Orthognathic surgery and dentofacial orthopedics in adult Class II Division 1 treatment: Mandibular sagittal split osteotomy versus Herbst appliance

The aim of this study was to assess to what extent adult Herbst treatment is an alternative to orthognathic surgery by comparing the dentoskeletal treatment effects in 46 adult Class II Division 1 subjects treated with a combined orthodontic-orthognathic surgery approach (mandibular sagittal split osteotomy without genioplasty) and 23 adult Class II Division 1 subjects treated with the Herbst appliance. Lateral headfilms in habitual occlusion from before and after treatment (multibracket appliance treatment after surgery or Herbst treatment) were analyzed. All surgery and Herbst subjects were treated successfully to Class I occlusal relationships with normal overjet and overbite. In the surgery group, the improvement in sagittal occlusion was achieved by skeletal more than dental changes; in the Herbst group, the opposite was the case. Skeletal and soft tissue facial profile convexity was reduced significantly in both groups, but the amount of profile convexity reduction was larger in the surgery group. The success and predictability of Herbst treatment for occlusal correction was as high as for surgery. Thus, Herbst treatment can be considered an alternative to orthognathic surgery in borderline adult skeletal Class II malocclusions, especially when a great facial improvement is not the main treatment goal.