Skeletal and Dental Changes in Class II division 1 Malocclusions Treated with Splint-Type Herbst Appliances

Abstract

Dental changes are as important as skeletal changes to attaining the final occlusal results. Long-term, prospective, double-blinded, randomized clinical trials are needed to support these conclusions.

Optimization of Class II Malocclusion Treatments Using the Forsus™ Fatigue Resistance Device and Its Post-Treatment Effect in Adult Patients: A Case Report

“…Other functional appliances, such as the Herbst and the Jasper-jumper, provide, in a long-term run, the same dentoskeletal results as the hybrid appliances [8,11,12,18,19,[21][22][23]25]. However, the Herbst appliance, because it is stiff and restricts mandibular move, it is considered extremely uncomfortable to adult patients, in addition to presenting high breakage levels and complex installation [10,22,26]. The semi-rigid devices, as the Jasper-Jumper, although it allows greater freedom to the functional movements, its flexibility increases the breakage risks [10,11,31].…”

“…The treatment option was, then, the use of the Forsus fixed functional appliance because it is easy to instalatt [10,11,13] and, mainly, because it provides comfort to patient, allowing greater freedom to the eccentric and centric mandible movements [7,[11][12][13][14][15][16][17]33,34], and, also, better resistance [10,13] and performance with light forces (average of 220 to 250g) [15,35]. Other functional appliances, such as the Herbst and the Jasper-jumper, provide, in a long-term run, the same dentoskeletal results as the hybrid appliances [8,11,12,18,19,[21][22][23]25]. However, the Herbst appliance, because it is stiff and restricts mandibular move, it is considered extremely uncomfortable to adult patients, in addition to presenting high breakage levels and complex installation [10,22,26].…”

“…Based on this and supported by the literature, it was possible to consider and suggest some treatment options to the patient, such as a surgical-orthodontic treatment [20,38]; upper first molar extractions [39,40], the use of intermaxillary Class II elastics [24,41], which would need patient cooperation; and the use of fixed functional appliances-rigid [18,19,[21][22][23]25], semi-rigid [8,11,12,37], but, mainly, hybrid appliances as the Forsus™ Fatigue Resistant Device [3,7,11,[13][14][15]17,[32][33][34]35]. The chosen protocol was to use the Forsus™ Fatigue Resistant Device that has shown to be an effective device, providing greater comfort to patients [7,11,[14][15][16][17]33,34] and good resistance [10,13,15,35] when treating Class II malocclusions.…”

“…The Forsus hybrid functional appliance is not as stiff as the orthopedic devices such as the Herbst [10,22,26], the APM [27,28] and the Mara [29,30], furthermore, it is not as fragile as the "Jasper Jumper" [10,11,31]. It is a comfortable device [7], as it does not completely limit the mandible movement and, in the current version, it shows a very low breakage rate [10,14,[32][33][34].…”

“…In the twenty-first century, the launch of the Forsus™ Fatigue Resistant Device brought a new proposal to treatments, considering patient comfort in the set-up day and along the treatment, due to the lack of mandibular postural change and easiness of performing the functional mandibular movements [7,11,[14][15][16][17]. Additionally, there are also scientific evidences demonstrating that the impact on growth pattern is temporary after treatment as, in a long-term run, changes responding to growth pattern already exists genetically [3,16,[18][19][20][21][22][23][24][25].…”