The Herbst appliance updated.

The aim of this paper is to analyze the evolution that the Herbst appliance has experienced in the last 30 years. In particular the different designs proposed for the Herbst appliance are examined and the related differences in clinical management, indications, and treatment effects are also illustrated. The two major challenges in the clinical management of the Herbst appliance are represented by the choice of the type of stabilization and by the control of the proclination of the lower incisors. The use of acrylic splints presents a set of relevant advantages: the construction technique is simple, the appliance can be worn easily by the patients, and the height of the splint can be adjusted to the growth pattern. Moreover, the acrylic splint Herbst can be used to reposition the mandible in cases with temporomandibular disorders. As for the proclination of the lower incisors, an accurate assessment of the neuromuscular pattern of the individual patient before treatment can provide the clinician with reliable criteria to evaluate the risk for incisor proclination during Herbst therapy.