Application of palatally positioned mini-screws together with the Herbst appliance for rehabilitating adult patients with skeletal types of distal dental arch relationships: a clinical case

Abstract

Relevance. Utilizing the Herbst appliance for managing distal occlusal relationships in patients with completed facial growth serves as an alternative to surgico-orthodontic methods. This approach, however, extends the treatment duration and necessitates stabilization of the upper molars following removal of the appliance when moving the anterior segment of the upper dentition distally.

Objective. To clinically substantiate the feasibility of combining the Herbst appliance with palatally positioned mini-screws for treating distal dental occlusal relationships in adult patients.

Description of сlinical сases. Clinical photographic documentation and diagnostic modeling of facial and dentition were conducted for two patients. This was complemented by the computation and analysis of jaw CT scans and profile cephalometric radiographs. The AMORF method was employed for a quantitative evaluation of dentomaxillofacial anomalies. Hypotheses were drawn based on the employment of a 6.0 mm micro-implant at the median suture in projection with teeth 1.6-2.6, alongside the Herbst appliance, suggesting potential stability of the upper molars during the distal repositioning of the anterior segment of the upper dentition.

Conclusion. The outcomes from the documented clinical cases suggest that integrating palatally positioned mini-screws with the Herbst appliance facilitates stable positioning of the upper jaw’s first molars during the distal movement of the anterior segment, attributed to the solid support provided by the mini-screw implant.