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Class II treatment by extraction of maxillary first molars or Herbst appliance: dentoskeletal and soft tissue effects in comparison

  • J.W. BooijEmail author
  • J. Goeke
  • E.M. Bronkhorst
  • C. Katsaros
  • S. Ruf
Original article

Abstract

Aim

To compare dentoskeletal and soft tissue treatment effects of two alternative Class II division 1 treatment modalities (maxillary first permanent molar extraction versus Herbst appliance).

Methods

One-hundred-fifty-four Class II division 1 patients that had either been treated with extractions of the upper first molars and a lightwire multibracket (MB) appliance (n = 79; 38 girls, 41 boys) or non-extraction by means of a Herbst-MB appliance (n = 75; 35 girls, 40 boys). The groups were matched on age and sex. The average age at the start of treatment was 12.7 years for the extraction and for 13.0 years for the Herbst group. Pretreatment (T1) and posttreatment (T2) lateral cephalograms were retrospectively analyzed using a standard cephalometric analysis and the sagittal occlusal analysis according to Pancherz.

Results

The SNA decrease was 1.10° (p = 0.001) more pronounced in the extraction group, the SNB angle increased 1.49° more in the Herbst group (p = 0.000). In the extraction group, a decrease in SNB angle (0.49°) was observed. The soft tissue profile convexity (N-Sn-Pog) decreased in both groups, which was 0.78° more (n. s.) pronounced in the Herbst group. The nasolabial angle increased significantly more (+ 2.33°, p = 0.025) in the extraction group. The mechanism of overjet correction in the extraction group was predominantly dental (65% dental and 35% skeletal changes), while in the Herbst group it was predominantly skeletal (58% skeletal and 42% dental changes) in origin.

Conclusion

Both treatment methods were successful and led to a correction of the Class II division 1 malocclusion. Whereas for upper first molar extraction treatment more dental and maxillary effects can be expected, in case of Herbst treatment skeletal and mandibular effects prevail.

Keywords

Class II treatment Herbst appliance Maxillary molar extraction Treatment effects 

Klasse-II-Therapie mit Extraktion der ersten oberen Molaren oder Herbst-Behandlung: Dentoskeletale und Weichteileffekte im Vergleich

Zusammenfassung

Studienziel

Vergleich der dentoskeletalen und weichteilspezifischen Effekte zweier alternativer Behandlungsformen bei Klasse-II/1-Anomalien (Extraktion der oberen Sechsjahrmolaren oder Herbst-Scharnier).

Methode

Einhundertvierundfünfzig Patienten mit Klasse-II/1-Anomalien waren entweder durch Extraktion der ersten oberen Molaren und Anwendung einer Light-Wire-Multibracket-Apparatur (n = 79; 38 Mädchen und 41 Jungen) oder extraktionsfrei per Herbst-Multibracket-Apparatur (n = 75; 35 Mädchen und 40 Jungen) behandelt worden. Die Alters- und Geschlechterverteilung in den beiden Gruppen war ausgeglichen. Das Durchschnittsalter zu Behandlungsbeginn betrug in der Extraktionsgruppe 12,7, in der Herbst-Gruppe 13,0 Jahre. Prät- (T1) und posttherapeutische (T2) Fernröntgenseitenbilder wurden anhand einer standardmäßigen kephalometrischen Auswertung und einer sagittalen Okklusionsanalyse (SO-Analyse) nach Pancherz retrospektiv ausgewertet.

Resultate

Die Rückgänge des SNA-Winkels waren in der Extraktionsgruppe um 1,1° ausgeprägter (p = 0,001). Der SNB-Winkel stieg in der Herbst-Gruppe auf eine Differenz von 1,49° zur Extraktionsgruppe an (p = 0,000), in letzterer war ein Rückgang dieses Winkels (0,49°) zu verzeichnen. Die Konvexität des Weichteilprofils (N-Sn-Pog) nahm in beiden Gruppen ab, die Rückgänge fielen in der Herbst-Gruppe um 0,78° stärker aus (n. s.). Beim Nasolabialwinkel zeigte die Extraktionsgruppe signifikant höhere Anstiege (+ 2,33°; p = 0,025). Dem in der Extraktionsgruppe vorherrschenden dentalen Korrekturmechanismus (Veränderungen zu 65% dental und zu 35% skeletal) stand ein primär skeletaler Mechanismus (58% skeletal und 42% dental) in der Herbst-Gruppe gegenüber.

Schlussfolgerung

Beide Behandlungsmethoden bewirkten eine erfolgreiche Korrektur der Klasse-II/1-Anomalien. Während bei therapeutischer Extraktion der ersten oberen Molaren stärkere dentale und maxilläre Effekte zu erwarten sind, ist bei Anwendung eines Herbst-Scharniers davon auszugehen, dass die skeletalen und mandibulären Effekte überwiegen werden.

Schlüsselwörter

Klasse-II-Therapie Herbst-Scharnier Extraktion oberer Molaren Behandlungseffekte 

Notes

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • J.W. Booij
    • 1
    • 6
    Email author
  • J. Goeke
    • 2
  • E.M. Bronkhorst
    • 3
  • C. Katsaros
    • 4
  • S. Ruf
    • 5
  1. 1.Department of Orthodontics and Oral BiologyRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
  2. 2.Private PracticeHamburgGermany
  3. 3.Department Preventive and Curative DentistryRadboud University Nijmegen Medical CenterNijmegenThe Netherlands
  4. 4.Department of Orthodontics and Dentofacial OrthopedicsUniversity of BernBernSwitzerland
  5. 5.Department of OrthodonticsUniversity of GiessenGiessenGermany
  6. 6.-AC GorinchemNetherlands

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