Orthodontic treatment of nongrowing patient with class II division 2 malocclusion by Herbst appliance

Abstract

Background. Inheritance is most casual etiological factor of Class II division 2 malocclusion. This kind of malocclusion is very difficult for treatment specially in older patients. Case report. In the female patient, 20 years old, at the beginning of the treatment at the School of Dentistry in Belgrade, lateral cephalogram showed skeletal and dentoalveolar Class II division 2 malocclusion. She was in the Herbst treatment for 8 months and 12 months more with a fixed multibracket appliance. The measurements were performed on lateral cephalograms before and after the treatment: ii, is, mi, ms, Pg and ss. The distance from these points to occlusal perpendicular line (Olp) were measured and compared from cephalogram before to cephalogram after the treatment. Temporomandibular joint (TMJ) tomograms were compared from before and after the treatment by superimposition. Correction was found in molar and incisor relation, overjet and overbite. There were found sagital skeletal changes and soft tissue profile improvement. Conclusion. Herbst appliance is effective in the treatment of Class II malocclusions, even in adult patients. Dental and skeletal changes as a result of Herbst treatment could be good choice instead of camouflage orthodontics or surgical decision.

Uvod. Malokluzije klase II odeljenja 2 uglavnom su nasledne etiologije. Pripadaju komplikovanijim slučajevima za ortodontsku terapiju, naročito kod starijih bolesnika. Prikaz bolesnika. Kod bolesnice stare 20 godina, na početku terapije koja je sprovedena na Stomatološkom fakultetu u Beogradu, na profilnom telerendgen snimku dijagnostikovana je skeletna i dentoalveolarna nepravilnost klase II odeljenja 2. Terapija Herbst-aparatom trajala je 8 meseci i još 12 meseci fiksnim aparatom. Na profilnom telerendgen snimku pre i posle terapije merena su rastojanja između okluzalne perpendikularne linije OLP i: najmezijalnije tačke aproksimalne površine gornjeg prvog molara (ms), najmezijalnije tačke aproksimalne površine donjeg prvog molara (mi), incizalne ivice gornjeg sekutića (is), incizalne ivice donjeg sekutića (ii), najudaljenije tačke prednje strane maksile (ss) i najisturenije tačke profila brade (Pg). Upoređene su vrednosti sa snimaka pre i posle terapije. Profilni snimci temporomandibularnog zgloba (TMZ) pre i posle terapije superponirani su i potom analizirani. Primenom Herbst aparata korigovan je odnos molara i odnos inciziva, kao i incizalni stepenik i incizalni preklop. Uočene su sagitalne skeletne promene i poboljšanje izgleda mekotkivnog profila bolesnika. Zaključak. Herbst aparat je efikasan u terapiji malokluzije klase II, čak i kod starijih bolesnika. Dentalne i skeletne promene kao rezultat terapije Herbst aparatom mogu ukazati na dobar izbor umesto terapije ortodontskom kamuflažom ili ortognatskom hirurgijom.