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 base appliance connected on each side by a telescoping tube and rod assembly that functions as a straight arm to hold your mandible as far forward as allowed by the setting of the telescopic assemblies, which is adjustable.  In this manner, the appliance provides a zone of absolute protection for a damaged TMJ, unlike the anti-retrusive ramps of joint protective stabilization appliances, which only protect the TMJs when you bite down far enough to engage their inclines.  

  

 

One advantage of telescopic appliances is that they distribute the forces needed to protect the TMJs evenly among all the upper and lower teeth, which  prevents sore teeth and unwanted tooth movement.  Another advantage of telescopic appliances is that they do not interference with tongue posture,  because the hardware is attached to the outside surfaces of the upper teeth, well away from any potential contact with the tongue.

 

 

 

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 gravity and bruxism pull it backward. In addition, telescopic appliances can 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 and redirect the forces 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 by rotating the components, as described in more detail in the file MULTI-LEVEL TREATMENT OF SLEEP APNEA under the FOR DOCTORS tab.  

  

COSTS

A telescopic appliance for TMJ treatment costs $2600.