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Orthodontic Class II:1 treatment—efficiency and outcome quality of Herbst-multibracket appliance therapy

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Abstract

Objectives

The aim of this retrospective investigation was to assess the efficiency and outcome quality of Class II:1 treatment (Tx).

Material and methods

The investigation is based on the evaluation of all Class II:1 patients that ever (1986–2014) started Tx with a Herbst appliance and subsequently a multibracket appliance (MBA) at the study center. Study casts from before Tx, after Herbst-MBA Tx, and (if available) after ≥ 24 months of retention were evaluated using the Peer Assessment Rating (PAR) index, the Ahlgren scale, and standard occlusal variables.

Results

In total, 526 Class II:1 patients with a mean pre-Tx age of 14.4 years (range 9.8–44.4) had received Herbst-MBA Tx; 18 patients discontinued Tx before completion. For 240 patients, data from ≥ 24 months of retention were available. The pre-Tx PAR score of 32.4 ± 8.83 was reduced to 8.0 ± 4.51 during Tx. A slight increase to 8.8 ± 5.11 occurred during retention. The percentage of patients which could be assigned to the category “greatly improved” was 62% after Tx and 57% after retention; only 2–3% had to be assigned to the category “worse/no different.” The outcome ratings according to the Ahlgren scale revealed 17% excellent, 35% good, 45% satisfactory, and 3% unsuccessful results.

Conclusions

Class II:1 Tx using Herbst-MBA is an efficient approach in orthodontic care. During a mean active Tx period of 2 years, high-quality results can be obtained in the majority of patients.

Clinical relevance

The present investigation is the first to investigate a large unselected cohort of consecutive Herbst-MBA patients to determine representative data on the efficiency and the outcome quality of this Tx approach.

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Acknowledgements

The authors acknowledge H. Hudel (Department of Medical Statistics, University of Giessen, Germany) for his advice regarding statistical analysis.

Author information

Authors and Affiliations

  1. Department of Orthodontics, University of Giessen, Schlangenzahl 14, 35392, Giessen, Germany

    N. Bock, J. Ruehl & S. Ruf

Authors
  1. N. Bock
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  2. J. Ruehl
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  3. S. Ruf
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Contributions

The study was designed by N. Bock and S. Ruf and all measurements were performed by J. Ruehl. All authors contributed to data analysis and interpretation while the manuscript was prepared and revised by N. Bock and S. Ruf. All authors gave final approval and agreed to be accountable for all aspects of the work.

Corresponding author

Correspondence to N. Bock.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The protocol for this retrospective investigation was approved by the ethical committee of the Faculty of Medicine, University of Giessen, Germany (80/14).

Informed consent

For this type of study, formal consent is not required.

Electronic supplementary material

Supplementary Figure 1

Diagrams showing the outcome quality as assessed by (a) PAR Index and (b) Ahlgren Scale. The percentages of results at T2 being rated as “greatly improved”, “improved” and “worse/no different” (PAR) as well as “excellent”, “good”, “acceptable” and “unsuccessful” (Ahlgren) are given. (GIF 151 kb)

High resolution image (EPS 1717 kb)

Supplementary Table 1

Retention at follow-up (T2). The percentage of patients is given for each possible combination of retention regime in the upper and lower jaw. *145 of the 117/*28 of the 52 patients had an additional removable appliance for night-time wear (mostly activator). (XLS 33 kb)

Supplementary Table 2

Changes of PAR score, overjet and overbite as well as sagittal molar and canine relationships (right/left) during T1-T0 and T2-T1. For each variable, median (Med), the mean value (Mean), standard deviation (SD), minimum (Min) and maximum (Max) as well as the p-value (p) of the change are given. cw: cusp widths, *negative changes mean favorable development in terms of Class II correction (XLS 27 kb)

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Bock, N., Ruehl, J. & Ruf, S. Orthodontic Class II:1 treatment—efficiency and outcome quality of Herbst-multibracket appliance therapy. Clin Oral Invest 22, 2005–2011 (2018). https://doi.org/10.1007/s00784-017-2294-9

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  • DOI: https://doi.org/10.1007/s00784-017-2294-9

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