Niko C. Bock

Herbst treatment of Class II division 1 malocclusions in retrognathic and prognathic facial types.

OBJECTIVE The aim of this retrospective pilot study was to analyze and compare the short-term and long-term changes of Herbst treatment in Class II division 1 subjects of the retrognathic and prognathic facial type. MATERIALS AND METHODS The subject material comprised 10 retrognathic (mean SNA = 74.5 degrees, SNB = 70.4 degrees, ML/NSL = 41.1 degrees) and 16 prognathic (mean SNA = 86.7 degrees, SNB = 81.5 degrees, ML/NSL = 25.1 degrees) Class II division 1 subjects treated with the Herbst appliance for an average period of 7 months. Lateral head films from before (T1), immediately after (T2), 12 months after (T3), and 39 months after (T4) Herbst treatment were analyzed with the SO-analysis (analysis of changes in sagittal occlusion) and standard cephalometrics. RESULTS During the treatment period (T2-T1) the two facial type groups showed similar favorable changes for all variables. During the posttreatment periods of 12 months (T3-T2) and 39 months (T4-T2) recovering changes occurred. In the long-term, a tendency of more unfavorable growth changes was stronger (not significant) for retrognathic subjects than for prognathic subjects. CONCLUSION On a long-term basis, retrognathic subjects are prone to exhibit more unfavorable mandibular growth changes than prognathic subjects and, thus, might exhibit a greater risk for an occlusal relapse when a stable Class I occlusion is not attained after treatment.

Occlusal stability of adult Class II Division 1 treatment with the Herbst appliance

INTRODUCTION During recent years, some articles have been published on Herbst appliance treatment in adult patients, an approach that has been shown to be most effective in Class II treatment in both early and late adulthood. However, no results on stability have yet been published. Our objective was to analyze the short-term occlusal stability of Herbst therapy in adults with Class II Division 1 malocclusions. METHODS The subjects comprised 26 adults with Class II Division 1 malocclusions exhibiting a Class II molar relationship > or =0.5 cusp bilaterally or > or =1.0 cusp unilaterally and an overjet of > or =4.0 mm. The average treatment time was 8.8 months (Herbst phase) plus 14.7 months (subsequent multi-bracket phase). Study casts from before and after treatment and after an average retention period of 32 months were analyzed. RESULTS After retention, molar relationships were stable in 77.6% and canine relationships in 71.2% of the teeth. True relapses were found in 8.2% (molar relationships) and 1.9% (canine relationships) of the teeth. Overjet was stable in 92.3% and overbite in 96.0% of the patients; true relapse did not occur. CONCLUSIONS Herbst treatment showed good occlusal stability 2.5 years after treatment in adults with Class II Division 1 malocclusions.

Post-treatment occlusal changes in Class II division 2 subjects treated with the Herbst appliance

The aim of this retrospective study was to analyse and compare the post-treatment occlusal changes of Class II division 2 treatment with the Herbst appliance in early adolescent, late adolescent, and adult subjects. The subjects were 37 Class II division 2 patients (19 females and 18 males) treated at the Orthodontic Department, University of Giessen, Germany. All were in the late mixed or permanent dentition and exhibited a Class II molar relationship > or =0.5 cusp width (CW) bilaterally or > or =1.0 CW unilaterally, an overbite (OB) >3.0 mm, and two upper central incisors retroclined. The subjects were divided into three skeletal maturity groups based on evaluation of hand wrist radiographs: early adolescent (n = 10, stages MP3-E to MP3-FG at start of treatment, age range: 11.3-13.2 years), late adolescent (n = 14, stages MP3-G to MP3-I at start of treatment, age range: 14.1-16.4 years), and adult (n = 13, stages R-I to R-J at the start of treatment, age range: 16.3-25.6 years). Study casts from before treatment (T1), after Herbst-Tip-Edge-Multibracket appliance treatment (T2), and after an average retention time of 27 months (T3) were analysed. Statistical analysis was undertaken using t-tests for paired and unpaired samples. For the whole sample, the molar relationship at T3 was stable in 82.4 per cent, the canine relationship in 82.9 per cent, and OB in 75.7 per cent of the cases. In the different skeletal maturity groups, the stability of the molars, canines, and overbite was as follows: early adolescents: 95.0, 100.0, and 70.0 per cent, respectively; late adolescents: 92.9, 74.1, and 85.7 per cent, respectively; and adults 61.5, 80.8, 69.2 per cent, respectively. Occlusal correction of Class II division 2 malocclusions with Herbst treatment was relatively stable 2 years post-treatment. The outcome of treatment of adolescents was more stable than that of adults.

Class II subdivision treatment with the Herbst appliance

OBJECTIVE To assess the effectiveness of Class II subdivision Herbst nonextraction treatment and its short-term stability retrospectively. MATERIALS AND METHODS Twenty-two Class II subdivision (SUB: right-left molar difference ≥0.75 cusp width) and 22 symmetric Class II patients (SYM: ≥0.75 cusp width bilaterally) were matched according to gender and pretreatment handwrist radiographic stage. The mean treatment duration of the Herbst and subsequent multibracket phase was 8 months and 14 months, respectively. The mean retention period amounted to 36 months. Dental casts from before treatment (T1), after Herbst treatment (T2), after Multibracket treatment (T3), and after retention (T4) were evaluated. RESULTS A bilateral Class I or super Class I molar relationship was seen in 72.7% (SUB) and 77.3% (SYM) at T3. The corresponding values at T4 were 63.7% (SUB) and 72.7% (SYM). A unilateral or bilateral Class III molar relationship was more frequent in the SUB group (T3: +4.6%; T4: +13.6%). For overjet, similar mean values were seen in both groups after treatment (T3: SUB, 2.7 mm; SYM, 2.3 mm) and after retention (T4: SUB, 3.0 mm; SYM, 3.4 mm). This was also true for the midline shift (T3: SUB, -0.4 mm; SYM, 0.0 mm; T4: SUB, -0.3 mm; SYM, 0.0 mm). CONCLUSION Class II subdivision Herbst treatment was successful similarly to symmetric Class II Herbst treatment. However, a slight overcompensation of the molar relationship (Class III tendency) was more frequent in the subdivision patients (original Class I side).

Plaque control effectiveness and handling of interdental brushes during multibracket treatment—a randomized clinical trial

SUMMARY The aim of this randomized clinical trial was to compare the plaque control effectiveness and handling of an interdental brush with a short curved handle and a triangular cross-section of the brush head (IDB) and an interdental brush with a long straight handle in combination with a monotufted brush head (MTB). In a split-mouth design, 110 multibracket patients were randomly assigned to group A using the MTB in the first and third quadrants and the IDB in the second and fourth quadrants or to group B who proceeded the other way around. A crossover was performed after 3 months. The plaque index (PI) was scored every 6 weeks for a period of 24 weeks, and handling was evaluated using visual analogue scales (VAS). Wilcoxon tests were used to determine differences in PI and VAS scores between the two brushes and for PI differences between the different observation periods. Differences concerning personal preference and perceived cleaning efficacy were analysed with chi-square tests. The significance levels used were P < 0.001 and P < 0.01. The PI decreased significantly, but no statistically significant difference was found between the two brushes. Subjects experienced less pain and reported better access behind the archwire with the IDB. The use of an interdental brush reduced the PI irrespective of the design of the brush head. In direct comparison, adolescent patients preferred the IDB. Further trials are required to investigate the effectiveness of the IDB in reducing decalcification during orthodontic treatment.

Is Herbst-Multibracket Appliance Treatment More Efficient in Adolescents than in Adults?

OBJECTIVE To determine whether Herbst treatment is more efficient in adolescent than in adult Class II division 1 subjects. MATERIALS AND METHODS All Class II division 1 patients with a full secondary dentition who had been treated at the orthodontic department of the University of Giessen with a Herbst appliance between 1990 and 2000 were considered. The complete records of 77 patients were available. According to their skeletal maturity, as assessed on hand-wrist radiographs, the subjects were divided into an adolescent group (MP3-F to MP3-H; n = 49; mean age 13.5 years) and an adult group (R-IJ to R-J; n = 28; mean age 20.7 years). Pretreatment and posttreatment dental casts were evaluated using the Peer Assessment Rating (PAR) Index. The reductions in PAR scores of the two groups were compared. RESULTS Before treatment, both groups had a severe Class II division 1 malocclusion. The average PAR score of the adolescent patients was slightly lower (27.8) than that of the adult patients (28.8). After treatment, good results were reached for both groups, and the average PAR scores of the two groups were comparable (adolescents: 4.5; adults: 4.8). The average reductions in PAR score were 82.7% (23.3 points) for the adolescent group and 82.9% (24.0 points) for the adults, indicating great improvement in both groups. CONCLUSIONS Because good treatment results were achieved, with substantial improvement of the pretreatment situation in both groups, Herbst treatment can be considered equally efficient in adolescent and in adult Class II division 1 subjects.

Facial Profile and Lip Position Changes in Adult Class II, Division 2 Subjects Treated with the Herbst-Multi bracket Appliance. A Radiographic Cephalometric Pilot Study

Objective:To examine the treatment and post-treatment effects of the Herbst-Multibracket (MB) appliance on facial profile and lip position in adult Class II, Division 2 subjects.Material and Methods:Lateral head films of 16 consecutivelytreated adult Class II, Division 2 subjects (8 males, 8 females) with an average age of 18.8 years pre-treatment were analyzed on three occasions: before treatment (T1), after Herbst-MB treatment (T2) and 2 years post-treatment (T3).Results:Treatment period (T2–T1): an increase occurred in the hard tissue profile angle (2.5°; p < 0.001), the soft tissue profile angle excluding the nose (2.6°; p < 0.01), and the soft tissue profile angle including the nose (1.8°; p < 0.05). The upper lip became more retrusive in relation to the Esthetic line (EL) (0.8 mm; p < 0.05) while the lower lip’s position was unchanged. Lower lip coverage of the upper incisors was reduced (0.8 mm; p < 0.05). Post-treatment period (T3–T2): the soft tissue profile angle (excluding the nose) increased (1.6°; p < 0.01), while the hard and soft tissue profile angles including the nose remained unchanged. Both, the upper and lower lips became more retrusive in relation to the EL (0.9 mm; p < 0.01 and 1.0 mm; p < 0.001). The lower lip coverage of the upper incisors remained unchanged.Conclusion:The hard and soft tissue profiles were straightened during Herbst-MB treatment, including a brief follow-up period. The lips became more retrusive while the lower lip coverage of the upper incisors was reduced.ZusammenfassungZiel:Untersuchung der bei erwachsenen Klasse-II/2-Probanden während und nach der Behandlung mit einer Herbst-Multibracket-(MB-)Apparatur auftretenden Veränderungen des Gesichtsprofils und der Lippenposition.Material und Methodik:Fernröntgenseitenbilder von 16 konsekutiv behandelten erwachsenen Klasse-II/2-Probanden (8 männliche, 8 weibliche) mit einem Durchschnittsalter von 18,8 Jahren vor der Behandlung wurden zu drei Zeitpunkten ausgewertet: vor der Behandlung (T1), nach der Herbst-MB-Behandlung (T2) und 2 Jahre nach der Behandlung (T3).Ergebnisse:Behandlungszeitraum (T2–T1): Es trat eine Vergrößerung des knöchernen Profilwinkels (2,5°; p < 0,001), des Weichteilprofilwinkels exklusive Nase (2,6°; p < 0,01) und des Weichteilprofilwinkels inklusive Nase (1,8°; p < 0,05) auf. Die Oberlippe nahm eine – gemessen in Relation zur Esthetic line (EL) – retrusivere Position ein (0,8 mm; p < 0,05), während sich die Position der Unterlippe nicht veränderte. Die Überdeckung der oberen Inzisivi durch die Unterlippe wurde reduziert (0,8 mm; p < 0,05). Nachuntersuchungszeitraum (T3–T2): Während sich der knöcherne Profilwinkel und der Weichteilprofilwinkel inklusive Nase nicht veränderten, vergrößerte sich der Weichteilprofilwinkel exklusive Nase (1,6°; p < 0,01). Sowohl die Ober- als auch die Unterlippe nahmen eine – gemessen in Relation zur EL – retrusivere Position ein (0,9 mm; p < 0,01 and 1,0 mm; p < 0,001). Die Überdeckung der oberen Inzisivi durch die Unterlippe veränderte sich nicht.Schlussfolgerung:Während der Herbst-MB-Behandlung und des kurzen Nachuntersuchungszeitraumes erfolgte eine Begradigung des knöchernen Profils und des Weichteilprofils. Die Lippen nahmen eine retrusivere Position ein, während die Überdeckung der oberen Inzisivi durch die Unterlippe verringert wurde.

Erratum to: Skeletal anchorage for everybody? A questionnaire study on frequency of use and clinical indications in daily practice

Aim The purpose of this survey was to determine how commonly, and in what clinical situations, German-based orthodontists use skeletal anchorage devices in daily clinical practice.

Stability of Class II fixed functional appliance therapy--a systematic review and meta-analysis.

OBJECTIVES To systematically search for scientific evidence concerning the stability of treatment (Tx) results achieved by means of Class II fixed functional appliance therapy and to assess possible differences between appliances. SEARCH METHODS An electronic search of databases and orthodontic journals was carried out (until December 2013), with supplemental hand searching. In addition to the names of all identified appliances, the term fixed functional was used in combination with each of the following search terms: long-term, post-Tx, relapse, retention, stability. SELECTION CRITERIA To be included in the review, the articles had to contain clear data on: Class II Tx with a fixed functional appliance (>5 patients), post-Tx period ≥ 1 year, assessment of ANB angle, Wits appraisal, molar relationship, soft-tissue profile convexity excluding the nose, overjet and/or overbite. DATA COLLECTION AND ANALYSIS The literature search revealed 20 scientific investigations which corresponded to only two of the 76 identified appliances (Herbst and Twin Force Bite Corrector). As only one publication was found for the Twin Force Bite Corrector, a meta-analysis could only be performed for Herbst Tx. The data were extracted, pooled and weighted according to the number of patients in each study. RESULTS The mean values for post-Tx relapse (percentages relative to the Tx changes) were: ANB angle 0.2 degrees (12.4 per cent), Wits appraisal 0.5mm (19.5 per cent), sagittal molar relationship 1.2mm/0.1 cusp widths (21.8 per cent /6.5 per cent); soft-tissue profile convexity excluding nose less than 0.1 degrees (1.0 per cent), overjet 1.8mm (26.2 per cent), overbite Class II:1 1.4mm (44.7 per cent), overbite Class II:2 1.0mm (22.2 per cent). CONCLUSIONS The scientific evidence concerning the stability of Tx results is inexistent for most fixed functional appliances for Class II correction except for Herbst appliance Tx. Even if the evidence level of most included studies is rather low, good dentoskeletal stability without clinically relevant changes was found for most variables.

Herbst plus Lingual versus Herbst plus Labial: a comparison of occlusal outcome and gingival health

OBJECTIVES To analyse and compare the effects during Herbst treatment combined with a lingual (completely customized) or labial (straight-wire) multibracket appliance (MBA), with special regard to lower incisor gingival recessions. SUBJECTS AND METHODS Eighteen Class II:1 patients [overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp widths (CW) bilaterally or 1.0 CW unilaterally, median age 16.0 years] treated with a Herbst appliance in combination with a lingual MBA (group LINGUAL) were retrospectively matched (molar relationship and skeletal maturity) to 18 Class II:1 patients treated with a Herbst appliance combined with a labial MBA (group LABIAL). Study models and intraoral photographs from before and after treatment were evaluated regarding occlusal variables and gingival recessions. Lateral cephalograms from before, during (before and after Herbst), and after treatment were analysed to assess lower incisor changes. RESULTS Both groups showed similar reductions of overjet (5.4/5.6mm), overbite, (2.9/2.7mm) and sagittal molar relationship (0.9/0.8 CW). During the Herbst phase, the changes in lower incisor inclination and incisal edge position were significantly smaller in the LINGUAL than in the LABIAL group (iiL/ML: +7.0/+12.7degrees, P = 0.002; ii-MLppg: +2.5/+3.9mm, P = 0.004). For the total treatment period, no significant differences were found (iiL/ML: +5.3/+8.6degrees; ii-MLppg: +2.1/+2.4mm). No clinically relevant gingival recessions were seen. CONCLUSION Both treatment approaches successfully corrected the malocclusion. The group LINGUAL exhibited significantly less proclination during the Herbst phase only. Neither treatment approach induced deleterious gingival recessions.