What Causes a Class II Overbite
Most Class II overbites are not caused by upper teeth that stick out. They are caused by a lower jaw that sits too far back. The upper front teeth appear to protrude, the chin looks recessed, and the bite does not fit together properly. Roughly one in four orthodontic patients presents with this pattern.
In growing children and teens, the lower jaw can be encouraged to advance with a fixed jaw-advancing appliance such as the MARA or Herbst, or with the Angel A6 clear aligner system. The correction targets the underlying skeletal cause rather than masking it with tooth-only movement that tends to relapse.
A recessed lower jaw also shifts the tongue base posteriorly into the airway, which is why children with significant overbites often snore or mouth-breathe. Advancing the jaw improves the bite and the airway dimension at the same time.
The earlier the pattern is identified, ideally by the AAO-recommended age 7 evaluation, the more growth potential remains for skeletal redirection.
Functional Appliances for Jaw Advancement
Limestone Hills offers four jaw-advancement options covering the age range from primary dentition through early adulthood. The right choice depends on age, growth stage, severity, vertical pattern (gummy versus normal smile line), and whether the patient still has baby teeth.
| Appliance | How It Works | Skeletal Correction | Best Age | Comfort | Cost at Limestone Hills |
|---|---|---|---|---|---|
| MARA (Practice Standard) |
Elbow connectors on molar crowns hold the lower jaw forward continuously. | Yes, skeletal + dental | 11 to 14 | Most comfortable fixed option | +$1,000 add-on to braces |
| Herbst |
Telescoping pistons push the jaw forward and add a vertical intrusive force.
|
Yes, skeletal + dental
|
11 to 14
|
Bulkier than MARA, more cheek irritation | +$1,000 add-on to braces |
| Angel A6 (Clear Aligner) |
Clear aligners with built-in advancement blocks guide the lower jaw forward while also aligning teeth.
|
Yes, skeletal + dental
|
8 to 12 (still in baby teeth)
|
Removable, no metal | Included in Angel comprehensive aligner fee |
| Forsus Springs |
Spring rod from the molar to the archwire works like a built-in Class II elastic with an intrusive component.
|
No, dental movement only
|
12+ (mild cases)
|
Moderate | Included with braces fee |
| Carriere Motion (Not Offered) |
Distalizer with elastics worn before braces are placed.
|
No, dental movement only
|
11+
|
Requires high compliance | Not offered (see explanation below) |
Why not Carriere Motion
Herbst vs. MARA: How Limestone Hills Orthodontics Chooses
The MARA and Herbst both produce skeletal correction. The choice between them comes down to comfort, smile pattern, and durability.
MARA: Limestone Hills Default
Herbst: Selected for Gummy-Smile Cases
In a patient who already shows more gum than normal when smiling, this intrusive component helps prevent the gummy pattern from worsening during treatment.
The Herbst is bulkier than the MARA and carries a higher rate of component breakage, so the practice reserves it for cases where the smile-line advantage outweighs the comfort tradeoff.
The CBCT scan and clinical photos at the consultation show the smile-line pattern in three dimensions. Dr. Viecilli explains the tradeoff in plain language at the treatment-plan meeting before any appliance is ordered.
Fixed vs. Removable: Why Limestone Hills Orthodontics Uses Fixed Correctors First
For older children and teens with permanent teeth, Limestone Hills uses fixed appliances (MARA or Herbst) rather than removable functional appliances such as the Bionator or Activator. The reason is biomechanical and compliance-based.
Continuous force matters more than peak force: Skeletal correction depends on the total duration of forward jaw positioning during the growth spurt. A removable appliance worn 14 to 16 hours per day delivers force only when the patient remembers to wear it. A fixed appliance delivers force every minute the teeth are touching.
The MARA and Herbst are working during meals, during school, and during sleep. The total effective wear time is roughly double a compliant removable appliance and three to four times a typical removable appliance with normal teen compliance patterns.
Younger patients still in primary dentition are not candidates for fixed appliances cemented to first molars (the molars have not erupted enough or are still primary). For ages 8 to 12 with baby teeth or mixed dentition, Limestone Hills uses the Angel A6 clear aligner system.
Aligners are worn 22 hours per day with good compliance because the patient sees the appliance as braces equivalent rather than as a bulky retainer. Lost sets are replaced at the next appointment with the next set in the sequence, rather than a 2 to 4 week lab fabrication delay.
Timing: The Growth Window That Makes These Appliances Work
Skeletal jaw advancement only works during active growth. The mandibular condyle, which is the growth plate that allows the lower jaw to lengthen, is most responsive to forward positioning during the pre-pubertal and pubertal growth spurt. After growth slows, the same appliance produces tooth movement instead of skeletal change.
| Age Range | Recommended Appliance | Expected Skeletal Response |
|---|---|---|
| 8 to 10 (baby teeth, mixed dentition) | Angel A6 mandibular advancement | There is high growth potential, and full-time aligner wear delivers continuous force. |
| 11 to 14 (permanent teeth, growth spurt) |
MARA (default) or Herbst (gummy-smile cases)
|
High; this is the highest-leverage window for fixed jaw-advancing appliances.
|
| 15 to 17 (late growth) |
MARA case-by-case
|
Moderate; CBCT confirms whether residual condylar growth is available before recommending the appliance.
|
| 18+ (post-growth) |
Surgical correction or camouflage with elastics and TADs
|
Low; appliance produces dental movement only. Skeletal correction in adults requires orthognathic surgery.
|
Why Limestone Hills wait for a full-size stainless steel archwire before activating the appliance
The MARA, Herbst, and Forsus all push the lower jaw forward, and that force travels through the lower teeth before reaching the jaw.
If the braces’ archwire is too thin and flexible, the lower front teeth tip forward instead of the jaw moving. This is called incisor proclination, and it undermines the skeletal correction.
Dr. Viecilli activates these appliances only when the patient reaches a full-size .019 by .025-inch stainless steel archwire in a .022-inch bracket slot. The wire is rigid enough to hold the front teeth in position, so the correction occurs at the jaw and not at the teeth.
This typically requires four to six months of initial alignment before the appliance is placed.
Daily Experience: Eating, Speech, and Hygiene
Most patients describe a heavy, tight feeling in the lower jaw for the first three to five days after MARA or Herbst activation. Acetaminophen handles the discomfort. Eating returns to normal within one to two weeks as the muscles adapt to the new closed-bite position.
Eating
Soft foods for the first week. Avoid sticky candy, ice, hard nuts, popcorn kernels, and chewy meats that could dislodge a crown or bend a piston rod. Once the appliance is settled, the patient returns to a normal diet with the same restrictions as braces.
Speech
Most patients adapt to the appliance with no noticeable speech change after the first week. Reading aloud at home accelerates tongue adaptation.
Hygiene
Brushing technique matters more than usual. The metal components around the molars trap plaque if not cleaned thoroughly. Limestone Hills demonstrates the brushing routine at placement and reviews it at every check-in visit. A water flosser is recommended for patients with bands or crowns on the molars.
Activities
Sports and music continue normally. Wind-instrument players adapt to the appliance within a week or two. A custom mouthguard is recommended for contact sports; the front desk has the mold-and-ship instructions.
Cost, Insurance, and Financing
MARA
Herbst
Angel A6 Mandibular Advancement
Forsus Springs
The MARA or Herbst fee covers custom crown fabrication, the connector or piston components, placement, and all adjustments through active treatment. The fee is added to the comprehensive braces case rather than billed as a separate treatment.
Most PPO orthodontic benefits apply to the comprehensive case the appliance attaches to. Limestone Hills offers OrthoSync 0% in-house financing with $600 down for jaw-advancement cases, CareCredit with approved credit, Cherry with $189.99 down and a soft credit pull, and a 3% pay-in-full discount.
Community discounts (military, teachers, first responders, healthcare workers, family) apply when the appliance is part of a comprehensive plan. The free CBCT scan at consultation produces a written treatment-fee estimate before any commitment.
Frequently Asked Questions
What is the difference between MARA, Herbst, Forsus, and Angel A6?
Forsus springs deliver Class II force through the existing braces but produce dental movement only, not skeletal change, and they are reserved for milder cases. Angel A6 uses clear aligners with built-in advancement blocks for younger patients still in baby teeth, where fixed appliances are not candidates.
Why does Dr. Viecilli prefer the MARA?
The Herbst remains the right choice when the patient presents with a gummy smile that needs the intrusive force the piston design produces.
Will my child still need braces after the MARA or Herbst?
The braces are placed first (4 to 6 months of initial alignment to build up to a full-size stainless steel archwire), then the MARA or Herbst is activated for 9 to 12 months of active correction, then the appliance is removed and braces continue for 3 to 6 months of finishing. Total treatment runs 18 to 24 months end-to-end.
How often are check-in visits during treatment?
How much does it cost?
Community discounts apply when the appliance is part of a comprehensive plan. OrthoSync 0% in-house financing is available with $600 down.