Three‐dimensional skeletal mandibular changes associated with Herbst appliance treatment

Souki, Bernardo Quiroga; Vilefort, Paula Loureiro Cheib; Oliveira, Dauro Douglas; Andrade, Ildeu; Ruellas, Antônio Carlos de Oliveira; Yatabe, Marília; Nguyen, Tung; Franchi, Lorenzo; McNamara, James A.; Cevidanes, Lucia

doi:10.1111/ocr.12154

Cited by 34 publications

(34 citation statements)

References 24 publications

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“…The results agree with earlier conventional 2D studies that observed increases in mandibular length in patients treated with the Herbst appliance [9,[24][25][26]. The observed effect on condylar growth is also similar to that reported by Souki et al, who showed in 3D that the net growth of the condyles in all surfaces was significantly greater in the Herbst group [22]. The results indicate a true stimulation of bone apposition at the condyles, and ultimately may help maximize the skeletal outcome by generating substantially more growth in the sagittal dimension.…”

Section: Discussionsupporting

confidence: 92%

“…As the morphological changes during each of the observation time periods contain both normal growth and changes due to treatment, the normal growth process that contributes to the correction must be factored out to evaluate the skeletal effect due to the appliance. Only two studies have evaluated in 3D the additional skeletal effects on the mandible by comparing patients treated with the device with control groups undergoing one phase nonorthopedic dental treatment [8,22]. Like previous 2D studies, these have led to disparate conclusions in terms of the mandibular length, largely because obtaining a standardized control group is challenging in retrospective studies as it is hard to match the follow-up time precisely.…”

Section: Discussionmentioning

confidence: 99%

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3D assessment of mandibular skeletal effects produced by the Herbst appliance

et al. 2020

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Background: A functional appliance is commonly used to optimize the development of the facial skeleton in the treatment of Class II malocclusion. Recent three-dimensional(3D) image-based analysis offers numerous advantages in quantitative measurement and visualization in orthodontics. The aim of this study was to localize in 3D the skeletal effect produced by the Herbst appliance on the mandible using the geometric morphometric technique. Methods: Twenty patients treated with a Herbst appliance and subsequent fixed appliances were included. Conebeam computed tomography (CBCT) images were taken before treatment (T1), 8 weeks after Herbst appliance removal (T2), and after subsequent fixed appliance treatment (T3). Spatially dense morphometric techniques were used to establish the corresponding points of the mandible. The mandibular morphological changes from T1-T2, T2-T3, and T1-T3 were calculated for each patient by superimposing two mandibular models at two time points with robust Procrustes superimposition. These changes were then compared to the morphological changes estimated from normative mandibular growth curves over the same period. The proportion of cases exceeding the growth expression for controls was compared to a normal population using a one tailed binomial test. Results: Approximately 1.5-2 mm greater condylar changes and 0.5 mm greater changes in the chin occurred from Tl to T2. This effect lasted until the completion of treatment (T1-T3), but there was no obvious skeletal effect during the orthodontic phase (T2-T3). Approximately 40-50% of the patient sample exceeded condylar growth by > 1.5 mm compared to untreated controls (p < .05). However, changes at the chin were not statistically significant. Conclusions: The principal skeletal effect of Herbst appliance treatment was additional increase in condylar length for about half of the sample. This inconsistency may relate to the degree of mandibular growth suppression associated with a specific malocclusion.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

3D assessment of mandibular skeletal effects produced by the Herbst appliance

et al. 2020

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“…Several studies evaluated the skeletal and dental effects of the Herbst appliance (2)(3)(4)(8)(9)(10)(11). However, few studies (12,13) verified whether the device causes alveolar bone loss in the region of the lower incisors.…”

Section: Introductionmentioning

confidence: 99%

Dentoalveolar Evaluation of Lower Incisors by CBCT after Treatment with Herbst Appliance

et al. 2018

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This study aimed to evaluate the effects of the Herbst appliance on the proclination and protrusion of the lower incisors, and to verify if the device causes alveolar bone loss in the anterior region of the mandible. This is a retrospective study. The sample consisted of 35 individuals. The treatment group consisted of 22 individuals (8 girls and 14 boys; initial mean age of 8.2 years) who used the Cantilever Herbst appliance for a period of 12 months. The control group consisted of 13 individuals (3 girls and 10 boys; initial mean age of 8.9 years) who received no treatment and were followed up for a period of approximately 18 months. Cone-beam computed tomography scans were performed at the beginning and at the end of the observational period. The medullary bone thickness (MT), buccal cortical bone thickness (BCT), lingual cortical bone thickness (LCT), and lower incisors proclination and protrusion were evaluated. Data were submitted to statistical analysis (ANCOVA and Student’s t-test) with a significance level of 5%. There was no significant difference in MT, BCT, LCT and incisor proclination between groups. Incisor proclination increased in the treated group with no statistical significance. The treatment group showed a significant increase in the protrusion of the incisors (p = 0.02). The Herbst appliance promoted a small proclination and protrusion of the lower incisors, without relevant clinical implications. The Herbst appliance did not cause bone loss in the anterior region of the mandible during Class II treatment.

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“…LeCornu et al showed significant bone remodelling activity within the glenoid fossae of HA patients. Souki et al found a significant increase and change in the pattern of bone remodelling and a different magnitude and direction of condylar growth after HA treatment. However, bone remodelling processes, both from the condyles and/or the glenoid fossae, cannot explain the extensive drift and repositioning of the condyle within the glenoid fossa after 8 or 12 months of treatment, following mandibular advancements ranging from 4 to 10 mm.…”

Section: Discussionmentioning

confidence: 99%

Condyle‐glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study

Vilefort

Farah

Gontijo

et al. 2019

Orthod Craniofacial Res

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Objectives To perform a three‐dimensional evaluation of the position of the condyles in patients treated with Herbst appliance (HA) in two stages of cervical vertebral maturation. Setting and sample population Retrospective case‐control study. Pubertal Herbst group (PHG; n = 24, mean age 14.5 years, CS 3 and CS 4) and pre‐pubertal Herbst group (PPHG; n = 17, mean age 9.9 years, CS 1 and CS 2) were contrasted with comparison groups of non‐orthopaedically treated Class II patients in pubertal (PCG; n = 17, mean age 13.9 years) and pre‐pubertal maturational stages (PPCG; n = 18, mean age 10.6 years). Materials and Methods Cone‐beam computer tomography scans were taken before treatment (T0) and at T1 after 8 to 12 months. Point‐to‐point measurements of the displacement of the condyles between T0 and T1, relative to the glenoid fossae, were performed in the X, Y, Z and 3D perspectives. Qualitative assessments using semi‐transparent overlays and colour mapping also were produced. Results The displacement of the condyles within the glenoid fossae in the treated groups was small (<0.75 mm; P > .05). Relative to the glenoid fossa, condylar position at T1 was similar to T0 in pre‐pubertal and pubertal groups (P > .05). Similar condylar rotations from T0 to T1 were observed in Herbst and comparison groups, and no significant difference was found between pre‐pubertal and pubertal patients. Conclusions Regardless the stage of skeletal maturation, HA treatment did not change the condyle‐glenoid fossa relationship.

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Three‐dimensional skeletal mandibular changes associated with Herbst appliance treatment

Cited by 34 publications

References 24 publications

3D assessment of mandibular skeletal effects produced by the Herbst appliance

3D assessment of mandibular skeletal effects produced by the Herbst appliance

Dentoalveolar Evaluation of Lower Incisors by CBCT after Treatment with Herbst Appliance

Condyle‐glenoid fossa relationship after Herbst appliance treatment during two stages of craniofacial skeletal maturation: A retrospective study

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