The headgear effect of the Herbst appliance: A

cephalometric long-term study

Hans Pancherz, DDS, Odont. Dr., and Margareta Anehus-Pancherz, DDS, DMD
Giessen, Germany

The short- and long-term effects of the Herbst appliance on the maxillary complex were evaluated in
45 patients who had Class II malocclusions. The patients were followe d for 6.4 years (5 to 10 years)
after treatment. Lateral cephalograms from before and after 7 months of treatment, 6 months, and
6.4 years after treatment were analyzed. During Herbst treatment the upper molars were distalized in
96% of the subjects (maximum 4.5 mm), and the upper molars were intruded in 69% of the subjects
(maximum 3.5 mm). The maxillary occlusal plane was opened in 82% of the subjects (maximum
7.5~ Sagittal maxillary jaw base position seemed unaffected by therapy. A downward tipping of the
palatal plane was noted in 47% of the subjects (maximum 2~ During the first 6 months after therapy
most of the treatment changes reverted. During the following 5.9 years after treatment, normal
growth developmental changes prevailed: the upper molars moved mesiaily, and the teeth extruded,
the occlusal plane closed, the maxilla grew anteriorly, and the palatal plane tipped downward. In
conclusion the Herbst appliance exhibited a pronounced high-pull headgear effect on the maxillary
complex. Without proper retention, however, the effect seemed to be of a temporary nature. (AMJ
ORTHODDENTOFACORTHOP1993;103:510-20.)

The Herbst appliance ~': has been shown to
be most effective in the management o f Class II mal-
occlusions. ~4 The short- and long-term effects o f the
appliance on the occlusion and on mandibular growth
have been analyzed thoroughly in a number of inves-
tigations. 2"" Six to eight months o f Herbst therapy
ordinarily leads to overcorrected Class I dental arch
relationships with an incomplete cuspal interdigita-
tion. 24 The occlusal changes seen during treatment are
mainly a result o f an increase in mandibular growth 2z'~'9
and maxillary and mandibular tooth m o v e m e n t s 2 Man-
dibular condyle position seems unaffected by Herbst
therapy. ~~ Posttreatment recovering tooth movements
frequently occur, and the occlusion tends to settle into
Class I within 6 months after the appliance is removed, tt
On a long-term basis it is as if Herbst treatment has
only a temporary impact on the existing skeletofacial
growth pattern. ~2 In particular this appears to be true
for mandibular growth. 9 Despite recovering posttreat-
ment growth changes, functional stability o f the occlu-
sion seems to counteract occlusal relapses. 6'~2
In the evaluation o f the effects o f the Herbst appli-
ance, the impact o f treatment on the maxilla has re-
ceived little attention. The aim of the present investi-
gation was to analyze cephalometrically the short- and
long-term effects o f Herbst therapy on the maxillary
complex.
SUBJECTS
The original sample of Class It, Division 1 malocclusions
treated with the Hcrbst appliance was comprised of 118 pa-
tients. Herbst therapy resulted in Class I or overcorrected
Class I dental arch relationships in all 118 cases. After Herbst
treatment, tooth irregularities and arch discrepancy problems
were dealt with in 39 subjects with conventional multibracket
appliances (with or without extractions of teeth). Of the re-
maining 79 patients those 45 subjects who were followed at
least 5 years (5 to 10 years) after therapy were surveyed.
Posttreatment retention (upper plate or activator) for 1 to 2
years was performed in 29 of the subjects. No retention was
performed in 16 subjects. At the time of follow-up, 9 subjects
exhibited a Class II molar relapse, whereas 36 subjects were
considered stable. Relapse was diagnosed when a Class 1I
molar relationship.(a deviation of more than a half cusp width
from normal relationship) Was present. The patient material
is presented in Table I. The different anchorage systems of
the Herbst appliance used are shown in Figs. 1 and 2.
In the evaluation of the immediate treatment effects of
the Herbst appliance, 30 untreated Class It subjects of the
same age and skelctofacial structure as the Herbst group was
used for comparison. In the evaluation of the long-term effects
of Herbst treatment, an ideal occlusion group, the Bolton
Standards 1~was used for comparison.

METHOD
From the Department of Orthodontics, University of Giessen.
Copyright 9 1993 by the American Association of Orthodontists. In the Herbst patients, lateral head films with the mouth
0889-5406193151.00 + 0.10 811135481 wide open were evaluated. The radiographs were taken before

510
American Journal of Orthodontics and Dentofacial Orthopedics Pancherz and Anehtts-Pancherz 511
Volume 103, No. 6

Table I. Herbst appliance treatment of 45 Class II, Division 1 malocclusions. Distributions of

patient material

- I " I ,eoo I "

Set
Male 34 -
Female 1I
Age at start of treatment (years) 12.4 l.i
Age at follow-up(years) 19.4 1.4
Treatment period (T) (years) 0.6 0.1
Posnreatment period 1 (PI) (years) 0.5 0
Posttreatment period 2 (P2) (years) 5.9 1.2
Total observation period (O) (years) 7.0 1.1
Anchorage
Partial 19
Total 26
Retention
None 16
Upper plate 5
Aktivator 24
Upper second molars erupted at start
Yes 37
No 8
Upper third molar germs present
Yes 42
No 3
Somatic maturation at treatment
Prepeak 27
Peak 13
Postpeak 5

and after 7 months of Herbst treatment, 6 months after treat-
ment when the occlusion had settled," and 6.4 years after
treatment. The changes in cephalometrie records occurring
during four examination periods were analyzed: Treatment
period (T). Differences in changes: after treatment minus
before treatment. Posttreatment period 1 (PI): Differences
in changes: 6 months after treatment minus before treatment.
Posttreatment period 2 (P2): Differences in changes: 6.4
years after treatment minus 6 months after treatment. Total
observation period (0): Differences in changes: 6.4 years
after treatment minus before treatment.
In the untreated Class II control group, mouth-open lateral
head films, from before and after 6 months (Mean = 6
months; SD = 0.4 months) were evaluated, and the cepha-
lometrie changes were recorded.
In the ideal occlusion control group (Bolton Standards '~)
composite head film tracings (from 16 males and 16 females)
were evaluated at the ages of 11 and 18 years, and the ceph-
alometric changes during a 7-ygar period were recorded.
The registration from the roentgenograms were drawn on
matte acetate tracing film. Linear measurements were made
to the nearest 0.5 mm and the angular measurements to the
nearest 0.5 ~. No correction was made for linear enlargement
(approximately 7% in the median plane). For the subjects
with ideal occlusion (Bolton Standards), adjustments was
made for radiographic enlargement of 5.5% so as to fit the
radiographs of the Herbst sample.
The reference points and reference lines used in the ceph-
alometric analysis are shown in Fig. 3 and have been defined
earlier2"' The occlusal line (OL) and occlusal line perpen-
dicular (OLP) through sella (S) were used as a reference grid
for the linear measurements2 The grid and the nasion-sella
line (NSL) from the first tracing were transformed to the
following tracings after superimposition of the head films by
using the stable structures of the anterior cranial base for
orientation."
An analysis of sagittal and vertical maxillary dental and
skeletal changes (d) occurring during the different exami-
nation periods was performed. The analysis comprised the
following variables.
1. ms/OLP(d) minus A/OLP(d) (mm)--Change in sag-
ittal molar position within the maxilla.
2. mc/NL(d) (mm)--Change in vertical molar position
within the maxilla.
3. OL/NSL(d) (degrees)--Change in maxillary occlusal
plane inclination.
4. NL/NSL(d) (degrees)--Change in maxillary jaw base
inclination.
5. A/OLP(d) (mm)--Change in sagittal jaw base po-
sition.
STATISTICAL METHODS
The arithmetic mean (Mean) and standard deviation
(SD) were calculated for each cephalometric variable.
To assess the statistical significance of changes that
512 Pancherz and Anehus-Pancherz American Journal of Orthodontics and Dentofacial Orthopedics
June 1993

Fig. 1. Herbst appliance with partial maxillary and mandibular anchorage (A through E).

Fig. 2. Herbst appliance with total maxillary and mandibular anchorage. A through E, At the start of
treatment. Twistflex arch wires on the upper and lower front teeth for tooth alignment. F through H,
Replacement of the twistflex wires with heavy rectangular arch wires (0.017 x 0.022 inch). Note the
reactivation of the telescoping mechanism.
American Journal of Orthodontics and Dentofacial Orthopedics
Voh~me 103, No. 6
Table II. Method error evaluation of the
different variables in the examination periods:
T, PI, P2 and O (see Method section)
(mmVar,o ,e
or degrees) IIIIT PI
ms/OLP(d) minus A/OLP(d) 0.6 0.6
mc/NL(d) 0.8 0.6
OL/NSL(d) 0.8 0.9
A/OLP(d)
NL/NSL(d)
0.2
1.3
0.5
0.6
occurred during the various examination periods, t tests
for paired samples were performed, and to compare the
Herbst and control groups during the treatment period
(T), t tests for independent samples were performed.
The levels of significance used were p < 0.001,
p < 0.01, andp < 0.05. T h e p >-- 0.05 was considered
not significant (ns).
The size of the combined method error (ME) in
locating, superimposing, and measuring the changes in
the different landmarks was calculated by the formula
ME = / 2~d=, where d is the difference between two
V 2n
registrations of a pair, and n is the number of double
registrations. Before and after treatment, 6-month, and
6.4-year posttreatment cephalograms from 10 randomly
chosen subjects were analyzed on two different occa-
sions. The size of the method error for the different
variables is seen in Table II.
RESULTS
The results of the analysis of maxillary dental and
skeletal changes occurring during the four examination
periods are shown in Figs. 4 to 8.
Sagittal maxillary molar position changes (Fig. 4)
During the treatment period (T) of 7 months, the
molars were distalized in 96% of the subjects, whereas
the tooth position remained unchanged in 4% of the
subjects. On the average, the molars were moved dis-
tally by 2.1 mm (p < 0.001r) during the examination
period. The maximum distal movement was 4.5 ram.
In the untreated Class II control group, the molars
moved mesially by an average of 0.3 mm (p <
0.01). The difference between the Herbst and control
group was statistically significant (p < 0.001).
During the first posttreatment period (PI) of 6
Pancherz a/zd Anehus-Pancherz 513
NSL OLP
P2 0
0.7 0.8
0.5 0.8
0.5 0.9
0.8
1.3
0.7
1.8
NL-
Iv
OL v
mc
v - - w
Fig. 3. Reference points and lines used in cephalometric
analysis.
months, the molars moved mesially in 84% of the sub-
jects. No changes in molar position were seen in 16%
of the subjects. On the average the molars moved me-
sially by 1.1 mm (p < 0.001) during the examination
period. The maximum mesial movement was 4.0 mm.
During the second posttreatment period (P2) of 5.9
years, the molars moved further mesially in 73% of the
subjects. No changes in molar position were seen in
27% of the subjects. On the average the molars moved
mesially by 1.6 mm (p < 0.001) during the exami-
nation period. The maximum mesial movement was 5.5
mm.
During the total observation period (O) of 7.0 years,
a net effect of distal molar movement during H e r b s t
treatment was found in 27% of the subjects (maximum
3.5 mm). In 60% of the subjects the molars had moved
mesially (maximum 4.0 mm). No changes in molar
position were seen in 13% of the subjects. On the av-
erage, the molars had moved mesially by 0.6 mm
(p < 0.05) during the examination period, which was
60% of that seen in the Bolton control group.
Vertical maxillary molar position changes (Fig. 5)
During the treatment period (T) the molars were
intruded in 69% of the subjects. In 4% of the subjects
extrusive molar movements were recorded (maximum
1.0 mm). No changes in vertical molar position were
seen in 27% of the subjects. On the average, the molars
were intruded by 0.7 mm (p < 0.001) during the ex-
amination period. The maximum intrusive movement
 514 Pancherz and Anehus-Pancherz American Journal of Orthodontics and Dentofacial Orthopedics
June 1993

mm
o,P
4

3
+
2 I

OL

// , //

T P1 Pz O

I 2 I---I Herbst
3 Control

Fig. 4. Sagittal maxillary molar position changes (Mean, SD) in 45 patients with Class II, Division 1
malocclusions who were treated with Herbst appliance.Registrations during four examination periods:
treatment period (T), posttreatment period 1 (P1), posttreatment period 2 (P2), and total observation
period (O).

was 3.5 mm. In the untreated Class II control group
the molars extruded with an average of 0.4 mm
(p < 0.001). The difference between the Herbst and
9 control groups was statistically significant (p < 0.001).
During the first posttreatment period (PI), the mo-
lars extruded in 89% of the subjects. No changes in
vertical molar position were seen in 11% of the subjects.
On the average, the molars extruded by 1.1 mm
(p < 0.001) during the examination period. The max-
imum extrusive movement was 2.5 mm.
During the second posttreatment period (P2), ex-
trusive molar movements were seen in all subjects.
On the average, the molars extruded by 3.5 mm
(p < 0.001). The maximum extrusive movement was
7.5 mm.
During the total observation period (O), extrusive
molar movements (maximum 7.5 mm) were seen in all
subjects investigated. On the average, the molars ex-
truded by 3.9 mm (p < 0.001), which was comparable
to that seen in the Bolton control group.
Maxillary occlusal plane inclination changes
(Fig. 6)
During the treatment period (T), the occlusal plane
tipped downward in 82% of the subjects (maximum
7.5~ In 7% of the subjects an upward tipping of the
occlusal plane was recorded (maximum 1.5~ The in-
clination of the occlusal plane remained unchanged in
11% of the subjects. On the average, the occlusal plane
tipped downward by 2.0 ~ (p < 0.001) during the ex-
amination period. In the untreated Class II control
group, an upward tipping of the occlusal plane by an
average of 0.4 ~ (p < 0.01) was recorded. The differ-
ence i~etween the Herbst and control groups was sta-
tistically significant (p < 0.001).
During the first posttreatment period (PI), the oc-
clusal plane tipped upward in 71% of the subjects (max-
imum 5.5 mm). A downward tipping of the occlusal
plane was noted in 20% of the subjects (maximum
2.0~ The inclination of the occlusal plane remained
unchanged in 9% of the subjects. On the average the
American Journal of Orthodontics and Dentofacial Orthopedics Pancherz o/td A n e h u s ~ 515
Volume 103, No. 6

mm

6
T

5 T I )\
§
4

3
'lj J
//I
//I
"

i//i
//I
2 .OL

L
m Herbst
2
Control
Fig. 5. Vertical maxillary molar position changes (Mean, SD) in 45 patients with Class II, Division 1
malocclusions who were treated with Herbst appliance. Registrations during four examination periods:
treatment period (T), posttreatment period 1 (P1), posttreatment period 2 (P2), and total observation
period (O).

occlusal plane tipped upward by 1.1 ~ (p < 0.001) dur-
ing the examination period.
During the second posttreatment period (P2), the
occlusal plane tipped further upward in 71% of the
subjects (maximum 6.5~ In 20% of the subjects the
occlusal plane tipped downward (maximum 2.5~ The
inclination of the occlusal plane remained unchanged
in 9% of the subjects. On the average, the occlusal
planetipped upward by 1.5 ~ (p < 0.001) during the
examination period.
During the total observation period (O), an upward
tipping of the occlusal plane was recorded in 62% of
the subjects (maximum 8.5~ A downward tipping of
the occlusal plane was seen in 36% of the subjects
(maximum 4.5~ The occlnsal plane remained un-
changed in one subject (2%). On the average, the oc-
clusal plane tipped upward by 0.6 mm (ns) during the
examination period. This was about half of that seen
in the Bolton control group.
Palatal plane inclination changes (Fig. 7)
During the treatment period (T), there was a down-
ward tipping of the palatal plane in 47% of the subjects
(maximum 2.0*). In 29% 6f the subjects an uPward
tipping of the palatal plane was noted (maximum 2.0~
The palatal plane inclination remained unchanged in
24% of the subjects. On the average, the palatal plane
tipped downward by 0.2 ~ (ns) during the examination
period. In comparison with the untreated Class II con-
trol group, no significant difference was seen.
During the first posttreatment period (PI), the pal-
atal plane tipped upward in 40% of the subjects (max-
imum 2.0~ In 31% of the subjects a downward tipping
of the palatal plane was seen (maximum 2.5~ The
516 Pancherz and Anehus-Pancherz American Journal of Orthodontics and Dcntofacial Orthopedics
June 1993

degrees

3
4" 2
OL

"I
1
2
I r-] Herbst
3
Control
4

Fig. 6. Maxillary occlusal plane inclination changes. (Mean, SD) in 45 patients with Class !1, Division
1 malocclusions who were treated with the Herbst appliance. Registrations during four examination
periods: treatment period (T), posttreatment period 1 (P1), posttreatment period 2 (P2), and total
observation period (O).

palatal plane inclination remained unchanged in 29%
of the subjects. On the average, the palatal plane tipped
upward by 0.1 ~ (ns) during the examination period.
During the second examination period (P2), the pal-
atal plane tipped downward in 67% of the subjects
(maximum 4.5"). In 22% of the subjects an upward
tipping of the palatal plane was recorded (maximum
92.0~ The palatal plane inclination remained unchanged
in 11% of the subjects. On the average, the palatal
plane tipped downward by an average of 1.0 ~
(p < 0.001) during the examination period.
During the total ~bservation period (O), the palatal
plane tipped downward in 78% of the subjects (maxi-
mum 3.5~ In 13% of the subjects an upward tipping
of the palatal plane was noted (maximum 2.5~ The
palatal plane inclination remained unchanged in 9% of
the subjects. On the average, the palatal plane tipped
downward by 1.1 ~ (p < 0.001) during the examination
period. This was about twice as much as that seen in
the Bolton control group.
Sagittal maxillary jaw base position changes
(Fig. 8)
During the treatment period (T), the maxilla was
positioned anteriorly in 49% of the subjects, whereas
jaw position was unchanged in another 49% of the
subjects. In one subject (2%) there was a posterior
positioning of the maxilla (1.5 mm). On the average
the maxilla grew forward by 0.4 mm (p < 0.001) dur-
ing the examination period. In comparison with the
untreated Class II control group no statistical significant
difference was seen.
During the first posttreatment period (PI), the max-
illa was positioned anteriorly in 73% of the subjects
(maximum 3.5 mm) whereas the jaw position was un-
changed in 27% of the subjects. On the average, the
maxilla grew forward by 0.8 mm (p < 0.001) during
the examination period.
During the second posttreatment period (P2), the
maxilla was positioned anteriorly in 84% of the subjects
(maximum 8.5 mm), whereas an unchanged position
 American Journal of Orthodontics and Dentofacial Orthopedics
Volume 103oNo. 6
degrees
3
§ 2
P2
1
m [--1 Herbst
2
Fig. 7. Palatal plane inclination changes (Mean, SD) in 45 patients with Class II, Division 1 malocclusions
who were treated with Herbst appliance. Registrations during four examination periods: treatment
period 09, posttreatment period 1 (P1), posttreatment period 2 (P2), and total observation period (O).
of the jaw was recorded in 16% of the subjects. On the
"average, the maxilla grew forward by 2.4 mm
(p < 0.001) during the examination period.
During the total observation period (O), the maxilla
was positioned forward in all subjects investigated
(maximum 10.0 mm). The average amount of forward
growth was 3.6 mm (p < 0.001), which was about
half of that seen in the Bolton control group.
DISCUSSION
The patient material was well defined. The sample
surveyed could be considered to be comprised of con-
secutively treated cases. All patients were treated in the
adolescent growth period. 7 At the end of the observation
period, 5 to 10 years after treatment, growth was fin-
ished (according to the Ru stage of the hand-wrist ra-
diographs) ~6 in all cases but one. When comparing the
9 subjects with Class II molar relapse with those 36
subjects without relapse, no differences were seen be-
J
tween the two groups with respect to dentofacial struc-
ture before and after Herbst treatment, as well as 6
months after treatment. Thus the subjects in the two
groups responded equally to therapy and were com-
parable with respect to the early posttreatment changes
(P1 period).
During the second posttreatment period (P2), how-
ever, adverse maxillary molar changes were more pro-
nounced in the relapse than, in the stable cases. 6 When
Pancherz and Anehus-Pancherz 517
-!- --
0
h
Control
examining the patients clinically and with the aid of
their dental casts, two relapse promoting observations
were made that could explain the difference in adverse
molar tooth movements seen in the two patient groups:
(1) a lip-tongue dysfunction habit, e.g., atypical swal-
lowing pattern ~7'~8 at the end of the total observation
period was noted in all relapse cases but in none of the
stable cases, and (2) an unstable Class I cuspal inter-
digitation (registered by clinical inspection and by
"hand articulating" the dental casts from 6 months after
treatment) existed in eight of the relapse cases but in
only two of the stable cases.
Treatment changes
The telescope mechanism of the Herbst appliance
produces an posterior-upward directed force on the
maxillary jaw base and dentition and an anterior-down-
ward directed force on the mandibular jaw base and
dentition (Figs. 1 and 2). The force system on the
maxillary complex could be compared to that of a high-
,pull headgear. ~9
Especially pronounced was the headgear effect of
the Herbst appliance on the upper molars. The teeth
were distalized and intruded (Figs. 4 and 5), and as a
result the maxillary occlusal plane tipped downward
(Fig. 6). :0
Furthermore, like high-pull headgear traction, 2~the
Herbst appliance seemed to have a rotational effect on
 518 Poltcher7. ottd Anehus-Pancherz American Journal of Orthodontics and Dentofacial Orthopedics
June 1993

mm

6
OLP
5

+ 4

2 OL

T P2 0
/ 1--I Herbst
2
Control
Fig. 8. Sagittal maxillary jaw base position changes (Mean, SD) in 45 patients with Class II, Division
1 malocclusions who were treated with Herbst appliance. Registrations during four examination periods:
treatment period IT), posttreatment period 1 (PI), posttreatment period 2 (P2), and total observation
period (O).

the maxillary skeleton tipping the palatal plane down-
ward (Fig. 7). It must be pointed out, however, that
this was not a consistent pattern. The amount and di-
rection of maxillary rotation varied considerably be-
tween patients.
No obvious effect of Herbst treatment on sagittal
jaw base position (Fig. 8) could be shown. This is in
agreement with srme previous Herbst studies that used
linear measurements for recording maxillary treatment
changes. 3'2' When, however, the treatment changes
were evaluated by means of angular measurements an
inhibition of maxillary growth was noted. 2
Posttreatment changes
During the first 6 months after the tlerbst appliance
was removed, the treatment changes reverted to a great
extent." The molars moved anteriorly and extruded,
and the occlusal plane closed. Similar findings were
found after headgear treatment. :-'24
During the fol!owing 5.9 years after treatment, the
maxillary dental and skeletal changes seen were mainly
a result of normal growth development.'3'25 When, how-
ever, comparing the Herbst subjects With the ideal oc-
clusion control group (Bolton Standards) at the end of
the observation period (6.4 years after therapy), it was
noted that the amount of sagittal maxillary growth was
less in the treated Class II cases (Fig. 8).
Influence of anchorage
The anchorage system of the Herbst appliance was
partial (Fig. 1) in 19 subjects and total (Fig. 2) in 26
subjects. However, no treatment differences in the
American Journal of Orthodontics and Dentofacial Orthopedics
Vohtme 103, No. 6
amount of sagittal or vertical molar movements were
found when comparing the two anchorage systems. In
a previous investigation" a difference between partial
and total anchorage was found for maxillary incisors
and mandibular molars only: the upper front teeth were
moved more lingually, and the lower molars were
moved more mesially in the total than in the partial
anchorage cases.
Influence of retention
After Herbst treatment, retention for 1 to 2 years
was performed in 29 subjects, whereas no retention was
performed in 16 subjects (Table I). A difference be-
tween the retention and nonretention group was found
for the sagittal molar position only. During the first
posttreatment period (PI), the relapse in sagittal molar
position was less (0.5 mm; p < 0.05) in the retention
group than in the nonretention group." On a long-term
basis, however, no difference was found between the
two groups. Obviously, the retention period was too
short for stabilizing sagittal tooth position changes.
Concerning vertical molar position, the activators
used for retention after Herbst treatment were not meant
for retaining vertical tooth position. On the contrary,
the acrylic covering the occlusal surfaces was removed
s o as to enhance vertical eruption of the molars for
further improvement of the incisor overbite.
Influence of second and third molars
Erupted or nonerupted second molars at the start of
treatment, as well as the presence or absence o f third
molar germs, did not affect the short- and long-term
response of the Herbst appliance on the sagittal or ver-
tical position of the maxillary first molars.
Influence of the treatment growth period
In a previous Herbst study 7 it was shown that so-
matic maturation had a significant influence on the man-
dibular skeletal and dental treatment response. When
grouping the present subjects in relation to their treat-
ment growth period (prepeak, peak, and postpeak) ac-
cording to the method of Pancherz and Hhgg, 7 no dif-
ferences in maxillary dental and skeletal changes oc-
curring during the treatment or posttreatment periods
were found.
SUMMARY AND CONCLUSIONS
The purpose o f this investigation was to analyze
cephalometrically the short- and long-term effects of
the Herbst appliance on the maxillary complex. The
patient material comprised 45 patients with Class II,
Division 1 malocclusions who were treated with the
Herbst appliance for 7 months and followed for 5 to
Pancherz and Anehus-Pancherz 519
10 years after treatment. During the treatment period
the following changes occurred:
1. The maxillary molars were moved distally in
96% of the subjects (maximum 4.5 mm).
2. The maxillary molars were intruded in 69% of
the subjects (maximum 3.5 mm).
3. The maxillary occlusal plane was tipped down-
ward in 82% of the cases (maximum 7.5~
4. The palatal plane was tipped downward in 47%
of the cases (maximum 2.0~
5. Sagittal maxillary jaw position seemed unaf-
fected by treatment.
During the first 6 months after Herbst therapy most
of the treatment changes reverted. During the following
years after treatment (mean 5.9 years), normal growth
developmental changes prevailed.
It can b e concluded that the Herbst appliance ex-
hibits a marked high-pull headgear effect on the max-
illary complex. Especially pronounced is the distalizing
effect on the molars. The clinician could take advantage
o f this effect when attacking Class II malocclusions
with maxillary crowding and thus possibly avoid ex-
tractions of permanent teeth.
REFERENCES
I. Herbst E. Dreissigj~ihrige Erfahrungen mit dem Retentions-
scharnier. Zahn~irztl Rundschau 1934;43:1515-24; 1563-8;
1611-6.
2. PancherzH. Treatment of Class 11malocclusionsby bitejumping
with the Herbst appliance: a cephalometrie investigation. AM J
ORTnOD 1979;76:423-41.
3. Pancherz H. The mechanism of Class II correction in Herbst
appliance treatment: a cephalometricinvestigation. AMJ OR~OD
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