The Joint Protective Telescopic Appliance

Telescopic (AKA Herbst) appliances can provide even more protection for the TMJs than joint protective stabilization appliances, because they keep working even when the mouth is partly open.  A telescopic appliance is composed of an upper and a lower appliance connected on each side by a tube and rod (telescopic assembly) that acts like a straight arm to prevent the condyles from moving any further backward than the effective length of the tubes, which is adjustable.  In this manner, the telescopic assembly can provide a zone of absolute protection for a damaged TMJ, unlike anti-retrusive ramps, which only protect the TMJs when you bite down far enough to engage their inclines.  
 
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One advantage of telescopic appliances is that they distribute the forces needed to protect the TMJs evenly among all the upper and lower teeth.  All the lower teeth are pushed forward from all the upper teeth.  This feature prevents directional tooth pressures that can cause inadvertent tooth movement in single arch or partial coverage appliances.
 
Another advantage of telescopic appliances is that they do not interference with normal tongue posture, which would affect mandibular (lower jawbone) posture, because the telescoping mechanisms rest between the teeth and the cheeks, well away from any potential contact with the tongue, making the appliance surprisingly comfortable despite all the hardware it contains. Also, anything that interferes with tongue posture impairs healthy jaw posture by pushing it backward.
 
When telescopic appliances are used for TMJ protection, the telescopic components are not set to hold the mandible further forward than its natural bracing position, just to prevent it from retruding excessively during sleep when it is exposed to the forces of gravity pulling it backward.  In addition, telescopic appliances can also include a variety of different bite surfaces to create special orthopedic effects, such as pivoting to relieve inflammation or a flat front bite plate to reduce the force of nocturnal clenching or grinding. 
 
When telescopic appliances are used for treatment of obstructive sleep apnea, the telescopic components start with the mandible only slightly advanced and continue advancing gradually.  
  
COSTS
A basic telescopic appliance with microadjustable features, such as used for titration in treatment of obstructive sleep apnea, costs $1900.