A New Model of Herbst Appliance for Young O.S.A.S. Patients

The purpose of this study is to evaluate the efficacy of elastomeric resin variant of Herbst's device in the treatment of obstructive sleep apnea syndrome (OSAS). Obstructive sleep apnea syndrome (OSAS) is a respiratory function disorder that affects approximately 2% of children aged 3–5 years. Treatment of this problem is commonly addressed in a pediatric patient with mandibular advancement devices (MAD) or, when necessary, rapid maxillary expansion (RME) treatment. However, in younger patients, mandibular advancement devices are not easy to wear because of the poor mechanical retention of deciduous teeth. The new Herbst was used on a 3-year-old and 2-month-old child with instrumentally confirmed severe OSAS (AHI 9). It was decided to apply a removable appliance that, by promoting mandibular advancement, would increase the retropharyngeal airspace. This choice also seemed justified in relation to the child's obvious class II skeletal malocclusion. Clinical examination revealed the presence of an 11-mm overjet, severe class II relations between deciduous molars, and poor sagittal projection of the chin. It was decided to apply a Herbst appliance, modified and adapted to the needs of the young patient, using a high-retention elastomeric resin (SRIvocap Elastomer, Ivoclar Vivadent) and metal bars connection to force mandibular protrusion. Night-time use of the appliance was prescribed and a schedule of periodic recalls was set. Six months after application of the new device, there was a reduction in nocturnal apnoeic episodes and improvement in snoring (AHI 2). Orthodontically, these results were associated with complete resolution of the class II problem with correction of the molar relation, improvement of the overjet and overbite, and aesthetic advancement of the mandible. The proposed device proved to be very stable in the oral cavity and interesting because it can improve, if not solve, both skeletal and respiratory problems. Because it is a removable device, it requires good cooperation, aided by the little discomfort felt by the patient. Elastomeric resin represents an excellent material for the construction of Herbst's removable device in young OSAS patients. This type of material allows an earlier start of treatment, as it overcomes the problem of poor retention on deciduous teeth.