GapGapJJ
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I was doing some research and I found an interesting article:
https://www.sciencedirect.com/science/article/pii/S176172272400024X
In this article, an 18 year old was expanded with a MARPE first to address his maxillary deficiency, then onto a TAD anchored Herbst Appliance treatment. 4 TADs were used, 2 for the upper and two for the lower. The four TADs were connected to the arches with elastic power chains to reinforce anchorage and counteract the dental side effects of Herbst treatment. The results are quite interesting. Even despite his age and him being CVM5 (Post-pubertal; relatively little growth remaining), he was able to adapt his mandibular position 7mm forward. In theory, given enough time, when the mandible is held forward, the condylar region will adapt and bone and cartilage remodelling can occur. This is only one case study, but I thought it was interesting, as 7 mm of mandibular position adaptation is no joke, that is the difference between a Class I and Class II bite!
Now my question is, say if we have both a retrusive mandible and maxilla (i.e the pharyngeal is too narrow because of the maxilla), could it help the mandible adapt to the maxillary protraction? We have some evidence that the reverse pull head gear when combined with MARPE expansion and a proper protocol such as Alt RAMEC can protract the adult maxilla. Here is actually a recent video where JawHacks interviews someone who had significant protraction as an adult. While the mandible could jut to compensate for this new position, that is not a favourable position for the mandible to hold for a prolonged period due to muscle fatigue. The Herbst appliance, however would force the mandible in that forward position without the muscle fatigue, and over time allow the mandible to adapt to that new forward position.
In the study, there was minimal dental alveolar effects, which adds more merit to the TAD anchorage. Also, a year after a treatment was very minimal relapse as evident by the SNB, ANB, and overjet. The overjet at the end of treatment was 2 mm, a year after it was 3 mm. Keep in mind though, the original overjet was 7 mm. So this is quite the improvement.
What do yall think about this?
https://www.sciencedirect.com/science/article/pii/S176172272400024X
In this article, an 18 year old was expanded with a MARPE first to address his maxillary deficiency, then onto a TAD anchored Herbst Appliance treatment. 4 TADs were used, 2 for the upper and two for the lower. The four TADs were connected to the arches with elastic power chains to reinforce anchorage and counteract the dental side effects of Herbst treatment. The results are quite interesting. Even despite his age and him being CVM5 (Post-pubertal; relatively little growth remaining), he was able to adapt his mandibular position 7mm forward. In theory, given enough time, when the mandible is held forward, the condylar region will adapt and bone and cartilage remodelling can occur. This is only one case study, but I thought it was interesting, as 7 mm of mandibular position adaptation is no joke, that is the difference between a Class I and Class II bite!
Now my question is, say if we have both a retrusive mandible and maxilla (i.e the pharyngeal is too narrow because of the maxilla), could it help the mandible adapt to the maxillary protraction? We have some evidence that the reverse pull head gear when combined with MARPE expansion and a proper protocol such as Alt RAMEC can protract the adult maxilla. Here is actually a recent video where JawHacks interviews someone who had significant protraction as an adult. While the mandible could jut to compensate for this new position, that is not a favourable position for the mandible to hold for a prolonged period due to muscle fatigue. The Herbst appliance, however would force the mandible in that forward position without the muscle fatigue, and over time allow the mandible to adapt to that new forward position.
In the study, there was minimal dental alveolar effects, which adds more merit to the TAD anchorage. Also, a year after a treatment was very minimal relapse as evident by the SNB, ANB, and overjet. The overjet at the end of treatment was 2 mm, a year after it was 3 mm. Keep in mind though, the original overjet was 7 mm. So this is quite the improvement.
What do yall think about this?
