改良Herbst矫治器的临床应用

目的 :观察改良Herbst矫治技术的临床矫治效果。方法 :本实验选择 12例Ⅱ类错病人为对象 ,采用改良Herbst矫治器 ,经过6——— 8个月的过程 ,观察、评估该治疗方法的矫治效果 ,并介绍该技术的矫治要点、步骤及特点。结果 :临床Ⅱ类错病例 ,采用改良Herbst矫治器 ,获得快速、显著的治疗效果。结论 :改良Herbst矫治器是一种疗效肯定的固定功能性矫治器 ,适用于青少年 (恒牙列 )、青少年后期和年轻成人的Ⅱ类错 ,这种治疗方法能使边缘性骨性Ⅱ类错避免正颌外科手术 ,临床操作简便 ,易于在临床推广应用。     

应用Herbst矫治器矫治恒牙期安氏Ⅱ~1类错

目的研究Herbst矫治器矫治恒牙期安氏Ⅱ1类错牙合的疗效。方法用Herbst矫治器矫治20例安氏Ⅱ1类错牙合患者,并对治疗前后的X线头颅侧位定位片进行分析比较。结果Herbst矫治器矫治恒牙期安氏Ⅱ1类错牙合,Ⅱ类关系的改善是上下颌综合作用的结果,其促进下颌骨生长及下颌牙前移的效应占主要因素。其中SNB增加(+4.1°),ANB减小(-4.6°),下颌骨的长度增加,上切牙舌倾,下切牙唇倾,下磨牙前移升高,前后牙垂直方向变化导致上下牙合平面顺时针旋转,软组织侧貌明显改善。结论应用Herbst矫治器治疗安氏Ⅱ1类错牙合,通过对牙、颌作用后产生综合效应,能在较短的时间内达到良好的效果。     

应用Herbst矫治器矫治恒牙期安氏Ⅱ1类错(牙合)

目的研究Herbst矫治器矫治恒牙期安氏Ⅱ1类错(牙合)的疗效.方法用Herbst矫治器矫治20例安氏Ⅱ1类错(牙合)患者,并对治疗前后的X线头颅侧位定位片进行分析比较.结果 Herbst矫治器矫治恒牙期安氏Ⅱ1类错(牙合),Ⅱ类关系的改善是上下颌综合作用的结果,其促进下颌骨生长及下颌牙前移的效应占主要因素.其中SNB增加(+4.1°),ANB减小(-4.6°),下颌骨的长度增加,上切牙舌倾,下切牙唇倾,下磨牙前移升高,前后牙垂直方向变化导致上下(牙合)平面顺时针旋转,软组织侧貌明显改善.结论应用Herbst矫治器治疗安氏Ⅱ1类错(牙合),通过对牙、颌作用后产生综合效应,能在较短的时间内达到良好的效果.     

应用Herbst矫治器矫治恒牙期安氏Ⅱ1类错

目的研究Herbst矫治器矫治恒牙期安氏Ⅱ1类错(牙合)的疗效.方法用Herbst矫治器矫治20例安氏Ⅱ1类错(牙合)患者,并对治疗前后的X线头颅侧位定位片进行分析比较.结果 Herbst矫治器矫治恒牙期安氏Ⅱ1类错(牙合),Ⅱ类关系的改善是上下颌综合作用的结果,其促进下颌骨生长及下颌牙前移的效应占主要因素.其中SNB增加(+4.1°),ANB减小(-4.6°),下颌骨的长度增加,上切牙舌倾,下切牙唇倾,下磨牙前移升高,前后牙垂直方向变化导致上下(牙合)平面顺时针旋转,软组织侧貌明显改善.结论应用Herbst矫治器治疗安氏Ⅱ1类错(牙合),通过对牙、颌作用后产生综合效应,能在较短的时间内达到良好的效果.     

下颌前伸矫治器和Herbst矫治器治疗AngleⅡ类错的对比研究

目的 :比较下颌前伸矫治器 (MandibularProtractionAppliance ,MPA)和Herbst矫治器对AngleⅡ类错牙合的治疗效果。方法 :选择 2 6例AngleⅡ类错牙合病人 ,男 14例 ,女 12例 ,最大 13岁 ,最小 10岁。X线头影测量显示主要为下颌后缩及轻微上颌前突 ,手腕片显示为生长发育高峰期。将这些病人分成两组 ,一组用下颌前伸矫治器治疗 (MPA组 ) ,另一组用Herbst矫治器进行治疗 (HA组 )。功能矫治结束时 ,两组病例均摄X线头颅定位侧位片 ,由专人定点、测量 ,并进行统计学分析。结果 :X线头影测量结果显示两组病例中Co -Pg、Go -Pg及Co -Go均增大 ,其变化量经统计学检验差异无显著性意义 ,表明下颌前伸矫治器及Herbst矫治器均能促进下颌骨生长 ,尤其是下颌升支的生长 ;SNB、ANB、U1-L1、U1-NL及L1-MP的变化量经过统计学检验差异有显著性意义 ,说明下颌前伸矫治器和Herbst矫治器都能有效矫治AngleⅡ类错牙合颌骨矢状关系不调 ,尤其是前者更有效 ,而Herbst矫治器易引起支抗丢失 ,即易使上颌前牙舌向倾斜、下颌前牙唇倾。结论 :下颌前伸矫治器和Herbst矫治器治疗早期AngleⅡ类错牙合均可取得明显的骨胳改变 ,但前者治疗效果更好     

下颌前伸矫治器和Herbst矫治器治疗Angle Ⅱ类错牙合的对比研究

目的:比较下颌前伸矫治器(Mandibular Protraction Appliance,MPA)和Herbst矫治器对Angle Ⅱ类错牙合的治疗效果.方法:选择26例Angle Ⅱ类错牙合病人,男14例,女12例,最大13岁,最小10岁.X线头影测量显示主要为下颌后缩及轻微上颌前突,手腕片显示为生长发育高峰期.将这些病人分成两组,一组用下颌前伸矫治器治疗(MPA组),另一组用Herbst矫治器进行治疗(HA组).功能矫治结束时,两组病例均摄X线头颅定位侧位片,由专人定点、测量,并进行统计学分析.结果:X线头影测量结果显示两组病例中Co-Pg、Go-Pg及Co-Go均增大,其变化量经统计学检验差异无显著性意义,表明下颌前伸矫治器及Herbst矫治器均能促进下颌骨生长,尤其是下颌升支的生长;SNB、ANB、U1-L1、U1-NL及L1-MP的变化量经过统计学检验差异有显著性意义,说明下颌前伸矫治器和Herbst矫治器都能有效矫治Angle Ⅱ类错牙合颌骨矢状关系不调,尤其是前者更有效,而Herbst矫治器易引起支抗丢失,即易使上颌前牙舌向倾斜、下颌前牙唇倾.结论:下颌前伸矫治器和Herbst矫治器治疗早期Angle Ⅱ类错牙合均可取得明显的骨胳改变,但前者治疗效果更好.     

Herbst矫治器双期矫治与拔牙矫治AngleⅡ类错[牙合]的对比研究

目的 比较Herbst矫治器双期矫治和单纯拔牙矫治恒牙期Angle Ⅱ类错(牙合)的效果.方法 选择18例及16例FG-G期恒牙期Angle Ⅱ类错(牙合)患者,分别作为Herbat组和拔牙组;Herbst组经金属铸造夹板式Herbat矫治器矫治后,立即接受方丝弓矫治器完成二期矫治;拔牙组拔出4个双尖牙方丝弓技术矫治;通过X线头影测量方法评价两组疗效.结果 前牙覆盖减小及磨牙关系改善中,Herbst组骨性变化占44%及57%,而拔牙组主要为86%及78%的牙性变化;较拔牙组的变化,Herbst组下颌升支长度、下颌体长度、下颌有效长度分别多增加了1.59mm、1.26mm和2.41mm SNB多增加了2.15°,ANB多减小了1.66°(P<0.001);Herbst组软组织侧貌突度具有更加明显的减小.结论 对以下颌后缩为主要特征的恒牙期Ⅱ类错(牙合),采用Herbst矫治器双期矫治具有显著疗效,而不宜单纯采用拔牙矫治.     

Herbst矫治器对成人骨性Ⅱ类错(牙合)畸形矫治的疗效评价

Herbst矫治器是一种能有效治疗骨性Ⅱ类错[牙合]伴下颌后缩的固定性功能矫治装置,它不仅可应用于矫治儿童及青少年Ⅱ类错[牙合],亦对矫治该错[牙合]类型的成人也有一定效果,并结合改变了骨及牙等组织,有效改善了侧貌,且远期疗效较稳定,是一种矫正成人边缘性骨性Ⅱ类错[牙合]畸形行之有效的方法,本文将对此作一综述。     

多曲方丝弓矫治技术在直丝弓矫治器中的应用

目的：观察MEAW技术在直丝弓矫治器中矫治错[牙合]的临床效果,探讨其矫治特点。方法：选择0.022″系统的直丝弓矫治器,使用MEAW技术对10例Ⅲ类错[牙合]和3例前牙开[牙合]病例进行矫治。结果：13例患者均取得了满意的临床矫治效果。结论：在直丝弓矫治器中使用MEAW技术矫治错[牙合]效果明显,值得临床推广。     

Tweed-Merrifield定向力原理在安氏II类I分类错牙合治疗中的应用

目的　介绍Tweed Merrifield定向力原理 ,探讨其在治疗安氏II类I分类错牙合的临床机理。方法　通过评价临床治疗的 10例安氏II类I分类错牙合病例 ,介绍改进的Tweed Merrifield矫治方法及步骤 ,并分析矫治中使用的力系 ,同时介绍一典型病例的治疗过程及治疗结果。结果　表明正确应用Tweed Merrifield原理在临床上能成功治疗安氏II类I分类错牙合。结论　方丝弓是一种有效的矫治安氏II类I分类错牙合的固定矫治器 ,只要在治疗中正确应用Tweed Merrifield原理 ,掌握好力的使用及支抗的控制 ,疗效非常显著     

Treatment of Class II high angle malocclusions with the Herbst appliance: a cephalometric investigation.

The purpose of this study was to examine the results of treatment of Class II malocclusions by using two different designs of the Herbst appliance. Cephalometric records from lateral headplates of 19 consecutively treated Class II cases were evaluated. The headplates were taken before and after the treatment stage in which the Herbst appliance was used. The patients were divided into two groups: the first group, normohypodivergent, was treated with the Herbst appliance attached to bands; the second group, hyperdivergent, was treated with the Herbst appliance attached to acrylic splints in which a high-pull headgear was also used. The results were compared between these groups and with a control group age-matched from Bolton standards to match the changes in the Herbst samples against what might be expected in case of normal growth during similar periods of time. The results of the investigation revealed the following: (1) 9 months of treatment resulted in Class I dental arch relationships in all 19 cases; (2) the Herbst appliance attached to bands did not significantly modify the vertical growth pattern of the normohypodivergent patients; and (3) in hyperdivergent patients, the use of a Herbst appliance attached to acrylic splints in conjunction with the use of a high-pull headgear allowed a better control of the vertical dimension, as assessed by the cephalometric parameters (FA, FMA, Go-Gn-SN). The clinician should be aware of the different dentofacial changes induced in the vertical plane by different designs of the Herbst appliance to better program treatment strategy.     

功能矫治器治疗三维方向错牙合畸形的研究

目的：：评价功能矫治器治疗下颌后缩同时伴有垂直向、横向不调错畸形的疗效。方法：对20名下颌后缩同时伴有垂直向、横向不调错畸形的患者(平均年龄12.8岁)采用功能矫治器及固定矫治器双期矫治,通过X线头影测量比较矫治前、中、后有关指标的变化并进行统计分析。结果：所有患者功能矫治后,SNB增大(P<0.05),ANB减小(P<0.05),上磨牙压低并后移(P<0.05),下磨牙升高并前移(P<0.05)。双期矫治后,前牙达到正常覆覆盖关系,后牙达到中性关系或尖窝交错的咬合关系,下颌平面未发生明显的顺时针旋转,上下颌牙列矢状向、垂直向、横向关系协调。结论：采用功能矫治器双期矫治下颌后缩同时伴有垂直向、横向不调的错畸形,可获得满意的治疗效果。     

"Effective" TMJ and chin position changes in Class II treatment

OBJECTIVE: To evaluate the "effective" temporomandibular joint (TMJ) changes (the sum of condylar modeling, glenoid fossa modeling, and condylar position changes within the fossa), and their influence on chin position in patients with a Class II division 1 malocclusion treated orthodontically with a multibracket appliance and Class II elastics (Tip-Edge) and orthopedically with a fixed functional appliance (Herbst). MATERIALS AND METHODS: Two groups of successfully treated subjects were evaluated: Tip-Edge (n = 24) and Herbst (n = 40). The Bolton Standards served as a control group. Lateral head films obtained before treatment and after an observation period of 2.6 years (Herbst also after 0.6-year period) were analyzed. RESULTS: In comparison with the Herbst and control groups, the Tip-Edge group exhibited less favorable sagittal "effective" TMJ growth and chin position changes necessary for skeletal Class II correction. CONCLUSIONS: Orthodontic therapy with a multibracket appliance and Class II elastics seems not to have any favorable sagittal orthopedic effect on the mandible, while bite jumping with the Herbst appliance has a favorable sagittal orthopedic effect on a short-time basis.     

Herbst矫治器治疗年轻成人安氏Ⅱ类2分类错的研究

目的评价Herbst矫治器治疗年轻成人安氏Ⅱ类2分类错的疗效。方法对12名安氏Ⅱ类2分类错的年轻成人患者,采用铸造夹板式Herbst矫治器及固定矫治器矫治,通过X线头影测量比较矫治前后有关指标的变化并进行统计分析。结果矫治后SNA、Co-Go、Go-Po变化无统计学意义,SNB增加,ANB减小,上下前牙唇倾,上磨牙后移,下磨牙升高并前移,下颌平面、平面顺时针旋转。患者矫治后前牙达到浅覆、浅覆盖关系,磨牙达到中性关系。结论年轻成人安氏Ⅱ类2分类错可通过铸造夹板式Herbst矫治器结合固定矫治器获得满意的效果。     

Class II correction in patients treated with class II elastics and with fixed functional appliances: a comparative study.

The aim of the present study was to evaluate quantitatively the skeletal and dental changes contributing to Class II corrections in subjects treated with Class II elastics (Begg technique) compared with subjects treated with fixed functional appliances (Herbst appliance). Thirty-six male patients with Class II, Division 1 malocclusions whose treatment had not included extraction were investigated. Eighteen were treated with the Begg technique, and eighteen were treated with Herbst appliance for an average period of 1.3 and 0.5 years, respectively. Lateral radiographs in habitual occlusion were taken at the start of treatment and 12 months afterwards. In the Begg group, the maxilla moved forward 1 mm more than in the Herbst group, and the mandible moved 1 mm more in the Herbst group than in the Begg group. The skeletal improvement in the Herbst group exceeded the changes in the Begg group by, on average, 2.0 mm (P <.01). The overjet reduction in the Begg group was larger (2.1 mm; P <.01) than in the Herbst group, mostly because of dental movements. The skeletal part of the overjet reduction was 4% in the Begg group compared with 51% in the Herbst group. The molar correction was similar in both groups, but in the Begg group, the skeletal improvement was 10%, compared with 66% in the Herbst group. The overbite correction and the increase in the anterior lower facial height and in the NSL/ML angle were larger in the Begg group (P <.05). The conclusions of this study were that the changes contributing to the Class II corrections in Begg and Herbst therapy were skeletal and dental. The skeletal changes were, however, larger in the Herbst-treated group. On the other hand, favorable and unfavorable vertical changes were more pronounced in the group treated with Class II elastics.     

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目的    探讨改良式Herbst 矫治器矫治安氏Ⅱ类下颌后缩伴上牙弓狭窄患者的临床疗效。方法    2004—2009年在南昌大学口腔医院正畸科采用改良式Herbst矫治器治疗11例安氏Ⅱ类下颌后缩伴上牙弓狭窄患者,通过矫治前后头影片的测量对比,分析该矫治器的疗效。结果    经改良式Herbst矫治器治疗6～8个月后,11例患者的下颌均明显前移,上下牙弓协调,下颌后缩面型显著改善。结论    改良式Herbst矫治器能有效地矫治安氏Ⅱ类下颌后缩伴上牙弓狭窄的患者。     

Orthognathic surgery and dentofacial orthopedics in adult Class II Division 1 treatment: mandibular sagittal split osteotomy versus Herbst appliance.

The aim of this study was to assess to what extent adult Herbst treatment is an alternative to orthognathic surgery by comparing the dentoskeletal treatment effects in 46 adult Class II Division 1 subjects treated with a combined orthodontic-orthognathic surgery approach (mandibular sagittal split osteotomy without genioplasty) and 23 adult Class II Division 1 subjects treated with the Herbst appliance. Lateral headfilms in habitual occlusion from before and after treatment (multibracket appliance treatment after surgery or Herbst treatment) were analyzed. All surgery and Herbst subjects were treated successfully to Class I occlusal relationships with normal overjet and overbite. In the surgery group, the improvement in sagittal occlusion was achieved by skeletal more than dental changes; in the Herbst group, the opposite was the case. Skeletal and soft tissue facial profile convexity was reduced significantly in both groups, but the amount of profile convexity reduction was larger in the surgery group. The success and predictability of Herbst treatment for occlusal correction was as high as for surgery. Thus, Herbst treatment can be considered an alternative to orthognathic surgery in borderline adult skeletal Class II malocclusions, especially when a great facial improvement is not the main treatment goal.     

Temporomandibular joint remodeling in adolescents and young adults during Herbst treatment: A prospective longitudinal magnetic resonance imaging and cephalometric radiographic investigation

The aim of this prospective study was to analyze and compare the temporomandibular joint adaptive mechanisms in 25 adolescent and 14 young adult Class II malocclusions treated with the Herbst appliance. Temporomandibular joint remodeling was analyzed by magnetic resonance imaging. In each subject, 4 magnetic resonance images of both temporomandibular joints were available: before treatment, at the start of treatment (when the Herbst appliance was placed), during treatment (6 to 12 weeks after appliance placement), and after treatment (when the appliance was removed). Furthermore, effective temporomandibular joint changes (the sum of condylar remodeling, fossa remodeling, and condyle-fossa relationship changes) were analyzed with the aid of lateral cephalometric radiographs from before and after treatment. All subjects were treated to Class I or overcorrected Class I dental arch relationships, and their mandibles became significantly (P <.001) more prognathic. After 6 to 12 weeks of Herbst treatment, signs of condylar remodeling were seen at the posterosuperior border in 48 of the 50 adolescent condyles and in 26 of the 28 young adult condyles. Bilateral remodeling of the mandibular ramus could be detected in 1 adolescent and 2 young adult patients. Signs of glenoid fossa remodeling at the anterior surface of the postglenoid spine were noted in 36 adolescent and 22 young adult temporomandibular joints. Effective temporomandibular joint changes during treatment were more horizontally directed and larger in both adolescents and young adult patients treated with the Herbst appliance than in an untreated group of subjects with ideal occlusion (Bolton standards). The increase in mandibular prognathism accomplished by Herbst therapy in both adolescents and young adults seems, in particular, to be a result of condylar and glenoid fossa remodeling. Because the Herbst appliance is most successful in Class II patients also at the end of the growth period, the treatment method could be an alternative to orthognathic surgery in borderline skeletal Class II cases. Magnetic resonance imaging renders an excellent opportunity to visualize the temporomandibular joint remodeling growth processes.     

Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial.

The aim of this study was to evaluate the effectiveness of Herbst and Twin-block appliances for established Class II Division I malocclusion. The study was a multicenter, randomized clinical trial carried out in orthodontic departments in the United Kingdom. A total of 215 patients (aged 11-14 years) were randomized to receive treatment with either the Herbst or the Twin-block appliance. Treatment with the Herbst appliance resulted in a lower failure-to-complete rate for the functional appliance phase of treatment (12.9%) than did treatment with Twin-block (33.6%). There were no differences in treatment time between appliances, but significantly more appointments (3) were needed for repair of the Herbst appliance than for the Twin-block. There were no differences in skeletal and dental changes between the appliances; however, the final occlusal result and skeletal discrepancy were better for girls than for boys. Because of the high cooperation rates of patients using it, the Herbst appliance could be the appliance of choice for treating adolescents with Class II Division 1 malocclusion. The trade-off for use of the Herbst is more appointments for appliance repair.     

The Herbst appliance--its biologic effects and clinical use

The purpose of this article is to survey the Herbst bite-jumping method. An outline of appliance design and appliance construction is given. The effects of the treatment method on the dentofacial complex and on the masticatory system have been analyzed with the aid of dental casts, cephalometric roentgenograms, and electromyographic registrations from the masticatory muscles. The use and effectiveness of the Herbst appliance in the treatment of Class II malocclusions are exemplified by clinical cases, some of which were followed for 5 years after treatment. The Herbst appliance is most effective in the treatment of Class II malocclusions, provided it is used as indicated. Thus, the appliance must be limited to growing persons only. The treatment method should not be looked upon as a last resort to be used only when other treatment approaches have failed. Treatment prognosis is best in subjects with a brachyfacial growth pattern. Unfavorable growth, unstable occlusal conditions, and persisting oral habits after treatment are potential risk factors for occlusal relapses. As treatment with the Herbst appliance is performed during a relatively short period, the hard and soft tissues (teeth, bone, and musculature) would need some time for adaptation to the new mandibular position after the appliance is removed. Posttreatment retention as a routine with a removable functional appliance is therefore recommended.