Mandibular incisor position changes in relation to amount of bite jumping during Herbst/multibracket appliance treatment: a radiographic-cephalometric study

Evaluating the Effects of Carriere Motion Appliance and Twin Block Appliances in Class II Correction-A Retrospective Study

This retrospective study compared Class II orthodontic non-extraction treatment using Carriere Motion Appliance (CMA) and Twin Block (TB) appliances.

METHODS

The treatment of 38 patients was assessed. Pre- and post-treatment cephalometric radiographs were analyzed to evaluate skeletal, dental, and soft tissue treatment outcomes and efficacy.

RESULTS

Both appliances effectively corrected the Class II molar relationship. When measured at the distal aspect of the first molar, TB achieved 4.22 mm, while CMA had a 2.55 mm correction. When measured in the mesial aspect, the CMA achieved a 3.9 mm correction. The changes in SNB and ANB were statistically significant only in the TB group. The CMA appliance demonstrated statistically significantly less protrusion of the mandibular incisors and less upper incisor retrusion without vertical changes compared to the TB appliance. The TB demonstrated statistically significant lower lip protrusion compared to the CMA.

CONCLUSION

The CMA corrects Class II malocclusions only by exerting a dentoalveolar influence and does not demonstrate the added effects associated with TB, such as elongation of lower facial height (LFH) and less loss of lower anchorage. Nonetheless, the correction in the TB group comprised both dentoalveolar and skeletal components. The CMA promotes a multidirectional upper and lower molar movement, and despite our 2D cephalometric analysis, we were able to estimate the extent of upper molar derotation.

Efficacy of an innovative Herbst appliance with TADs for patients with hyperdivergent class II malocclusion: study protocol for a randomised controlled trial

INTRODUCTION

Class II treatment with mandibular retrusion often involves the Herbst appliance due to its efficiency and low requirement of cooperation. Despite its advantages, it causes side effects concerning the occlusal plane and pogonion in terms of clockwise rotation that hinder the desired mandibular advancement for hyperdivergent patients. In this study, we will use a newly designed Herbst appliance, and a protocol that is accompanied by TADs for vertical control to avoid maxillary clockwise rotation. We hypothesise that the effect of the Herbst appliance with the vertical control approach will be beneficial for maintaining or even decreasing the skeletal divergence in hyperdivergent class II patients compared with conventional Herbst treatment.

METHODS AND ANALYSIS

This study is a randomised, parallel, prospective controlled trial that will study the efficacy of Herbst with or without vertical control in children with hyperdivergent skeletal class II malocclusion. A total of 44 patients will be enrolled and randomised in a ratio of 1:1 to either Herbst treatment or Herbst treatment with vertical control. Participants will be recruited at the Shanghai Stomatological Hospital, Shanghai, China. The primary endpoint is the change in the angle indicating the occlusal plane and Sella-Nasion plane from baseline (T0) to the primary endpoint (T2) on cephalometric measurements by lateral X-ray examination. Important secondary outcomes include the root length of the anterior teeth, and the assessment score of the Visual Analogue Scale Questionnaire, etc. Safety endpoints will also be evaluated.

ETHICS AND DISSEMINATION

This study has been approved by the ethics committee of the Shanghai Stomatological Hospital (Approval No. (2021) 012). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ChiCTR2100049860, Chinese Clinical Trial Registry.

Changes in the craniofacial structures and esthetic perceptions of soft-tissue profile alterations after distalization and Herbst appliance treatment

INTRODUCTION

The purpose of this prospective clinical trial is to evaluate the changes of soft tissues and designate the esthetic perceptions of children with Class II malocclusion after Herbst appliance therapy and maxillary molar distalization using stereophotogrammetry.

METHODS

Thirty patients were allocated either to Herbst (6 boys and 9 girls; mean age = 11.60 ± 0.82 years) or distalization (4 boys and 11 girls; mean age = 11.46 ± 1.30 years) groups. Dentoskeletal and soft-tissue treatment changes were examined objectively by cephalometric analysis and stereophotogrammetry, respectively. Pre- and posttreatment profile views were evaluated subjectively by orthodontists and laypeople using the 7-point Likert scale. Intra- and intergroup comparisons for the repeated measurements were performed with 2-way variance analysis. Bonferroni test was used for multiple comparisons (P ≤0.05).

RESULTS

Greater skeletal changes were observed in the Herbst group than in the distalization group. Maxillary incisor retrusion and mandibular incisor protrusion were observed in the distalization and Herbst groups, respectively. Stereophotogrammetric measurements showed that mandibular body length and lower and anterior facial height increased in both treatment groups. Convexity angle (P = 0.020) and labiomental angle (P = 0.033) were greater in the Herbst group than the distalization group.

CONCLUSIONS

The skeletal contribution to correction of maxillomandibular discrepancy was greater in the Herbst group than the distalization group. Significant profile improvements were recorded for both groups with treatment. After both treatments, orthodontists were found to have higher rates of detection in the profiles than laypeople. The esthetic contribution of treatments to the facial profile was found similar in both groups.

Treatment Effects of the Herbst Appliance in Class II Malocclusion Patients after the Growth Peak

OBJECTIVE

 The aim of this study was to evaluate dentoskeletal changes in the treatment of Class II malocclusion with the Herbst Cantilever Bite Jumper (CBJ) appliance, associated with multibracket appliances after the growth peak, at pretreatment.

MATERIALS AND METHODS

 A sample of 37 individuals was divided into two groups: the experimental group comprised 16 patients treated consecutively for a mean period of 2.52 years with the Herbst CBJ appliance associated with multibracket appliances. A total of 21 subjects (10 males and 11 females) with Class II malocclusion and mean age at T1 of 16.08 years were followed for a mean period of 2.12 years composed the control group. Comparisons between the two groups were performed using initial and final lateral cephalograms. Comparisons between experimental and control groups at pretreatment and of the treatment changes were performed by Mann-Whitney or independent t-tests.

RESULTS

 Experimental group exhibited a significantly greater labial inclination of the mandibular incisors in comparison to the control group. Additionally, significantly greater corrections in overbite, overjet, and molar relationship were observed in the experimental than in the control groups.

CONCLUSION

 The effects of the Herbst CBJ appliance, associated with fixed appliances after the growth peak in Class II malocclusion treatment are correction in molar relationship toward a Class I relationship, decrease of the overjet, decrease of the overbite, and mandibular incisors labial inclination.

Stepwise versus single-step mandibular advancement with functional appliance in treating class II patients : A meta-analysis

BACKGROUND

Difference in the functional orthopedic effect between stepwise mandibular advancement (SWA) and single-step mandibular advancement (SSA) in Angle class II patients remains unclarified.

OBJECTIVE

To compare the treatment effects of SWA and SSA on skeletal and dentoalveolar changes in class II patients.

METHODS

Randomized controlled trials (RCTs) and nonrandomized studies that compared differences in skeletal and dentoalveolar effects on class II patients between SWA and SSA were identified in PubMed, Embase, CENTRAL, and Web of Science. The grey literature was also searched. The primary outcomes were the mandibular length, L1-MP, and (ANB). Secondary outcomes included Pog sagittal, SNB, overjet, and mandibular plane angle.

RESULTS

Seven studies, including three RCTs and four cohort studies, were retrieved. Meta-analyses revealed pooled mean differences (95% confidence interval) of 0.79 mm (0.45 to 1.12 mm) for Pog sagittal, 0.53° (0.19 to 0.87°) for SNB, -0.51° (-0.83 to -0.20°) for ANB, -0.17° (-0.72 to 0.39°) for the mandibular plane angle, -0.41 mm (-0.90 to 0.09 mm) for overjet, -1.87° (-3.23 to -0.52°) for L1-MP, and 1.03 mm (0.63 to 1.42 mm) for the mandibular length. Publication bias was not observed, except for Pog sagittal. The quality of evidence for each outcome was judged as low (mandibular length, SNB and overjet) and very low (Pog sagittal, ANB, L1-MP and mandibular plane angle).

CONCLUSIONS

Although the magnitude of differences in clinical practice was limited, SWA might be more appropriate because it produces a greater skeletal change and less dental compensation than SSA. As the level of current evidence is low, more high-quality RCTs are needed.

Three-dimensional comparison of the skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed appliances: A CBCT study

OBJECTIVES

To compare three-dimensional (3D) skeletal and dentoalveolar effects of the Herbst and Pendulum appliances followed by fixed orthodontic treatment in growing patients.

SETTING AND SAMPLE POPULATION

A sample of 35 adolescents with cone-beam computed tomography scans obtained prior to Herbst and Pendulum treatment (T1) and immediately after fixed appliance treatment (T2).

MATERIALS AND METHODS

Patients with Class II malocclusion was assessed retrospectively and divided into two treatment groups: Herbst group (n = 17, age: 12.0 ± 1.6 years) and Pendulum group (n = 18, age: 12.1 ± 1.5 years), with a mean treatment duration of 2.8 ± 0.8 years and 2.5 ± 0.7 years, respectively. Reconstructions of the maxillomandibular and dentoalveolar regions and data in 3D were obtained relative to cranial base, maxillary and mandibular regional superimpositions. Treatment outcomes (T2-T1) were compared between both groups using t tests for independent samples (P<.05).

RESULTS

Significant increase in mandibular length was observed in the Herbst group (7.3 ± 3.5 mm) relative to the Pendulum group (4.6 ± 4.5 mm). Inferior and anterior displacements of Pogonion were 2.2 mm and 1.6 mm greater in the Herbst group, respectively. The mesial displacement of the lower first molars was significantly greater in the Herbst group (1.9 mm). The upper first molars had contrasting results in sagittal displacement, with 0.6 ± 1.7 mm of distal displacement with the Pendulum and 1.4 ± 2.1 mm of mesial displacement with the Herbst. Lower incisor projection and proclination were similar between groups.

CONCLUSIONS

The Herbst and Pendulum appliances followed by comprehensive orthodontic treatment effectively corrected Class II malocclusion in growing patients, but with differing skeletal and dentoalveolar effects.

Twenty-year clinical experience with fixed functional appliances

Introduction:

Considering the large number of fixed functional appliances, choosing the best device for your patient is not an easy task.

Objective:

To describe the development of fixed functional appliances as well as our 20-year experience working with them.

Methods:

Fixed functional appliances are grouped into flexible, rigid and hybrid. They are different appliances, whose action is described here. Four clinical cases will be reported with a view to illustrating the different appliances.

Conclusions:

Rigid fixed functional appliances provide better skeletal results than flexible and hybrid ones. Flexible and hybrid appliances have similar effects to those produced by Class II elastics. They ultimately correct Class II with dentoalveolar changes. From a biomechanical standpoint, fixed functional appliances are more recommended to treat Class II in dolichofacial patients, in comparison to Class II elastics.

Dentoalveolar Evaluation of Lower Incisors by CBCT after Treatment with Herbst Appliance

Abstract This study aimed to evaluate the effects of the Herbst appliance on the proclination and protrusion of the lower incisors, and to verify if the device causes alveolar bone loss in the anterior region of the mandible. This is a retrospective study. The sample consisted of 35 individuals. The treatment group consisted of 22 individuals (8 girls and 14 boys; initial mean age of 8.2 years) who used the Cantilever Herbst appliance for a period of 12 months. The control group consisted of 13 individuals (3 girls and 10 boys; initial mean age of 8.9 years) who received no treatment and were followed up for a period of approximately 18 months. Cone-beam computed tomography scans were performed at the beginning and at the end of the observational period. The medullary bone thickness (MT), buccal cortical bone thickness (BCT), lingual cortical bone thickness (LCT), and lower incisors proclination and protrusion were evaluated. Data were submitted to statistical analysis (ANCOVA and Student’s t-test) with a significance level of 5%. There was no significant difference in MT, BCT, LCT and incisor proclination between groups. Incisor proclination increased in the treated group with no statistical significance. The treatment group showed a significant increase in the protrusion of the incisors (p = 0.02). The Herbst appliance promoted a small proclination and protrusion of the lower incisors, without relevant clinical implications. The Herbst appliance did not cause bone loss in the anterior region of the mandible during Class II treatment.

Herbst appliance with skeletal anchorage versus dental anchorage in adolescents with Class II malocclusion: study protocol for a randomised controlled trial

Background

The Herbst appliance is an orthodontic appliance that is used for the correction of class II malocclusion with skeletal discrepancies. Research has shown that this is effective. However, a potential harm is excessive protrusion of the lower front teeth. This is associated with gingival recession, loss of tooth support, and root resorption. This trial evaluates a method of reducing this problem.

Methods/Design

The study is a single-center, randomised, assessor-blinded, superiority clinical trial with parallel 1:1 allocation. Male and female young people (10–14 years old) with prominent front teeth (class II, division 1) will be treated in one orthodontic clinic. Group 1 will be treated with the conventional Herbst appliance with dental anchorage and group 2 with the Herbst appliance with indirect skeletal anchorage for 12 months. The primary objective will be to compare the proclination of the lower incisors between the Herbst appliance with dental anchorage and skeletal anchorage. Secondary objectives will be to evaluate the changes occurring between the groups in the mandible, maxilla, lower and upper molars, and in gingival recession and root resorption at the end of the treatment. Additionally, the young patient’s experience using the appliances will be assessed. The primary outcome measure will be the amount of lower incisor proclination at the end of treatment. This will be assessed by cone-beam computed tomography (CBCT) superimposition. Secondary outcome measures will be the changes in the mandible, maxilla, lower and upper molars at the end of treatment assessed by tomography superimposition and the young patient’s experience using the appliances assessed by self-reported questionnaires and semi-structured interviews. The randomisation method will be blocked randomisation, using software to generate a randomised list. The allocation concealment will be done in opaque envelopes numbered from 1 to 40 containing the treatment modality. The randomisation will be implemented by the secretary of the Department of Orthodontics of Rio de Janeiro State University before the beginning of the study. The patients and the orthodontists who will treat the patients cannot be blinded, as they will know the type of appliance used. The technician who will take the CBCT image and the data analyst will be blinded to patients’ group allocation.

Discussion

If this new intervention is effective, the findings can change orthodontic practice and may also be relevant to other forms of treatment in which appliances are fixed to the bones of the jaws. However, if the bone anchoring is not effective, the trial will provide much needed information on the use of this comparatively new development.

Trial registration

ClinicalTrials.gov, protocol ID: NCT0241812. Registered on 26 March 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2297-5) contains supplementary material, which is available to authorized users.

Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance

OBJECTIVE

To assess the types and frequencies of clinical complications experienced when using a modified lingual Herbst appliance and to compare these with those associated with conventional Herbst appliances reported in the literature.

METHODS

Treatment records for 35 consecutive subjects treated during the observation period from October 2013 to August 2014 who received a combination of a lingual appliance and a modified Herbst appliance (WIN, DW LingualSystems) were assessed for complications linked to Herbst treatment phase. Complications were analyzed descriptively, and complication-free intervals were calculated using Kaplan-Meier plots. To enable a comparison with data reported in the literature, the cumulative treatment time for all subjects was divided by the total number of complications.

RESULTS

71.4% of Herbst treatments were free from complications (n = 25). Complications were seen on 13 occasions (8 instances of Herbst attachment loosening, 5 L-Pin fractures). Most of these complications could be fixed chair side utilizing simple clinical measures. Considering all complications as identical statistical events, the percentage of treatments free from complications would be 88% for 100 days, 70% for 200 days and 56.8% for 300 days. For severe complications, the averaged complication-free treatment interval was found to be 27.8 months.

CONCLUSION

In terms of clinical sturdiness, and taking into consideration the step-wise mode of activation used here as well as the differences in the design of the various Herbst appliances, the WIN-Herbst appliance was found to be superior to comparable vestibular Herbst appliances, as well as the banded Herbst appliance belonging to the preceding generation of customized lingual systems. Success in treatment of non-compliant Angle Class II correction is considered to have better predictability using the modified anchorage strategy of the WIN-Herbst appliance.

Mandibular incisor inclination, tooth irregularity, and gingival recessions after Herbst therapy: a 32-year follow-up study

INTRODUCTION

The aim of this study was to analyze the very long-term results after Herbst treatment with respect to changes in the mandibular incisor segment: incisor inclination, incisor alignment, and gingival status.

METHODS

Fourteen patients were derived from a sample of 22 consecutive patients with Class II Division 1 malocclusions treated with the banded Herbst appliance. Intraoral photographs, mandibular dental casts, and lateral head films were analyzed from before (T1, age 12.5 years) and after (T2, age 14 years) treatment, and at 6 years (T3, age 20 years) and 32 years (T4, age 46 years) after treatment.

RESULTS

At T1, incisor inclination in the 14 subjects was, on average, 100.1°. From T1 to T2, the incisors were proclined in 11 (79%) of the 14 patients, with an average value of 5.2°. Maximum proclinations of 10° were found in 2 subjects. From T2 to T4, tooth inclination recovered completely in 7 (63%) of the 11 patients. Incisor irregularity values were, on average, 3.4 mm at T1 and 3.0 mm at T2. These increased from T2 to T4 by 40% and had an average value of 5.0 mm at T4. Clinically insignificant labial gingival recessions on single front teeth were registered in 1 subject at T2 and in 8 subjects at T4. Gingival recessions were seen especially on bodily displaced incisors.

CONCLUSIONS

In Herbst patients followed for 32 years after therapy, proclined mandibular incisors generally rebounded. The increase in posttreatment incisor tooth irregularity was not thought to be related to incisor tooth inclination changes but more likely resulted from physiologic processes occurring throughout life. Minor gingival recessions (especially on bodily displaced and crowded canines and incisors) seen in a few patients, 32 years after treatment, seemed not to be related to the posttreatment tooth inclination changes.

[Skeletal Class II treatment with the miniscrew-anchored Herbst]

No-compliance orthodontic treatment has recently become very popular. Unlike removable appliances requiring patient compliance, the Herbst appliance is a widely used fixed functional bite-jumping device generating predictable results in the treatment of skeletal class II malocclusions. The main problem associated with tooth-borne bite-jumping appliances is the generation of unavoidable dental movements, especially proclination of lower incisors, in addition to the skeletal effect. These dento-alveolar compensations can, when uncontrolled, compromise treatment results. This article describes two cases managed with a new treatment protocol based on the association of a modified Herbst appliance and temporary skeletal anchorage devices (TSADs) for efficient treatment of skeletal class II malocclusions.

Mini-implants and the efficiency of Herbst treatment: a preliminary study

Background

The purpose of this study is to present the use of a modified Herbst appliance in association with temporary anchorage devices (TADs) in order to enhance the correction of skeletal class II malocclusions.

Methods

Ten consecutive adolescents scheduled for Herbst treatment were assigned to two treatment groups. Five cases were treated with a modified miniscrew-supported Herbst appliance (experimental group (EG)) and five cases with a conventional cast Herbst appliance (control group (CG)). In all cases, the Herbst was kept in place for 9 months and was followed by fixed appliances until class I relationships were achieved. The initial (T1) and final (T2) lower incisor inclination on lateral headfilms were analyzed for each case, and the mean increase for the five EG patients and the five CG patients were compared.

Results

The mean increase in lower incisor inclination at the end of treatment was 1° (range 0° to 2°) for the EG and 7° (range 4° to 10°) for the CG.

Conclusions

The rational association of TADs with the Herbst appliance can optimize treatment efficiency and skeletal response by reducing the occurrence of excessive lower incisor proclination.