Los minitornillos en el tratamiento con Herbst

Abstract

Introduction. The objective of this study was to systematically evaluate the available scientific evidence that relates the efficiency of mandibular advancement procedures with Herbst functional apparatus and the associated adverse effects combined with mini-screws in the mandibular arch. Material and method. An electronic search of the databases was carried out: Embase, Scopus, PubMed, Web of Science, Google Scholar Beta, OpenGrey and PQDT Open. Unpublished literature and on-going studies were also verified electronically through ClinicalTrials.gov and Ictrp. The analytical review is comprised between the years 2004-2017. The work followed the PRISMA statement. Results. The primary MHS result shows a decrease in proclination (2° ± 1.4°) with increased protrusion (2.5 mm ± 1.4 mm) of the mandibular incisors and a greater mesialization of the mandibular molars (1.8 mm ± 1.6 mm) with a significant difference of p < 0.05, compared to a conventional Herbst treatment (CH), thus guaranteeing a greater mandibular advance by the correction of the class II first division of Angle. The secondary results can be considered as: absence of pain, little alteration of the mastication and gingival recession, with in some cases unwanted movements of the TAD’s and no iatrogenic damage to the root. Conclusion. The Herbst mandibular advancement device with interradicular mini-screws (MHS) is more clinically effective with respect to conventional Herbst (CH), because it increases the anchoring unit and avoids the proclination of the mandibular incisors providing a greater orthopedic mandibular advance.