Comparison of anchorage reinforcement with temporary anchorage devices or a Herbst appliance during lingual orthodontic protraction of mandibular molars without maxillary counterbalance extraction
Identifieur interne : 001308 ( Main/Curation ); précédent : 001307; suivant : 001309Comparison of anchorage reinforcement with temporary anchorage devices or a Herbst appliance during lingual orthodontic protraction of mandibular molars without maxillary counterbalance extraction
Auteurs : Rebecca Metzner [Allemagne] ; Rainer Schwestka-Polly [Allemagne] ; Hans-Joachim Helms [Allemagne] ; Dirk Wiechmann [Allemagne]Source :
- Head & Face Medicine [ 1746-160X ] ; 2015.
Abstract
Orthodontic protraction of mandibular molars without maxillary counterbalance extraction in cases of aplasia or extraction requires stable anchorage. Reinforcement may be achieved by using either temporary anchorage devices (TAD) or a fixed, functional appliance. The objective was to compare the clinical effectiveness of both methods by testing the null-hypothesis of no significant difference in velocity of space closure (in mm/month) between them. In addition, we set out to describe the quality of posterior space management and treatment-related factors, such as loss of anchorage (assessed in terms of proportions of gap closure by posterior protraction or anterior retraction), frequencies of incomplete space closure, and potential improvement in the sagittal canine relationship.
Twenty-seven subjects (15 male/12 female) with a total of 36 sites treated with a lingual multi-bracket appliance were available for retrospective evaluation of the effects of anchorage reinforcement achieved with either a Herbst appliance (nsubjects = 15; 7 both-sided/8 single-sided Herbst appliances; nsites = 22) or TADs (nsubjects = 12; 2 both-sided; 10 single-sided; nsites = 14). Descriptive analysis was based on measurements using intra-oral photographs which were individually scaled to corresponding plaster casts and taken on insertion of anchorage mechanics (T1), following removal of anchorage mechanics (T2), and at the end of multi-bracket treatment (T3).
The null-hypothesis was rejected: The rate of mean molar protraction was significantly faster in the Herbst-reinforced group (0.51 mm/month) than in the TAD group (0.35). While complete space closure by sheer protraction of posterior teeth was achieved in all Herbst-treated cases, space closure in the TAD group was achieved in 76.9 % of subjects by sheer protraction of molars, and it was incomplete in 50 % of cases (mean gap residues: 1 mm). Whilst there was a deterioration in the canine relationship towards Angle-Class II malocclusion in 57.14 % of space closure sites in TAD-treated subjects (indicating a loss of anchorage), an improvement in canine occlusion was observed in 90.9 % of Herbst-treated cases.
Subjects requiring rapid space closure by molar protraction in combination with a correction of distal occlusion may benefit from using Herbst appliances for anterior segment anchorage reinforcement rather than TAD anchorage.
Url:
DOI: 10.1186/s13005-015-0079-4
PubMed: 26092262
PubMed Central: 4475330
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PMC:4475330Le document en format XML
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anchorage reinforcement with temporary anchorage devices or a Herbst appliance during lingual orthodontic protraction of mandibular molars without maxillary counterbalance extraction</title><author><name sortKey="Metzner, Rebecca" sort="Metzner, Rebecca" uniqKey="Metzner R" first="Rebecca" last="Metzner">Rebecca Metzner</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Orthodontics, Hannover Medical School, Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthodontics, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Schwestka Polly, Rainer" sort="Schwestka Polly, Rainer" uniqKey="Schwestka Polly R" first="Rainer" last="Schwestka-Polly">Rainer Schwestka-Polly</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Orthodontics, Hannover Medical School, Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthodontics, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation></author><author><name sortKey="Helms, Hans Joachim" sort="Helms, Hans Joachim" uniqKey="Helms H" first="Hans-Joachim" last="Helms">Hans-Joachim Helms</name><affiliation wicri:level="3"><nlm:aff id="Aff2">Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Medical Statistics, University Medical Center Göttingen, Göttingen</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Göttingen</settlement></placeName></affiliation></author><author><name sortKey="Wiechmann, Dirk" sort="Wiechmann, Dirk" uniqKey="Wiechmann D" first="Dirk" last="Wiechmann">Dirk Wiechmann</name><affiliation wicri:level="3"><nlm:aff id="Aff1">Department of Orthodontics, Hannover Medical School, Hannover, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Department of Orthodontics, Hannover Medical School, Hannover</wicri:regionArea><placeName><region type="land" nuts="2">Basse-Saxe</region><settlement type="city">Hanovre</settlement></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff3">Private Practice, Bad Essen, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Private Practice, Bad Essen</wicri:regionArea><wicri:noRegion>Bad Essen</wicri:noRegion><wicri:noRegion>Bad Essen</wicri:noRegion><wicri:noRegion>Bad Essen</wicri:noRegion></affiliation></author></analytic><series><title level="j">Head & Face Medicine</title><idno type="eISSN">1746-160X</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Orthodontic protraction of mandibular molars without maxillary counterbalance extraction in cases of aplasia or extraction requires stable anchorage. Reinforcement may be achieved by using either temporary anchorage devices (TAD) or a fixed, functional appliance. The objective was to compare the clinical effectiveness of both methods by testing the null-hypothesis of no significant difference in velocity of space closure (in mm/month) between them. In addition, we set out to describe the quality of posterior space management and treatment-related factors, such as loss of anchorage (assessed in terms of proportions of gap closure by posterior protraction or anterior retraction), frequencies of incomplete space closure, and potential improvement in the sagittal canine relationship.</p></sec><sec><title>Methods</title><p>Twenty-seven subjects (15 male/12 female) with a total of 36 sites treated with a lingual multi-bracket appliance were available for retrospective evaluation of the effects of anchorage reinforcement achieved with either a Herbst appliance (n<sub>subjects</sub> = 15; 7 both-sided/8 single-sided Herbst appliances; n<sub>sites</sub> = 22) or TADs (n<sub>subjects</sub> = 12; 2 both-sided; 10 single-sided; n<sub>sites</sub> = 14). Descriptive analysis was based on measurements using intra-oral photographs which were individually scaled to corresponding plaster casts and taken on insertion of anchorage mechanics (T1), following removal of anchorage mechanics (T2), and at the end of multi-bracket treatment (T3).</p></sec><sec><title>Results</title><p>The null-hypothesis was rejected: The rate of mean molar protraction was significantly faster in the Herbst-reinforced group (0.51 mm/month) than in the TAD group (0.35). While complete space closure by sheer protraction of posterior teeth was achieved in all Herbst-treated cases, space closure in the TAD group was achieved in 76.9 % of subjects by sheer protraction of molars, and it was incomplete in 50 % of cases (mean gap residues: 1 mm). Whilst there was a deterioration in the canine relationship towards Angle-Class II malocclusion in 57.14 % of space closure sites in TAD-treated subjects (indicating a loss of anchorage), an improvement in canine occlusion was observed in 90.9 % of Herbst-treated cases.</p></sec><sec><title>Conclusion</title><p>Subjects requiring rapid space closure by molar protraction in combination with a correction of distal occlusion may benefit from using Herbst appliances for anterior segment anchorage reinforcement rather than TAD anchorage.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zhu, Y" uniqKey="Zhu Y">Y Zhu</name></author><author><name sortKey="Hollis, Jh" uniqKey="Hollis J">JH Hollis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Susin, C" uniqKey="Susin C">C Susin</name></author><author><name sortKey="Haas, An" uniqKey="Haas A">AN Haas</name></author><author><name sortKey="Opermann, 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