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      The Herbst appliance and its modifications - prevalence and individuality

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          Abstract

          Objective

          The aim of this study was to analyze the use of modified, cast splint Herbst appliances for the treatment of skeletal class II as an alternative to surgical bite correction over a period of five years.

          Materials and methods

          The patient cases all originate from the patients of the Department of Orthodontics at the University Medical Center of the Johannes Gutenberg University Mainz, Germany and the orthodontic practice Dres. Zöller, Kaiserslautern, Germany. Inclusion criteria were orthodontic treatment with the Herbst appliance and its modifications. The type of modification, number and frequency of the different modifications were determined on the basis of patient files, X-ray documents, photos and models.

          Results

          Of a total of 2881 new admissions over a period of five years, 1751 patients came from the Department of Orthodontics at the University Medical Center of the Johannes Gutenberg University Mainz and 1130 from the orthodontic practice in Kaiserslautern. A total of 336 patients were treated with a Herbst appliance during the period mentioned. 14 (13%) of the cases from the Herbst patient collective of the University Medical Center and 45 (19%) of the cases from the orthodontic practice were classified as modifications. The following modifications could be determined in descending order: University Medical Center Mainz: Herbst for anchorage during space closure (65%) > distalization (14%) ≥ bar construction as a space maintainer (14%) > Herbst applicance for anchoring for the adjustment of impacted teeth (7%); orthodontic practice Kaiserslautern: Herbst appliance with quadhelix in the maxilla (42%) > distalization (27%) > space closure (15%) > bar construction as a space maintainer (9%) > adjustment of impacted teeth (7%), multiple modifications occurred at 11%. The combination of quadhelix and Herbst appliance as well as multiple modifications have not yet been used in the University Medical Center Mainz. As an alternative to dysgnathia surgery, 23 adult patients (> 18 years) from the University Medical Center and 22 from the orthodontic practice were treated with a Herbst appliance.

          Conclusion

          Nearly 12% of Herbst appliances are used in everyday orthodontic practice and almost 18% of these are used with modification(s). The high anchoring quality and force-effect geometry of the Herbst appliance is suitable for combining and treating various other treatment tasks in addition to the classical treatment task of class II therapy.

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          Most cited references23

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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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            Treatment of class II malocclusions by jumping the bite with the Herbst appliance. A cephalometric investigation.

            H Pancherz (1979)
            The purpose of this study was to investigate the effect of continuous bite jumping with the Herbst appliance on the occlusion and craniofacial growth. The material consisted of twenty growing boys with Class II, Division 1 malocclusion. Ten of the boys were treated with the Herbst appliance for 6 months. The other ten boys served as a control group. Dental casts, profile roentgenograms, and TMJ radiographs were analyzed before and after 6 months of examination. The following treatment results were found: 1. Normal occlusal conditions occurred in all patients. 2. Maxillary growth may have been inhibited or redirected. The SNA angle was reduced slightly. 3. Mandibular growth was greater than average. The SNB angle increased. 4. Mandibular length increased, probably because of condylar growth stimulation. 5. Lower facial height increased. The mandibular plane angle, however, remained unchanged. 6. The convexity of the soft- and hard-tissue profile was somewhat reduced.
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              Malocclusion in the deciduous dentition of Caucasian children.

              P Tschill, A Sonko, C. W. Bacon (1997)
              In this study the occlusal characteristics of the deciduous dentition in a sample of young children were investigated to determine whether consensual trends exists, and if the occlusal characteristics in the primary dentition may be considered as acceptable predictors for occlusal relationships in the permanent dentition. Four hundred and seven boys and three hundred and eighty-two girls aged 4-6 years participated in the epidemiological study. Recording of the occlusal traits was made according to the method described by the Fédération Dentaire Internationale in 1973, adapted to the primary dentition. Lack of space was frequent (24 per cent in the upper anterior segments), as well as lateral crossbites (16 per cent), excessive overjet of 6 mm or more (6 per cent), Class II relationships (26 per cent) and anterior open bites (37.4 per cent). Obvious similarities could be seen with other investigations on occlusal traits of the primary dentition of Caucasian children. Cross-comparison with available data suggest that the development of the occlusion is a continuum for many aspects, with most of the major occlusal trends characterizing the permanent dentition in Europoid populations detectable at early stages. The striking difference in the primary dentition was the much higher prevalence of anterior open bites: this is the only figure expected to decrease dramatically in the permanent dentition. With due reservation inherent to the nature of epidemiological data on malocclusion and their interpretation, it is concluded that, provided the patient's cooperation is satisfactory, early attention may be given to malocclusion, but should mainly be focused on lateral crossbites and sagittal malrelationships.
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                Author and article information

                Contributors
                Christina Erbe:
                ORCID: http://orcid.org/0000-0003-1950-640X
                erbe@uni-mainz.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): 5 May 2021
                Publication date PMC-release: 5 May 2021
                Publication date Collection: 2021
                Volume: 17
                Electronic Location Identifier: 15
                Affiliations
                [1 ]GRID grid.410607.4, Department of Orthodontics, , University Medical Center of the Johannes Gutenberg-University, ; Augustusplatz 2, D-55131 Mainz, Germany
                [2 ]Orthodontic Practice, Pirmasenser Straße 59, 67655 Kaiserslautern, Germany
                Author information
                http://orcid.org/0000-0003-1950-640X
                Article
                Publisher ID: 266
                DOI: 10.1186/s13005-021-00266-2
                PMC ID: 8097934
                PubMed ID: 33952290
                SO-VID: 50888e2c-b11b-4b9e-9ac1-8970620500e8
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. 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 in a credit line to the data.

                History
                Date received : 9 June 2020
                Date accepted : 23 April 2021
                Categories
                Subject: Short Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2021

                ScienceOpen disciplines: Orthopedics
                Keywords: herbst appliance,modification,class-ii-malocclusion,anchorage
                Data availability:
                ScienceOpen disciplines: Orthopedics
                Keywords: herbst appliance, modification, class-ii-malocclusion, anchorage

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