Herbst Appliance Reinforced with an Hybrid Hyrax Expander and Two Miniscrews in the Lower Arch: Case Report

Introduction: Class II growing patients can be successfully treated with the Herbst appliance, nevertheless this therapy generally produces side effects, such as upper incisors retroclination and lower incisors proclination, which eventually could reduce mandibular forward advancement. Treatment objectives: The purpose of this article is to show a treatment of class II malocclusion with crowding in both arches by a skeletally reinforced Herbst appliance. Treatment description: Two miniscrews were applied in the lower arch to control lower incisors proclination and in the upper arch an Hybrid palatal expander was used. Results: the correction of the severe class II malocclusion was obtained with mandibular advancement, avoiding lower incisors proclination with control also of the upper incisors. Upper crowding with lack of space for upper canine alignment was corrected. Conclusions: Upper and lower miniscrews worked successfully as anchorage for the entire treatment.