Prevalence, magnitude, and incidence of labial gingival recession with Herbst-multibracket appliance treatment: A retrospective cohort study

Abstract

Objective: To assess the prevalence and magnitude of labial gingival recession (LGR) before and after as well as the incidence during Class II:1 Herbst-Multibracket appliance (Herbst-MBA) treatment (Tx) plus retention in a retrospective cohort study.

Materials and methods: Records of Class II:1 patients who completed Herbst-MBA Tx (mean pre-Tx age 14.4 years) at Department of Orthodontics, University of Giessen, Giessen, Germany were analyzed. Tx consisted of a Herbst phase (mean 8.1 months) and a subsequent MBA phase (mean 16.1 months). Study casts from before and after Herbst-MBA Tx plus ≥24 months of retention were evaluated.

Results: A total of 460 pre-Tx and 222 postretention study casts were available (total observation period: 59.2 ± 14.8 months). The overall prevalence for teeth with LGR ≥0.5 mm was 1.1% pre-Tx and 5.3% postretention. The highest prevalence of up to 5.3% (pre-Tx) and 16.4% (postretention) were seen for the lower incisors. Overall, the median magnitude of LGR was 0.0 mm pre-Tx/postretention (mean: 0.05 mm/0.08 mm). Incidence values of 4.0% (all teeth) and 10.0% to 11.4% (lower central incisors) were calculated for LGR ≥0.5 mm.

Conclusions: The prevalence of LGR ≥0.5 mm increased from, on average, 1.1% to 5.3% during ≈6 years of Herbst-MBA Tx plus retention. The highest incidence was seen in lower incisors (10.0%-11.4%). However, because of the overall mean magnitude of 0.08 mm postretention, the clinical relevance can be considered as insignificant.

Keywords: Gingival recession; Herbst.

Figure 1.

Herbst appliance. Cast splints in both arches connected by telescoping mechanisms between upper six and lower four establishing an incisal edge-to-edge relationship. A lingual arch connects the lower lateral segments.

Figure 2.

Measurement of the distance between the cemento-enamel junction and the deepest point of the gingival margin using a manual caliper.

Figure 3.

Patient flow chart. The numbers of Class II:1 patients who started/completed Herbst- multibracket appliance treatment and a retention period ≥24 months are given as well as the numbers of included pre- and postretention study casts.

Figure 4.

Prevalence (%) of labial gingival recession for teeth 17 to 47 before treatment (T0) and after Herbst-multibracket appliance treatment and a retention period ≥24 months (T1) for magnitude ≥0.5 mm (a), ≥1.0 mm (b), ≥2.0 mm (c) in all included study casts (T0, n = 460; T1, n = 222).