Mini-implants and the efficiency of Herbst treatment: a preliminary study

Cesare Luzi, Valeriano Luzi, Birte Melsen, Cesare Luzi, Valeriano Luzi, Birte Melsen

Abstract

Background: The purpose of this study is to present the use of a modified Herbst appliance in association with temporary anchorage devices (TADs) in order to enhance the correction of skeletal class II malocclusions.

Methods: Ten consecutive adolescents scheduled for Herbst treatment were assigned to two treatment groups. Five cases were treated with a modified miniscrew-supported Herbst appliance (experimental group (EG)) and five cases with a conventional cast Herbst appliance (control group (CG)). In all cases, the Herbst was kept in place for 9 months and was followed by fixed appliances until class I relationships were achieved. The initial (T1) and final (T2) lower incisor inclination on lateral headfilms were analyzed for each case, and the mean increase for the five EG patients and the five CG patients were compared.

Results: The mean increase in lower incisor inclination at the end of treatment was 1° (range 0° to 2°) for the EG and 7° (range 4° to 10°) for the CG.

Conclusions: The rational association of TADs with the Herbst appliance can optimize treatment efficiency and skeletal response by reducing the occurrence of excessive lower incisor proclination.

Figures

Figure 1
Figure 1
The lower cast structure of the modified Herbst with the bilateral hooks (a, b).
Figure 2
Figure 2
Mini-implants inserted between the lower first and second premolars. They were inserted in patients RR (a) and NP (b) from the EG.
Figure 3
Figure 3
The modified Herbst connected to the TAD with the 0.12-mm stainless steel ligature.
Figure 4
Figure 4
Patient JG from the CG. Pretreatment profile (a) and cephalogram (b). Posttreatment profile (c) and cephalogram (d). Lateral intraoral views pretreatment (e), with the Herbst (f), and posttreatment (g). The overjet is reduced mainly by dentoalveolar compensations.
Figure 5
Figure 5
Patient FM from the EG. Pretreatment profile (a) and cephalogram (b). Posttreatment profile (c) and cephalogram (d). Lateral intraoral views pretreatment (e), with the Herbst connected to TADs (f), and post-treatment (g). The pretreatment increased lower incisor inclination and was controlled during treatment; the overjet was reduced with maximum skeletal response [22].

References

    1. Buckhardt D, McNamara J, Baccetti T. Maxillary molar distalization or mandibular enhancement: a cephalometric comparison of comprehensive orthodontic treatment including the Pendulum and the Herbst appliances. Am J Orthod Dentofacial Orthop. 2003;123:108–16. doi: 10.1067/mod.2003.7.
    1. Hilgers JJ. The pendulum appliance for class II noncompliance therapy. J Clin Orthod. 1992;26:706–14.
    1. Jones RD, White MJ. Rapid class II molar correction with an open coil jig. J Clin Orthod. 1992;26:661–4.
    1. Locatelli R, Bednar J, Dietz VS, Giannelly AA. Molar distalization with super-elastic NiTi wire. J Clin Orthod. 1992;26:277–9.
    1. Carano A, Testa M. The distal jet for upper molar distalization. J Clin Orthod. 1996;30:374–80.
    1. Caprioglio A, Beretta M, Lanteri C. Maxillary molar distalization: pendulum and fast-back, comparison between two approaches for class II malocclusion. Prog Orthod. 2011;12:8–16. doi: 10.1016/j.pio.2011.02.007.
    1. Fortini A, Lupoli M, Parri M. The first class appliance for rapid molar distalization. J Clin Orthod. 1999;33:322–8.
    1. Jasper JJ. Jasper Jumper: a fixed functional appliance. Sheboygan: American Orthodontics; 1987.
    1. De Vincenzo JP. The Eureka spring: a new interarch force delivery system. J Clin Orthod. 1997;31:454–67.
    1. Eckhart JE. Introducing the MARA. Clin Impressions. 1998;7(2–5):24–7.
    1. Awbrey JJ. The bite fixer. Clin Impressions. 1999;8:10–7.
    1. Heinig N, Goz G. Clinical application and effects of the Forsus spring: a study of a new Herbst hybrid. J Orofac Orthop. 2001;62:436–50. doi: 10.1007/s00056-001-0053-6.
    1. Corbett MC, Molina FG. Twin force bite corrector: fight force and patient friendly. Syllabus, Carlsbad: Ortho Organizers; 2001.
    1. Martin J, Pancherz H. Mandibular incisor position changes in relation to amount of bite jumping during Herbst/multibracket appliance treatment: a radiographic-cephalometric study. Am J Orthod Dentofacial Orthop. 2009;136:44–51. doi: 10.1016/j.ajodo.2007.07.027.
    1. Barnett GA, Higgins DW, Major PW, Flores-Mir C. Immediate skeletal and dentoalveolar effects of the crown- or banded type Herbst appliance on class II division I malocclusion. Angle Orthod. 2008;78:361–9. doi: 10.2319/031107-123.1.
    1. Weschler D, Pancherz H. Efficiency of three mandibular anchorage forms in Herbst treatment: a cephalometric investigation. Angle Orthod. 2004;75:23–7.
    1. Wehrbein H, Glatzmaier J, Mundwiller U, Diedrich P. The orthosystem - a new system for orthodontic anchorage in the palate. J Orofac Orthop. 1996;57:142–53. doi: 10.1007/BF02191878.
    1. Velo S, Rotunno E, Cozzani M. The implant distal jet. J Clin Orthod. 2007;41:88–93.
    1. Kinzinger G, Gülden N, Yildizhan F, Diedrich P. Efficiency of a skeletonized distal jet appliance supported by miniscrew anchorage for noncompliance maxillary molar distalization. Am J Orthod Dentofacial Orthop. 2009;136:578–86. doi: 10.1016/j.ajodo.2007.10.049.
    1. Ludwig B, Glasl B, Kinzinger GS, Walde KC, Lisson JA. The skeletal frog appliance for maxillary molar distalization. J Clin Orthod. 2011;45:77–84.
    1. Al-Kalaly AA, Wong RW, Cheung LK, Purkayastha SK, Schätzle M, Rabie AB. Evaluation of bone thickness around the mental foramen for potential fixation of a bone-borne functional appliance: a computer tomography scan study. Clin Oral Impl Res. 2010;21:1288–93. doi: 10.1111/j.1600-0501.2010.01947.x.
    1. Luzi C, Luzi V. Orthodontie Française. 2013. Skeletal class II treatment with the miniscrew-anchored Herbst.
    1. Herbst E. Atlas und Grundriss der Zahnärztllichen Orthopädie. Munich: JF Lehmann Verlag; 1910.
    1. Pancherz H. The Herbst appliance—it’s biologic effects and clinical use. Am J Orthod. 1985;87:1–20. doi: 10.1016/0002-9416(85)90169-1.
    1. Flores-Mir C, Ayeh A, Goswani A, Charkhandeh S. Skeletal and dental changes in class II division I malocclusions treated with splint-type Herbst appliances. Angle Orthod. 2007;77:376–81. doi: 10.2319/0003-3219(2007)077[0376:SADCIC];2.
    1. Konik M, Pancherz H, Hansen K. The mechanism of class II correction in late Herbst treatment. Am J Orthod Dentofacial Orthop. 1997;112:87–91. doi: 10.1016/S0889-5406(97)70278-6.
    1. Pancherz H. The effects, limitations, and long-term dentofacial adaptations to treatment with the Herbst appliance. Semin Orthod. 1997;3:232–43. doi: 10.1016/S1073-8746(97)80056-4.
    1. Purkayastha SK, Rabie AB, Wong R. Treatment of skeletal class II malocclusion in adults: stepwise vs single-step advancement with the Herbst appliance. World J Orthod. 2008;9:233–43.
    1. Broch J, Slagsvold O, Røsler M. Error in landmark identification in lateral radiographic headplates. Eur J Orthod. 1981;3:9–13. doi: 10.1093/ejo/3.1.9.
    1. Lee KJ, Joo E, Kim KD, Lee JS, Park YC, Yu HS. Computed tomographic analysis of tooth-bearing alveolar bone for orthodontic miniscrew placement. Am J Orthod Dentofacial Orthop. 2009;135:486–94. doi: 10.1016/j.ajodo.2007.05.019.
    1. Farnsworth D, Rossouw PE, Ceen RF, Buschang P. Cortical bone thickness at common mini-implant placement sites. Am J Orthod Dentofacial Orthop. 2011;139:495–503. doi: 10.1016/j.ajodo.2009.03.057.
    1. Luzi C, Verna C, Melsen B. Guidelines for success in placement of orthodontic mini-implants. J Clin Orthod. 2009;43:39–44.
    1. Pancherz H. The modern Herbst appliance. In: Graber TM, Rakosi T, Petrovic AG, editors. Dentofacial orthopedics with functional appliances. 2. St Louis: Mosby; 1997. pp. 336–66.
    1. Kuroda S, Yamada K, Deguchi T, Hashimoto T, Kyung HM, Takano-Yamamoto T. Root proximity is a major factor for screw failure in orthodontic anchorage. Am J Orthod Dentofacial Orthop. 2007;131:S68–73. doi: 10.1016/j.ajodo.2006.06.017.
    1. Schätzle M, Männchen R, Zwahlen M, Lang NP. Survival and failure rates of orthodontic temporary anchorage devices: a systematic review. Clin Oral Implants Res. 2009;20:1351–9. doi: 10.1111/j.1600-0501.2009.01754.x.
    1. Moon CH, Lee DG, Lee HS, Im JS, Baek SH. Factors associated with the success rate of orthodontic miniscrews placed in the upper and lower posterior buccal region. Angle Orthod. 2008;78:101–6. doi: 10.2319/121706-515.1.
    1. Poggio PM, Incorvati C, Velo S, Carano A. “Safe zones”: a guide for miniscrew positioning in the maxillary and mandibular arch. Angle Orthod. 2006;76:191–7.
    1. Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA., Jr Mandibular changes produced by functional appliances in class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006;129:599.
    1. Schaefer AT, McNamara JA, Jr, Franchi L, Baccetti T. A cephalometric comparison of treatment with the Twin-block and stainless steel crown Herbst appliances followed by fixed appliance therapy. Am J Orthod Dentofacial Orthop. 2004;126:7–15. doi: 10.1016/j.ajodo.2003.06.017.

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