Temporomandibular joint remodeling in adolescents and young adults during Herbst treatment: A prospective longitudinal magnetic resonance imaging and cephalometric radiographic investigation.Am J Orthod Dentofacial Orthop 1999; 115(6):607-18AJ
The aim of this prospective study was to analyze and compare the temporomandibular joint adaptive mechanisms in 25 adolescent and 14 young adult Class II malocclusions treated with the Herbst appliance. Temporomandibular joint remodeling was analyzed by magnetic resonance imaging. In each subject, 4 magnetic resonance images of both temporomandibular joints were available: before treatment, at the start of treatment (when the Herbst appliance was placed), during treatment (6 to 12 weeks after appliance placement), and after treatment (when the appliance was removed). Furthermore, effective temporomandibular joint changes (the sum of condylar remodeling, fossa remodeling, and condyle-fossa relationship changes) were analyzed with the aid of lateral cephalometric radiographs from before and after treatment. All subjects were treated to Class I or overcorrected Class I dental arch relationships, and their mandibles became significantly (P <.001) more prognathic. After 6 to 12 weeks of Herbst treatment, signs of condylar remodeling were seen at the posterosuperior border in 48 of the 50 adolescent condyles and in 26 of the 28 young adult condyles. Bilateral remodeling of the mandibular ramus could be detected in 1 adolescent and 2 young adult patients. Signs of glenoid fossa remodeling at the anterior surface of the postglenoid spine were noted in 36 adolescent and 22 young adult temporomandibular joints. Effective temporomandibular joint changes during treatment were more horizontally directed and larger in both adolescents and young adult patients treated with the Herbst appliance than in an untreated group of subjects with ideal occlusion (Bolton standards). The increase in mandibular prognathism accomplished by Herbst therapy in both adolescents and young adults seems, in particular, to be a result of condylar and glenoid fossa remodeling. Because the Herbst appliance is most successful in Class II patients also at the end of the growth period, the treatment method could be an alternative to orthognathic surgery in borderline skeletal Class II cases. Magnetic resonance imaging renders an excellent opportunity to visualize the temporomandibular joint remodeling growth processes.