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.

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.