Class II:2 malocclusion-prevalence and progression of labial gingival recessions during Herbst-Multibracket appliance treatment.

OBJECTIVES: To determine the prevalence, incidence, and changes in magnitude of labial gingival recessions (LGR) in class II:2 patients during Herbst-Multibracket appliance (Herbst-MBA) treatment (Tx) plus retention. SUBJECTS AND METHODS: All class II:2 patients of the Department of Orthodontics, University of Giessen, Germany who completed Herbst-MBA Tx (mean pre-Tx age 15.6 years). The cohort had undergone a Herbst phase (mean 8.1 months) as well as a subsequent MBA phase (mean 14.4 months). Study casts were evaluated from pre-Tx and after Herbst-MBA Tx plus ≥ 24 months of retention. RESULTS: Ratable pre-Tx and post-retention study casts (total observation period 53.5 ± 10.3 months) were available from 94 out of 173 patients. No significant difference existed regarding pre-Tx LGR data between patients with and without complete records. The prevalence for teeth with LGR ≥ 0.5 mm was 1.4% pre-Tx respectively 6.7% post-retention. The highest values of up to 5.3% (pre-Tx) and 20.2% (post-retention) were determined for the upper first premolars and lower central incisors. Incidence values of 4.7% (all teeth) and up to 14.9% (upper first right premolars) respectively 11.1% (lower central incisors) were calculated (LGR ≥ 0.5 mm). The overall LGR mean magnitudes were 0.01 mm pre-Tx respectively 0.06 mm post-retention. CONCLUSIONS: For the prevalence of LGR ≥ 0.5 mm an average increase of 5.3% was determined during ≈ 4.5 years of Herbst-MBA Tx plus retention. The highest incidence was seen for lower central incisors and upper right premolars (11.1/14.9%). The overall LGR mean magnitude increased by 0.05 mm. CLINICAL RELEVANCE: Herbst-MBA Tx is a common approach for class II:2 malocclusions. Very little, however, is known regarding LGR development in respective patients.

Quality of orthodontic care-A multicenter cohort study in Germany : Part 1: Evaluation of effectiveness of orthodontic treatments and predictive factors.

AIMS: Orthodontic care and its effectiveness have increasingly become the focus of political and public attention in the recent past. Therefore, this multicenter cohort study aimed to report about the effectiveness of orthodontic treatments in Germany and to identify potential influencing factors. METHODS: A total of 586 patients from seven German study centers were screened for this cohort study, of which 361 patients were recruited at the end of their orthodontic treatment. Of these, 26 patients had missing study models and/or missing treatment information. Thus, 335 participants were included. The severity of malocclusion was rated using the Peer Assessment Rating (PAR) Index at baseline (T0) retrospectively and-prospectively-after the retention period (T1). Practitioner-, treatment- and patient-related information were analyzed in order to detect potential predictive factors for treatment effectiveness. RESULTS: Study participants (202 female and 133 male) were on average 14.8 (standard deviation [SD] ± 6.1) years old at start of active treatment. Average PAR score at T0 was 25.96 (SD ± 10.75) and mean posttreatment PAR score was 3.67 (SD ± 2.98) at T1. An average decrease of total PAR score by 22.30 points (SD ± 10.73) or 83.54% (SD ± 14.58; p < 0.001) was detected. Furthermore, 164 treatments (49.1%) were categorized as 'greatly improved' but only 3 treatments (0.9%) as 'worse or no different'; 81.5% of all cases finished with a high-quality treatment outcome (≤5 PAR points at T1). Logistic regression analyses detected staff experience as a significant predictive factor for high-quality results (odds ratio 1.27, p = 0.001, 95% confidence interval 1.11-1.46). CONCLUSION: The improvement rate among this selected German cohort indicated an overall very good standard of orthodontic treatment. Staff experience proved to be a predictive factor for high-quality results.

Herbst-multibracket appliance treatment: is there an association between lower incisor position changes and the development of labial gingival recessions?

PURPOSE: To assess a potential association between lower incisor (LI) position changes during Herbst-multibracket appliance (Herbst-MBA) treatment and the development of labial gingival recessions (LGR). METHODS: All class II patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who had undergone Herbst-MBA treatment until 2015 with study models and lateral cephalograms available from before (T0) and after treatment plus ≥24 months of retention (T3) were included (n = 259). Lateral cephalograms were evaluated regarding LI position changes: iiL/ML (angle between LI long axis and mandibular plane [MP]), ii-MLPg (distance between LI incisal edge and a line perpendicular to MP through pogonion), apex-MLPg (distance between LI apex and a line perpendicular to MP through pogonion), ii-MLii (distance between LI incisal edge and MP on a line perpendicular to MP through incisal edge). Using study models the distance between the cementoenamel junction and the deepest point of the gingival margin was defined as LGR. RESULTS: The following cephalometric mean changes were recorded (T0-T3): iiL/ML +5.9 ± 5.76° (p = 0.929), ii-MLPg -0.2 ± 0.25 mm (p = 0.430), apex-MLPg +0.1 ± 0.32 mm (p = 0.363), ii-MLii +0.1 ± 0.36 mm (p = 0.206). The mean increase of LGR magnitude measured on the study models was 0.1 ± 0.35 mm. However, no association with the cephalometric LI position changes was found (|R| ≤ 0.2). CONCLUSION: There is no association between the amount of LI position changes and the development of LGR during Herbst-MBA treatment plus retention. Nevertheless, individual predisposition or excessive treatment changes and extraordinary treatment approaches, respectively, might still lead to development of LGR.

Long-term effects of Class II orthodontic treatment on oral health.

AIM: To investigate the long-term (≥15 years) benefit of orthodontic Class II treatment (Tx) on oral health (OH). SUBJECTS AND METHODS: All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent Class II correction (Herbst-multibracket Tx, end of active Tx ≥ 15 years ago) and agreed to participate in a recall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated Class I controls without orthodontic Tx need during adolescence. RESULTS: Of 152 treated Class II patients, 75 could be located and agreed to participate at 33.7 ± 3.0 years of age (pre-Tx age: 14.0 ± 2.7 years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated Class I controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated Class I controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19-44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated Class II participants and the untreated Class I controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm). CONCLUSION: Patients with orthodontically treated severe Class II malocclusions had a lower risk for oral health impairment than the general population. The risk corresponded to that of untreated Class I controls (without orthodontic Tx need during adolescence).

Skeletal anchorage for everybody? a questionnaire study on frequency of use and clinical indications in daily practice.

AIM: The purpose of this survey was to determine how commonly, and in what clinical situations, German-based orthodontists use skeletal anchorage devices in daily clinical practice. METHOD: In early 2013, a set of questionnaires on the subject of skeletal anchorage devices was mailed to 2459 members of the German Orthodontic Society (Deutsche Gesellschaft für Kieferorthopädie, DGKFO). The questions dealt separately with mini screws (MSCs) and osseointegrated palatal implants (OPIs). The addresses were asked whether or not, as well as how frequently and in what clinical situations, they used these MSCs and/or OPIs, what their experience was, and to elaborate on their reasons for using or not using these devices. RESULTS: The rate of returned questionnaires was 48 %. To correctly interpret our data, it should be kept in mind that an unknown number of respondents did not distinguish between OPIs and palatally inserted MSCs. Overall, 62 % indicated that they did use MSCs and/or OPIs, although most of them (> 50 %) infrequently (≤ 2 new patients/3 months). Only ≤ 2 % were frequent users (> 2 new patients/week). While most users (> 70 %) indicated that their experience was mostly good, only ≤ 50 % considered the devices easy and trouble-free to use in daily clinical practice. The median percentage of insertion procedures conducted by the respondents themselves was 2 % for MSCs and 0 % for OPIs. Many of the non-users indicated that their treatment concept did not include suitable clinical indications (≥ 50 %), expressed skepticism about the success rates (56 % of MSC and 21 % of OPI non-users), or thought that the insertion procedures involved were too complex or time-consuming (33 % of MSC and 56 % of OPI non-users). CONCLUSION: A total of 62 % of German-based orthodontists participating in this survey indicated using skeletal anchorage devices, although most of them infrequently. Major reasons for non-use were lack of clinical indications, skepticism about the success rate of MSCs, and overly complex or time-consuming procedures of surgical OPI insertion.

Class II division 2 treatment--does skeletal maturity influence success and stability?

AIM: To analyze the influence of skeletal maturity on Herbst multibracket (MB) treatment of Class II division 2 malocclusions and its stability. MATERIAL AND METHODS: A total of 37 patients fulfilled the inclusion criteria (Class II division 2, fully erupted premolars and canines, Class II molar relationship ≥1/2 cusp widths bilaterally or 1 cusp width unilaterally, retention period ≥24 months). According to pretreatment hand wrist skeletal maturity the subjects were assigned to the groups EARLY (n=9), LATE (n=14) and ADULT (n=14). Lateral headfilms (T1: before treatment, T2: after Herbst MB treatment, T3: after retention) were analyzed using the Sagittal-Occlusal analysis and standard cephalometrics. RESULTS: During Herbst MB treatment (T2-T1), significant (p<0.001) molar relationship improvement was seen in all groups (EARLY: 3.6 mm; LATE: 3.7 mm; ADULT: 3.2 mm). The amount of skeletal effects contributing to molar correction varied markedly between the groups (EARLY: 19%; LATE: 62%; ADULT: 31%). Improvement (p<0.01) was also seen for ssNB angle (EARLY: 1.8°; LATE: 1.8°; ADULT: 0.9°) and overbite (EARLY: 3.3 mm; LATE: 4.5 mm; ADULT: 4.3 mm). During retention (T3-T2), minimal changes of molar relationship (<0.2 mm) and ssNB angle (<0.5°) were seen in all groups. Also the overbite relapsed (EARLY: 0.5 mm; LATE: 1.0 mm; ADULT: 1.1 mm) only to a clinically irrelevant extent. CONCLUSION: Irrespective of skeletal maturity, Herbst MB treatment of Class II division 2 malocclusions showed to be successful and stable. However, the LATE group showed the highest amount of skeletal effects contributing to the correction of the molar relationship.