Innovation at Arm’s Length

by Barry Chase, DDS

Over many years of practicing dental sleep medicine, I have become a big proponent of the Herbst appliance to treat Obstructive Sleep Apnea. It is indicated for a wide swath of the patient population including bruxers, people with significant opening, and those with extensive protrusive ranges of motion. I’ve always felt that Herbst arms have been the “weak link” because they break, they don’t maintain position over time, and it’s been mind-numbingly difficult to accurately titrate the bilateral arms.

Recently, Whole You™ offered a redesigned Herbst arm called the Respire Pink AT™ (Advanced Titration). I participated in their beta test and below are some of my experiences with this new game-changing innovation.

• Arms positioned parallel to the plane of occlusion. My experience is that this position reduces the vertical opening of the mandible requiring less use of elastics to maintain lip closure and promote nasal breathing. This positioning also places the connecting screws such that they do not rub the commissure of the lips or irritate the buccal mucosa of the cheeks. It might not seem like a big deal but it is.
• Rear access in the arm for insertion of new titration key. Both arms are adjusted in the same direction without removing and reinserting the key, which has a large, easy to grasp handle. This makes the Respire Pink AT™ arm less awkward and much easier to adjust than the traditional Herbst arms. The special titration key fits deeply and securely into the arm. Overall, the adjustments are a tremendous improvement over the old style Herbst arms.
• Visual measurement scale on the arm. Generally, I do not give the advancement tool to the patient so I can appropriately advance and record the adjustment. Recording the advancement is now much more accurate. I always found it annoying and distracting to count the turns as I inserted and removed the little metal keys to make adjustments. It makes telemedicine appointments much easier with the visual indicators of the measurement scale.
• 7 mm total advancement with only 4 turns for 1mm. The Respire Pink AT™ allows a total of 7mm of protrusion. This means I can request the lab to preset the arm at +1 mm, which allows me to reduce the mandibular position upon insert if needed, and still offer 6mm of additional advancement. This results in fewer resets and less likelihood of being overly aggressive with starting positions.
• Advancements allow for stress-free adjustment virtually or chairside. In the new world of dental telemedicine, the Respire Pink AT™ arm now makes it possible and easier for patients to adjust the device, which can be guided by the dentist more accurately using the measurement scale on the arm. The arms move the same way on each side which makes it more intuitive for the patient. The measurement scale depicts exactly what position the patient is in, and the new key makes it much easier to ajust the device, making it ideal for telemedicine.

The Respire Pink AT™ has now become my go-to when ordering Herbst oral appliances. Overall patient comfort is improved, horizontal adjustments are easier and more precisely calibrated, and it gives me extra adjustment capacity compared to the traditional pin-in-the-cylinder styles. I highly recommend trying the Respire Pink AT™ on your next few Herbst orders. I am confident you will find it a vast improvement and a welcomed innovation.