Pacific Coast Society of Orthodontists Bulletin Summer 2020 - 42

Let's Talk About That

mately 1 year, with the comprehensive treatment
lasting about 24 months.
6. What is done at each appointment during
this treatment? I like the MARA because at each
appointment I can take out the "elbows" to see
what the bite is like without the ramps in place.
This was much more difficult with the Herbst. It
also allows me to possibly leave the elbows out
completely for a month just to make sure we
have a stable result prior to taking the MARA appliance off completely. I only do this on patients
who might need more time in the MARA. Besides
removing the elbows and adding more shims to
move the mandible forward either symmetrically
or asymmetrically as needed, we also do wire
changes at each appointment.
7. What will your occlusal treatment goal be?
I treat to an ideal overjet and overbite. I do not
find the need to treat to edge-to-edge or negative
overjet.
8. If using two-phase treatment, how do you
retain between phases? N/A
9. If using two phases, how do you approach
Phase II? What appliances and auxiliaries do you
use? See my answer to Question 2.
10. What type of retention do you employ at the
end of treatment? Standard maxillary Hawley at
night, maxillary Essix for daytime, and a mandibular fixed retainer.
11. What are the shortcomings or possible complications of the appliance you are using, and
how do you handle them? It takes some effort to
become proficient with the MARA appliance. That
being said, the comfort level for patients (relative
to the Herbst) makes the effort well worth it. As
with any fixed appliance, we rely on the patients
to not abuse it. A significant majority of the patients do not have breakage problems, but there
are those memorable few who seem to not adapt
well to functioning with the mandible forward.

42	

They are most likely to present with the elbows
bent buccally. Removal of the appliance seems
to be a worry for my UCLA residents. But after
doing it once, they see it's an easy appliance to
remove. Once removed, there is almost certainly a
transient posterior open bite (due to the stainless-steel crowns on the first molars). This does
not persist after leveling the posterior teeth after
removal.
Dr. Bill Dischinger discusses the Herbst appliance
	
Dr. Bill Dischinger
maintains private practices
in Lake Oswego and Canby,
Oregon. He is an adjunct
professor at the University
of the Pacific Department
of Orthodontics in San
Francisco, California. Dr.
Dischinger has published
numerous articles and
written a book on a variety of subjects within the
specialty of orthodontics. Dr. Dischinger completed
his dental training at Oregon Health Sciences
University in 1997 and his orthodontic residency at
Tufts University in Boston in 1999. He and his wife,
Kari Lynn, have been married for more than 25
years and have four sons. He is a Key Opinion
Leader for both Ormco and Propel Orthodontics.
1. When is the ideal time to start treatment when
using your appliance? I typically want the second
molars erupted before beginning treatment but
I don't wait much past about 13.5 years of age,
as I like to help these patients be finished before
high school or early in high school if possible. So
for this patient, most likely we are ready to start
treatment or getting pretty close.
2. Would you use a one-phase or two-phase
treatment? This would definitely be a one-phase
treatment in our office at this age.
3. Which appliance would you use? Please be
specific, including any teeth to be bracketed. For
a Class II with a skeletally retruded mandible, I

PCSO Bulletin    Summer 2020



Pacific Coast Society of Orthodontists Bulletin Summer 2020

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