Long-term effects of the Herbst appliance in relation to the treatment growth period: a cephalometric study

The aim of this study was to analyse the long-term effects of Herbst treatment on the dentofacial complex with special reference to the growth period in which the patients were treated. The sample consisted of 40 male subjects with a Class II, division 1 malocclusion treated successfully with the Herbst appliance for an average period of 7 months. The patients were reinvestigated at the end of the growth period, on average 6.6 years (SD = 1.0 years) after therapy. Nineteen patients were treated before the maximum of pubertal growth (prepeak), 15 at the maximum (peak) and 6 after the pubertal growth maximum (post-peak). Sagittal skeletal and dental changes occurring during and after Herbst treatment were evaluated on lateral radiographs in centric occlusion. At the time of follow-up examination no group differences were seen in sagittal dental arch relationships. During the follow-up period after Herbst treatment maxillary and mandibular growth development were favourable and comparable in all three groups: mandibular growth exceeding maxillary growth by an average of 4.3 mm (SD = 2.4 mm). For natural reasons, however, the amount of jaw growth during the follow-up period was larger in the subjects treated before the maximum of pubertal growth than in the subjects treated at the later stages. The conclusion of this study was that the growth period in which Herbst treatment was performed did not seem to have any conclusive effect on the long-term results. However, in order to favour occlusal stability after treatment and to reduce the time of post-treatment retention, Herbst therapy in the permanent dentition at or just after peak height velocity of growth is recommended.