The integrated Herbst appliance-treatment effects in a group of adolescent males with Class II malocclusions compared with growth changes in an untreated control group

Department of Orthodontics, University of Umeå, Sweden.
The European Journal of Orthodontics (Impact Factor: 1.39). 05/2008; 30(2):120-7. DOI: 10.1093/ejo/cjm102
Source: PubMed

ABSTRACT In this study, the effect of the integrated Herbst appliance (IHA) was examined in 30 Swedish males (mean age 14.2 +/- 0.96 years) with a Class II malocclusion. An evaluation of hand-wrist radiographs showed that the patients were in the maturation stages MP3-F, MP3-FG, or MP3-G at the start of treatment. The average treatment time with the Herbst mechanics was 0.7 years. Dentoskeletal and soft tissue parameters were analysed on lateral radiographic head films taken at the start and end of the IHA treatment. The pre- and post-Herbst values of a number of skeletal and dental variables in the treatment group were compared with the corresponding values in a group of untreated age-matched males with Class II malocclusions. Differences in the cephalometric measurements pre- and post-Herbst treatment were determined using paired t-tests. In general, the control group exhibited only minor or no changes during the period of observation, whereas treatment with the IHA resulted in statistically significant and favourable changes of the recorded variables. In the IHA patients, ANB angle was reduced on average by 2.1 degrees. However, a skeletal post-normality (ANB = 3.9 degrees) remained even though a Class I dental relationship had been obtained. In comparison with treatment effects achieved with other designs of Herbst appliances, some minor differences in the changes of the variables SNA and ML/NSL were noted in the present study. These differences could probably be attributed to the particular treatment protocol which was applied in the IHA treatments.

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    Emily Deen, Michael G Woods
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    ABSTRACT: Introduction: The present study involved an assessment of the effects of the Herbst appliance used for Class II correction in subjects with different vertical facial patterns. Methods: Pre-and post-treatment lateral cephalograms of 91 growing Class II patients were divided into three vertical facial groups on the basis of mandibular plane angulation. All received a Herbst appliance and dental and skeletal changes were assessed in relation to pretreatment incisal overbite, overjet and the stage of cervical maturity. Results: Herbst appliance treatment was accompanied by changes in the angulation of the upper and lower incisors, overjet reduction and an increase in mandibular length. In general, the rotational facial changes occurring during treatment were minimal, so that dolichofacial patterns remained long and brachyfacial patterns remained short. Conclusion: Herbst appliance treatment can be expected to result in considerable Class II dental correction. It is unlikely, however, that its use will be associated with clinically significant forward rotation in dolichofacial subjects. Since dolichofacial patterns are likely to remain long-faced, even after considerable Class II dental correction, orthognathic surgery may still be a consideration if normal facial proportions, without excessive facial convexity and lip strain, are treatment aims. (Aust Orthod J 2015; 31: 59–68)
    Australian orthodontic journal 06/2015; 31(1):59-68. · 0.27 Impact Factor
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    ABSTRACT: Summary Objective: To assess the treatment effects of fixed functional appliances (FFAs) in treated versus untreated Class II patients by means of lateral cephalometric radiographs. Search methods: Unrestricted electronic search of 18 databases and additional manual searches up to October 2014. Selection criteria: Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with FFAs and their matched untreated controls. Data collection and analysis: Skeletal, dental, and soft tissue cephalometric data were annualized and stratified according to the time of evaluation in effects. Following risk of bias evaluation, the mean differences (MDs) and 95 % confidence intervals (CIs) were calculated with random-effects models. Patient- and appliance-related subgroup analyses and sensitivity analyses were performed with mixed-effects models. Results: Nine studies were included (244 patients; mean age: 13.5 years and 174 untreated controls; mean age: 12.8 years) reporting on cephalometric effects directly after the removal of FFAs. FFAs were found to induce a small reduction of SNA angle (MD = −0.83 degree/year, 95 % CI: −1.17 to −0.48), a small increase of SNB angle (MD = 0.87 degree/year, 95 % CI: 0.30–1.43), and moderate decrease of ANB angle (MD = −1.74 degree/year, 95 % CI: −2.50 to −0.98) compared to untreated Class II patients. FFA treatment resulted in significant dentoalveolar and soft tissue changes. Several patient- or appliance-related factors seem to affect the treatment outcome. Long-term effectiveness of FFAs could not be assessed due to limited evidence. Conclusions: According to existing evidence, FFAs seem to be effective in improving Class II malocclusion in the short term, although their effects seem to be mainly dentoalveolar rather than skeletal.
    The European Journal of Orthodontics 05/2015; DOI:10.1093/ejo/cjv034 · 1.39 Impact Factor
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    ABSTRACT: The purpose of this study was to compare the effects of a differently designed functional appliance (R-appliance) and the Anterior Inclined Bite Plate (AIBP) in Class II Division I (Cl II Div I) cases. Fifty patients (28 girls, 22 boys) were chosen for the study: 25 patients (13 girls, 12 boys) with mean age of 10.4±0.8 years were treated with R-appliance for 11±2 months, the other 25 patients (15 girls, 10 boys) with mean age of 9±1.2 years were treated with AIBP for 10±2 months. All patients had Cl II Div I malocclusion due to mandibular deficiency. Lateral cephalograms were analyzed at the beginning (T1, T 1) and end of the study (T2, T 2). Paired T-test showed that SNB had a significant increase in both groups. The same test revealed that IMPA was reduced in R-appliance for 3.1±4.7 (p<0.01), but it was increased for 0.1±5.1 (p<0.9) in AIBP group. T-test showed that the inter-group difference of IMPA was statistically significant (p<0.05). SNA showed an increase in both groups (p<0.9). Ar-B and Ar-Pog showed an increase in both groups and the differences between them were statistically significant. Mandibular advancement was achieved in both groups, but R-appliance achieved this result without lingual tipping of lower incisors.
    Journal of applied oral science: revista FOB 02/2011; 19(6):634-8. DOI:10.1590/S1678-77572011000600015 · 0.80 Impact Factor