Skip to main content
SpringerLink
Log in

Correction of Class II, Division 2 malocclusions using a completely customized lingual appliance and the Herbst device

Die Korrektur der Klasse-II/2-Anomalie mit einem vollständig individuellen lingualen Behandlungssystem und der Herbst-Apparatur

  • Original article
  • Published:
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Aim

The purpose of the present study was to examine the efficiency of correcting a Class II, Division 2 malocclusion using a completely customized lingual appliance.

Materials and methods

In 18 consecutively completed, Class II, Division 2 malocclusion patients, the correction of the upper incisor inclination, deep and distal bite were assessed by means of plaster casts, digital lateral cephalograms, and intraoral photographs taken at the time of debond. Furthermore, two independent calibrated examiners determined the weighted Peer Assessment Rating index (PAR Index) of the initial and end models.

Results

All Class II, Division 2 patients were treated successfully: upper incisor inclination using the palatal plane as a reference improved on average from 95.4° to 111.2°. The deep bite was reduced on average from 3.6 mm to 1.7 mm. Neutral occlusion was achieved in all patients who had undergone correction of an initially pronounced distal occlusion (4.5 mm on average). An 86.2% marked improvement was observed in the weighted PAR index score from an average of 24.7 at the beginning of treatment to 2.9 at the end of treatment, with no patient classified as “worse or no different.”

Conclusion

Class II, Division 2 malocclusions can be efficiently and reliably treated by a combination of a completely customized lingual appliance and the Herbst device.

Zusammenfassung

Ziel

Ziel der vorliegenden Untersuchung war die Überprüfung der Effizienz eines vollständig individuellen lingualen Behandlungssystems in Kombination mit der Herbst-Apparatur bei der Korrektur einer Klasse-II/2-Anomalie.

Patienten und Methodik

Bei 18 konsekutiv abgeschlossenen Behandlungen von Klasse-II/2-Patienten wurde zum Zeitpunkt der Entbänderung die Korrektur der Oberkieferfrontzahnneigung, des Tiefbisses und des Distalbisses durch die Therapie anhand von Gipsmodellen, digitalen Fernröntgenaufnahmen und intraoralen Fotos analysiert. Zusätzlich wurde von zwei unabhängigen kalibrierten Untersuchern der gewichtete „Peer-Assessment-Rating“-Index (gewichteter PAR-Index) der Anfangs- und Schlussmodelle erhoben.

Ergebnisse

Alle Klasse-II/2-Patienten wurden erfolgreich behandelt: Die Oberkieferfrontzahnneigung bezogen auf die Spina-Ebene wurde von durchschnittlich 95,4° auf 111,2° verbessert. Der ausgeprägte vertikale Überbiss konnte um durchschnittlich 3,6 mm auf durchschnittlich 1,7 mm verkleinert werden. Die anfangs ausgeprägte Distalokklusion (durchschnittlich 4,5 mm) konnte bei allen Patienten in eine Neutralokklusion überführt werden. Der gewichtete PAR-Index konnte durchschnittlich von 24,7 zu Behandlungsbeginn um 86,2% auf 2,9 deutlich verbessert werden; kein Patient fiel dabei in die Kategorie „unverändert oder verschlechtert“.

Schlussfolgerung

Okklusionsanomalien der Klasse II/2 können mit einer Kombination aus einem vollständig individuellen lingualen Behandlungssystem und einer Herbst-Apparatur effizient und zuverlässig behandelt werden.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Baccetti T, Franchi L, Stahl F (2009) Comparison of 2 comprehensive Class II treatment protocols including the bonded Herbst and headgear appliances: a double-blind study of consecutively treated patients at puberty. Am J Orthod Dentofacial Orthop 135:698 e691–610, discussion 698–699

    Article  PubMed  Google Scholar 

  2. Bock N, Ruf S (2008) Post-treatment occlusal changes in Class II Division 2 subjects treated with the Herbst appliance. Eur J Orthod 30:606–613

    Article  PubMed  Google Scholar 

  3. Bock NC, Santo C, Pancherz H (2009) Facial profile and lip position changes in adult Class II, Division 2 subjects treated with the Herbst-multibracket appliance. A radiographic cephalometric pilot study. J Orofac Orthop 70:51–62

    Article  PubMed  Google Scholar 

  4. Canut JA, Arias S (1999) A long-term evaluation of treated Class II Division 2 malocclusions: a retrospective study model analysis. Eur J Orthod 21:377–386

    Article  PubMed  Google Scholar 

  5. Dahlberg G (1940) Statistical methods for medical and biological students. Interscience, New York

  6. Freitas KM de, Freitas MR de, Janson G et al (2006) Retrospective analysis of orthodontic treatment outcomes and its relation to postretention stability. J Appl Oral Sci 14:324–329

    Article  PubMed  Google Scholar 

  7. DeGuzman L, Bahiraei D, Vig KW et al (1995) The validation of the Peer Assessment Rating index for malocclusion severity and treatment difficulty. Am J Orthod Dentofacial Orthop 107:172–176

    Article  PubMed  Google Scholar 

  8. Demling A, Dittmer MP, Schwestka-Polly R (2009) Comparative analysis of slot dimension in lingual bracket systems. Head Face Med 5:27

    Article  PubMed  Google Scholar 

  9. Devreese H, De Pauw G, Van Maele G et al (2007) Stability of upper incisor inclination changes in Class II Division 2 patients. Eur J Orthod 29:314–320

    Article  PubMed  Google Scholar 

  10. Drescher D (2000) Fernröntgenanalyse. In: Diedrich P (ed) Kieferorthopädie I, Praxis der Zahnheilkunde Bd 11, Urban & Fischer, München, pp 263–287

  11. Eberhard H, Hirschfelder U (1998) Treatment of Class II, Division 2 in the late growth period. J Orofac Orthop 59:352–361

    Article  PubMed  Google Scholar 

  12. Fuhrmann R, Berg R (1990) Nachuntersuchung von Patienten mit Deckbiß des Typs Angle-Klasse II, 2. Prakt Kieferorthop 4:11–20

    Google Scholar 

  13. Galletti C, Fauquet-Roure C, Raybaud P (2010) Treatment of Class III malocclusions in adults using the Incognito lingual technique. Int Orthod 8:227–252

    PubMed  Google Scholar 

  14. Galletti C, Mujagic M, Simon JS (2007) Orthodontie lingual: positionnement du premier arc dans la zone antérieure. Int Orthod 5:301–326

    Article  Google Scholar 

  15. Grauer D, Proffit WR (2011) Accuracy in tooth positioning with a fully customized lingual orthodontic appliance. Am J Orthod Dentofacial Orthop 140:433–443

    Article  PubMed  Google Scholar 

  16. Hamdan AM, Rock WP (1999) An appraisal of the Peer Assessment Rating (PAR) Index and a suggested new weighting system. Eur J Orthod 21:181–192

    Article  PubMed  Google Scholar 

  17. Holman JK, Hans MG, Nelson S, Powers MP (1998) An assessment of extraction versus nonextraction orthodontic treatment using the peer assessment rating (PAR) index. Angle Orthod 68:527–534

    PubMed  Google Scholar 

  18. Ileri Z, Basciftci FA, Malkoc S, Ramoglu SI (2011) Comparison of the outcomes of the lower incisor extraction, premolar extraction and non-extraction treatments. Eur J Orthod (epub)

  19. Kim TW, Little RM (1999) Postretention assessment of deep overbite correction in Class II Division 2 malocclusion. Angle Orthod 69:175–186

    PubMed  Google Scholar 

  20. Kinzel J, Aberschek P, Mischak I, Droschl H (2002) Study of the extent of torque, protrusion and intrusion of the incisors in the context of Class II, division 2 treatment in adults. J Orofac Orthop 63:283–299

    Article  PubMed  Google Scholar 

  21. Lagerström L, Fornell AC, Stenvik A (2011) Outcome of a scheme for specialist orthodontic care, a follow-up study in 31-year-olds. Swed Dent J 35:41–47

    PubMed  Google Scholar 

  22. Locatelli R, Bednar J, Dietz VS, Gianelly AA (1992) Molar distalization with superelastic NiTi wire. J Clin Orthod 26:277–279

    PubMed  Google Scholar 

  23. Lux CJ, Raeth O, Burden D et al (2004) Sagittal and vertical growth of the jaws in Class II, Division 1 and Class II, Division 2 malocclusions during prepubertal and pubertal development. J Orofac Orthop 65:290–311

    Article  PubMed  Google Scholar 

  24. Mavreas D, Athanasiou AE (2008) Factors affecting the duration of orthodontic treatment: a systematic review. Eur J Orthod 30:386–395

    Article  PubMed  Google Scholar 

  25. Mujagic M, Cuzin JF, Muller C (2008) La décompensation sur mesure. Apport de l’orthodontie linguale. Inf Dent 5:187–192

    Google Scholar 

  26. Muller C, Simon JS (2007) L’orthodontie moderne. Traitement esthétique. Inf Dent 89:581–585

    Google Scholar 

  27. Obijou C, Pancherz H (1997) Herbst appliance treatment of Class II, Division 2 malocclusions. Am J Orthod Dentofacial Orthop 112:287–291

    Article  PubMed  Google Scholar 

  28. Pancherz H (1985) The Herbst appliance − its biologic effects and clinical use. Am J Orthod 87:1–20

    Article  PubMed  Google Scholar 

  29. Pancherz H (1991) The nature of Class II relapse after Herbst appliance treatment: a cephalometric long-term investigation. Am J Orthod Dentofacial Orthop 100:220–233

    Article  PubMed  Google Scholar 

  30. Pinzan-Vercelino CR, Janson G, Pinzan A et al (2009) Comparative efficiency of Class II malocclusion treatment with the pendulum appliance or two maxillary premolar extractions and edgewise appliances [corrected]. Eur J Orthod 31:333–340

    Article  PubMed  Google Scholar 

  31. Richmond S, Shaw WC, Roberts CT, Andrews M (1992) The PAR Index (Peer Assessment Rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards. Eur J Orthod 14:180–187

    PubMed  Google Scholar 

  32. Ruf S, Pancherz H (2004) Orthognathic surgery and dentofacial orthopedics in adult Class II Division 1 treatment: mandibular sagittal split osteotomy versus Herbst appliance. Am J Orthod Dentofacial Orthop 126:140–152; quiz 254–145

    Article  PubMed  Google Scholar 

  33. Saelens NA, De Smit AA (1998) Therapeutic changes in extraction versus non-extraction orthodontic treatment. Eur J Orthod 20:225–236

    Article  PubMed  Google Scholar 

  34. Schweitzer M, Pancherz H (2001) The incisor-lip relationship in Herbst/multi-bracket appliance treatment of Class II, Division 2 malocclusions. Angle Orthod 71:358–363

    PubMed  Google Scholar 

  35. Schwestka-Polly R (2004) Proceedings in orthognathic surgery with condylar positioning. Inf Orthod Kieferorthop 36:205–218

    Article  Google Scholar 

  36. Tofeldt LN, Johnsson AC, Kjellberg H (2007) Evaluation of orthodontic treatment, retention and relapse in a 5-year follow-up: a comparison of treatment outcome between a specialist and a post-graduate clinic. Swed Dent J 31:121–127

    PubMed  Google Scholar 

  37. Bremen J von, Bock N, Ruf S (2009) Is Herbst-multi-bracket appliance treatment more efficient in adolescents than in adults? Angle Orthod 79:173–177

    Article  Google Scholar 

  38. Walkow TM, Peck S (2002) Dental arch width in Class II Division 2 deep-bite malocclusion. Am J Orthod Dentofacial Orthop 122:608–613

    Article  PubMed  Google Scholar 

  39. Wehrbein H, Feifel H, Diedrich P (1999) Palatal implant anchorage reinforcement of posterior teeth: A prospective study. Am J Orthod Dentofacial Orthop 116:678–686

    Article  PubMed  Google Scholar 

  40. Wiechmann D, Schwestka-Polly R, Hohoff A (2008) Herbst appliance in lingual orthodontics. Am J Orthod Dentofacial Orthop 134:439–446

    Article  PubMed  Google Scholar 

  41. Wiechmann D, Schwestka-Polly R, Pancherz H, Hohoff A (2010) Control of mandibular incisors with the combined Herbst and completely customized lingual appliance-a pilot study. Head Face Med 6:3

    Article  PubMed  Google Scholar 

  42. Wilmes B, Drescher D (2010) Application and effectiveness of the Beneslider: a device to move molars distally. World J Orthod 11:331–340

    PubMed  Google Scholar 

  43. Zentner A, Peylo S, Brothag D (2003) Predictive value of morphologic parameters for successful correction of Class II Division 2 malocclusion. Am J Orthod Dentofacial Orthop 123:279–285

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

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.

Author information

Authors and Affiliations

  1. Private Orthodontic Practice, Lindenstr. 44, 49152, Bad Essen, Germany

    J. Vu & D. Wiechmann

  2. Department of Orthodontics, Justus Liebig University, Gießen, Germany

    H. Pancherz

  3. Department of Orthodontics, Hannover Medical School, Hannover, Germany

    R. Schwestka-Polly & D. Wiechmann

Authors
  1. J. Vu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Pancherz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Schwestka-Polly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Wiechmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Vu.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vu, J., Pancherz, H., Schwestka-Polly, R. et al. Correction of Class II, Division 2 malocclusions using a completely customized lingual appliance and the Herbst device. J Orofac Orthop 73, 225–235 (2012). https://doi.org/10.1007/s00056-012-0077-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00056-012-0077-0

Keywords

Schlüsselwörter

Search

Navigation