Skeletal and dental changes in Class II division 1 malocclusions treated with splint-type Herbst appliances. A systematic review.

OBJECTIVE To evaluate skeletal and dental changes in growing individuals through lateral cephalograms obtained after the sole use of the splint-type Herbst appliances in Class II division 1 malocclusions. METHODS Several electronic databases (Pubmed, Medline, Medline In-Process & Other Non-Indexed Citations, Cochrane Library Database, Embase, Web of Sciences, Scopus, and Lilacs) were searched with the help of a health sciences librarian. Abstracts that appeared to fulfill the initial selection criteria were selected by consensus. The original articles were then retrieved. Their references were also hand-searched for possible missing articles. Clinical trials that assessed, through lateral cephalograms, immediate skeletal and dental changes with the use of splint-type Herbst appliances without any concurrent orthodontic appliances, surgical intervention, or syndromic characteristics were considered. A comparable untreated Class II division 1 malocclusion control group was required to factor out normal growth changes. RESULTS Three articles were finally selected and analyzed. An individual analysis of these articles was made and some methodological flaws were identified. The selected studies all showed statistically significant changes in the anteroposterior length of the mandible, vertical height of the ramus, lower facial height, mandibular incisor proclination, mesial movement of the lower molars, and distal movement of the upper molars. Posttreatment relapse in overjet and molar relationship was also observed. CONCLUSIONS Dental changes are as important as skeletal changes to attaining the final occlusal results. Long-term, prospective, double-blinded, randomized clinical trials are needed to support these conclusions.