{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T09:43:10Z","timestamp":1783762990980,"version":"3.55.0"},"reference-count":76,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"st1\">\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a \u201cheadgear effect.\u201d Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hypo- and hyperdivergent patients benefit from the Herbst's headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/060117-369.1","type":"journal-article","created":{"date-parts":[[2017,10,10]],"date-time":"2017-10-10T14:34:19Z","timestamp":1507646059000},"page":"3-9","source":"Crossref","is-referenced-by-count":31,"title":["Treatment changes of hypo- and hyperdivergent Class II Herbst patients"],"prefix":"10.2319","volume":"88","author":[{"given":"Kim","family":"Rogers","sequence":"first","affiliation":[{"name":"Private practice orthodontist, Dallas, Tex."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip M.","family":"Campbell","sequence":"additional","affiliation":[{"name":"Chairman, Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, Tex."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Tadlock","sequence":"additional","affiliation":[{"name":"Assistant Professor, Department of Orthodontics, Texas A&M University College of Dentistry, College of Dentistry, Dallas, Tex."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emet","family":"Schneiderman","sequence":"additional","affiliation":[{"name":"Professor, Department of Biomedical Sciences, Texas A&M University College of Dentistry, Dallas, Tex."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Buschang","sequence":"additional","affiliation":[{"name":"Regents Professor and Director of Orthodontic Research, Department of Orthodontics, Texas A&M University College of Dentistry, Dallas, Tex."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-88-1-3-b01","series-title":"Int J Adult Orthod Orthognath Surg","first-page":"97","article-title":"Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey","volume":"13","author":"Proffit \n              WR.","year":"1998","unstructured":"Proffit \n              WR.\n            \n            \n              Fields \n              HW\n              Jr, \n            \n            \n              Moray \n              LJ.\n            \n          \n          Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. 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Am J Orthod Dentofacial Orthop. 1999;116:435\u2013443."},{"key":"i0003-3219-88-1-3-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"818","article-title":"Three-dimensional treatment outcomes in Class II patients treated with the Herbst appliance: a pilot study","volume":"144","author":"LeCornu \n              M.","year":"2013","unstructured":"LeCornu \n              M.\n            \n            \n              Cevidanes \n              LH.\n            \n            \n              Zhu \n              H.\n            \n            \n              Wu \n              CD.\n            \n            \n              Larson \n              B.\n            \n            \n              Nguyen \n              T.\n            \n          \n          Three-dimensional treatment outcomes in Class II patients treated with the Herbst appliance: a pilot study. 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Int J Adult Orthod Orthognath Surg. 1998;13:97\u2013106."},{"key":"i0003-3219-88-1-3-b02","series-title":"Dent Pract Dent Rec","first-page":"113","article-title":"Tooth size and class distinction","volume":"20","author":"Beresford \n              JS.","year":"1969","unstructured":"Beresford \n              JS.\n            \n          \n          Tooth size and class distinction. Dent Pract Dent Rec. 1969;20:113\u2013120."},{"key":"i0003-3219-88-1-3-b03","series-title":"Br J Orthod","first-page":"53","article-title":"A comparative occlusal and cephalometric study of dental and skeletal anteriorposterior relationships","volume":"10","author":"Milacic \n              M.","year":"1983","unstructured":"Milacic \n              M.\n            \n            \n              Markovic \n              M.\n            \n          \n          A comparative occlusal and cephalometric study of dental and skeletal anteriorposterior relationships. Br J Orthod. 1983;10:53\u201354."},{"key":"i0003-3219-88-1-3-b04","series-title":"Am J Orthod Dentofacial Orthop","first-page":"599.e1","article-title":"Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review","volume":"129","author":"Cozza \n              P.","year":"2006","unstructured":"Cozza \n              P.\n            \n            \n              Baccetti \n              T.\n            \n            \n              Franchi \n              L.\n            \n            \n              De Toffol \n              L.\n            \n            \n              McNamara \n              JA\n              Jr. \n            \n          \n          Mandibular changes produced by functional appliances in Class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop. 2006;129:599.e1\u201312."},{"key":"i0003-3219-88-1-3-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"732","article-title":"Orthodontic treatment changes of chin position in Class II Division 1 patients","volume":"130","author":"LaHaye \n              MB.","year":"2006","unstructured":"LaHaye \n              MB.\n            \n            \n              Buschang \n              PH.\n            \n            \n              Alexander \n              RG.\n            \n            \n              Boley \n              JC.\n            \n          \n          Orthodontic treatment changes of chin position in Class II Division 1 patients. Am J Orthod Dentofacial Orthop. 2006;130:732\u2013741."},{"key":"i0003-3219-88-1-3-b06","series-title":"Am J Orthod Dentofacial Orthop","first-page":"180","article-title":"Perceptions of a balanced facial profile","volume":"104","author":"Czarnecki \n              ST.","year":"1993","unstructured":"Czarnecki \n              ST.\n            \n            \n              Nanda \n              RS.\n            \n            \n              Currier \n              GF.\n            \n          \n          Perceptions of a balanced facial profile. Am J Orthod Dentofacial Orthop. 1993;104:180\u2013187."},{"key":"i0003-3219-88-1-3-b07","series-title":"Am J Orthod Dentofacial Orthop","first-page":"464","article-title":"Significance of the soft tissue profile on facial esthetics","volume":"119","author":"Spyropoulos \n              MN.","year":"2001","unstructured":"Spyropoulos \n              MN.\n            \n            \n              Halazonetis \n              DJ.\n            \n          \n          Significance of the soft tissue profile on facial esthetics. Am J Orthod Dentofacial Orthop. 2001;119:464\u2013471."},{"key":"i0003-3219-88-1-3-b08","series-title":"Angle Orthod","first-page":"361","article-title":"Immediate skeletal and dentoalveolar effects of the crown- or banded type Herbst appliance on Class II division 1 malocclusion","volume":"78","author":"Barnett \n              GA.","year":"2008","unstructured":"Barnett \n              GA.\n            \n            \n              Higgins \n              DW.\n            \n            \n              Major \n              PW.\n            \n            \n              Flores-Mir \n              C.\n            \n          \n          Immediate skeletal and dentoalveolar effects of the crown- or banded type Herbst appliance on Class II division 1 malocclusion. 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Am J Orthod Dentofacial Orthop. 1999;116:435\u2013443."},{"key":"i0003-3219-88-1-3-b11","series-title":"Am J Orthod Dentofacial Orthop","first-page":"818","article-title":"Three-dimensional treatment outcomes in Class II patients treated with the Herbst appliance: a pilot study","volume":"144","author":"LeCornu \n              M.","year":"2013","unstructured":"LeCornu \n              M.\n            \n            \n              Cevidanes \n              LH.\n            \n            \n              Zhu \n              H.\n            \n            \n              Wu \n              CD.\n            \n            \n              Larson \n              B.\n            \n            \n              Nguyen \n              T.\n            \n          \n          Three-dimensional treatment outcomes in Class II patients treated with the Herbst appliance: a pilot study. 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Am J Orthod Dentofacial Orthop. 1998;114:437\u2013446."},{"key":"i0003-3219-88-1-3-b22","series-title":"Angle Orthod","first-page":"712","article-title":"Soft tissue changes with fixed functional appliances in Class II division 1","volume":"76","author":"Flores-Mir \n              C.","year":"2006","unstructured":"Flores-Mir \n              C.\n            \n            \n              Major \n              MP.\n            \n            \n              Major \n              PW.\n            \n          \n          Soft tissue changes with fixed functional appliances in Class II division 1. 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Dental Press J Orthod. 2013;18:21.e21\u201327."},{"key":"i0003-3219-88-1-3-b33","series-title":"Am J Orthod Dentofacial Orthop","first-page":"197","article-title":"Dental and orthopedic effects of high-pull headgear in treatment of Class II, division 1 malocclusion","volume":"102","author":"Firouz \n              M.","year":"1992","unstructured":"Firouz \n              M.\n            \n            \n              Zernik \n              J.\n            \n            \n              Nanda \n              R.\n            \n          \n          Dental and orthopedic effects of high-pull headgear in treatment of Class II, division 1 malocclusion. Am J Orthod Dentofacial Orthop. 1992;102:197\u2013205."},{"key":"i0003-3219-88-1-3-b34","series-title":"Am J Orthod Dentofacial Orthop","first-page":"140","article-title":"Orthognathic surgery and dentofacial orthopedics in adult Class II Division 1 treatment: mandibular sagittal split osteotomy versus Herbst appliance","volume":"126","author":"Ruf \n              S.","year":"2004","unstructured":"Ruf \n              S.\n            \n            \n              Pancherz \n              H.\n            \n          \n          Orthognathic surgery and dentofacial orthopedics in adult Class II Division 1 treatment: mandibular sagittal split osteotomy versus Herbst appliance. 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