Skeletal and dental effects of Herbst appliance anchored with temporary anchorage devices: A systematic review with meta‐analysis

Abstract

Background The aim was to evaluate the efficiency of using temporary anchorage devices (TADs) in minimizing the anchorage loss and increasing the skeletal effects during correction of Class II malocclusion with Herbst appliance. Materials and methods Search without restrictions was performed up to January 2021 in three electronic databases (CENTRAL, MEDLINE and EMBASE) for randomized controlled trials (RCTs), prospective and retrospective cohort studies. The included studies assessed the dental and skeletal changes in Class II malocclusion patients who were treated using Herbst appliance with or without TADs. The strength of evidence was ranked using GRADE. Results Fifty‐five records were initially retrieved. A total of 6 studies with 198 patients were finally considered. 4 studies were included in the meta‐analysis. The meta‐analysis showed that using TADs with acrylic splint Herbst appliance was effective in controlling the inclination of mandibular incisors by a mean difference of −5.49 degrees (95% C.I [−7.36, −3.63], P < .001) when compared to Herbst appliance alone. The results showed also that incorporating TADs with Herbst treatment resulted in greater mandibular skeletal effects including increasing mandibular bone base length by mean difference of 2.22 mm (95% C.I [0.82. 3.61], P = .002) and mandibular length by mean difference of 3.7 mm (95% C.I [1.55, 5.85], P < .001) when compared to Herbst appliance alone. Conclusions Based on a very low level of confidence, it seems that incorporating TADs during orthodontic treatment with Herbst appliance results in minimizing the anchorage loss and increasing the skeletal effects of Herbst appliance during correction of Class II malocclusion.

Evaluation of the Co–Go–Me angle as a predictor in Class II patients treated with Herbst appliance and skeletal anchorage: a retrospective cohort study

“…Comparing these results with those of the meta-analysis conducted by Yang ( 29 ) on the effects of the Herbst appliance on the sagittal position of the mandibular base (Pg_OLp), a greater Pog advancement was observed in the present study [3.34 mm ± 2.34 mm (Group 1) and 4.34 mm ± 2.41 mm (Group 2)] vs. the average of 1.45 mm found by the author. This confirmed the conclusions of Al-Dboush ( 30 ), stating that the combination of the Herbst appliance with TADs might increase the effectiveness of the traditional orthopedic treatment, thereby leading to a better projection of the chin, regardless of the growth pattern. On one hand, this outcome could be explained by greater control in the sagittal position of the lower incisors with skeletal anchorage, preserving the overjet needed for mandibular advancement ( 31 ).…”

On analysing clinical trial data using the change from baseline

“…In particular, the effect of anchorage reinforcement on reducing lower incisor inclination (1i-ML; in degrees) will be assessed. The studies identified from two recently published systematic reviews (Al-Dboush et al, 2021;Huang et al, 2021) are pooled here and their data re-analysed. Some studies initially included in the original systematic reviews are excluded however, since they measured inclination of the lower incisors relative to the NB line and not to the mandibular line or did not report complete descriptive statistics pre-treatment, post-treatment, and in terms of treatment-induced changes (post minus pre).…”

Mandibular Endochondral Growth Is Specifically Augmented by Nutritional Supplementation with Myo-Inositol Even in Rabbits

“…The effect of functional appliances depends on the degree of cooperation and compliance [ 16 , 17 ]. Therefore, removable functional appliances could only obtain dentoalveolar correction of Class II malocclusion without clinically significant skeletal changes [ 18 ]. Judged by these circumstances, the efficacy of functional appliances may not consistently manifest in routine clinical applications [ 19 ], which demands a more efficient, dependable, and secure therapeutic approach to stimulate mandibular growth.…”