Herbst appliance and Juvenile Idiophatic Arthritis : 3D mandibular and condylar growth effects

Aim: The aim of this study is to show the importance of Cone Beam Computerized Tomography to volumetrically quantify mandibular growth damage in patients with Juvenile Idiopathic Arthritis (JIA), measuring 3D condylar and mandibular real volumes, after using Herbst Appliance. Material and Methods: The present report documents, in a case of Juvenile Idiopathic Arthritis (JIA) with mandibular retrognathia, three-dimensional (3D) morphologic changes in the mandible, resulting from an interdisciplinary treatment with etanercept proposed by rheumatologist and with the Herbst appliance applied by orthodontists. Superimposition of the datasets was carried out according to anatomical structures in the brain (cranial base). Mandibular superimposition was performed according to the mandibular symphysis and the lower mandibular border. Results: The mandible moved forward and downward relative to the anterior cranial base. In addition, bone apposition was observed at almost all the surfaces of both mandibular condyles. Conclusions: A 13-year-old patient with juvenile idiopathic arthritis, and retrognathia was treated with Herbst Appliance for 1 year. Despite the presence of significant temporomandibular joint pathology, mandibular advancement was indicated to correct severe retrognathia by the Herbst Appliance.