Caries and white spot lesion trajectories of orthodontic patients across an observation period of 20 years.

OBJECTIVES: Fixed orthodontic appliances may increase the risk for caries and white spot lesions. The aim of this retrospective study was to determine the long-term associations between both in orthodontic patients. MATERIALS AND METHODS: 103 patients aged 36.6 ± 6.5 years whose fixed appliance orthodontic treatment had finished at least 15 years ago were included. Current clinical data and photographs (T3), panoramic x-ray and photographs from before treatment (T0), after debonding (T1) and at 2-year follow-up (T2) were available. Parameters of interest were dentine caries, "Missing/Filled Teeth" (MFT), "White Spot Lesion" (WSL) index and "Periodontal Screening and Recording" index (PSR; T3 only). RESULTS: At T0, 30.4% had no caries experience decreasing to 25.6%, 22.4% and 6.8% at T1, T2 and T3 resp. The median MFT (95% CI) at T0, T1, T2 and T3 was 2 (1;3), 3 (2;4), 3 (2;4) and 7 (6;9) resp. increasing significantly at each time point (p < 0.001 each); 30.1% had WSL at debonding. Patients with caries experience at T0 had a 2.4-fold increased risk of WSL at debonding. Dentine caries, caries experience and WSL at T1 were significantly associated with incident caries at T2, but not at T3. PSR at T3 had a significant association with previous caries incidence and WSL. CONCLUSIONS: Caries experience prior to orthodontic treatment may constitute a risk indicator for WSL, and caries experience and WSL at its end for caries incidence in the near term. CLINICAL RELEVANCE: Present caries and WSL may help identifying orthodontic patients with special need for prevention and counselling.

Twenty-year follow-up of functional treatment with a bionator appliance (part 2): a retrospective cephalometric analysis of skeletal and dentoskeletal changes.

OBJECTIVES: To investigate skeletal and dentoskeletal changes 20 years after bionator treatment. MATERIALS AND METHODS: Analog lateral cephalograms of 18 subjects treated with a bionator appliance during growth were digitized with a transmitted light scanner. Inclusion criteria were: increased overjet (≥4 mm), skeletal Class II, available lateral cephalograms before (T0), after (T1), and 20 years after (T2) treatment with only a Bionator. To assess standard cephalometric parameters, the software ivoris analyze was used. Data were analyzed using Friedman's two-way analysis of variance by ranks followed by Dunn's post hoc tests (P ≤ .05). RESULTS: During therapy (T0-T1), ANB decreased significantly by 1.9° and remained unchanged long term. SNA slightly decreased (-0.6°) during treatment, SNB and SNPg increased (+1.4°, +1.7°). All three parameters showed a significant increase at T2 (+1.2°, +1.6°, +1.6°). Vertical measurements (ML-NL, ML-NSL, NL-NSL) remained almost unchanged during therapy. NL-NSL also was unchanged during the long-term interval; ML-NSL and ML-NL decreased significantly (-3.4°, -4.9°). During treatment, the maxillary incisors retroclined (OK1-NL: -1.6°, OK1-NA: -0.6°), the mandibular incisors proclined (UK1-ML: +3.5°, UK1-NB: +4.9°), neither significantly. Long term, there was a nonsignificant tendency toward proclination of upper (OK1-NL: +0.1°, OK1-NA: +0.7°) and retroclination of lower incisors (UK1-ML: -1.5°, UK1-NB: -5°). CONCLUSIONS: Changes of ANB after bionator treatment without additional fixed appliances remained stable after 20 years. The observed long-term changes are probably consequences of well-known physiological and age-related processes.

Upper airway changes following high oblique sagittal split osteotomy (HSSO).

The aim of this study was to evaluate volumetric changes of the posterior airway space (PAS) following bimaxillary surgery using a high oblique sagittal split osteotomy (HSSO) of the mandibular ramus. The cone beam CTs of Class II and Class III patients taken before (T0) and 6-12 months after surgery (T1) were analyzed using 3D software (Mimics® Innovation Suite 18.0). The PAS was divided into three segments (superior, middle, inferior) by three planes parallel to the Frankfurt horizontal plane intersecting at the posterior nasal spine, the velum palatinum and the epiglottis. Total (TPAS) and partial volumes (SPAS = superior, MPAS = middle, IPAS = inferior) were calculated. For the 25 Class II patients, a highly significant increase (p<0.001) of the total, middle and inferior airway space (TPAS: +33.6%, MPAS: +43.1%, IPAS: +55.9%) was found, while the increase of the upper airway space was statistically not significant (+5.4%, p = 0.074). For the 28 Class III patients, the total, middle and inferior airway space increased statistically insignificantly (TPAS: +4.6%, p = 0.265, MPAS: +2.7%, p = 0.387, IPAS: +2.8%, p = 0.495), while the increase of the upper airway space was statistically significant (+9.7%, p = 0.010). Bimaxillary orthognathic surgery using the HSSO technique led to a significant increase of PAS for Class II patients and could conserve the PAS for Class III patients.

Outcome quality of Class II division 1 Herbst-multibracket appliance treatment: influence of pretreatment Class II severity and skeletal maturity.

BACKGROUND: No reliable predictive factors for treatment (Tx) success and outcome quality in Class II:1 Tx have been identified yet. OBJECTIVE: To assess the influence of pre-Tx Class II severity and skeletal maturity on outcome quality after Herbst-multibracket appliance (MBA) Tx. SUBJECTS AND METHODS: All Class II:1 patients who completed Herbst-MBA Tx between 1986 and 2014 at University of Giessen, Germany. Pre-Tx (T0), post-Tx (T1), and (if available) post-retention (≥24 months; T2) study casts were evaluated using the Peer Assessment Rating (PAR) index and the Ahlgren scale. Three occlusal severity (mild, moderate, and severe) and four skeletal maturity (pre-peak, peak, post-peak, and adult) subgroup categories were defined. RESULTS: Four hundred eight-five patients (age at T0: 14.4 ± 3.2 years) could be evaluated; post-retention (T3) data were available for 230 patients. For the total sample, the median PAR score was 32.4 ± 8.85 at T0, 8.0 ± 4.52 at T1, and 8.8 ± 5.11 at T2. Very low correlations between the subgroup categories (occlusal severity/skeletal maturity) and PAR-score reduction were detected both during Tx (r = 0.12/r = 0.05) and the total observation period (r = 0.17/r = 0.03). The overall outcome quality according to Ahlgren was: 17.0% excellent, 34.8% good, 43.8% acceptable, 2.2% unacceptable, and 2.2% not assessable. The association with the subgroup categories was: p = 0.019 (occlusal severity)/p = 0.820 (skeletal maturity). LIMITATIONS: Retrospective study design with follow-up data was not available from all subjects and no data from untreated controls. Tx was performed by several physicians using different kind of MBAs. CONCLUSION: Class II:1 Herbst-MBA Tx is an effective and successful Tx approach irrespective of pre-Tx skeletal maturity but dependent-to a certain extent-on Class II severity. Thus, when considering a Herbst appliance for Class II correction, neither of the two variables should considerably limit the indication.

Prevalence, magnitude, and incidence of labial gingival recession with Herbst-multibracket appliance treatment: A retrospective cohort study.

OBJECTIVE: To assess the prevalence and magnitude of labial gingival recession (LGR) before and after as well as the incidence during Class II:1 Herbst-Multibracket appliance (Herbst-MBA) treatment (Tx) plus retention in a retrospective cohort study. MATERIALS AND METHODS: Records of Class II:1 patients who completed Herbst-MBA Tx (mean pre-Tx age 14.4 years) at Department of Orthodontics, University of Giessen, Giessen, Germany were analyzed. Tx consisted of a Herbst phase (mean 8.1 months) and a subsequent MBA phase (mean 16.1 months). Study casts from before and after Herbst-MBA Tx plus ≥24 months of retention were evaluated. RESULTS: A total of 460 pre-Tx and 222 postretention study casts were available (total observation period: 59.2 ± 14.8 months). The overall prevalence for teeth with LGR ≥0.5 mm was 1.1% pre-Tx and 5.3% postretention. The highest prevalence of up to 5.3% (pre-Tx) and 16.4% (postretention) were seen for the lower incisors. Overall, the median magnitude of LGR was 0.0 mm pre-Tx/postretention (mean: 0.05 mm/0.08 mm). Incidence values of 4.0% (all teeth) and 10.0% to 11.4% (lower central incisors) were calculated for LGR ≥0.5 mm. CONCLUSIONS: The prevalence of LGR ≥0.5 mm increased from, on average, 1.1% to 5.3% during ≈6 years of Herbst-MBA Tx plus retention. The highest incidence was seen in lower incisors (10.0%-11.4%). However, because of the overall mean magnitude of 0.08 mm postretention, the clinical relevance can be considered as insignificant.

Long-term (≥15 years) effects of Class II treatment: a longitudinal and cross-sectional study on signs and symptoms of temporomandibular disorders.

BACKGROUND: The aetiology of temporomandibular disorders (TMD) is controversial and post-orthodontic long-term TMD data of Class II populations are scarce. OBJECTIVES: To analyse the long-term (≥15 years) effects of Herbst-multibracket appliances (MBA) Class II treatment (Tx) on signs and symptoms of TMD. SUBJECTS AND METHODS: All patients (University of Giessen, Germany) who underwent Herbst-MBA Tx (end of active Tx ≥ 15 years ago), could be located and agreed to participate in a recall. Available records from before (T0) and after (T1) active Tx were used for comparison with the recall data (T2). All findings were classified according to research diagnostic criteria for temporomandibular disorders (RDC/TMD) and diagnostic criteria for temporomandibular disorders (DC/TMD) as well as the Helkimo index. RESULTS: Seventy-two out of 152 patients participated at age 33.7 ± 3.0 years. Complete TMD data-sets (T0 + T1 + T2) were available for 33 participants. Participants and non-participants did not differ significantly at T0 or T1 in terms of general clinical data, occlusal relationship or TMD prevalence. At all time-points, 79-91 per cent of the patients were free of TMD signs and symptoms (RDC/TMD and DC/TMD). The TMD prevalence fluctuated: 21 per cent (T0), 9 per cent (T1), 15 per cent (T2). Similar findings with a trend towards improvement during T0-T1 and recurrence during T1-T2 were seen for the Helkimo index. There were no statistically significant differences. LIMITATIONS: The participation rate of only 62 per cent, the disparate availability of records (T0, T1), the fact that the patients were not treated at exactly the same time period and that no untreated control group is available. CONCLUSION: In the long-term (≥15 years) Herbst-MBA Class II Tx neither seems to increase nor decrease the risk for developing TMD.

Long-term (≥15 years) post-treatment changes and outcome quality after Class II:1 treatment in comparison to untreated Class I controls.

Aim: To investigate the long-term (≥15 years) post-treatment (Tx) occlusal changes and outcome quality after Class II:1 Tx. Subjects and Methods: Herbst-MBA Tx had been performed at age 12.8 ± 2.7 years in 119 patients. A recall was conducted and study models from before and after active Tx, after retention as well as after recall were evaluated using standard occlusal variables and the PAR index. These data were compared to 31 untreated Class I controls. Results: 52 out of 119 patients could be located and participated at 33.6 ± 3.1 years. Compared to the 67 patients who did not participate in the recall, the pre- and post-Tx occlusal data of the participants did not differ systematically; however, the PAR scores were higher by 3.0-4.7 points at all times. Pre-Tx, the mean values of the 52 participants were: PAR = 27.2 ± 7.6, Class II molar relationship (MR) = 0.7 cusp widths (cw), overjet = 8.2 mm, overbite = 4.1 mm. After Tx, the PAR score was 3.4 ± 2.2. A Class I MR (0.0 ± 0.1 cw) with normal overjet (2.3 ± 0.7 mm) and overbite (1.3 ± 0.7 mm) existed. At recall, a mild PAR score increase to 8.2 ± 5.5 points had occurred; this was mainly due to increased overjet and overbite values (3.6 ± 1.1 and 2.8 ± 1.6 mm) while the MR was stable (0.0 ± 0.2 cw). For all these variables, similar findings were made in the untreated controls. Conclusion: The occlusal outcome of Class II:1 Tx showed very good long-term stability. While mild changes occur post-Tx, the long-term result is similar to untreated Class I controls.

Outcome quality and long-term (≥15 years) stability after Class II:2 Herbst-multibracket appliance treatment in comparison to untreated Class I controls.

Aim: To investigate the outcome quality and the long-term (≥15 years) post-treatment (Tx) changes after Class II:2 Herbst-multibracket appliance (MBA) Tx. Subjects and Methods: In this longitudinal observational study, a recall of Class II:2 patients who had been treated by a Herbst-MBA during adolescence was conducted. Study models from before and after active Tx, after retention and after recall were assessed using standard occlusal variables and the peer assessment rating index (PAR). These data were compared to historical untreated Class I controls. Results: Twenty out of 33 patients (61%) could be located and participated at age 33.9 ± 2.7 years. When comparing their data to the 13 patients who did not participate, the pre- and post-Tx occlusal findings did not differ systematically; however, the PAR scores of the non-participants were by 3.3-8.2 points higher at all times and the non-participants were 2.1-2.5 years older. Pre-Tx at age 14.4 ± 2.7 years, the participants showed the following mean values: PAR = 15.0 ± 7.0, Class II molar relationship (MR) = 0.8 ± 0.3 cusp widths (cw), overbite = 5.3 ± 1.3 mm. After Tx, a PAR score of 2.9 ± 1.3 and a super Class I MR (-0.1 ± 0.1 cw) with normal overbite (1.2 ± 0.8 mm) existed. At recall, a PAR score increase to 5.9 ± 3.6 points had occurred, mainly caused by an increase of overbite to 2.5 ± 1.5 mm. The average MR remained Class I (0.0 ± 0.2 cw). For all variables, the untreated controls exhibited similar findings. Conclusion: The occlusal outcome of Class II:2 Herbst-MBA Tx exhibited very good long-term stability. While mild post-Tx changes occurred, the long-term findings are similar to untreated Class I controls.

Nonsyndromic oligodontia : Does the Tooth Agenesis Code (TAC) enable prediction of the causative mutation?

OBJECTIVES: The literature suggests an association between phenotype and causative mutation in nonsyndromic oligodontia. Thus, the present study was designed to verify this hypothesis in a consecutive cohort of patients. METHODS: All patients with nonsyndromic oligodontia who had been treated at the study center (Department of Orthodontics, University of Giessen, Germany) over the period 1986-2013 were contacted. Candidates were included only if at least one more family member had hypo- or oligodontia (i.e., without regard to the number of congenitally missing teeth). A total of 20 patients were included. After evaluating the dental status of each participant, the Tooth Agenesis Code (TAC) was applied. On this basis, a tentative diagnosis was made to predict which gene (MSX1, AXIN2, EDA, or PAX9) was likely to show mutation. Afterwards this hypothesis was confirmed or rejected by analyzing a saliva sample for mutation of the predicted gene. If confirmed, any available family members were also genetically analyzed. RESULTS: Based on their TAC scores and sums, gene mutations were predicted for MXS1 in 11, AXIN2 in 3, EDA in 6, and PAX9 in none of the patients. The evaluation of MSX1 yielded variants in 4 of 11 cases, all of which were classified as nonpathogenic since they were not considered as functional mutations. The evaluation of EDA yielded a pathogenic exon-7 mutation in 2 of 6 patients, both being brothers with different TAC scores; the same mutation, which represents a novel missense mutation, was also found in other members of the same family. The evaluation of AXIN2 yielded variants in 3 of 3 cases, all of which were classified as nonpathogenic. CONCLUSIONS: Our findings obtained in consecutive patients with nonsyndromic oligodontia did not reveal any clinically relevant associations between oligodontia phenotype (based on TAC) and causative mutations for nonsyndromic oligodontia.

Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part I: photographic data evaluation.

Background: White spot lesions (WSLs) are a frequent side-effect of multibracket appliance treatment. The effect of local fluoridation on post-orthodontic WSL is however inconclusive. Objective: Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment. Trial design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study. Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding. Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24). Outcomes: Photographic WSL assessment (dimension and luminance) of the upper front teeth (T0-T5). Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each). Recruitment: The clinical study duration lasted from March 2011 to September 2013. Blinding: Unblinding was performed after complete data evaluation. Numbers analysed: Intent-to-treat analysis set comprising 39 participants (test: n = 21, placebo: n = 18). Outcome: Dimensional WSL quantification showed limited reliability. Luminance improvement (%) of WSL, however, was seen after 6 months (test/placebo: tooth 12, 24.8/18.0; tooth 11, 38.4/35.4; tooth 21, 39.6/38.3; and tooth 22, 15.2/25.0). No statistically significant group difference existed. Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation. Harms: Similar adverse events occurred in both groups; none was classified as possibly related to the study product. Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation. Conclusion: Based on the results of this study, no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment. Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731). Protocol: The protocol wasn't published before trial commencement.

Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part II: clinical data evaluation.

Background: White spot lesions (WSL) frequently occur as side-effect of multibracket appliance treatment. The clinical effects of local fluoridation on post-orthodontic WSL and oral health development are however inconclusive. Objective: In vivo monitoring of clinical WSL and oral health changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment. Trial design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study. Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding. Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24). Outcomes: Clinical evaluation of WSL index, lesion activity, plaque index, gingival bleeding index, and decayed, missing, and filled teeth index as well as saliva buffer capacity and stimulated salivary flow rate (T0-T5). Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each). Recruitment: The clinical study duration lasted from March 2011 to September 2013. Blinding: Unblinding was performed after complete data evaluation. Numbers analysed: Intention-to-treat analysis set comprised 39 participants (test: n = 21, placebo: n = 18). Outcome: No clinical parameter except stimulated salivary flow rate (fluoride group: 1.1ml/min, placebo group: 0.74ml/min; P = 0.022) showed a statistically significant group difference after 24 weeks. Harms: Several adverse events occurred similarly frequent in both groups; none was classified as possibly related to the study product. Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation. Conclusion: Based on the results of this study, no clinical effect of post-orthodontic high-dose fluoride treatment on WSL and oral health changes could be detected. Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731). Protocol: The protocol wasn't published before trial commencement.

Herbst plus Lingual versus Herbst plus Labial: a comparison of occlusal outcome and gingival health.

OBJECTIVES: To analyse and compare the effects during Herbst treatment combined with a lingual (completely customized) or labial (straight-wire) multibracket appliance (MBA), with special regard to lower incisor gingival recessions. SUBJECTS AND METHODS: Eighteen Class II:1 patients [overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp widths (CW) bilaterally or 1.0 CW unilaterally, median age 16.0 years] treated with a Herbst appliance in combination with a lingual MBA (group LINGUAL) were retrospectively matched (molar relationship and skeletal maturity) to 18 Class II:1 patients treated with a Herbst appliance combined with a labial MBA (group LABIAL). Study models and intraoral photographs from before and after treatment were evaluated regarding occlusal variables and gingival recessions. Lateral cephalograms from before, during (before and after Herbst), and after treatment were analysed to assess lower incisor changes. RESULTS: Both groups showed similar reductions of overjet (5.4/5.6mm), overbite, (2.9/2.7mm) and sagittal molar relationship (0.9/0.8 CW). During the Herbst phase, the changes in lower incisor inclination and incisal edge position were significantly smaller in the LINGUAL than in the LABIAL group (iiL/ML: +7.0/+12.7degrees, P = 0.002; ii-MLppg: +2.5/+3.9mm, P = 0.004). For the total treatment period, no significant differences were found (iiL/ML: +5.3/+8.6degrees; ii-MLppg: +2.1/+2.4mm). No clinically relevant gingival recessions were seen. CONCLUSION: Both treatment approaches successfully corrected the malocclusion. The group LINGUAL exhibited significantly less proclination during the Herbst phase only. Neither treatment approach induced deleterious gingival recessions.

Occlusal stability after Herbst treatment of patients with retrognathic and prognathic facial types : A pilot study.

OBJECTIVES: The purpose of this study was to assess and compare occlusal changes induced by Herbst treatment and the stability of these changes in patients with retrognathic and prognathic facial types. PATIENTS AND METHODS: The sample comprised 11 retrognathic (SNA ≤76°, SNB ≤72°, ML/NSL ≥36°) and 10 prognathic (SNA ≥83°, SNB ≥80°, ML/NSL ≤32°) patients with Class II molar relationships of ≥0.5 cusp widths bilaterally or ≥1.0 cusp width unilaterally. Both groups involved similar distributions of skeletal maturity before treatment. Study parameters were assessed on casts reflecting the situations before treatment (T0), after Herbst treatment (T1), after multibracket treatment immediately following Herbst treatment (T2), and after a mean of 31.1 months of retention (T3). RESULTS: Sagittal molar relationships improved by 0.8 cusp widths in the retrognathic and by 0.7 cusp widths in the prognathic group during active treatment (T0-T2). Insignificant changes of ≤0,2 cusp widths were seen in both groups during retention (T2-T3). Overjet decreased by 8.6 mm in the retrognathic and by 5.5 mm in the prognathic group during T0-T2, and both groups showed clinically irrelevant amounts of relapse by 0.7 mm during T2-T3. Overbite improved by 1.2 mm in the retrognathic and by 2.5 mm in the prognathic group during T0-T2, reaching mean values of 1.0 mm or 1.4 mm by T2, which was followed by 0.2 mm or 1.1 mm of relapse during T2-T3. CONCLUSION: Treatment with a Herbst appliance seems to offer stable correction of the sagittal occlusal relationships in Class II patients with retrognathic or prognathic facial types, with the vertical changes being more pronounced in the prognathic cases.

Dentoskeletal effects during Herbst-Multibracket appliance treatment: a comparison of lingual and labial approaches.

OBJECTIVES: To analyse and compare the effects during Herbst treatment (Tx) when combined with lingual (completely customized) or labial (straight-wire) multibracket appliances (MBA). SUBJECTS AND METHODS: 18 Class II division 1 patients (Overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp width bilaterally or 1 cusp width unilaterally, median age 16.0 years) treated with lingual (completely customized) MBA in combination with a Herbst appliance were matched (sagittal molar relationship and skeletal maturity) to 18 Class II division 1 Herbst patients treated with labial (straight-wire) MBA. Lateral cephalograms from before, during and after all active Tx were analysed using the SO-analysis and standard cephalometric variables. RESULTS: During the Herbst phase (LINGUAL: mean = 13.9 months, LABIAL: mean = 8.5 months) smaller average Overjet and molar relationship changes were seen in the LINGUAL (5.3mm/4.4mm) than in the LABIAL (8.0mm/5.9mm) group. This was due to the fact that the LABIAL patients were treated to overcorrected sagittal relationships. During the total Tx period (Herbst + MBA; LINGUAL: mean = 3.1 years, LABIAL: mean = 1.9 years) the average amounts of Overjet and molar relationship changes were similar in both groups (LINGUAL: 4.0mm/3.3mm, LABIAL: 5.1mm/3.7mm). Overjet correction was achieved by 45% (LINGUAL) and 37% (LABIAL) skeletal changes; the respective amounts for molar relationship correction were 55% (LINGUAL) and 51% (LABIAL). CONCLUSION: For most variables, similar effects occurred during Herbst Tx whether combined with lingual (completely customized) or labial (straight-wire) MBA.

Stability of Class II fixed functional appliance therapy--a systematic review and meta-analysis.

OBJECTIVES: To systematically search for scientific evidence concerning the stability of treatment (Tx) results achieved by means of Class II fixed functional appliance therapy and to assess possible differences between appliances. SEARCH METHODS: An electronic search of databases and orthodontic journals was carried out (until December 2013), with supplemental hand searching. In addition to the names of all identified appliances, the term fixed functional was used in combination with each of the following search terms: long-term, post-Tx, relapse, retention, stability. SELECTION CRITERIA: To be included in the review, the articles had to contain clear data on: Class II Tx with a fixed functional appliance (>5 patients), post-Tx period ≥ 1 year, assessment of ANB angle, Wits appraisal, molar relationship, soft-tissue profile convexity excluding the nose, overjet and/or overbite. DATA COLLECTION AND ANALYSIS: The literature search revealed 20 scientific investigations which corresponded to only two of the 76 identified appliances (Herbst and Twin Force Bite Corrector). As only one publication was found for the Twin Force Bite Corrector, a meta-analysis could only be performed for Herbst Tx. The data were extracted, pooled and weighted according to the number of patients in each study. RESULTS: The mean values for post-Tx relapse (percentages relative to the Tx changes) were: ANB angle 0.2 degrees (12.4 per cent), Wits appraisal 0.5mm (19.5 per cent), sagittal molar relationship 1.2mm/0.1 cusp widths (21.8 per cent /6.5 per cent); soft-tissue profile convexity excluding nose less than 0.1 degrees (1.0 per cent), overjet 1.8mm (26.2 per cent), overbite Class II:1 1.4mm (44.7 per cent), overbite Class II:2 1.0mm (22.2 per cent). CONCLUSIONS: The scientific evidence concerning the stability of Tx results is inexistent for most fixed functional appliances for Class II correction except for Herbst appliance Tx. Even if the evidence level of most included studies is rather low, good dentoskeletal stability without clinically relevant changes was found for most variables.

Removable plate treatment of anterior forced crossbite: Effectiveness, efficiency, and potential outcome predictors.

OBJECTIVES: In addition to studying the effectiveness and efficiency of removable acrylic plates in correcting anterior forced crossbite, the influence of outcome predictors were evaluated. METHODS: In all, 65 patients met the inclusion criteria of anterior forced crossbite, mixed dentition, removable plate treatment, and complete case documentation. Effectiveness was assessed based on pre- and posttreatment study casts (which were analyzed for successful treatment outcomes defined as ≥ 1 mm of overjet and overbite) and efficiency was assessed based on treatment duration and number of appointments. Potential outcome predictors were also evaluated, including age, gender, dental maturity, Angle Class, number of teeth in crossbite, severity of crossbite, overbite, ANB angle, Wits appraisal, mandibular plane angle, and patient compliance. RESULTS: Successful crossbite correction was achieved in 48 of the 65 patients (74%) within a median of 2.8 months and 2.0 appointments. Plate treatment was discontinued following another median of 11.6 months and 6.5 appointments. Promising outcome predictors are the number of teeth in crossbite (1-2 versus 3-4 teeth = success in 81 versus 42% of cases), dental maturity (early versus late mixed dentition = success in 84 versus 52% of cases), and Angle Class (I versus III = success in 83 versus 61% of cases). CONCLUSION: Removable acrylic plates were found to be moderately effective and efficient in correcting anterior forced crossbite. Children presenting with Angle Class I and crossbites involving not more than two teeth when treatment is started during the period of early mixed dentition had the best prognosis for treatment success.

Class II subdivision treatment with the Herbst appliance.

OBJECTIVE: To assess the effectiveness of Class II subdivision Herbst nonextraction treatment and its short-term stability retrospectively. MATERIALS AND METHODS: Twenty-two Class II subdivision (SUB: right-left molar difference ≥0.75 cusp width) and 22 symmetric Class II patients (SYM: ≥0.75 cusp width bilaterally) were matched according to gender and pretreatment handwrist radiographic stage. The mean treatment duration of the Herbst and subsequent multibracket phase was 8 months and 14 months, respectively. The mean retention period amounted to 36 months. Dental casts from before treatment (T1), after Herbst treatment (T2), after Multibracket treatment (T3), and after retention (T4) were evaluated. RESULTS: A bilateral Class I or super Class I molar relationship was seen in 72.7% (SUB) and 77.3% (SYM) at T3. The corresponding values at T4 were 63.7% (SUB) and 72.7% (SYM). A unilateral or bilateral Class III molar relationship was more frequent in the SUB group (T3: +4.6%; T4: +13.6%). For overjet, similar mean values were seen in both groups after treatment (T3: SUB, 2.7 mm; SYM, 2.3 mm) and after retention (T4: SUB, 3.0 mm; SYM, 3.4 mm). This was also true for the midline shift (T3: SUB, -0.4 mm; SYM, 0.0 mm; T4: SUB, -0.3 mm; SYM, 0.0 mm). CONCLUSION: Class II subdivision Herbst treatment was successful similarly to symmetric Class II Herbst treatment. However, a slight overcompensation of the molar relationship (Class III tendency) was more frequent in the subdivision patients (original Class I side).

Dentoskeletal changes in adult Class II division 1 Herbst treatment--how much is left after the retention period?

The aim of this study was to assess dentoskeletal changes following Herbst-Multibracket treatment in adult Class II division 1 patients. The subject material comprised 15 adult Class II division 1 subjects exhibiting a Class II molar relationship more than or equal to 0.5 cusps bilaterally or more than or equal to 1.0 cusps unilaterally and an overjet more than or equal to 6.0 mm. The average treatment time was 9 months (Herbst phase) plus 13.9 months (Multibracket phase). Lateral headfilms from before treatment (T1), after Herbst-Multibracket treatment (T2), and after at least 24 months of retention (T3) were analysed using the 'sagittal-occlusal analysis' (Pancherz, 1982) as well as standard cephalometric variables. During the treatment period (T2-T1), molar relationship, overjet (-6.2 mm), and overbite (-2.1 mm) were successfully corrected. The Class II jaw base relationship improved (ANB -0.8 degrees and Wits -1.1 mm) and the hard as well as soft tissue profile straightened (NApg +1.5 degrees, NsNoPgs +1.2 degrees, and NsSnPgs +1.5 degrees). During the retention period of on average 35.5 months (T3-T2), the amount of occlusal relapse (T3-T2) was small (less than or equal to 1.0 mm). The jaw base relationship (ANB +0.3 degrees and Wits +0.7 mm) and the profile convexities (NApg -0.3 degrees, NsNoPgs -0.6 degrees, and NsSnPgs +0.6 degrees) deteriorated slightly. Following the retention period, only minimal amounts of skeletal changes contributing to Class II correction in adult Herbst-Multibracket treatment were retained. Thus, adult Herbst-Multibracket treatment results in mainly dental changes, which however, showed good stability.

Plaque control effectiveness and handling of interdental brushes during multibracket treatment--a randomized clinical trial.

SUMMARY: The aim of this randomized clinical trial was to compare the plaque control effectiveness and handling of an interdental brush with a short curved handle and a triangular cross-section of the brush head (IDB) and an interdental brush with a long straight handle in combination with a monotufted brush head (MTB). In a split-mouth design, 110 multibracket patients were randomly assigned to group A using the MTB in the first and third quadrants and the IDB in the second and fourth quadrants or to group B who proceeded the other way around. A crossover was performed after 3 months. The plaque index (PI) was scored every 6 weeks for a period of 24 weeks, and handling was evaluated using visual analogue scales (VAS). Wilcoxon tests were used to determine differences in PI and VAS scores between the two brushes and for PI differences between the different observation periods. Differences concerning personal preference and perceived cleaning efficacy were analysed with chi-square tests. The significance levels used were P < 0.001 and P < 0.01. The PI decreased significantly, but no statistically significant difference was found between the two brushes. Subjects experienced less pain and reported better access behind the archwire with the IDB. The use of an interdental brush reduced the PI irrespective of the design of the brush head. In direct comparison, adolescent patients preferred the IDB. Further trials are required to investigate the effectiveness of the IDB in reducing decalcification during orthodontic treatment.