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Comparison of 2 comprehensive Class II treatment protocols including the bonded Herbst and headgear appliances: a double-blind study of consecutively treated patients at puberty.
Am J Orthod Dentofacial Orthop. 2009 Jun; 135(6):698.e1-10; discussion 698-9.AJ

Abstract

INTRODUCTION

The aim of this clinical trial was to compare the effects of 2 protocols for single-phase comprehensive treatment of Class II Division 1 malocclusion (bonded Herbst followed by fixed appliances [BH + FA] vs headgear followed by fixed appliances and Class II elastics [HG + FA]) at the pubertal growth spurt.

METHODS

Fifty-six Class II patients were enrolled in the trial and allocated by personal choice to 2 practices, where they underwent 1 of 2 treatment protocols (28 patients were treated consecutively with BH + FA, and 28 patients were treated consecutively with HG + FA). All patients started treatment at puberty (cervical stage [CS] 3 or CS 4) and completed treatment after puberty (CS 5 or CS 6). Lateral cephalograms were taken before therapy and 6 months after the end of comprehensive therapy, with an average interval of 28 months. Longitudinal observations of a matched group of 28 subjects with untreated Class II malocclusions were compared with the 2 treated groups. Analysis of variance (ANOVA) with post-hoc tests was used for statistical comparisons. Discriminant analysis was applied to identify preferential candidates for the BH + FA protocol on the basis of profile changes (advancement of the soft tissues of the chin).

RESULTS

The success rate (full occlusal correction of the malocclusion after treatment) was 92.8% in both treatment groups. The BH + FA group showed a significant increase in mandibular protrusion. The increase in effective mandibular length (Co-Gn) was significantly greater in both treatment groups when compared with natural growth changes in the Class II controls. Significantly greater improvement in sagittal maxillomandibular relationships was found in the BH + FA group. Retrusion of maxillary incisors and mesial movement of mandibular molars were significant in the HG + FA group. The BH + FA group showed significantly greater forward movements of soft-tissue B-point and pogonion compared with both the HG + FA and the control groups. Two pretreatment variables were significant (F = 4.48; P <0.01) in predicting the posttreatment amount of mandibular soft-tissue improvement in the BH + FA group: Co-Go-Me and pogonion to nasion perpendicular.

CONCLUSIONS

Class II treatment with either protocol during the pubertal growth spurt induces significant favorable dentoskeletal and occlusal changes. Functional jaw orthopedics had a greater favorable impact on the advancement of the chin. The clinical indications for the preferential use of the Herbst appliance at puberty are a small mandibular angle and mandibular retrusion before treatment. When treated with the BH + FA protocol, these Class II patients have the greatest probability of achieving significant improvement in the profile by advancement of the soft tissues of the chin.

Authors+Show Affiliations

Department of Orthodontics, University of Florence, Florence, Italy. t.baccetti@odonto.unifi.itNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19524823

Citation

Baccetti, Tiziano, et al. "Comparison of 2 Comprehensive Class II Treatment Protocols Including the Bonded Herbst and Headgear Appliances: a Double-blind Study of Consecutively Treated Patients at Puberty." 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. 135, no. 6, 2009, pp. 698.e1-10; discussion 698-9.
Baccetti T, Franchi L, Stahl F. Comparison of 2 comprehensive Class II treatment protocols including the bonded Herbst and headgear appliances: a double-blind study of consecutively treated patients at puberty. Am J Orthod Dentofacial Orthop. 2009;135(6):698.e1-10; discussion 698-9.
Baccetti, T., Franchi, L., & Stahl, F. (2009). Comparison of 2 comprehensive Class II treatment protocols including the bonded Herbst and headgear appliances: a double-blind study of consecutively treated patients at puberty. American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 135(6), e1-10; discussion 698-9. https://doi.org/10.1016/j.ajodo.2008.03.015
Baccetti T, Franchi L, Stahl F. Comparison of 2 Comprehensive Class II Treatment Protocols Including the Bonded Herbst and Headgear Appliances: a Double-blind Study of Consecutively Treated Patients at Puberty. Am J Orthod Dentofacial Orthop. 2009;135(6):698.e1-10; discussion 698-9. PubMed PMID: 19524823.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of 2 comprehensive Class II treatment protocols including the bonded Herbst and headgear appliances: a double-blind study of consecutively treated patients at puberty. AU - Baccetti,Tiziano, AU - Franchi,Lorenzo, AU - Stahl,Franka, PY - 2007/12/24/received PY - 2008/03/01/revised PY - 2008/03/01/accepted PY - 2009/6/16/entrez PY - 2009/6/16/pubmed PY - 2009/7/23/medline SP - 698.e1-10; discussion 698-9 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 - 135 IS - 6 N2 - INTRODUCTION: The aim of this clinical trial was to compare the effects of 2 protocols for single-phase comprehensive treatment of Class II Division 1 malocclusion (bonded Herbst followed by fixed appliances [BH + FA] vs headgear followed by fixed appliances and Class II elastics [HG + FA]) at the pubertal growth spurt. METHODS: Fifty-six Class II patients were enrolled in the trial and allocated by personal choice to 2 practices, where they underwent 1 of 2 treatment protocols (28 patients were treated consecutively with BH + FA, and 28 patients were treated consecutively with HG + FA). All patients started treatment at puberty (cervical stage [CS] 3 or CS 4) and completed treatment after puberty (CS 5 or CS 6). Lateral cephalograms were taken before therapy and 6 months after the end of comprehensive therapy, with an average interval of 28 months. Longitudinal observations of a matched group of 28 subjects with untreated Class II malocclusions were compared with the 2 treated groups. Analysis of variance (ANOVA) with post-hoc tests was used for statistical comparisons. Discriminant analysis was applied to identify preferential candidates for the BH + FA protocol on the basis of profile changes (advancement of the soft tissues of the chin). RESULTS: The success rate (full occlusal correction of the malocclusion after treatment) was 92.8% in both treatment groups. The BH + FA group showed a significant increase in mandibular protrusion. The increase in effective mandibular length (Co-Gn) was significantly greater in both treatment groups when compared with natural growth changes in the Class II controls. Significantly greater improvement in sagittal maxillomandibular relationships was found in the BH + FA group. Retrusion of maxillary incisors and mesial movement of mandibular molars were significant in the HG + FA group. The BH + FA group showed significantly greater forward movements of soft-tissue B-point and pogonion compared with both the HG + FA and the control groups. Two pretreatment variables were significant (F = 4.48; P <0.01) in predicting the posttreatment amount of mandibular soft-tissue improvement in the BH + FA group: Co-Go-Me and pogonion to nasion perpendicular. CONCLUSIONS: Class II treatment with either protocol during the pubertal growth spurt induces significant favorable dentoskeletal and occlusal changes. Functional jaw orthopedics had a greater favorable impact on the advancement of the chin. The clinical indications for the preferential use of the Herbst appliance at puberty are a small mandibular angle and mandibular retrusion before treatment. When treated with the BH + FA protocol, these Class II patients have the greatest probability of achieving significant improvement in the profile by advancement of the soft tissues of the chin. SN - 1097-6752 UR - https://www.unboundmedicine.com/medline/citation/19524823/Comparison_of_2_comprehensive_Class_II_treatment_protocols_including_the_bonded_Herbst_and_headgear_appliances:_a_double_blind_study_of_consecutively_treated_patients_at_puberty_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0889-5406(09)00221-2 DB - PRIME DP - Unbound Medicine ER -