Nedeljković Nenad, Zivojinović Vesna, Ivanović Mirjana
Clinic for Orthodontics, School of Dentistry, University of Belgrade, Belgrade, Serbia.
Srp Arh Celok Lek. 2009 Nov-Dec;137(11-12):675-80. doi: 10.2298/sarh0912675n.
Sagittal mandible deficiency is the most common cause of skeletal Class II malocclusion. Treatment objective is to stimulate sagittal mandible growth. Fixed functional Herbst appliance use is beneficial for shortening the time required for treatment and does not depend on patient compliance.
A 13-year-old girl was referred to the Clinic of Orthodontics, School of Dentistry in Belgrade following previous unsuccessful treatment of her skeletal Class II malocclusion using an activator. The patient's poor cooperation had led to failure of the treatment. Patient was subjected to the Herbst treatment for 6 months followed by fixed appliance for another 8 months. Lateral cephalograms before and after the treatment was performed. The remodelation of condylar and fossal articulation was assessed by superimposition of pre- and post-treatment temporomandibular joint tomograms. The promotion of oral hygiene and fluoride use was performed because orthodontic treatment carries a high caries risk and risk for periodontal disease. Skeletal and dental changes were observed after treatment (correction [Max+Mand]: molar relation 7 mm, overjet 8 mm, skeletal relation 5 mm, molars 2 mm, incisors 3 mm). Combination of Herbst and fixed appliances was effective in the treatment of dental and skeletal irregularities for a short period of time.
In the retention period, 14 months after treatment, occlusal stability exists. Follow-up care in oral prevention is based on regular recalls at the dental office and supervision at home by the parents.
下颌矢状向发育不足是骨性II类错牙合畸形最常见的病因。治疗目标是刺激下颌矢状向生长。使用固定功能矫治器Herbst矫治器有助于缩短治疗所需时间，且不依赖患者的依从性。
一名13岁女孩此前使用肌激动器治疗骨性II类错牙合畸形未成功，随后被转诊至贝尔格莱德牙科学院正畸科。患者合作不佳导致治疗失败。患者接受了6个月的Herbst矫治，随后又使用固定矫治器治疗了8个月。治疗前后拍摄了头颅侧位片。通过治疗前后颞下颌关节断层片的叠加来评估髁突和关节窝关节的重塑情况。由于正畸治疗有较高的龋齿风险和牙周疾病风险，因此进行了口腔卫生促进和氟化物使用指导。治疗后观察到骨骼和牙齿的变化（矫治效果[上颌+下颌]：磨牙关系改善7mm，覆盖减小8mm，骨骼关系改善5mm，磨牙改善2mm，前牙改善3mm）。Herbst矫治器和固定矫治器联合使用在短时间内有效治疗了牙齿和骨骼的不整齐。
在治疗后14个月的保持期内，咬合稳定。口腔预防的随访护理基于在牙科诊所定期复诊以及家长在家中的监督。
