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Cephalometric study of Class II Division 1 patients treated with an extended-duration, reinforced, banded Herbst appliance followed by fixed appliances.
Am J Orthod Dentofacial Orthop. 2016 Nov; 150(5):818-830.AJ

Abstract

INTRODUCTION

The Herbst appliance has been used in the treatment of Class II malocclusions with deficient mandibles. Various protocols, including different durations of the orthopedic treatment phase and stepwise advancement of the mandible, have been advocated for increasing the orthopedic effects. The objective of this study was to investigate the skeletal and dental changes in patients treated with a reinforced banded Herbst appliance for an extended duration and fixed appliance therapy.

METHODS

The study group consisted of 30 patients (16 boys, 14 girls; mean age, 12.3 ± 2.5 years) with Class II Division 1 malocclusions who were successfully treated with the new Herbst protocol followed by fixed appliances. Lateral cephalometric radiographs were taken before treatment, at the completion of Herbst treatment, and after removal of fixed appliances. The average treatment times were 1.5 ± 0.7 years for the Herbst treatment and 1.8 ± 0.5 years for the fixed appliances. A control Class II sample from the Bolton-Brush study was used to subtract growth from treatment changes to determine the appliance effect. Data were analyzed using analysis of variance and the Tukey-Kramer test.

RESULTS

After the Herbst treatment, the incisal relationships of all subjects had been overcorrected to end-to-end relationships. Overjet was reduced by 7.2 mm after subtracting changes from growth. The skeletal contribution was 2.5 mm (35%), and the dental contribution was 4.7 mm (65%). The molar relationship was overcorrected to a more Class I relationship by 7.5 mm. The Wits appraisal was improved by 4.2 mm. Vertically, overbite was decreased by 3.3 mm. The maxillary and mandibular molars were extruded by 1 mm. The occlusal plane rotated clockwise by 5° with little change in the mandibular plane angle. After the treatment with fixed appliances, the overjet correction was maintained at 7.6 mm. The skeletal contribution was 2.9 mm (38%), and the dental contribution was 4.7 mm (62%). The molar relationship was corrected to a Class I relationship by 5.9 mm. The Wits appraisal was improved by 3.2 mm. Vertically, overbite was decreased by 4.2 mm. The maxillary and mandibular molars were extruded by 0.3 and 0.8 mm, respectively. The occlusal plane rotated clockwise by 1.2° with little change in the mandibular plane angle.

CONCLUSIONS

Doubling the usual orthopedic treatment time with the reinforced Herbst appliance followed by fixed appliance therapy was effective in correcting Class II Division 1 malocclusions with excess overjet and overbite. In this sample of successfully treated patients, most changes after Herbst and fixed appliance therapy were dentoalveolar (62%). However, the skeletal changes attained in the orthopedic phase of treatment were maintained after fixed appliance therapy.

Authors+Show Affiliations

Private practice, Austin, Tex.Private practice, Augusta, Ga.Private practice, Augusta, Ga.Professor, Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WVa.Clinical associate professor, Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WVa.Professor, Department of Biostatistics, West Virginia University, Morgantown, WVa.Professor and chair, Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, WVa. Electronic address: pngan@hsc.wvu.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27871709

Citation

Tomblyn, Travis, et al. "Cephalometric Study of Class II Division 1 Patients Treated With an Extended-duration, Reinforced, Banded Herbst Appliance Followed By Fixed Appliances." 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. 150, no. 5, 2016, pp. 818-830.
Tomblyn T, Rogers M, Andrews L, et al. Cephalometric study of Class II Division 1 patients treated with an extended-duration, reinforced, banded Herbst appliance followed by fixed appliances. Am J Orthod Dentofacial Orthop. 2016;150(5):818-830.
Tomblyn, T., Rogers, M., Andrews, L., Martin, C., Tremont, T., Gunel, E., & Ngan, P. (2016). Cephalometric study of Class II Division 1 patients treated with an extended-duration, reinforced, banded Herbst appliance followed by fixed appliances. American Journal of Orthodontics and Dentofacial Orthopedics : Official Publication of the American Association of Orthodontists, Its Constituent Societies, and the American Board of Orthodontics, 150(5), 818-830. https://doi.org/10.1016/j.ajodo.2016.04.020
Tomblyn T, et al. Cephalometric Study of Class II Division 1 Patients Treated With an Extended-duration, Reinforced, Banded Herbst Appliance Followed By Fixed Appliances. Am J Orthod Dentofacial Orthop. 2016;150(5):818-830. PubMed PMID: 27871709.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cephalometric study of Class II Division 1 patients treated with an extended-duration, reinforced, banded Herbst appliance followed by fixed appliances. AU - Tomblyn,Travis, AU - Rogers,Michael, AU - Andrews,Lee,2nd AU - Martin,Chris, AU - Tremont,Timothy, AU - Gunel,Erdogan, AU - Ngan,Peter, PY - 2015/09/01/received PY - 2016/04/01/revised PY - 2016/04/01/accepted PY - 2016/11/23/entrez PY - 2016/11/23/pubmed PY - 2017/3/23/medline SP - 818 EP - 830 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 - 150 IS - 5 N2 - INTRODUCTION: The Herbst appliance has been used in the treatment of Class II malocclusions with deficient mandibles. Various protocols, including different durations of the orthopedic treatment phase and stepwise advancement of the mandible, have been advocated for increasing the orthopedic effects. The objective of this study was to investigate the skeletal and dental changes in patients treated with a reinforced banded Herbst appliance for an extended duration and fixed appliance therapy. METHODS: The study group consisted of 30 patients (16 boys, 14 girls; mean age, 12.3 ± 2.5 years) with Class II Division 1 malocclusions who were successfully treated with the new Herbst protocol followed by fixed appliances. Lateral cephalometric radiographs were taken before treatment, at the completion of Herbst treatment, and after removal of fixed appliances. The average treatment times were 1.5 ± 0.7 years for the Herbst treatment and 1.8 ± 0.5 years for the fixed appliances. A control Class II sample from the Bolton-Brush study was used to subtract growth from treatment changes to determine the appliance effect. Data were analyzed using analysis of variance and the Tukey-Kramer test. RESULTS: After the Herbst treatment, the incisal relationships of all subjects had been overcorrected to end-to-end relationships. Overjet was reduced by 7.2 mm after subtracting changes from growth. The skeletal contribution was 2.5 mm (35%), and the dental contribution was 4.7 mm (65%). The molar relationship was overcorrected to a more Class I relationship by 7.5 mm. The Wits appraisal was improved by 4.2 mm. Vertically, overbite was decreased by 3.3 mm. The maxillary and mandibular molars were extruded by 1 mm. The occlusal plane rotated clockwise by 5° with little change in the mandibular plane angle. After the treatment with fixed appliances, the overjet correction was maintained at 7.6 mm. The skeletal contribution was 2.9 mm (38%), and the dental contribution was 4.7 mm (62%). The molar relationship was corrected to a Class I relationship by 5.9 mm. The Wits appraisal was improved by 3.2 mm. Vertically, overbite was decreased by 4.2 mm. The maxillary and mandibular molars were extruded by 0.3 and 0.8 mm, respectively. The occlusal plane rotated clockwise by 1.2° with little change in the mandibular plane angle. CONCLUSIONS: Doubling the usual orthopedic treatment time with the reinforced Herbst appliance followed by fixed appliance therapy was effective in correcting Class II Division 1 malocclusions with excess overjet and overbite. In this sample of successfully treated patients, most changes after Herbst and fixed appliance therapy were dentoalveolar (62%). However, the skeletal changes attained in the orthopedic phase of treatment were maintained after fixed appliance therapy. SN - 1097-6752 UR - https://www.unboundmedicine.com/medline/citation/27871709/Cephalometric_study_of_Class_II_Division_1_patients_treated_with_an_extended_duration_reinforced_banded_Herbst_appliance_followed_by_fixed_appliances_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0889-5406(16)30370-5 DB - PRIME DP - Unbound Medicine ER -