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Go east or go west- Non-surgical class 2 correction in adult patients. EOS. Dirk Wiechmann. Episode 80. April 8th 2021

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Farooq Ahmed

Go east or go west: Non-surgical class 2 correction in adult patients Dirk Wiechmann

Join me as i summerise Professor Dirk Wiechmann’s lecture at the EOS lecture series looking at class 2 adult correction using either a Herbt appliance or TADs

 

2 concepts

  1. Herbst and lingual appliances: West advance lower dento-alveolar complex
  2. Lingual appliances with TADs: East distalise maxillary arch

 

 

  1. West: Herbst and lingual appliances, Wiechmann 2010, Vu 2012, Bock 2016
    1. Advancement of alveolar complex of mandible mainly
    2. Distaisation of upper molars little 1:3

Advantages

  • Lingual appliances – idealise lower incisor inclination Wiechmann 2010
  • Similar outcomes for labial and lingual with Herbst – Bock 2016
  • Lingual and herbst assessed by ABO – all patients met ABO Mujagic 2020
    • Including severe cases 30-40 ABO CRE score still achieved similar outcomes to less severe cases

Stability Pancherz 2014

  • 30 year stability overall acceptable
  • Indicator for instability
    • Poor interdigitation
    • Retention regime not complied – Dirk recommended Activator with 1mm activation for 2 years
  1. East: Lingual appliances with TADs
  • 4 miniscrews: 2 buccal, 2 palatal
    • Placed interdental buccal 5-6 buccal and palatal
    • Direction retraction: Powerchain from TAD to hook on canine tooth
    • Superimposed in TAD – retraction of anterior teeth
    • Occlusal plane rotation: clockwise, maxilla and mandible
      • Aids class 2 correction

Study 23 patients

Superimpose pre and post models and compared to predicted set up

  • No difference in outcome Vs predicted outcome in overjet reduction
  • 96% of outcome Vs predicted

Stability

  •  
  • New mechanics, limited literature
  • Labial appliances and minscrews: Total maxillary arch distalisation: stable Bechtold 2020

When to decide Herbst or Miniscrews?

 

East: En Masse distalisation

  • Severe lower frontal crowding
  • Lower incisor proclination
  • Fragile gingiva

West: Herbst

  • No or little lower frontal crowding
  • Thick and large attached gingiva
  • Retrusive profile
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