Herbst/multibracket appliance treatment of Class II division 1 malocclusions in early and late adulthood. A prospective cephalometric study of consecutively treated subjects

Abstract

A prospective study of 23 consecutive adult Class II division 1 malocclusion subjects (19 female and 4 male) treated with the Herbst/multibracket (MB) appliance is presented. The skeletal, dental, and facial profile changes were evaluated in addition to the mechanism of Class II correction during the Herbst phase and the settling of the occlusion during the MB phase. The mean pre-treatment age of the subjects was 21.9 years (15.7-44.4 years). Lateral head films in habitual occlusion from before treatment (T1) and after the Herbst (T2) and MB (T3) phases were analysed using standard cephalometrics and the sagittal occlusion analysis. For the standard cephalometrics, normal growth standards were utilized as control parameters. All patients were treated successfully to a Class I occlusal relationship with a normal overjet and overbite. The mandibular variables (SNB and SNPg) showed an angular increase (1.22 and 0.93 degrees, respectively) during T2-T1 followed by an angular reduction (0.40 and 0.23 degrees, respectively) during T3-T2. Compared with normal growth standards, all mandibular parameters were affected favourably by Herbst/MB treatment. Both the skeletal and soft tissue profile convexities were significantly reduced. Over the entire observation period (T3-T1), the largest amount of profile convexity reduction was seen for the soft tissue profile excluding the nose (mean 3.14 degrees). Class II correction was achieved by both skeletal and dental changes: overjet correction by 13 per cent skeletal and 87 per cent dental changes, and molar correction by 22 per cent skeletal and 78 per cent dental changes. In conclusion, on a short-term basis, the Herbst/MB appliance combination was found to be a powerful tool for non-surgical, non-extraction, treatment of Class II division I subjects in early and late adulthood.