Furthermore, because the telescoping
assembly is a one-piece construction and can-
not come apart like the traditional rod and
single tube Herbst devices, the HTH axle ful-
fills the need for a truly non-compliant appli-
ance. The one-piece design also mitigates the
potential risk of harming the patient when the
rod and tube bind, bend or disengage, or when
the attaching screws back out or break, intro-
ducing the potential for aspiration. Because
the screw, rod and tube are all part of the one-
piece axle assembly, a higher level of safety is
introduced to Herbst therapy.
The third component of the HTH appliance
contributing to its uniqueness is the ball and
socket joint (Figs. 10a, 10bFigs. 10a, 10bFigs. 10a, 10bFigs. 10a, 10bFigs. 10a, 10b). The ball and
socket joint provides the mechanism for unre-
stricted lateral movement—a feature unlike any
other Herbst design. The ball and socket joint,
which allows the telescoping assembly to move
unrestricted 40° in every plane, provides a level
of patient comfort and range of motion un-
available in any other modern Herbst design
(Fig. 11Fig. 11Fig. 11Fig. 11Fig. 11). Forty degrees of travel is remarkable
because it exceeds the human range of lateral
motion, thereby ensuring that the patient can-
not find the limit of the appliance and, out of
habit or frustration, break it.
The ball portion of the joint is, in fact, a special
screw that has a spherical head and is captured
within the socket, which is soldered to the axle
assembly (Fig. 12Fig. 12Fig. 12Fig. 12Fig. 12). The threaded portion of the
screw is engineered with an “interference” char-
acteristic that makes the screw lock with the
accompanying nut when the two are joined. This
locking action eliminates the need for special
adhesives such as Ceka Bond, which is used
routinely with screw-type Herbst appliances.
Another design characteristic of the screw is its
ability to completely imbed the threaded por-
tion of its length below the upper surface of the
FIG 9a
FIG 8
FIG 7
FIG 11
FIG 13
.050
Hex head
wrench
Spherical
screw head
Interference
thread
Mating
chamfer
FIG 10a FIG 10b
FIG 12
nut. Relative to shear forces, the weakest part of
a screw is the last cut of the thread. If that cut is
near the top interface between screw and nut,
the susceptibility of the screw to fail at that point
is dramatically increased. On the other hand, if
that last thread can be buried within the depth of
the nut by the addition of harmonized mating
chamfers, then the strength of the screw against
shear forces is greatly enhanced. By burying the
HTH screw thread within the depth of the nut,
the entire axle assembly is guarded against fail-
ure from shear forces unlike any other screw-
type Herbst appliance.
Using a one-piece axle, crimpable shims, and
soldered posts (Fig 13Fig 13Fig 13Fig 13Fig 13), the Hanks Telescoping
Herbst offers the clinician many advantages over
current Herbst designs: fewer emergency ap-
pointments, increased patient comfort, user-
friendlier components. Getting the Herbst out
of the 20th Century has been a challenging, yet
rewarding design goal—a goal that Emil Herbst,
if he could havelooked forward in time, would
have proclaimed, “wunderbar”.
*The Herbst appliance is a trademark of Dentaurum.
Interproxomal edge of crown
Mesio-distal location of axle screw
G O O D P R A C T I C E 5
Indirect Bonding
Custom Base - A Vehicle for Change
In a previous issue of this newsletter, we
presented an overview, through a ques-
tion and answer format, of the current
status of the Indirect Bonding technique,
or simply “IB”. This article will examine
more closely a specific element that lies
at the heart of the IB technique. This tech-
nology is typically described as the Cus-
tom Base Method. The Custom Base fea-
ture, however, has much greater impact
than being just one step in the sequence
of a number of technical steps in the IB
fabrication process. Unfortunately, it is
too frequently glossed over in most IB
discussions with little or no attention given
its greater role in the totality of IB’s treat-
ment potential. The Custom Base Method
was developed as a solution to address
the shortcomings of the original method-
ology of bracket placement and position-
ing used in IB, the Clean Base Method.
To review, the Clean Base Method refers
to the laboratory procedure of applying
a temporary “adhesive” material to the
bracket base. This temporary “adhesive”
allows the bracket to be luted to the pa-
tient working model as part of the IB pro-
cess. It is interesting to note that the tem-
porary “adhesive” of choice for the Clean
Base Method was, and still is, a caramel-
like candy called, “Sugar Daddy”.
After all the brackets have been placed
to a prescribed position on their corre-
sponding teeth on the working model,
transfer trays are fabricated over the
models, the trays and captured brackets
Dr. William C. Machata, DDS
are released from the models, and the
temporary “adhesive” cleaned off of the
bracket bases. The resulting brackets in
the transfer trays are then delivered
chairside with a “Clean Base” ready for
application of the clinical bonding adhe-
sive. While this methodology has been
proven to work, it is a technique sensi-
tive system not without its problems both
in the laboratory and clinical settings. In
the lab it can be difficult and frustrating
to work with. It is sticky and messy at
times while at other times too runny or
too viscous and has a limited work ing
time mak ing positioning and reposi-
tioning of brackets a challenge. In the
clinic the challenge is no less daunting
or troublesome. Gauging the proper
amount of adhesive to use from one
base to the next can be difficult. Po-
tential problems run the gamut from
too much application of adhesive with
excess flash and its attendant compli-
cations to not enough adhesive result-
ing in voids and increased bond fail-
ure both immediate and time delayed.
By contrast, the Custom Base Method
ut ilizes a diametrically opposed ap-
proach to bracket adhesion in the lab.
In this methodology a f inite layer of
curable adhesive is applied to the
bracket bases during the lab process.
After fabrication of the transfer trays
this true, fully cured adhesive layer is
nnnnnototototot removed from the bracket bases
as is done in the Clean Base Method.
In passing, the distinct ion between the
two methods might seem of minor sig-
nificance in relation to the entire scope
of IB. In fact there is a subtle but sig-
nificant sophist ication to the Custom
Base Method that bears further atten-
tion and discussion.
The abilit y, in a controlled laboratory
environment, to manage this process of
precisely applying adhesives is a power-
ful tool for change. Not only does the
Custom Base establish a positive, secure
interface with either traditional mesh pads
or the engineered gridwork of one-piece
brackets, but it also conforms intimately
with its mating tooth surface. In addition,
it functions as the direct intermediary join-
ing mechanism between bracket, no mat-
ter whether metal or ceramic or polymer,
and tooth via the applied clinical adhe-
sive. By definition then, what has emerged
is a “truly custom base bracket”, specific
for each individual patient taking into
accountability the geographic variations
that normally occur on the crown sur-
faces of each tooth in the arch. Taken to
its logical extension, the Custom Base
Bracket is, in essence, the quintessential
pre-pasted bracket.
What implications can we draw from this?
Some may be more obvious than others.
In practical terms, the benefits of an inte-
grated adhesive/bracket coupled together
with close and accurate adaptation to
tooth surfaces are difficult to isolate from
the benefits of precise and consistent
bracket placement and positioning. Each
augments the other. Taken together, fre-
quently reported results with the Custom
Base IB system are:
1. Fewer bond failures
2. Less adhesive flash with easier
cleanup at the bonding appointment
Dr. William Machata is the Director of Clinical
Applications at American Orthodontics.
Taken to its logical
extension, the Custom Base
Bracket is, in essence, the
quintessential pre-pasted
bracket.
6 G O O D P R A C T I C E
3. More hygienic appliances with
lesser potential for decalcification
4. Expedient bracket removal,
especially ceramic appliances, and
easier cleanup at debonding
5. More accurate posterior alignment
and occlusion
6. Less need to reposition brackets for
case finishing
7. More complete utilization of arch
wire properties with fewer adjust-
ments
8. Reduced chair time - initially and
throughout treatment
9. Potentially shortened treatment time
10. More efficient time management
and enhanced staff utilization
11. Less doctor time at bondings
12. A stress reduced working environ-
ment for both staff and doctor
As a whole or in varying combinations
of parts, one can readily relate how the
above translates to increased office and
treatment efficiency along with their at-
tendant economic impact and advantage.
On face value alone, the Custom Base
Method represents a significant step for-
ward in the evolution and perfection of
IB in terms of its accuracy, consistency,
and reliability. Beyond that, however, it
has much greater inherent potential than
just serving as a technical management
tool in the lab.
A few paragraphs back we equated
Custom Base with a “quintessential pre-
4. Custom Base - suveyor with model
5. Custom Base - bracket positioning on
surveyor
6. Custom Base - flash removal
7. Custom Base - typical setup, TIME TM self-
ligating brackets
1. Clean Base - bracket placement
2. Clean Base - transfer tray with brackets
3. Clean Base - chairside application of
bonding adhesive
pasted bracket”. What was implied was
that the Custom Base Method, as an
integral component of IB, was capable
of delivering ever ything a pre-paste
system could, and more. What is the
basis for this assert ion? If the primar y
function of the Custom Base IB sys-
tem is precise bracket positioning and
placement, then it logically follows that
one has the option to alter the posi-
t ion and orientation of the brackets to
whatever degree desired, within finite
limits (bracket size, tooth size, etc.).
This abilit y to alter and modify the
placement and position of the appli-
ance is the key that opens the door to
other options.
Properly applying the Custom Base
Method can transform the basic func-
t ion of IB by enabling it to modify the
built-in prescription of the appliance.
Together with enhanced positioning in-
strumentation, the Custom Base be-
comes not just a tool but a vehicle to
deliver an individualized, custom, pa-
t ient-specific prescription.
If we go one step further and equate pa-
tient specific prescript ions with patient
specific treatment, then for the first time
G O O D P R A C T I C E 7
President Richard Iverson and Vice
President of Manufacturing Michael
Bogenschuetz accept the 2002
Wisconsin Manufacturer of the Year
Award. The annual competition is
cosponsored by Virchow, Krause &
Company LLP, a regional accounting
and consulting firm; Michael Best &
Friedrich LLP, a large Midwestern lawfirm; and Wisconsin Manufacturers &
Commerce, the state’s largest business
association.
GRGRGRGRGRAAAAAND AND AND AND AND AWWWWWAAAAARDRDRDRDRD
American Orthodontics, Sheboygan
Chairman Dan Merkel shelled out big
bucks for his daughter’s braces in the
1960s.
And, as the saying goes: If you can’t
beat ‘em, join ‘em. He started American
Orthodontics in 1968 because he saw a
market for high-qualit y affordable
orthodontics.
Judges were quick to note that through
process automation and state-of-the-art
technology, American Orthodontics is able
to manufacture 95 percent of its products
in Wisconsin, compared to most of its
compet itors, which have moved
manufacturing to Mexico. Over the last
four years, automation has increased the
company’s productivity by 24 percent.
Judges also noted that American
Orthodont ics has experienced sales
growth every year since it was founded,
and company sales are outpacing the
indust r y. The company does
approximately 50 percent internationally.
Employing 240 Wisconsin workers, the
company has set the industry standard
in product quality, employee retention,
customer service and low-cost production
of orthodontic supplies.
“In its 34-year history, the company has
achieved many milestones, yet it continues
to refine its business by developing new
products, improving upon existing lean
manufacturing processes, and providing
world-class customer service,” said Mike
Spude, a judge in the medium category.
American Orthodontics is committed
to serving its employees by offering a
safe and comfortable work environment,
and as a result, its employee turnover
rate is practically zero. That, as well as
the fact that the company is ISO 9001
certified, also impressed the judges.
(Reprinted by permission, Corporate Report
Wisconsin, March 2003, pg. 32)
8. Custom Base - typical setup, TIME TM self-
ligating brackets
9. Custom Base - transfer tray with brackets.
Note the integration of adhesive and base.
bracket placement and posit ioning po-
tentials need to be considered as part
of the diagnosis and treatment plan-
ning process. It is clear that IB is not
the same technology it was several de-
cades ago but what it can ultimately be
is yet to be determined. We can readily
anticipate, however, that future change
will occur at a greater rate, the scope
of IB will expand, and that it will par-
ticipate more broadly and directly into
the delivery of patient treatment.
8 G O O D P R A C T I C E
1714 Cambridge Avenue • P.O. Box 1048 • Sheboygan, WI U.S.A. 53082-1048
USA and Canada: 800-558-7687 • 920-457-5051 • Fax: 920-457-1485 • e-mail: amo@americanortho.com
Low Profile Brackets
The newest member of the Mini Master Series
family is American’s new Low Profile Systems.
The combination of the unique design
features of Master Series brackets with a very
low profile mini bracket produces a system
with incomparable benefits for both patients
and doctors. The coordinated in/out bracket
heights have been reduced to the bare
minimum while still allowing easy ligation.
Low Profile brackets are available in
• A Roth system
• A Roth system with vertical slots
• An Alexander system
• A McLaughlin Bennett system
• The Butterfly system
• A Modified Straight Wire system
The American Orthodontics versions of the Alexander, the Roth
and the McLaughlin Bennett Systems are not claimed to be a
duplication of any other, nor does American Orthodontics imply
that they are endorsed in any way by these doctors.
Low Profile Tubes
Low Profile buccal tubes offer the same low
profile and smooth rounded edges as our LP
brackets. In addition, the LP tubes have
positioning guides for easy placement on the
tooth, a funneled entrance for easy wire
insertion and the facial guide is color coded
for tube ident ification.
Hanks Telescoping
Herbst
®
A patented one-piece Herbst design with
telescoping assembly that will not disengage,
the Hanks Telescoping Herbst utilizes a unique
ball and socket assembly that eliminates
binding and allows for unlimited lateral
excursion.
*Patents #6,244,862 #6,361,315
Modified DB Tweezer
LP Buccal Tube placement is made easy thanks
to our Modified Direct Bond Tweezer made
specifically to fit the LP tube positioning
guides.
Pearl Chain and
Ligatures
Almost invisible: our newest color Pearl is
designed to complement our cosmetic brackets.
Available in Unisticks, 6 Sticks and
Plastic Chain.
For more information on AO seminars, please contact Patrick
Dunda at 800-558-7687, ext. 173
July 25, 2003
Concepts and Controversies in Orthodontics
Dr. S. Jay Bowman
Dallas, TX
Sept. 26, 2003
Clinical Efficiency
Dr. John Valant, Dr. Stephen Hanks, Mr. Charles Lewis
Seattle, WA
Seminars
Oct. 31-Nov. 2, 2003
Halloween Seminar
Las Vegas, NV
Nov. 14 - 15, 2003
Clinical Efficiency
Dr. John Valant, Dr. Stephen Hanks, Mr. Charles Lewis
Orlando, FL
Feb. 19-21, 2004
AO Annual Ski Seminar
South Lake Tahoe, NV