scholarly journals Treatment changes of hypo- and hyperdivergent Class II Herbst patients

2017 ◽  
Vol 88 (1) ◽  
pp. 3-9 ◽  
Author(s):  
Kim Rogers ◽  
Phillip M. Campbell ◽  
Larry Tadlock ◽  
Emet Schneiderman ◽  
Peter H. Buschang

ABSTRACT Objectives: To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients. Materials and Methods: The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures. Results: The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a “headgear effect.” Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients. Conclusions: Hypo- and hyperdivergent patients benefit from the Herbst's headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.

1975 ◽  
Vol 2 (2) ◽  
pp. 85-91 ◽  
Author(s):  
D. M. Menezes

This study was based on a cephalometric analysis of 45 children composed of two groups: a treated group with an Angle Class II division 1 occlusion and an untreated control group. The object of this study was to investigate changes in the dentofacial complex as a result of Begg therapy in the group of children having an Angle Class II division 1 occlusion compared with the untreated control group. Each child of the treated group had lateral skull radiographs taken during the experimental period: one before commencement of treatment, the second at the end of the first stage of treatment; that is as soon as the incisors reached an edge-to-edge relationship; and the third at the end of treatment 12 months after appliances were removed. Two lateral skull radiographs were taken of the children who formed the control group, one at the beginning, and the other at the end, of the experimental period. It was found that short term changes in the dento-facial complex during Begg treatment were associated with a significant increase in the height of the lower molars, a significant reduction in the height of the lower incisors and a significant reduction in apical base difference. The long term changes in the dentofacial complex as a result of Begg treatment were associated with a significant increase in the height of the lower molars, a significant reduction in apical base difference and some increase in lower facial height.


2019 ◽  
Vol 24 (5) ◽  
pp. 30-39 ◽  
Author(s):  
Deborah Brindeiro de Araújo Brito ◽  
José Fernando Castanha Henriques ◽  
Camilla Foncatti Fiedler ◽  
Guilherme Janson

ABSTRACT Objective: This study aimed at comparing the dentoskeletal changes in patients with Class II division 1 malocclusion, treated with three types of fixed functional appliances. Methods: A sample comprising 95 patients with the same malocclusion, retrospectively selected, and divided into four groups, was used: G1 consisted of 25 patients (mean age 12.77 ± 1.24 years) treated with Jasper Jumper appliance; G2, with 25 patients (mean age 12.58 ± 1.65 years) treated with the Herbst appliance; G3, with 23 patients (mean age 12.37 ± 1.72 years) treated with the Mandibular Protraction Appliance (MPA); and a Control Group (CG) comprised of 22 untreated subjects (mean age 12.66 ± 1.12 years). Intergroup comparison was performed with ANOVA, followed by Tukey test. Results: The Jasper Jumper and the Herbst group showed significantly greater maxillary anterior displacement restriction. The Jasper Jumper demonstrated significantly greater increase in the mandibular plane angle, as compared to the control group. The MPA group demonstrated significantly greater palatal inclination of the maxillary incisors. Vertical development of the maxillary molars was significantly greater in the Herbst group. Conclusions: Despite some intergroup differences in the amount of dentoskeletal changes, the appliances were effective in correcting the main features of Class II malocclusions.


2019 ◽  
Vol 9 ◽  
pp. 165-171
Author(s):  
Pornpan Jariyavithayakul ◽  
Chairat Charoemratrote

Objectives: The objectives of the study were to investigate the effect of lower posterior tooth extrusion on skeletal and dental changes in Class II division 1 deep bite short-faced growing patients. Materials and Methods: Twenty-two growing patients with Class II/1 malocclusion deep bite/short-face were treated using a pre-adjusted edgewise-fixed appliance. The curve of Spee (COS) was leveled by rectangular wire and posterior vertical elastic. Two consecutive lateral cephalometric radiographs were collected before and after treatment. Changes from the cephalometric analysis were compared with 22 untreated matched subjects during the observation period with independent t-test. Results: The reduction of deep bite from the COS in the treated group was 2.83 mm which was obtained by a greater amount of posterior extrusion (1.37 mm), than anterior intrusion (0.58 mm), and lower facial height significantly increased (3.70 mm). The treated group showed significant forward mandibular position from SNB (1.36°), Pg-Nperp (1.53 mm), and the skeletal relationship improved (ANB = −0.88°). The mandibular plane angles (SN-MP and FMA) showed no significant changes during treatment. Dental changes revealed significant decreases in overjet and overbite, whereas the position and inclination of the upper and lower incisors were not significantly different. Conclusions: The increase of lower facial height in Class II deep bite short-faced growing patients was successfully accomplished by lower posterior tooth extrusion with the use of rectangular wire with posterior vertical elastic. The mandibular plane angle did not change during treatment. Class II skeletal relationship improved by the forward position of the mandible in hypo- and normodivergent pattern subjects.


Author(s):  
Mahamad Irfanulla Khan ◽  
Praveen Kumar Neela ◽  
Nayeem Unnisa ◽  
Ajit Kumar Jaiswal ◽  
Nadeem Ahmed ◽  
...  

Background and aim. Class II malocclusions are most commonly seen in orthodontic practice and in the recent times Twin Block appliance has been the most popular and widely used among removable functional appliances for the correction of Class II malocclusion in growing patients. The aim of this retrospective study was to evaluate the dentoskeletal effects produced by the Twin Block appliance for the correction of Class II division 1 malocclusion with retrognathic mandible. Methods. Pre-treatment (T1) and post-treatment (T2) lateral cephalograms of 30 patients treated with Twin Block appliance (mean age  =  10.8 ± 1.2 years) for the correction of class II division 1 malocclusion were compared with the 30 untreated class II control patients (mean age 11.2 ± 0.8 years) who did not undergo any treatment during this period. Both the groups were evaluated for the dentoskeletal changes using 24 angular and linear cephalometric measurements. The differences between the pre and post-treatment were calculated using a paired t-test. Results. The cephalometric analysis revealed that the Twin Block appliance stimulated mandibular growth and statistically significant differences were found between the two groups. Twin Block patients showed a statistically very high significant (p<0.001) increase in mandibular length (6.02 mm) compared with the control group (0.3 mm). ‘Headgear effect’ on the maxilla, increase in lower anterior facial height, significant reduction of overjet, overbite and Class I molar relationship was achieved in the Twin Block group. However, no significant changes appeared in the control group. Conclusion: The results of the present study conclude that the Twin Block appliance is effective in the treatment of Class II malocclusion and this is due to a combination of skeletal and dentoalveolar changes in both the arches.


2013 ◽  
Vol 18 (4) ◽  
pp. 43-52 ◽  
Author(s):  
Paulo Roberto dos Santos-Pinto ◽  
Lídia Parsekian Martins ◽  
Ary dos Santos-Pinto ◽  
Luiz Gonzaga Gandini Júnior ◽  
Dirceu Barnabé Raveli ◽  
...  

OBJECTIVE: The purpose of the study was to evaluate the influence of the skeletal maturation in the mandibular and dentoalveolar growth and development during the Class II, division 1, malocclusion correction with Balters bionator. METHODS: Three groups of children with Class II, division 1, malocclusion were evaluated. Two of them were treated for one year with the bionator of Balters appliance in different skeletal ages (Group 1: 6 children, 7 to 8 years old and Group 2: 10 children, 9 to 10 years old) and the other one was followed without treatment (Control Group: 7 children, 8 to 9 years old). Lateral 45 degree cephalometric radiographs were used for the evaluation of the mandibular growth and dentoalveolar development. Tantalum metallic implants were used as fixed and stable references for radiograph superimposition and data acquisition. Student's t test was used in the statistical analysis of the displacement of the points in the condyle, ramus, mandibular base and dental points. Analysis of variance one-fixed criteria was used to evaluate group differences (95% of level of significance). RESULTS: The intragroup evaluation showed that all groups present significant skeletal growth for all points analyzed (1.2 to 3.7 mm), but in an intergroup comparison, the increment of the mandibular growth in the condyle, ramus and mandibular base were not statically different. For the dentoalveolar modifications, the less mature children showed greater labial inclination of the lower incisors (1.86 mm) and the most mature children showed greater first permanent molar extrusion (4.8 mm).


2021 ◽  
Vol 7 (4) ◽  
pp. 276-281
Author(s):  
Puja Khanna ◽  
Sumit Chhabra ◽  
Preeti Munjal ◽  
Sunny Mittal ◽  
Nishtha Arora

Association of tongue posture with dental and facial skeletal pattern have been suggested in past. This study was undertaken to assess tongue posture and dimensions in Class I and Class II Dentoskeletal patterns to determine whether any correlation exists between tongue posture and skeletal pattern of an individual. Cephalograms of 150 individuals (aged 18-23 years), taken in Natural Head Position (NHP) and tongue at rest were divided into three groups i.e. Group 1 – Class I Normal occlusion, Group 2 – Class II Division 1 Normodivergent and Group 3 – Class II Division 1 Hypodivergent, consisting of 50 samples each. To ensure the rest position of tongue, patient was asked to relax for 30 seconds after coating the tongue with barium sulphate in midline and then to swallow, and the X-ray was taken at the end of swallowing. Each group was divided into two subgroups according to sex. Groups were constituted according to the Frankfort mandibular plane angle (FMA) angle. The subjects who had skeletal Class II pattern due to mandibular retrusion and not due to maxillary prognathism were only included in the study group. Statistical analysis was done using the software SPSS version 21.0. The statistical tests used were unpaired t-test and One-way ANOVA test with post-hoc bonferroni test. The p-value was considered significant if less than 0.05.The dorsum of the tongue was higher at back and lower in front in Class II Division 1 Hypodivergent group as compared to Class I Normal occlusion group (P&#60;.05). Tongue height and tongue length were significantly reduced in Class II Division 1 Normodivergent and Class II Division 1 Hypodivergent malocclusion groups when compared to Class I control group (P&#60;.05).The study supports the existence of a relationship between posture & dimensions of the tongue with Class I and Class II skeletal patterns.


2012 ◽  
Vol 06 (02) ◽  
pp. 123-132 ◽  
Author(s):  
Elcin Esenlik ◽  
Fidan Alakus Sabuncuoglu

ABSTRACTObjectives: The aim of this study was to investigate the alveolar and symphysis region properties in hyper-, hypo-, and normodivergent Class II division 1 anomaliesMethods: Pretreatment lateral cephalograms of 111 young adult female patients with skeletal Class II division 1 anomalies were compared to those of 54 Class I normal subjects (control group). Class II cases were divided into hyperdivergent (n = 58), hypodivergent (n = 19), and normodivergent groups (n = 34). The heights and widths of the symphysis and alveolus and the depth of maxillary palate were measured on the lateral cephalogramsResults: Mean symphysis width was wider in the hypodivergent Class II group than in the other groups, while mean symphysis height was similar among all groups. Maxillary palatal depth, upper incisor angle, upper and lower molar alveolar heights, and Id–Id′ width were also similar among groupsConclusion: Symphysis width is the main factor in the differential diagnosis of Class II division 1 anomaly rather than symphysis height and hypodivergent Class II Division 1 anomaly is more suitable for mandibular incisors movements. (Eur J Dent 2012;6:123-132)


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Mary-Eleni Zouloumi ◽  
Kleopatra Tsiouli ◽  
Simeon Psomiadis ◽  
Olga-Elpis Kolokitha ◽  
Nikolaos Topouzelis ◽  
...  

Abstract Objectives To assess the perceived facial changes in class II division 1, convex profile patients treated with functional followed by fixed orthodontic appliances. Subjects and methods The study sample consisted of 36 pairs of pre- and post-treatment photographs (frontal and profile, at rest) of 12 patients treated with activator, 12 with twin-block, and 12 controls with normal profiles, treated without functional appliances. All photographs were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. Visual analog scale (VAS) ratings of changes in facial appearance were assessed. Results The patient groups were similar in sex distributions, age, and treatment duration. The different rater groups showed strong to excellent agreement. There were no significant differences among treatment groups (F = 0.91; P = 0.526; Wilks lambda = 0.93), raters (F = 1.68; P = 0.054; Wilks lambda = 0.83), and when testing the combined effect of treatment and rater on the results (F = 0.72; P = 0.866; Wilks lambda = 0.85). The raters detected slightly more positive changes in the activator and twin-block groups, compared to the control group, regarding the lower face and the lips, but these findings did not reach significance. Furthermore, their magnitude hardly exceeded 1/20th of the total VAS length. Limitations Retrospective study design. Conclusions The perceived facial changes of convex profile patients treated with functional, followed by fixed orthodontic appliances, did not differ from those observed in normal profile patients, when full-face frontal and profile photos were simultaneously assessed. Consequently, professionals should be skeptical regarding the improvement of a patient’s facial appearance when this treatment option is used.


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