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Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation.
Am J Orthod Dentofacial Orthop. 2006 Nov; 130(5):582-93.AJ

Abstract

INTRODUCTION

The crown Herbst appliance was introduced in the late 1980s because of shortcomings of the banded Herbst. In edgewise Herbst treatment, a fixed appliance is used with the crown Herbst to maximize the skeletal effects of treatment. Treatment response to the edgewise Herbst appliance has not been reported in the literature. Our objective was to investigate skeletal and dental changes in patients with Class II malocclusions treated with the edgewise Herbst appliance.

METHODS

Fifty-two consecutive patients were treated with the edgewise Herbst appliance; 32 (18 girls, 14 boys) met the criterion of 16 months out of Herbst treatment and were included in the study. Mean treatment time with this appliance was 8.0 +/- 1.8 months. Patients in the mixed dentition received additional treatment with 2 x 4 appliances until proper overbite, overjet, and torque on the incisors and permanent first molars were achieved. Patients in the permanent dentition were treated with full appliances to finalize the occlusion. Cephalometric measurements were taken at pretreatment, posttreatment, and 16 months after removal of the Herbst appliance, and the results were compared with 32 untreated Class II subjects from the Bolton Brush Study, matched for sex, age, and cephalometric dentofacial morphology. Data were analyzed with ANOVA, Tukey-Kramer multiple comparison tests, and 2-tailed t tests.

RESULTS

After 8 months of Herbst treatment, incisal relationship was overcorrected to an end-to-end incisal relationship and improved 8.4 mm, compared with the control group. The maxilla moved backward 1.4 mm at Point A, and the mandible moved forward 1.7 mm. The maxillary incisors moved lingually 1.7 mm, and the mandibular incisors were proclined 3.6 mm. The molars were corrected to a Class III relationship with a change of 7.2 mm compared with the control group. The mandible moved downward and forward. However, the condyle showed only 0.2 mm forward movement in the fossa. Sixteen months after appliance removal, the molars had relapsed into a Class I relationship, for a net change of 2.4 mm compared with the control group. Net overjet gain was 2.7 mm. Net restraint of maxillary growth was 1.3 mm, and net forward movement of the mandible was 1.0 mm. The maxillary incisors had no net movement, and the mandibular incisors had a net forward movement of 0.3 mm. Overall, skeletal change contributed 85% of the net overjet correction.

CONCLUSIONS

Class II treatment with the edgewise Herbst appliance is accompanied by both skeletal and dental changes. The changes are stable, with significant skeletal differences remaining 16 months after appliance removal. The forward and downward movement of the mandible with minimal changes in the position of the condyles in the fossae suggests a combination of condylar growth and remodeling of the glenoid fossa with treatment.

Authors+Show Affiliations

Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WV 26506, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17110255

Citation

VanLaecken, Ryan, et al. "Treatment Effects of the Edgewise Herbst Appliance: a Cephalometric and Tomographic Investigation." American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, vol. 130, no. 5, 2006, pp. 582-93.
VanLaecken R, Martin CA, Dischinger T, et al. Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation. Am J Orthod Dentofacial Orthop. 2006;130(5):582-93.
VanLaecken, R., Martin, C. A., Dischinger, T., Razmus, T., & Ngan, P. (2006). Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation. American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 130(5), 582-93.
VanLaecken R, et al. Treatment Effects of the Edgewise Herbst Appliance: a Cephalometric and Tomographic Investigation. Am J Orthod Dentofacial Orthop. 2006;130(5):582-93. PubMed PMID: 17110255.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment effects of the edgewise Herbst appliance: a cephalometric and tomographic investigation. AU - VanLaecken,Ryan, AU - Martin,Chris A, AU - Dischinger,Terry, AU - Razmus,Thomas, AU - Ngan,Peter, PY - 2004/10/19/received PY - 2005/01/08/revised PY - 2005/01/30/accepted PY - 2006/11/18/pubmed PY - 2006/12/9/medline PY - 2006/11/18/entrez SP - 582 EP - 93 JF - American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics JO - Am J Orthod Dentofacial Orthop VL - 130 IS - 5 N2 - INTRODUCTION: The crown Herbst appliance was introduced in the late 1980s because of shortcomings of the banded Herbst. In edgewise Herbst treatment, a fixed appliance is used with the crown Herbst to maximize the skeletal effects of treatment. Treatment response to the edgewise Herbst appliance has not been reported in the literature. Our objective was to investigate skeletal and dental changes in patients with Class II malocclusions treated with the edgewise Herbst appliance. METHODS: Fifty-two consecutive patients were treated with the edgewise Herbst appliance; 32 (18 girls, 14 boys) met the criterion of 16 months out of Herbst treatment and were included in the study. Mean treatment time with this appliance was 8.0 +/- 1.8 months. Patients in the mixed dentition received additional treatment with 2 x 4 appliances until proper overbite, overjet, and torque on the incisors and permanent first molars were achieved. Patients in the permanent dentition were treated with full appliances to finalize the occlusion. Cephalometric measurements were taken at pretreatment, posttreatment, and 16 months after removal of the Herbst appliance, and the results were compared with 32 untreated Class II subjects from the Bolton Brush Study, matched for sex, age, and cephalometric dentofacial morphology. Data were analyzed with ANOVA, Tukey-Kramer multiple comparison tests, and 2-tailed t tests. RESULTS: After 8 months of Herbst treatment, incisal relationship was overcorrected to an end-to-end incisal relationship and improved 8.4 mm, compared with the control group. The maxilla moved backward 1.4 mm at Point A, and the mandible moved forward 1.7 mm. The maxillary incisors moved lingually 1.7 mm, and the mandibular incisors were proclined 3.6 mm. The molars were corrected to a Class III relationship with a change of 7.2 mm compared with the control group. The mandible moved downward and forward. However, the condyle showed only 0.2 mm forward movement in the fossa. Sixteen months after appliance removal, the molars had relapsed into a Class I relationship, for a net change of 2.4 mm compared with the control group. Net overjet gain was 2.7 mm. Net restraint of maxillary growth was 1.3 mm, and net forward movement of the mandible was 1.0 mm. The maxillary incisors had no net movement, and the mandibular incisors had a net forward movement of 0.3 mm. Overall, skeletal change contributed 85% of the net overjet correction. CONCLUSIONS: Class II treatment with the edgewise Herbst appliance is accompanied by both skeletal and dental changes. The changes are stable, with significant skeletal differences remaining 16 months after appliance removal. The forward and downward movement of the mandible with minimal changes in the position of the condyles in the fossae suggests a combination of condylar growth and remodeling of the glenoid fossa with treatment. SN - 1097-6752 UR - https://www.unboundmedicine.com/medline/citation/17110255/Treatment_effects_of_the_edgewise_Herbst_appliance:_a_cephalometric_and_tomographic_investigation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0889-5406(06)00890-0 DB - PRIME DP - Unbound Medicine ER -