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 finely adjustable.  In this manner, they provide 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 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 telescopic appliance for TMJ treatment costs $2500.