Neuromuscular and skeletal adaptations following mandibular forward positioning induced by the Herbst appliance.

The purpose of this study was to examine neuromuscular and skeletal adaptations to changes in sagittal jaw relationships induced by the Herbst appliance. Six patients (age, 9 years and 5 months to 11 years and 2 months) with Angle Class II, division 1 malocclusions were studied longitudinally. The structural changes were determined by analyzing serial lateral cephalograms. Electromyographic recordings of specific masticatory muscles were used to evaluate neuromuscular adaptations. Similar cephalometric changes were observed in all patients. In all patients, lateral pterygoid muscle activity increased immediately after insertion of the appliance, but the activity decreased markedly after 4 to 6 months of treatment. In 4 of the 6 patients studied, however, the condyles were located in a slightly more downward and forward position. These findings indicate that the adaptation of muscular function occurs within a relatively short period and precedes the compensatory morphological changes produced through functional appliance therapy.