Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance

Abstract

ObjectiveTo assess the types and frequencies of clinical complications experienced when using a modified lingual Herbst appliance and to compare these with those associated with conventional Herbst appliances reported in the literature.MethodsTreatment records for 35 consecutive subjects treated during the observation period from October 2013 to August 2014 who received a combination of a lingual appliance and a modified Herbst appliance (WIN, DW LingualSystems) were assessed for complications linked to Herbst treatment phase. Complications were analyzed descriptively, and complication-free intervals were calculated using Kaplan-Meier plots. To enable a comparison with data reported in the literature, the cumulative treatment time for all subjects was divided by the total number of complications.Results71.4 % of Herbst treatments were free from complications (n = 25). Complications were seen on 13 occasions (8 instances of Herbst attachment loosening, 5 L-Pin fractures). Most of these complications could be fixed chair side utilizing simple clinical measures. Considering all complications as identical statistical events, the percentage of treatments free from complications would be 88 % for 100 days, 70 % for 200 days and 56.8 % for 300 days. For severe complications, the averaged complication-free treatment interval was found to be 27.8 months.ConclusionIn terms of clinical sturdiness, and taking into consideration the step-wise mode of activation used here as well as the differences in the design of the various Herbst appliances, the WIN-Herbst appliance was found to be superior to comparable vestibular Herbst appliances, as well as the banded Herbst appliance belonging to the preceding generation of customized lingual systems. Success in treatment of non-compliant Angle Class II correction is considered to have better predictability using the modified anchorage strategy of the WIN-Herbst appliance.

Quality of occlusal outcome following space closure in cases of lower second premolar aplasia using lingual orthodontic molar mesialization without maxillary counterbalancing extraction

“…The mean speed of space closure was found to be 0.57 mm / month, which is slightly (12%) increased compared to those reported by Metzner et al (0.51 mm / month) [ 12 ]. This may be explained by this study having utilized a Herbst telescope system (WIN appliance, DW Lingualsystems, Bad Essen, Germany) which is less susceptible to appliance fractures or failures [ 10 ] than the appliance of the type used by Metzner et al (Incognito appliance, 3 M Top Service für Lingualtechnik, Bad Essen, Germany) [ 12 , 15 ]: When using a Herbst appliance or a Jasper-Jumper as anchorage during molar mesialisation, it is crucial to keep the rate of appliance fractures low, in order to achieve reduced treatment duration by a continuous space closure strictly from a posterior direction, without anchorage or interruption of fixed treatment. The Herbst appliance in combination with the CCLA used here is considered to be suitable for this purpose, based on previous research outcomes [ 10 ].…”

“…The treatment involved the use of a completely customized lingual appliance (WIN, DW LingualSystems, Bad Essen; Germany) in combination with a Herbst appliance (modified MiniScope, American Orthodontics, USA) for anchorage reinforcement [ 10 ]. Second molar brackets were designed with occlusal pads to reduce antagonistic interference.…”

Class II division 2 nonextraction treatment using skeletal anchorage – a case report

“…Jednakże u 1,5-7 % pacjentów ortodontycznych diagnozuje się wadę klasy II z retruzją siekaczy górnych, charakteryzującą się klasą II na zębach trzonowych, retruzją siekaczy górnych, pogłębionym nagryzem pionowym (1,2,3). Jest wiele strategii leczenia klasy II z retruzją siekaczy (4,5,6,7,8,9,10). Jednak wydaje się, że dystalizacja trzonowców jest jednym z najczęściej stosowanych bezekstrakcyjnych protokołów terapeutycznych.…”

The Herbst Appliance and its Modifications - Prevalence and Individuality

“…E ciency for the dentist, integration into everyday practice as well as fast and good effectiveness led to the further development and variations of the xed Class II mechanics [11,12]. The literature to this day includes extensive investigations of the Herbst appliance on dentoskeletal effects, changes in the facial pro le, muscle activity, anchoring problems (headgear effect and protrusion of the mandibular incisors), clinical complications, design of the appliance and comparisons between a surgical correction of class II and use of the Herbst appliance [8,13,14,15,16].…”