Objective: To assess the alveolar bone changes and gingival recession following Herbst appliance therapy. Materials and methods: Electronic databases such as PubMed, Ovid, Cochrane Library, Lilacs, Scopus, Web of Science, and Embase were searched until August 2022. Hand-searching of major orthodontic journals was performed to identify all peer-reviewed articles potentially relevant to the review. The quality of the selected studies was ranked using the revised Cochrane risk of bias tool for nonrandomized trials—Risk of Bias In Nonrandomized Studies (ROBINS) 1. Results: Five relevant articles (all nonrandomized studies) were considered for qualitative analysis. The risk of bias was low for four studies and moderate for one. The reduction in the vertical alveolar bone height was 0.13 ± 0.07 mm, with the Herbst appliance. The mean difference in the loss of buccal cortical thickness between the Herbst appliance and untreated control group was 0.22 mm [95% confidence interval (CI) of −0.62–0.18]. Subsequent to Herbst appliance therapy, in the mandibular anterior region 0.1 ± 0.5 mm of gingival recession was observed. Conclusion: Herbst appliance treatment produces a negligible reduction in the buccal cortical thickness, vertical alveolar bone height, and gingival recession. Clinical significance: Though the changes produced by the Herbst appliance were minimal, they are clinically important considering the young age of the patients warranting periodic periodontal assessment.