Treatment of skeletal class II malocclusion in adults: stepwise vs single-step advancement with the Herbst appliance.

To compare 2 groups of mature patients treated with the Herbst appliance and present a new protocol based on tissue responses to enhance skeletal response.Lateral cephalograms taken before and after treatment for 2 groups of patients--the first treated with the Herbst appliance with maximum jumping and the second with the Herbst appliance with stepwise advancement--were examined with conventional cephalometric analysis and the sagittal-occlusal analysis of Pancherz to assess the dental, skeletal, and soft tissue changes.The mode of correction of the Class II malocclusion was through skeletal and dental changes. However, in the stepwise sample, the amount of correction due to skeletal changes was higher. In both groups, the soft tissue profile convexity was reduced significantly.Herbst appliance therapy can be considered a modality for the correction of skeletal Class II malocclusions in mature patients and should be added to orthodontia's armamentarium.