Stepwise advancement herbst appliance versus mandibular sagittal split osteotomy

Abstract

Objective: To compare the treatment effects and long-term stability of the stepwise Herbst appliance and mandibular sagittal split osteotomy in skeletal Class II adult patients.Materials and Methods: Subjects comprised 16 patients in the Herbst group and another 16patients in the surgery (mandibular sagittal split osteotomy) group. Lateral head films were takenbefore treatment (T0), after removal of the Herbst appliance/surgery (T1), after the fixed appliancetreatment (T2), and 3 years after treatment (T3). All films were analyzed by standard cephalometricsand SO-analysis (analysis of changes in sagittal occlusion).Results: All Herbst and surgery patients were treated successfully to Class I occlusal relationships with normal overjet and overbite. Both groups showed a significant change in mandibular baseadvancement (SNB, SNPg, Pg/OLp), which resulted in a decrease in the ANB angle, the Witsappraisal, and facial convexity. However, the surgery group showed larger changes in the parametersmentioned above. In terms of long-term stability, both groups achieved stable results, and no significant difference occurred over time.Conclusion: Stepwise advancement Herbst appliance therapy can be used to treat borderlineskeletal Class II adult patients with long-term stability. (Angle Orthod. 2009;79:1084-1094.) © 2009 by The EH Angle Education and Research Foundation, Inc.