Mandibular orthopedic advancement in different facial patterns and distinct stages of skeletal maturation.

Fernando Penteado Lopes Da Silva

doi:10.1590/2177-6709.26.2.e21bbo2

Abstract

ABSTRACTThe Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism. Because of the continuous action in a full-time basis, treatment time using it normally takes from six to ten months, and is usually followed by a second phase of full fixed appliances, in order to obtain both occlusal refinement and long term stability. Despite Herbst appliance’s effectiveness in the occlusal and dentoalveolar perspectives, its facial results may differ among patients with different growth patterns, as well as in distinct stages of skeletal maturation. In the current paper, two patients with different facial patterns are presented, who were treated under the same protocol, using Herbst and full fixed appliances in different skeletal maturation stages, and both dentoalveolar and facial results are compared and discussed.

Highlights

The negative effect caused by mandibular retrognathism on the face is often the reason why adult patients seek orthodontic-surgical treatment approaches.[1,2,3,4,5] Patients treated during craniofacial growth stages, on the other hand, may have benefits from the orthopedic mandibular advancement
The Herbst appliance can be very effective in treatment of Class II patients with mandibular retrognathism
The comparison of Herbst effects in different facial patterns has been studied for several years, and often presents similar results regarding to the maintenance of mandibular growth direction, as well as to a satisfactory dentoalveolar correction, as recently demonstrated by Atresh et al.[28]

Summary

INTRODUCTION

The negative effect caused by mandibular retrognathism on the face is often the reason why adult patients seek orthodontic-surgical treatment approaches.[1,2,3,4,5] Patients treated during craniofacial growth stages, on the other hand, may have benefits from the orthopedic mandibular advancement. Two case reports will be presented, of Class II patients treated in distinct stages of skeletal maturation, using the same protocol of mandibular orthopedic advancement, followed by a full fixed appliances orthodontic treatment. It was explained that an orthodontic-surgical approach could be necessary in the future, in case of a unsuccessful orthopedic treatment In these terms, the mandibular orthopedic advancement was initiated with a Herbst appliance designed for mixed dentition.[27] After the accomplishment of orthopedic approach (Phase 1), an orthodontic stage with full fixed appliances took place (Phase 2), in order to obtain occlusal refinement. The facial analysis highlighted a maxillomandibular retrusion associated to both mandibular retrognathism and increased nasolabial angle.[3] The patient presented a Class II, division 2 malocclusion at the final stage of mixed dentition, with maxillary and mandibular incisor crowding, and good labial competence (Fig 10). There was extrusion movement of mandibular molars, as a consequence of the vertical dentoalveolar remodeling caused by mandibular advancement with Herbst appliance[6,7,9] (Fig 16)

DISCUSSION

CONCLUSION