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Lorenzoni DC, Barbosa OTDAM, Cury-Saramago ADA, Mattos CT. Class II subdivision treatment and stability with asymmetric Herbst appliance: A case report. Int Orthod 2024; 22:100838. [PMID: 38290193 DOI: 10.1016/j.ortho.2023.100838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 02/01/2024]
Abstract
Non-surgical treatment of Class II subdivision may involve complex mechanics or asymmetric tooth extraction in its resolution. This report demonstrates the result and the short-term stability of Class II subdivision treated with asymmetrically installed Herbst appliance followed by conventional fixed orthodontic appliance. The approach allowed the correction of the unilateral Class II molar relationship and increased overjet, as well as the deviation of dental midlines, with improvement in lip posture and facial profile. The results remained stable two years after treatment, confirming the treatment success.
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Affiliation(s)
- Diego Coelho Lorenzoni
- Departamento de Odontoclínica, Disciplina de Ortodontia, Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, RJ, Brazil.
| | | | | | - Cláudia Trindade Mattos
- Departamento de Odontoclínica, Disciplina de Ortodontia, Faculdade de Odontologia, Universidade Federal Fluminense, Niterói, RJ, Brazil
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Manni A, Boggio A, Gastaldi G, Cozzani M. Is significant mandibular advancement possible after the peak of puberty? Dento-osseous palatal expansion and the STM4 technique (Skeletal Therapy Manni Telescopic Herbst 4 miniscrews): A case report. Int Orthod 2024; 22:100868. [PMID: 38471383 DOI: 10.1016/j.ortho.2024.100868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Treatment of skeletal class II growing patients often requires the use of functional appliances, aimed at promoting mandibular advancement. Among these, Herbst appliance is recommended for its effectiveness, efficiency, and reduced need for compliance. Despite its skeletal favourable effects, well-known dental compensations can occur, especially when the appliance is not used close to the pubertal peak: upper incisors retroclination, lower incisors proclination, upper molars distalization and lower molars mesialization could reduce the overjet needed for a proper mandibular advancement. To counteract these unfavourable effects skeletal anchorage could be crucial. AIM The aim of this case report is to describe and evaluate the effects of using a skeletally anchored Herbst appliance in an 18-year-old (CVM5) male patient with skeletal Class II malocclusion and a convex profile. TREATMENT PROTOCOL The treatment started with a tooth-bone-borne palatal expansion, then the upper arch was bonded with pre-adjusted ceramic brackets. After 2months, a Manni Telescopic Herbst (MTH) supported by 4 miniscrews (two in the maxilla and two in the mandible) was applied. To avoid anchorage loss, TADs were connected with elastic chains to the arches. Nine months later, the Herbst was removed, the lower teeth were bonded and the patient wore class 2 elastics to stabilise the occlusion. RESULTS AND CONCLUSIONS After 24months the treatment goal was achieved with a considerable improvement of the profile and a clinically significant mandibular advancement (Pogonion moved forward 7mm). A one-year follow-up lateral X-rays showed a good stability of the result.
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Affiliation(s)
- Antonio Manni
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; Istituto Giuseppe Cozzani, La Spezia, Italy
| | - Andrea Boggio
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; Istituto Giuseppe Cozzani, La Spezia, Italy.
| | - Giorgio Gastaldi
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Cozzani
- Postgraduate Program in Orthodontics, Vita-Salute San Raffaele University, Milan, Italy; Istituto Giuseppe Cozzani, La Spezia, Italy
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Manni A, Migliorati M, Boggio A, Drago S, Paggi E, Calzolari C, Gastaldi G, Cozzani M. Evaluation of the Co-Go-Me angle as a predictor in Class II patients treated with Herbst appliance and skeletal anchorage: a retrospective cohort study. FRONTIERS IN ORAL HEALTH 2024; 5:1389628. [PMID: 38745852 PMCID: PMC11091312 DOI: 10.3389/froh.2024.1389628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction A condylion-gonion-menton (Co-Go-Me) angle threshold of 125.5° has been introduced as a predictive parameter of cephalometric mandibular response in the orthopedic treatment of growing Class II patients with functional appliances, despite some contradictions in the literature. Considering the lack of studies evaluating the role of skeletal anchorage, this study aims to reassess the threshold of 125.5° in the Co-Go-Me angle as a useful predictor in growing skeletal Class II patients treated with acrylic splint Herbst appliance and two mini-screws in the lower arch (STM2). Methods Thirty-five consecutively treated patients (20 males, 15 females; mean age, 11.37 years) with mandibular retrusion were classified into two groups according to their Co-Go-Me baseline values (Group 1, <125.5°; Group 2, >125.5°). The STM2 protocol involved the use of the MTH Herbst appliance with an acrylic splint in the lower arch and two interradicular mini-screws as anchorage reinforcement. Cephalometric analysis was performed by the same operator for each patient at baseline (T0) and at the end of the Herbst phase (T1). The effects of time and group on the variables were assessed by a repeated-measures analysis of variance. The primary research outcome was the difference between the groups in terms of mandibular responsiveness to treatment referred to as the relative difference (T1-T0) in Co_Gn. Results The mean duration of the treatment was 9.5 months. No statistically significant differences between groups were detected at baseline, except from the expected SN/GoMe° (p < 0.001) and Co-Go mm (p = 0.028). No statistically significant changes between groups, which were caused by the treatment, were found considering the mandibular sagittal and vertical skeletal parameters. Similarly, no statistically significant differences were found in the dental changes between the high-angle and low-angle patients, apart from the upper molar sagittal position (p = 0.013). Discussion and conclusions The 125.5° threshold in the Co-Go-Me value was not a reliable predictive parameter for the mandibular response in growing patients treated with the MTH Herbst appliance and lower skeletal anchorage. Due to its effective control in the sagittal and vertical planes, the STM2 technique might be an appropriate protocol to use in treating skeletal Class II patients, regardless of the growth pattern.
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Affiliation(s)
- Antonio Manni
- Department of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Istituto Giuseppe Cozzani, La Spezia, Italy
| | - Marco Migliorati
- Department of Integrated Diagnostic and Surgical Sciences, University of Genoa, Genoa, Italy
| | - Andrea Boggio
- Department of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Istituto Giuseppe Cozzani, La Spezia, Italy
| | - Sara Drago
- Department of Integrated Diagnostic and Surgical Sciences, University of Genoa, Genoa, Italy
| | - Elena Paggi
- Department of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Istituto Giuseppe Cozzani, La Spezia, Italy
| | - Chiara Calzolari
- Department of Integrated Diagnostic and Surgical Sciences, University of Genoa, Genoa, Italy
| | - Giorgio Gastaldi
- Department of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
| | - Mauro Cozzani
- Department of Dentistry, Vita-Salute San Raffaele University, Milan, Italy
- Istituto Giuseppe Cozzani, La Spezia, Italy
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Shimoyama M, Kanzaki H, Tohyama S, Ida T, Ishikawa M, Katsumata Y, Arai C, Wada S, Manase S, Tomonari H. Mandibular Endochondral Growth Is Specifically Augmented by Nutritional Supplementation with Myo-Inositol Even in Rabbits. Dent J (Basel) 2024; 12:49. [PMID: 38534273 DOI: 10.3390/dj12030049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Mandibular retrognathism occurs by insufficient mandibular growth and causes several issues, such as respiratory difficulty and diminished masticatory function. At present, functional orthodontic appliances are used for stimulating mandibular growth in pediatric cases. However, the effectiveness of functional appliances is not always stable in daily practices. A more effective, reliable, and safer therapeutic method for mandibular growth promotion would be helpful for growing mandibular retrognathism patients. As we previously discovered that nutritional supplementation of myo-inositol in growing mice specifically increases mandibular endochondral growth, we performed preclinical animal experiments in rabbits in this study. Briefly, six-week-old male Japanese white rabbits were fed with or without myo-inositol supplementation in laboratory chow until 25 weeks old, and 3D image analysis using micro CT data and histological examinations was done. Myo-inositol had no systemic effect, such as femur length, though myo-inositol specifically augmented the mandibular growth. Myo-inositol increased the thickness of mandibular condylar cartilage. We discovered that the nutritional supplementation of myo-inositol during the growth period specifically augmented mandibular growth without any systemic influence, even in rabbits. Our results suggest the possibility of clinical use of myo-inositol for augmentation of the mandibular growth in growing mandibular retrognathism patients in the future.
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Affiliation(s)
- Miho Shimoyama
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Hiroyuki Kanzaki
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Syunnosuke Tohyama
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Tomomi Ida
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Misao Ishikawa
- Department of Anatomy, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Yuta Katsumata
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Chihiro Arai
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Satoshi Wada
- Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Kanazawa 920-0293, Japan
| | - Shugo Manase
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
| | - Hiroshi Tomonari
- Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan
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The Use of TADs in the Mandibular Arch to Prevent Proclination of the Lower Incisors during the Use of the Mini Scope Herbst Appliance. Case Rep Dent 2022; 2022:9144900. [PMID: 36276238 PMCID: PMC9581635 DOI: 10.1155/2022/9144900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/12/2022] [Indexed: 11/17/2022] Open
Abstract
Class II malocclusions are the most frequent within the Italian population. Normally, these malocclusions are caused by a reduction in a mandibular component whose functional stimulus is still very much cause for debate. The negative effect of all types of Class II functional appliances is in the proclination of the lower incisors, which, in subjects whose incisors are already labially inclined, must be checked at all times to avoid serious consequences to these elements. In this case study, a girl aged 14 years and 5 months presented with Class II malocclusion, 2nd division with a convex profile and a visibly retruded chin. The lower incisors presented a marked proclination (-1/Go-Gn ini = 107.7°) in a brachyfacial patient. To avoid further inclination of the lower incisors a Herbst appliance was mounted in two separate sittings. The first part of the appliance including the tubes was mounted to the upper jaw allowing the vestibularisation of the upper incisors in order to increase the overjet. Once this was obtained the lower part of the appliance was mounted together with the telescopic arms associated with two temporary anchorage devices (TADs) in positions 36-37 and 46-47, and an anterior section 33-43 with distal loop to which two double metallic ligatures were anchored at the TADs to contrast the negative effect of the appliance. At the end of the first functional phase, the treatment was refined using MBK fixed therapy to finish the case. The orthodontic therapy led to a visible improvement of the profile and the achievement of a first-class dental-skeletal result on both sides. From the cephalometric evaluation carried out immediately after the Herbst appliance treatment at time T1 and at the end of the orthodontic therapy T2 it was possible to verify a slight increase in the inclination of the lower incisors (-1/Go-Gn fin = 108°). In conclusion, it can be said that the use of the skeletal anchorage avoided, in this case, the proclination effect in the lower incisors due to the use of a Herbst appliance.
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Manni A, Papi G, Migliorati M. Six years long term evaluation of a class II division 1 patient treated with Herbst appliance and 2 miniscrews in the lower arch as anchorage reinforcement: A case report. Int Orthod 2022; 20:100642. [DOI: 10.1016/j.ortho.2022.100642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/30/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022]
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Papageorgiou SN. On analysing clinical trial data using the change from baseline. J Orthod 2021; 48:451-454. [PMID: 34873949 PMCID: PMC8652353 DOI: 10.1177/14653125211059544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Spyridon N Papageorgiou
- Clinic of Orthodontics and Pediatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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