Clinical effects of fixed functional Herbst appliance in the treatment of class II/1 malocclusion

Abstract

Introduction. Sagittal mandible deficiency is the most common cause of skeletal Class II malocclusion. Treatment objective is to stimulate sagittal mandible growth. Fixed functional Herbst appliance use is beneficial for shortening the time required for treatment and does not depend on patient compliance. Case outline. A 13-year-old girl was referred to the Clinic of Orthodontics, School of Dentistry in Belgrade following previous unsuccessful treatment of her skeletal Class II malocclusion using an activator. The patient's poor cooperation had led to failure of the treatment. Patient was subjected to the Herbst treatment for 6 months followed by fixed appliance for another 8 months. Lateral cephalograms before and after the treatment was performed. The remodelation of condylar and fossal articulation was assessed by superimposition of pre- and post-treatment temporomandibular joint tomograms. The promotion of oral hygiene and fluoride use was performed because orthodontic treatment carries a high caries risk and risk for periodontal disease. Skeletal and dental changes were observed after treatment (correction [Max+Mand]: molar relation 7 mm, overjet 8 mm, skeletal relation 5 mm, molars 2 mm, incisors 3 mm). Combination of Herbst and fixed appliances was effective in the treatment of dental and skeletal irregularities for a short period of time. Conclusion . In the retention period, 14 months after treatment, occlusal stability exists. Follow-up care in oral prevention is based on regular recalls at the dental office and supervision at home by the parents.

Uvod. Sagitalna mandibularna nerazvijenost je najčešći uzrok skeletne malokluzije II klase. Cilj lečenja je da se podstakne sagitalni rast donje vilice. Primena fiksnog funkcionalnog Herbst aparata skraćuje vreme lečenja i ne zavisi od saradnje pacijenta. Prikaz slučaja. Trinaestogodišnja devojčica primljena je na Kliniku za ortopediju vilica Stomatološkog fakulteta u Beogradu posle neuspešnog lečenja skeletne malokluzije II klase aktivatorom. Podvrgnuta je lečenju Herbst aparatom tokom šest meseci, nakon čega je terapija nastavljena fiksnim ortodontskim aparatom još osam meseci. Lateralni cefalogrami urađeni su pre i posle lečenja. Remodelacija kondila i fose artikularis ocenjivana je superpozicijom tomograma temporomandibularnog zgloba pre i posle lečenja. Pacijentkinji je posebno skrenuta pažnja na adekvatnu oralnu higijenu i primenu fluorida zbog rizika od razvoja karijesa i periodontalnog oboljenja. Skeletne i dentalne promene uočene su posle lečenja (korekcija[Max+Mand]: odnos molara 7 mm, incizalni stepenik 8 mm, skeletni odnos 5 mm, molari 2 mm, incizivi 3 mm). Kombinacija Herbst aparata i fiksnog ortodontskog aparata bila je efikasna u lečenju dentalne i skeletne nepravilnosti za kratak vremenski period. Zaključak. Četrnaest meseci nakon lečenja i dalje je zastupljena okluzivna stabilnost. Kontrola oralne prevencije zasniva se na redovnim pregledima u stomatološkoj ambulanti i nadgledanju pacijenta u održavanju oralne higijene.