Management of juvenile idiopathic arthritis in a 15-year-old patient: A digitally designed Herbst appliance combined with rapid maxillary expansion for transversal and sagittal correction

Abstract

Juvenile idiopathic arthritis (JIA) is the most frequent systemic inflammatory disease involving temporomandibular joints in children. The reported prevalence of temporomandibular joint involvement in patients with juvenile idiopathic arthritis varies from 17% to 87% depending on the population studied, the subtypes, and the method for diagnosis. A 15-year-old girl was referred to the Department of Oral and Maxillofacial Surgery and the Department of Orthodontics of Parma University, Italy, for the evaluation and treatment of a three-dimensional facial deformity secondary to mandibular hypoplasia. The treatment strategy involved the use of a digitally designed Herbst appliance to promote mandibular growth and address facial asymmetry, occlusal plane deviation, and dental malocclusion. This phase was followed by fixed orthodontic therapy to finalize dental alignment and ensure occlusal stability. At the conclusion of the treatment, the patient demonstrated substantial functional and aesthetic improvements, with stability maintained during a three-year follow-up period. This case underscores the efficacy of combining functional therapeutic protocols with advanced digital technologies in the multidisciplinary management of JIA-associated dentofacial anomalies, offering a less invasive alternative to surgical interventions.