Facial-profile attractiveness changes in adult patients treated with the Herbst appliance

Aim

The goal of this study was to compare facial profile attractiveness changes of adult patients treated with the Herbst appliance assessed by orthodontists and laypeople.

Materials and methods

The patient sample comprised 28 adult Herbst patients. Facial profile photographs of the patients were randomly divided into two evaluation sets (before T0, after treatment T1). Ten members of the Angle Society of Europe (orthodontists) and 10 dental students in their third semester (laymen) rated both sets of photographs using Visual Analog Scales (VAS) with an interval of 1 day between the ratings.

Results

On average, both orthodontists and students found an improvement in facial profile attractiveness through Herbst appliance treatment (VAS T1–T0?=?0.3?±?1.9 cm). However, the interindividual perception of profile attractiveness varied greatly in the two rater groups. For both time periods (T0, T1), lower VAS ratings were given by students than by orthodontists.

Conclusion

Herbst therapy in adult patients generally improves facial profile attractiveness. Students rated facial profiles more critically than orthodontists.     

Class II treatment by extraction of maxillary first molars or Herbst appliance: dentoskeletal and soft tissue effects in comparison

Aim

To compare dentoskeletal and soft tissue treatment effects of two alternative Class II division 1 treatment modalities (maxillary first permanent molar extraction versus Herbst appliance).

Methods

One-hundred-fifty-four Class II division 1 patients that had either been treated with extractions of the upper first molars and a lightwire multibracket (MB) appliance (n?=?79; 38 girls, 41 boys) or non-extraction by means of a Herbst-MB appliance (n?=?75; 35 girls, 40 boys). The groups were matched on age and sex. The average age at the start of treatment was 12.7 years for the extraction and for 13.0 years for the Herbst group. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were retrospectively analyzed using a standard cephalometric analysis and the sagittal occlusal analysis according to Pancherz.

Results

The SNA decrease was 1.10° (p?=?0.001) more pronounced in the extraction group, the SNB angle increased 1.49° more in the Herbst group (p?=?0.000). In the extraction group, a decrease in SNB angle (0.49°) was observed. The soft tissue profile convexity (N-Sn-Pog) decreased in both groups, which was 0.78° more (n. s.) pronounced in the Herbst group. The nasolabial angle increased significantly more (+?2.33°, p?=?0.025) in the extraction group. The mechanism of overjet correction in the extraction group was predominantly dental (65% dental and 35% skeletal changes), while in the Herbst group it was predominantly skeletal (58% skeletal and 42% dental changes) in origin.

Conclusion

Both treatment methods were successful and led to a correction of the Class II division 1 malocclusion. Whereas for upper first molar extraction treatment more dental and maxillary effects can be expected, in case of Herbst treatment skeletal and mandibular effects prevail.     

Three-dimensional evaluation of soft tissue changes in the orofacial region after tooth-borne and bone-borne surgically assisted rapid maxillary expansion

Objectives

This study seeks to three-dimensionally assess soft tissue changes in the orofacial region following tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME).

Materials and methods

This prospective cohort study included 40 skeletally mature patients with transverse maxillary hypoplasia. A tooth-borne distractor (Hyrax) was used for expansion in 25 patients. In the remaining 15, a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were acquired before treatment (T0) and 22 months later (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed 3D models were computed to evaluate the degree of skeletal and soft tissue changes in the maxillary region.

Results

Distance maps showed negative distances (mean ?1.25 (±1.5) mm) in the middle of the upper lip, indicating posterior repositioning of this area. The cheek region showed positive changes (mean 1.66 (±1.1) mm), reflecting the underlying increase in maxillary width. There was no significant difference between the two groups in all measured distances (p?>?0.05). Retro-positioning of the upper lip accompanied skeletal remodeling in the anterior alveolar region at a mean ratio of 88 %, while the cheek region followed 32 % of the alveolar expansion.

Conclusion

Soft tissue changes following SARME include posterior repositioning of the upper lip and increased projection of the cheek area. These changes were comparable between bone-borne and tooth-borne appliances.

Clinical relevance

This study provides clinicians with more information over the expected orofacial soft tissue changes following SARME     

Effects of fixed appliances in correcting Angle Class?II on the depth of the posterior airway space

Objective

The objective of this retrospective study based on the metric evaluation of lateral cephalograms was to investigate the extent to which treatment with two different fixed appliances for the correction of Angle Class?II influenced the morphology of the extrathoracic airway space (the posterior airway space, PAS).

Patients and methods

A total of 43?patients with Angle Class?II malocclusion were classified into two groups according to the appliance used for treatment: the functional mandibular advancer (FMA; n?=?18) or the Herbst appliance (n?=?25). Lateral cephalograms were taken of each patient at the start of functional jaw orthopedic treatment (time point T1) and at its completion (time point T2). Specific distances and angles were measured and analyzed in a cephalometric analysis.

Results

We observed major differences among the 43?patients in the depth of the posterior airway space during treatment with fixed appliances for Angle Class?II correction. Regression analysis revealed that changes in sagittal and vertical positions had different effects on the depth of specific PAS sections: increases in anterior facial height are associated proportionately with increases in PAS width, particularly in the upper region. On the other hand, increases in posterior facial height and in the mandible??s forward displacement correlated inversely to the decreases in depth, particularly in the central and lower PAS regions. The two treatment appliances (FMA, Herbst appliance) had the same effects on extrathoracic airway depth.

Conclusions

Analyses of lateral cephalograms indicate that Angle Class?II treatment with fixed appliances does not prevent sleep apnea in patients at risk. Nevertheless, this study does not permit absolutely reliable conclusions about the dimensions of the pharyngeal airway space. As the lateral cephalogram provides good images of structures in the midsagittal plane but is incapable of imaging the transverse dimension, there is an automatic lack of information concerning the precise width and volume of the extrathoracic airway space.     

Soft tissue outcome after mandibular advancement—an anthropometric evaluation of 171 consecutive patients

Objectives

There is an ongoing discussion in the literature about preoperative planning and postoperative evaluation of orthognathic surgery and its impact on facial appearance and aesthetics.

Materials and Methods

We present an anthropometric and cephalometric evaluation of orthognathic surgery results based on reference anthropometric data. In 171 Class II patients, mandibular advancement by bilateral sagittal split osteotomy was performed. Preoperative as well as 3 and 9 months postoperative standardized frontal view and profile photographs and lateral cephalograms were evaluated in a standardized manner by use of 21 anthropometric indices. In cephalograms, SNA and SNB angle as well as Wits appraisal were investigated. Results of anthropometric and cephalometric measurements were correlated.

Results

Lower vermilion contour, vermilion and cutaneous total lower lip height, nose–lower face height, nose–face height, upper face–face height, upper lip– and chin–mandible height index showed significant pre- to postoperative changes as well as SNB angle and Wits appraisal. Furthermore, medial–lateral cutaneous upper lip height, vermilion and cutaneous total lower lip height and philtrum–mouth width index presented significant correlations to cephalometric measurements.

Conclusions

The investigated anthropometric indices and cephalometric measurements presented reproducible results related to surgery. The correlation of cephalometric to anthropometric measurements has been proven useful for preoperative planning and postoperative evaluation of orthognathic surgery patients.

Clinical relevance

The presented anthropometric measurements and their observed correlation to cephalometric measurements could lead to a better prediction and optimized planning of the soft tissue result in orthognathic surgery patients and thereby improve the aesthetic outcome.     

Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry

Purpose

Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes.

Material and methods

Twenty-eight patients with class II relationship and 33 with class III underwent bimaxillary surgery. All subjects had available both a traced lateral cephalogram and a traced lateral photogram taken pre- and postsurgery in natural head position (median follow-up, 9.4?±?0.6 months).

Results

Facial convexity and lower lip length were highly correlated with hard tissue movements cephalometrically in class III patients and 2-D photogrammetrically in both classes. In comparison, cephalometric correlations for class II patients were weak. Correlations of hard and soft tissue movements between pre- and postoperative corresponding landmarks in horizontal and vertical planes were significant for cephalometry and 2-D photogrammetry. No significant difference was found between cephalometry and 2-D photogrammetry with respect to soft to hard tissue movement ratios.

Conclusions

This study revealed that cephalometry is still a feasible standard for evaluating and predicting outcomes in routine orthognathic surgery cases. Accuracy could be enhanced with 2-D photogrammetry, especially in class II patients.     

Musculoskeletal Changes as a Sequel to Advancement Genioplasty: A Long-Term Cephalometric Prospective Study

Aims

The aim of this study was to evaluate cephalometrically the stability of hard tissues and soft tissue changes of advancement genioplasty 2 years after surgery.

Methods

A prospective study was conducted which comprised of 25 patients, who underwent advancement genioplasty alone with no other orthognathic surgical procedures. Immediate pre-operative, 6 months postoperative, and 2 years postoperative lateral cephalograms were compiled and assessed.

Results

The mean surgical advancement planned was around 8 mm. Six months post-surgery, the relapse rate was 15% of the surgical advancement which was considerably reduced in the following 18 months to 7%. The ratio of soft tissue to bony advancement at pogonion was 0.9:1. There are significant alterations in the soft tissue profile in terms of decrease in the soft tissue thickness, facial convexity angle, deepened mentolabial sulcus and minimal increase in the lower lip height.

Conclusion

Advancement genioplasty was considered as a relatively stable procedure, if adequate muscular pedicle and internal rigid fixation were maintained. The present study was of 2 years, and we can expect further changes in the hard and soft tissues, which are clinically irrelevant.

     

Longitudinal soft-tissue profile changes in adolescent Class?I subjects

Objective

The purpose of this study was to assess longitudinal changes in the soft-tissue profile in untreated subjects from the prepubertal through the postpubertal stages of development as defined by the cervical vertebral maturation (CVM) method.

Methods

A total of 14?boys and 15?girls who were longitudinally followed from about 10 through about 16?years of age with Class?I occlusal, normal anteroposterior, and vertical skeletal relationships were selected. Lateral cephalograms at three consecutive developmental periods (prepubertal, pubertal, and postpubertal) corresponding to the different stages in CVM had to be available for all selected subjects. Eleven angular and 18?linear measurements were made. Analysis of variance was used to search for significant changes between developmental periods. Duncan’s test for multiple comparisons was then used to identify the source of any significant difference. Differences between the genders were determined by using the Student t-test.

Results

Nasal prominence and dimensions increased more than chin, upper and lower lip prominences and dimensions. After puberty, males had more soft tissue changes than females. In females, growth changes mostly took place between the prepuberty and puberty growth periods.

Conclusion

These results can be used by orthodontists as representative of the soft tissue profile changes during the developmental period.     

Vomer flap for hard palate repair is related to favorable maxillary growth in unilateral cleft lip and palate

Objective

Vomer flap repair is assumed to improve maxillary growth because of reduced scarring in growth-sensitive areas of the palate. Our aim was to evaluate whether facial growth in patients with unilateral cleft lip and palate was significantly affected by the technique of hard palate repair (vomer flap versus two-flap).

Materials and methods

For this retrospective longitudinal study, we analyzed 334 cephalometric radiographs from 95 patients with nonsyndromic complete unilateral cleft lip and palate who underwent hard palate repair by two different techniques (vomer flap versus two-flap). Clinical notes were reviewed to record treatment histories. Cephalometry was used to determine facial morphology and growth rate. The associations among facial morphology at age 20, facial growth rate, and technique of hard palate repair were assessed using generalized estimating equation analysis.

Results

The hard palate repair technique significantly influenced protrusion of the maxilla (SNA: β?=??3.5°, 95 % CI?=??5.2-1.7; p?=?0.001) and the anteroposterior jaw relation (ANB: β?=??4.2°, 95 % CI?=??6.4-1.9; p?=?0.001; Wits: β?=??5.7 mm, 95 % CI?=??9.6-1.2; p?=?0.01) at age 20, and their growth rates (SNA p?=?0.001, ANB p?<?0.01, and Wits p?=?0.02).

Conclusions

The results suggest that in patients with unilateral cleft lip and palate, vomer flap repair has a smaller adverse effect than two-flap on growth of the maxilla. This effect on maxillary growth is on the anteroposterior development of the alveolar maxilla and is progressive with age. We now perform hard palate closure with vomer flap followed by soft palate closure using Furlow palatoplasty.

Clinical relevance

These findings may improve treatment outcome by modifying the treatment protocol for patients with unilateral cleft lip and palate.     

Three-dimensional analysis of changes of the malar–midfacial region after LeFort I osteotomy and maxillary advancement

Aim

It has been the objective of the present prospective study to assess visible volume changes of the facial soft tissue after LeFort I osteotomy with advancement and to determine the soft-tissue-to-hard-tissue ratios of advancement.

Patients and methods

Twenty adult patients (ten female, ten male, mean age 33.9?±?14.9 years) received a LeFort I osteotomy with advancement because of a maxillary protrusion. Lateral skull radiographs and optical three-dimensional (3D) scans of the facial surface were assessed preoperatively and 12 months after surgery. The lateral skull radiographs were used to carry out standard linear and angular cephalometric measurements. The pre- and postoperative optical 3D surface scans were registered. A well-defined area in the malar region was used to determine the visible volume changes for each side separately. The mean accommodation vector that transforms the preoperative into the postoperative surface was assessed for each facial half separately. The soft-tissue-to-hard-tissue ratios between the incision superius and the labrale superius, the maximal parasagittal advancement of soft tissue, and the accommodation vectors were calculated.

Results

A mean advancement of the incision superius of 5.3?±?2.1 mm was accompanied by a volume increase of 5.2?±?4.1 cm³ in the right malar–midfacial region and 4.6?±?4.7 cm³ on the left side, respectively, revealing a symmetrical volume change (p?=?0.370). The soft-tissue-to-hard-tissue ratios were 80?±?94% for labrale superius and incision superius, 56?±?79% (right) and 51?±?56% (left) for accommodation vector and incision superius and 97?±?79% (right) and 98?±?89% (left) for maximal parasagittal advancement of soft tissue and incision superius.

Discussion

The determination of volume changes and accompanying accommodation vectors complete the cephalometric analysis during the follow-up of patients undergoing LeFort I osteotomy. The data show that maxillary advancement leads to a more pronounced shifting of the soft tissues in the malar–midfacial area than of the upper lip. The new parameters will help to assess normative soft tissue data based on 3D imaging with a view to an improved three-dimensional prediction of the operative outcome of orthognathic surgery away from the midline.     

Use of Nasolabial Flap in Intra and Extraoral Reconstruction: Our Experience with 40 Cases

Purpose

This article represents the use of inferiorly based nasolabial flap in reconstruction of various intraoral and extraoral defects.

Patients and Methods

Nasolabial flaps were performed in 40 patients, for reconstruction of buccal mucosa, gingivobuccal sulcus, commissure, lower lip, floor of mouth, upper lip and lower alveolar defects.

Results

The most common defect site in the oral cavity was the buccal mucosa. Partial flap necrosis occurred in five patients. Out of 40 cases of carcinoma of lip, commissure and floor of the mouth, all the patients had good speech after complete healing of the wound. None of the patients who had lip or commissure reconstruction developed drooling of saliva due to lip incompetence.

Conclusion

The inferiorly based nasolabial flap provides reliable coverage of intermediate-sized oral cavity defects when used alone. Minimal donor morbidity is associated with its use. It is especially useful in elderly patients with facial skin laxity and where esthetics is not a major concern.     

Standards of Facial Esthetics: An Anthropometric Study

Aim

Anthropometry is an art and science used extensively for measuring the soft tissue proportions. While it is true that error is found in measurements of this kind, a great many trends of growth and development and therapy changes can be recorded with a significant degree of accuracy.

Objective

Facial proportion varies among the different ethnic groups and today, most of the available studies are done on western population. Hence an Anthropometric study was conducted in the local population.

Materials and Methods

The study was carried out with the aim of measuring the facial soft tissue proportion in the local population using anthropometry. Study was done using 100 subjects (50 males and 50 females) with Class I skeletal relationship and pleasing profile. Using standard anthropometric landmarks the various anthropometric measurements and facial proportional indices were determined (both horizontal and vertical) and were compared with that for North American Caucasians.

Results

The statistical analysis revealed significant differences in the facial proportion between the two populations.     

A Clinician’s Role in the Management of Soft Tissue Injuries of the Face: A Clinical Paper

Introduction

Injuries of the facial soft tissues may be due to road traffic accidents, industrial injuries, domestic and interpersonal violence, dog bites, human bites, war injuries etc. They may be described depending on the depth of involvement of the soft tissue and/or region since it gives the clinician the method of treatment. The soft tissue injuries must take into the underlying skeletal injury into account since these injuries if carelessly handled they leave deformed scarring in the most precious and beautiful part of the body.

Materials and Methods

Various patients reporting to the department of Oral and Maxillofacial Surgery, Narayana Dental College and hospital, Nellore were included in the study. Injuries in the various aspects of face at various anatomical areas has been presented with the mode of management.

Conclusion

The maxillofacial surgeon while attending these cases should avoid the need for revision by having a thorough knowledge of the anatomy, physiology of the soft tissues and treat them accordingly after following good clinical and radiological examination.     

Control of lower incisor inclination with a completely customized lingual appliance for dentoalveolar compensation of class III malocclusion

Objective

Bracket slots and orthodontic archwires offering high dimensional precision are needed for fully customized lingual appliances. We aimed to investigate whether high-precision appliances of this type enable dentoalveolar compensation of class III malocclusion so that lower incisor inclination at the end of treatment will closely match the anticipated situation as defined in a pretreatment setup.

Materials and methods

This retrospective study included a total of 34 consecutive patients who had worn a fully customized lingual appliance to achieve dentoalveolar compensation for class III malocclusion by intermaxillary elastics, or proximal enamel reduction, or extraction of teeth in one or both jaws. Casts fabricated at different points in time were three-dimensionally scanned to analyze how precisely the lower incisor inclinations envisioned in the setup were implemented in clinical practice.

Results

Aside from minor deviations of ±3.75°, the lower incisor inclinations were clinically implemented as planned even in patients with major sagittal discrepancies.

Conclusion

Treatment goals predefined in a setup of dentoalveolar compensation for class III malocclusion can be very precisely achieved via a customized lingual appliance. Correct planning can prevent undesirable lingual tipping of the lower incisors. This finding should not encourage a more liberal use of dentoalveolar compensation, but it should heighten clinicians’ awareness of how essential it is to sufficiently consider the individual anatomy of the dentoalveolar complex during treatment planning.     

Esthetic perception of changes in facial profile resulting from orthodontic treatment with extraction of premolars: A systematic review

Background

The authors conducted a systematic review to assess changes in patients’ facial profiles resulting from orthodontic treatment with and without extraction of 4 premolars and to identify cephalometric parameters that can assist decision making in borderline cases.

Positionierung der Oberkieferelemente mit der Latham-Apparatur bei Patienten mit Lippen-Kiefer-Gaumen-Spalten

Subject Matter. In cases of bilateral cleft lip, alveolus and palate, preoperative positioning of the premaxilla using Latham’s appliance has been described. This method is controversial, since it may cause growth defects. Patients and Methods. From 1992 to 2000, Latham’s appliance was inserted preoperatively into 20 patients with bilateral lip, alveolus and palate clefts with extreme premaxillary protrusion. Pin fixation ensued at the age of 3 months. After adjustment of the premaxilla, the soft palate was closed and bilateral lip adhesion as well as bilateral gingivoperiosteoplasty were performed directly after the removal of the appliance. Final lip closure took place 4–6 weeks later. At the age of 2 years, the hard palate was closed. Evaluation was based on combined face-maxilla models, standard photographs and, when available, lateral skull x-rays showing the relative position of the segments, the influence of Latham’s appliance on the nasal septum and the relation of the upper jaw to the skull base and mandibula. Results. In all cases, a satisfactory alveolar alignment was achieved; thickening and curvature of the nasal septum occurred but receded. Neither growth disturbances nor dental germ damage were seen. In two cases, complications arose from suture dehiscence of the lip adhesion: in one patient, a screw defect caused a loosening of the appliance and there was also a transmigration of the postpremaxillary pin. Conclusions. On the basis of our experience, the use of Latham’s appliance, combined with consistent orthodontic supervision and, if necessary, treatment, represents a practical option for the treatment of bilateral cleft lip, alveolus and palate, especially in cases with extreme protrusion of the premaxilla.      

Microcystic adnexal carcinoma of the upper lip misdiagnosed benign desmoplastic trichoepithelioma

Background

Desmoplastic trichoepithelioma (DT) is a benign appendageal tumour predominately localized on the facial skin. The histological diagnosis can be difficult in some cases. Partial malignant transformation of a DT is a rarity and a complete transformation has never been described in literature.

Case report

A DT of the upper lip was diagnosed histologically by a small biopsy 4 years previously. At presentation, the tumour had enlarged and had partly infiltrated the left side of the upper lip and subnasal region. Histological evaluation confirmed a microcystic adnexal carcinoma but without evidence of malignant transformation of the DT. It appeared that a too-small initial biopsy had led to the incorrect histological diagnosis of a benign tumour. Thus, it was necessary to perform a tumour resection and reconstruction using a two-flap technique including a rotation flap and an Abbé flap. Functional and aesthetic outcomes were good after 6 months. There were no recurrences during a 12-month follow-up.

Conclusion

A facial DT should be resected completely. Patients should be attended for follow-ups, keeping in mind the difficulty of making a proper histological diagnosis from small biopsies or excisions and the consequences of ablative facial surgery. However, in particular cases, subtotal defects of the upper lip region are amenable to reconstruction without gross functional or aesthetic deficits.     

Correction of Class?II, Division 2 malocclusions using a completely customized lingual appliance and the Herbst device

Aim

The purpose of the present study was to examine the efficiency of correcting a Class?II, Division?2 malocclusion using a completely customized lingual appliance.

Materials and methods

In 18 consecutively completed, Class?II, Division?2 malocclusion patients, the correction of the upper incisor inclination, deep and distal bite were assessed by means of plaster casts, digital lateral cephalograms, and intraoral photographs taken at the time of debond. Furthermore, two independent calibrated examiners determined the weighted Peer Assessment Rating index (PAR Index) of the initial and end models.

Results

All Class?II, Division?2 patients were treated successfully: upper incisor inclination using the palatal plane as a reference improved on average from 95.4° to 111.2°. The deep bite was reduced on average from 3.6?mm to 1.7?mm. Neutral occlusion was achieved in all patients who had undergone correction of an initially pronounced distal occlusion (4.5?mm on average). An 86.2% marked improvement was observed in the weighted PAR index score from an average of 24.7 at the beginning of treatment to 2.9 at the end of treatment, with no patient classified as ??worse or no different.??

Conclusion

Class?II, Division?2 malocclusions can be efficiently and reliably treated by a combination of a completely customized lingual appliance and the Herbst device.     

Dental compensation for moderate Class?III with vertical growth pattern by extraction of the lower second molars

Objectives

Analysis of the effects and side effects of treatment of patients with moderate skeletal Class?III and vertical growth pattern by means of extraction of the second molars in the lower jaw.

Patients and methods

A total of 20 patients with a mean age of 12.9 years were examined retrospectively. Inclusion criteria consisted of a Wits value of 0 to ?5, a posterior growth pattern of the mandible (Hasund analysis), an overjet of ?2 to 1?mm, and an overbite of 0 to ?3?mm. Treatment was performed using a straight-wire appliance. As part of the treatment, the lower second molars were extracted and Class?III elastics attached. Cephalograms and orthopantomograms taken before and after treatment were used for evaluation.

Results

Treatment resulted in a significant change in the mean overjet from 0.5?mm to 2.1?mm and the attainment of a positive mean overbite of ?1.0?mm to 0.9?mm. The occlusal plane rotated anteriorly from 18.8° to 13.7°. The skeletal parameters showed a change in the Wits value from ?3.3?mm to ?1.4?mm and an anterior mandibular rotation (ML-NSL 35.5° vs. 32.0°). The soft tissues revealed an increase in the distance between the lower lip and the ??esthetic line?? to the posterior (?2.0?mm vs. ?3.9?mm).

Conclusion

Dental compensation of moderate skeletal Class?III with a tendency to an anterior open bite with vertical growth pattern by extracting the lower second molars, combined with Class III elastics, resulted in an anterior rotation of the occlusal plane and mandible. Eighteen of 20 patients achieved a physiological overjet and positive overbite. A prerequisite for this therapy is the presence of lower wisdom teeth; a potential side effect is elongation of the upper second molars.     

L’evoluzione della cerniera di Herbst: indicazioni cliniche dei nuovi dispositivi

Objectives

The aim of this work is to describe indications, pros and cons and clinical use of the new Herbst appliances: Miniscope and Hanks Telescoping Herbst (HTH).

Material and methods

The Miniscope combines a telescopic mechanism with traditional eyelet loops. To maximize the effectiveness of this appliance it is necessary to use a specific screw, the AppleCore, that improves lateral excursion. The HTH is a one-piece appliance, easy to install, with no more pieces to fumble with or falling in patient's mouth. HTH features a unique ball and socket design, allowing unrestricted mandibular excursions.

Results and conclusions

The advantages of the Herbst appliance are unquestionable but there are some limitations too. The new Herbst Miniscope and HTH allow the clinician to overcome these limitations due to hinge modifications.The authors report the case of a 12 years old girl with class II malocclusion, deep bite and mandibular retrusion. At the beginning the patient was treated with fixed appliances and Class II elastics but, because of her poor compliance, a HTH was applied.