Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance

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Abstract

Objective

To assess the types and frequencies of clinical complications experienced when using a modified lingual Herbst appliance and to compare these with those associated with conventional Herbst appliances reported in the literature.

Methods

Treatment records for 35 consecutive subjects treated during the observation period from October 2013 to August 2014 who received a combination of a lingual appliance and a modified Herbst appliance (WIN, DW LingualSystems) were assessed for complications linked to Herbst treatment phase. Complications were analyzed descriptively, and complication-free intervals were calculated using Kaplan-Meier plots. To enable a comparison with data reported in the literature, the cumulative treatment time for all subjects was divided by the total number of complications.

Results

71.4 % of Herbst treatments were free from complications ( n = 25). Complications were seen on 13 occasions (8 instances of Herbst attachment loosening, 5 L-Pin fractures). Most of these complications could be fixed chair side utilizing simple clinical measures. Considering all complications as identical statistical events, the percentage of treatments free from complications would be 88 % for 100 days, 70 % for 200 days and 56.8 % for 300 days. For severe complications, the averaged complication-free treatment interval was found to be 27.8 months.

Conclusion

In terms of clinical sturdiness, and taking into consideration the step-wise mode of activation used here as well as the differences in the design of the various Herbst appliances, the WIN-Herbst appliance was found to be superior to comparable vestibular Herbst appliances, as well as the banded Herbst appliance belonging to the preceding generation of customized lingual systems. Success in treatment of non-compliant Angle Class II correction is considered to have better predictability using the modified anchorage strategy of the WIN-Herbst appliance.

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Most cited references 26

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Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey.

L J Moray, William R Proffit, H Fields (1997)

Data from the third National Health and Nutrition Examination Survey (NHANES III) provide a clear picture of malocclusion in the US population. Noticeable incisor irregularity occurs in the majority of all racial/ethnic groups, with only 35% of adults having well-aligned mandibular incisors. Irregularity is severe enough in 15% that both social acceptability and function could be affected, and major arch expansion or extraction of some teeth would be required for correction. About 20% of the population have deviations from the ideal bite relationship; in 2% these are severe enough to be disfiguring and are at the limit for orthodontic correction. In Mexican-Americans compared to the rest of the population, incisor irregularity and both severe Class II and Class III malocclusions are more prevalent, but deep bite and open bite are less prevalent. Application of the Index of Treatment Need to the survey data reveals that 57% to 59% of each racial/ethnic group has at least some degree of orthodontic treatment need. Over 30% of white youths, 11% of Mexican-Americans, and 8% of blacks report receiving treatment. Severe malocclusion is observed more frequently among blacks, which may reflect their lower level of treatment. Treatment is much more frequent in higher income groups, but approximately 5% of those in the lowest income group and 10% to 15% of those in intermediate income groups report being treated.

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Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review.

Paola Cozza, Tiziano Baccetti, Lorenzo Franchi … (2006)

The aim of this systematic review of the literature was to assess the scientific evidence on the efficiency of functional appliances in enhancing mandibular growth in Class II subjects. A literature survey was performed by applying the Medline database (Entrez PubMed). The survey covered the period from January 1966 to January 2005 and used the medical subject headings (MeSH). The following study types that reported data on treatment effects were included: randomized clinical trials (RCTs), and prospective and retrospective longitudinal controlled clinical trials (CCTs) with untreated Class II controls. The search strategy resulted in 704 articles. After selection according to the inclusion/exclusion criteria, 22 articles qualified for the final analysis. Four RCTs and 18 CCTs were retrieved. The quality standards of these investigations ranged from low (3 studies) to medium/high (6 studies). Two-thirds of the samples in the 22 studies reported a clinically significant supplementary elongation in total mandibular length (a change greater than 2.0 mm in the treated group compared with the untreated group) as a result of overall active treatment with functional appliances. The amount of supplementary mandibular growth appears to be significantly larger if the functional treatment is performed at the pubertal peak in skeletal maturation. None of the 4 RCTs reported a clinically significant change in mandibular length induced by functional appliances; 3 of the 4 RCTs treated subjects at a prepubertal stage of skeletal maturity. The Herbst appliance showed the highest coefficient of efficiency (0.28 mm per month) followed by the Twin-block (0.23 mm per month).

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The mechanism of Class II correction in Herbst appliance treatment. A cephalometric investigation.

H Pancherz (1982)

Sagittal skeletal and dental changes contributing to Class II correction in Herbst appliance treatment were evaluated quantitatively on lateral roentgenograms. The material consisted of forty-two Class II. Division 1 malocclusion cases. Twenty-two of these were treated with the Herbst appliance for 6 months. The other twenty cases served as a control group. The results of the investigation revealed the following: (1) Bite jumping with the Herbst appliance resulted in Class 1 occlusal relationships in all treated cases. (2) The improvement in occlusal relationships was about equally a result of skeletal and dental changes. (3) Class II molar correction averaging 6.7 mm. was mainly a result of a 2.2 mm. increase in mandibular length, a 2.8 mm. distal movement of the maxillary molars, and a 1.0 mm. mesial movement of the mandibular molars. (4) Overjet correction averaging 5.2 mm. was mainly a result of a 2.2 mm. increase in mandibular length and a 1.8 mm. mesial movement of the mandibular incisors. (5) Anterior condylar displacement (0.3 mm.), redirection of maxillary growth (0.4 mm.), and distal movement of the maxillary incisors (0.5 mm.) were of minor importance in the improvement in molar and incisor relationships seen. (6) A direct relationship existed between the amount of bite jumping at the start of treatment and the treatment effects on the occlusion and on mandibular growth. For a maximal treatment response, it is suggested that the Herbst appliance be constructed with the mandible jumped anteriorly as much as possible, namely, to an incisal edge-to-edge position. The clinician should be aware of the dental changes occurring during Herbst appliance treatment and make sure that these changes are not incongruous with his over-all treatment goal.

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Author and article information

Contributors

Dirk Wiechmann: wiechmann@dw-consulting.de

Julius Vu: juliusvu@gmail.com

Rainer Schwestka-Polly: Schwestka-Polly.Rainer@mh-hannover.de

Hans-Joachim Helms: Hans-Joachim.Helms@t-online.de

Michael Knösel: mknoesel@yahoo.de

Journal

Journal ID (nlm-ta): Head Face Med

Journal ID (iso-abbrev): Head Face Med

Title: Head & Face Medicine

Publisher: BioMed Central (London )

ISSN (Electronic): 1746-160X

Publication date (Electronic): 9 September 2015

Publication date PMC-release: 9 September 2015

Publication date Collection: 2015

Volume: 11

Electronic Location Identifier: 31

Affiliations

[ ]Orthodontic Practice, Lindenstrasse 44, Bad Essen, 49152 Germany

[ ]Department of Orthodontics, Hannover Medical School (MHH), Hannover, 30625 Germany

[ ]Department of Medical Statistics, University Medical Center Göttingen (UMG), Göttingen, 37099 Germany

[ ]Department of Orthodontics, University Medical Center Göttingen (UMG), Göttingen, 37099 Germany

Article

Publisher ID: 88

DOI: 10.1186/s13005-015-0088-3

PMC ID: 4564960

SO-VID: 20b396e3-cf48-47ed-8ad2-1ae3e0c29fd0

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 26 May 2015

Date accepted : 1 September 2015

Custom metadata

ScienceOpen disciplines: Orthopedics

Keywords: herbst appliance,complication,fracture,win appliance,angle class ii,lingual orthodontic treatment,survival rate,kaplan-meier

Data availability:

ScienceOpen disciplines: Orthopedics

Keywords: herbst appliance, complication, fracture, win appliance, angle class ii, lingual orthodontic treatment, survival rate, kaplan-meier

Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance

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Abstract

Objective

Methods

Results

Conclusion

Related collections

Orthopedics

Most cited references 26

Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey.

Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review.

The mechanism of Class II correction in Herbst appliance treatment. A cephalometric investigation.

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