Angle Class II, Division 1 Clinical Trial
Official title:
Skeletally Versus Dentally Anchored Herbst Appliance During Treatment of Class 2 Mandibular Deficiency in Adolescent Patients; A CBCT Study
The treatment of skeletal Class II malocclusion can be carried out through different approaches. One of these is the using of Fixed Functional Appliances (FFA), one of main drawbacks of these appliances is the proclination of the lower anterior teeth limiting the skeletal effect that is originally addressed in those patients.To overcome these limitations, miniplates anchored Forsus FRD were introduced, it showed high success rate in achieving a more skeletal effect with retroclination of lower anterior teeth rather than their proclination. Although Herbst appliance is categorized as the best FFA with more stable skeletal and dentoalveolar effects, miniplates had never been tried as an anchorage source with Herbst appliance in skeletal Class II patients.
Skeletal Class II malocclusion is one of the most common orthodontic problems, which occurs
in about one third of the population. Although there is many skeletal and dental combination
that can contribute for the creation of Class II, however, mandibular retrusion is considered
as the main contributing factor.
The treatment of skeletal Class II malocclusion can be carried out through three different
time intervals. The first is an early treatment before the pubertal growth spurt through
limiting the maxillary growth and stimulation of mandibular growth by using headgear and/or
functional appliances. The second intervention would be during the maximum growth spurt
through harnessing the spurt time to produce a more favorable skeletal effect by using of
functional appliances either removable or fixed. Once growth had ceased, the third and last
possible intervention would be one of the following treatment options; promoting the
remaining growth through the usage of Fixed Functional Appliances (FFA), camouflage treatment
and orthognathic surgery.
Fixed functional appliances (FFA) are aiming to stimulate mandibular growth by forward
posturing the mandible to correct the skeletal antero-posterior discrepancy. Although there
is always a controversy regarding the effectiveness of these appliances, many studies have
been demonstrated successful correction of skeletal class II in adolescent patients through
their use.
In a way to achieve this, it is recommended to use a rigid type of FFA like Herbst appliance
and the Functional Mandibular Advancer rather than semi-rigid appliances like Forsus Fatigue
Resistant Device (Forsus FRD).
Regardless of the patient's age, one of main drawbacks of these appliances is the
proclination of the lower anterior teeth limiting the skeletal effect that is originally
addressed in those patients.To overcome this limitation, mini screws had been used with both
rigid and semi-rigid types of FFA. Incremental enhancement in the skeletal measurement has
been noted by using them with the rigid type of FFA (e.g. Herbst appliance), however, the
effect was still purely dentoalveolar when it came to semi rigid FFA (e.g. Forsus FRD), never
to say that the success rate of these mini screws in the mandible is very low when compared
with the maxilla which means a more complication and inconsistency in the clinical results.
To overcome these limitations, miniplates anchored Forsus FRD were introduced, it showed high
success rate in achieving a more skeletal effect with retroclination of lower anterior teeth
rather than their proclination. Although Herbst appliance is categorized as the best FFA with
more stable skeletal and dentoalveolar effects,miniplates had never been tried as an
anchorage source with Herbst appliance.
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