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: 1.48). 05/2008; 30(2):120-7. DOI: 10.1093/ejo/cjm102
Source: PubMed


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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    • "Several studies have described positive effects with various functional appliances and have focused on their effects on skeletal and dental structures1,2,4,11,15,16,17,18,23,25. However, functional appliances restrict the growth of the maxilla3,10,14,21,22,26,27 and cause labial tipping of lower incisors3,20,29. Restriction of the maxilla and proclination of lower anterior incisors are the main disadvantages of such appliances. "
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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 · 0.92 Impact Factor
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    ABSTRACT: The purpose of this study was to compare the effects of a differently designed functional appliance (the R-appliance) with a twin-block (TB)-treated group. Thirty patients (18 girls and 12 boys) with a mean age of 10.5±0.7 years were treated with the R-appliance for 16.2±0.3 months and 25 (11 boys and 14 girls) with a mean age of 11.2±1.3 years with a TB for 16.1±1.4 months (control). All had a Class II division 1 malocclusion due to mandibular deficiency. Lateral cephalograms obtained at the beginning (T1) and end (T2) of the study were analysed. Paired t-tests showed that SNB significantly increased in both groups. The incisor mandibular plane angle (IMPA) was reduced in the R-appliance group by 1.9±4.9 degrees (P<0.04) but increased by 0.5±5.1 degrees (P<0.6) in the TB group. SNA in the R-appliance group showed an increase of 0.2±1.8 degrees (P<0.5), while it was decreased by 0.2±1.3 degrees (P<0.3) in the TB group. Both treatment modalities were successful in moving the mandible forward. However, with the R-appliance, this was achieved without retroclination of the lower incisors.
    The European Journal of Orthodontics 10/2010; 33(4):354-8. DOI:10.1093/ejo/cjq082 · 1.48 Impact Factor
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    ABSTRACT: This case illustrates the treatment of a 10.5-year-old girl with Class II Division I malocclusion and mandibular deficiency combined with vertical growth pattern. The patient was treated by a modified R-Appliance and extraction of upper and lower first bicuspids. Modified R-Appliance was used for 18 months followed by 17 months of Posterior bite plate, after which favorable correction of the malocclusion was observed. The SNB angle increased by 5 degrees and the IMPA decreased by 11 degrees. This case demonstrates that modified R-Appliance can be a suitable method for treatment of mandibular deficient cases with verticalgrowth pattern.
    International journal of orthodontics (Milwaukee, Wis.) 08/2012; 23(2):23-7.
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