Three-Dimensional Temporomandibular Joint Adaptations and Skeletal Outcomes Following Herbst Appliance Therapy in Class II Malocclusion: A Systematic Review
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Abstract
Background: Class II malocclusion associated with mandibular retrognathism is frequently managed using functional orthopedic appliances, including the Herbst appliance. Continuous mandibular advancement may influence condylar remodeling, mandibular skeletal adaptation, dentoalveolar compensation, and temporomandibular joint response; however, the extent and stability of these effects remain uncertain. Objective: This systematic structured literature review aimed to evaluate recent clinical and imaging-based evidence on temporomandibular joint adaptations, condylar remodeling, glenoid fossa response, skeletal and dentoalveolar outcomes, and post-treatment stability following Herbst appliance therapy in patients with Class II malocclusion. Methods: PubMed, Scopus, and Web of Science were searched for studies published between 2015 and 2025. Eligible studies included primary longitudinal, comparative, clinical, and imaging-based investigations evaluating Herbst appliance therapy in relation to TMJ, skeletal, dentoalveolar, or stability outcomes. Reviews, meta-analyses, case reports, animal studies, non-English publications, and studies without relevant outcomes were excluded. Because of heterogeneity in study design, imaging protocols, comparators, and outcome measures, findings were synthesized qualitatively. Results: Six studies were included in the qualitative synthesis. The evidence was predominantly CBCT-based and primarily supported osseous condylar, mandibular, and condyle–glenoid fossa adaptations following Herbst therapy. Dentoalveolar and alveolar effects contributed to treatment response, and limited clinical follow-up evidence suggested relative stability of sagittal occlusal correction. Direct evidence on articular disc position, soft-tissue TMJ adaptation, TMD incidence, treatment timing superiority, and detailed relapse mechanisms was limited. Conclusion: Herbst appliance therapy appears to contribute to Class II correction through combined osseous TMJ adaptation, condylar remodeling, mandibular skeletal response, and dentoalveolar compensation. However, conclusions regarding disc status, soft-tissue TMJ safety, TMD risk, and long-term relapse mechanisms remain constrained by the predominance of CBCT-based observational evidence
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