Extreme dentoalveolar compensation in the treatment of Class III malocclusion

Camouflage Orthodontic Treatment of a Severe Class III Malocclusion

Class III malocclusion remains the most challenging occlusal problem to treat due to the complexity of the interrelationships of the underlying skeletal and dental structures. Camouflage orthodontic treatment is a preferred alternative method used to manage mild to moderate Class III malocclusion in nongrowing patients. The aim of this article was to demonstrate a camouflage orthodontic treatment of a 22-year-old female patient diagnosed as having a severe skeletal Class III malocclusion characterized by a straight facial profile, reverse overjet, crowded maxillary incisors, retrognathic maxilla, prognathic mandible, and a hypodivergent facial pattern. The initial diagnosis suggested orthognathic surgery, but the patient preferred the alternative treatment. The treatment approach chosen was nonextraction camouflage orthodontic treatment combined with Class III elastics. At the end of treatment, the canines and molars were in a Class I relationship, while the incisors presented a normal overjet and overbite relationship. The maxillary and mandibular midlines corresponded with each other and with the midsagittal plane, and the smile aesthetics were improved. The facial profile was slightly improved, and the vertical face height was also slightly increased with treatment. The treatment results were maintained 15 months after treatment. It was concluded that camouflage orthodontic treatment can be used as an effective alternative method to achieve acceptable dentofacial aesthetics, functional occlusion, and stability in treating an adult patient diagnosed with severe skeletal Class III malocclusion characterized by a retrognathic maxilla, prognathic mandible, and a hypodivergent facial pattern.

Treatment of skeletal class III malocclusion with the Alt-RAMEC protocol and intermaxillary elastics : A retrospective cohort study

PURPOSE

This study aimed to evaluate the effects of the use of class III elastics with fixed appliances and the Alt-RAMEC procedure on dentofacial structures in patients diagnosed with skeletal class III malocclusion.

METHODS

The retrospective cohort study was performed on lateral cephalometric radiographs of 20 individuals (7 girls, 13 boys; mean chronological age 12.41 years) with skeletal class III malocclusion because of maxillary deficiency or maxillary deficiency and mandibular excess which were treated by using the Alt-RAMEC protocol and class III elastics. The patients were chosen from the archive of Gazi University Faculty of Dentistry, Department of Orthodontics. In order to distinguish between growth-related changes and the effects of treatment, results were compared with a control group consisting of 20 individuals (8 girls, 12 boys; mean chronological age 12 years) with similar skeletal characteristics.

RESULTS

In the treatment group, there were significant increases of 2.2°, 4.2° and 1° in the SNA, ANB and SN/GoGN angles, respectively, in contrast to the control group (p < 0.001). There was also a significant decrease of 1.9° in the SNB angle within the treatment group in contrast to the control group (p < 0.001). While the U1/SN angle increased by 1.4° in the treatment group, the L1-NB distance decreased by 0.7 mm (p < 0.01).

CONCLUSIONS

The results of this study showed that application of the Alt-RAMEC protocol and class III elastics with fixed appliances showed successful results in the management of skeletal class III malocclusions, while avoiding undesirable dental effects, such as excessive lingual tipping of the lower incisors.

Achieving Aesthetics and Function in Class III Malocclusion Through Orthodontic Camouflage: A Clinical Case Report

Class III malocclusion is a challenging dental and skeletal condition characterized by a protrusive mandible, retrusive maxilla, or a combination of both. Treatment options include growth modification, orthodontic camouflage, and orthognathic surgery. While surgery often provides definitive results for severe cases, orthodontic camouflage is a viable alternative for managing mild to moderate skeletal discrepancies in adults. This case report illustrates the successful use of orthodontic camouflage in a 19-year-old female with skeletal and dental class III malocclusion, emphasizing nonsurgical strategies to achieve functional and aesthetic improvements. The patient presented with concerns about her bite and facial profile. Clinical examination revealed a concave profile, prominent mandible, and class III molar and canine relationships with a negative overjet. The radiographic analysis confirmed a skeletal class III relationship (ANB angle of -2°) and normal vertical growth patterns. The chosen nonsurgical treatment plan involved fixed orthodontic appliances and class III intermaxillary elastics to correct the malocclusion and improve facial aesthetics. The treatment phases included initial alignment, class III elastic application to adjust the occlusion, and detailed finishing to refine results. After 20 months, the treatment resulted in a positive overjet, class I molar and canine relationships, and improved facial aesthetics with reduced mandibular prominence. The patient expressed satisfaction with both functional and aesthetic outcomes. This case demonstrates that orthodontic camouflage can effectively manage mild to moderate class III malocclusion in non-growing patients. Successful outcomes depend on precise treatment planning, patient compliance, and regular monitoring. While surgical options remain necessary for severe cases, orthodontic camouflage provides a less invasive alternative for suitable patients, significantly improving dental function and facial aesthetics.

Comparison of posttreatment stability after total mandibular arch distalization with mini-implants and mandibular setback surgery

OBJECTIVES

To compare posttreatment stability in skeletal Class III patients between those treated by total mandibular arch distalization (TMAD) with buccal mini-implants and those by mandibular setback surgery (MSS).

MATERIALS AND METHODS

The samples included 40 Class III adults, 20 treated by TMAD using buccal interradicular mini-implants and 20 treated with MSS. Lateral cephalograms were taken at pretreatment, posttreatment, and at least 1-year follow-up, and 24 variables were compared using statistical analysis.

RESULTS

Mandibular first molars moved distally 1.9 mm with intrusion of 1.1 mm after treatment in the TMAD group. The mandibular incisors moved distally by 2.3 mm. The MSS group exhibited a significant skeletal change of the mandible, whereas the TMAD group did not. During retention, there were no skeletal or dental changes other than 0.6 mm labial movement of the mandibular incisors (P < .05) in the MSS group. There was 1.4° of mesial tipping (P < .01) and 0.4 mm of mesial movement of the mandibular molars and 1.9° of labial tipping (P < .001) and 0.8 mm of mesial movement of the mandibular incisors in the TMAD group. These dental changes were not significantly different between the two groups.

CONCLUSIONS

The TMAD group showed a slightly decreased overjet with labial tipping of the mandibular incisors and mesial tipping of the first molars during retention. Posttreatment stability of the mandibular dentition was not significantly different between the groups. It can be useful to plan camouflage treatment by TMAD with mini-implants in mild-to-moderate Class III patients.

Comparison of Gingival Recession of Mandibular Incisors of Class III Patients Immediately after Compensatory or Surgical Orthodontic Treatment

OBJECTIVE

 This study aimed to compare gingival recession in mandibular anterior teeth in patients with Class III malocclusion, immediately after compensatory or surgical orthodontic treatment.

MATERIALS AND METHODS

 The sample consisted of 40 patients with Class III malocclusion, divided into two groups: Group 1 (compensatory), 20 patients treated with compensatory orthodontics, with a mean initial age of 20.26 years (standard deviation [SD] . = 7.44), mean final age of 23.07 years (SD = 7.32), and mean treatment time of 2.81 years (SD =0.84). Group 2 (surgical), who undergone orthodontic-surgical treatment, with a mean initial age of 23.08 years (SD =5.48), mean final age of 25.43 years (SD =5.12), and mean treatment time of 2.35 years (SD =1.56). Intraoral photographs taken before and after removal of the fixed orthodontic appliance were used to measure the gingival recession, from the cervical of the mandibular incisors from the most cervical point of the gingival margin to the cementoenamel junction. In the initial and final cephalograms, the position of the mandibular incisors was measured. The intergroup comparison was performed using the independent t-test.

RESULTS

 The results showed that there was no statistically significant difference in the gingival recession at the beginning, at the end, and of changes with treatment between the compensatory and surgical groups.

CONCLUSION

 It was concluded that the compensatory and surgical orthodontic treatments for Class III malocclusion showed similar results regarding the gingival recession of the mandibular incisors.

Orthodontic camouflage versus orthodontic-orthognathic surgical treatment in borderline class III malocclusion: a systematic review

OBJECTIVE

This systematic review evaluated the available evidence regarding the skeletal, dentoalveolar, and soft tissue effects of orthodontic camouflage (OC) versus orthodontic-orthognathic surgical (OOS) treatment in borderline class III malocclusion patients.

METHODS

Eligibility criteria. The included studies were clinical trials and/or follow-up observational studies (retrospective and prospective). Information sources. PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS were searched up to October 2021. Risk of bias. Downs and Black quality assessment checklist was used. Synthesis of results. The outcomes were the skeletal, dentoalveolar, and soft tissue changes obtained from pre- and post-cephalometric measurements.

RESULTS

Included studies. Out of 2089 retrieved articles, 6 were eligible and thus included in the subsequent analyses. Their overall risk of bias was moderate. Outcome results. The results are presented as pre- and post-treatment values or mean changes in both groups. Two studies reported significant retrusion of the maxillary and mandibular bases in OC, in contrast to significant maxillary protrusion and mandibular retrusion with increased ANB angle in OOS. Regarding the vertical jaw relation, one study reported a significant decrease in mandibular plane inclination in OC and a significant increase in OOS. Most of the included studies reported a significant proclination in the maxillary incisors in both groups. Three studies reported a significant proclination of the mandibular incisors in OOS, while four studies reported retroclination in OC.

CONCLUSION

Interpretation. The OSS has a protrusive effect on the maxillary base, retrusive effect on the mandibular base, and thus improvement in the sagittal relationship accompanied with a clockwise rotational effect on the mandibular plane. The OC has more proclination effect on the maxillary incisors and retroclination effect on the mandibular incisors compared to OOS. Limitation. Meta-analysis was not possible due to considerable variations among the included studies. Owing to the fact that some important data in the included studies were missing, conducting further studies with more standardized methodologies is highly urgent. Registration. The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199591).

CLINICAL RELEVANCE

The common features including skeletal, dental, and soft tissue characteristics of borderline class III malocclusion cases make it more difficult to select the most appropriate treatment modality that can be either OC or OOS. The availability of high-level evidence-systematic reviews-makes the clinical decision much more clear and based on scientific basis rather than personal preference.

Comparison of treatment effects after total mandibular arch distalization with miniscrews vs ramal plates in patients with Class III malocclusion

INTRODUCTION

This study aimed to compare treatment effects after total mandibular arch distalization with buccal interradicular miniscrews vs ramal plates in patients with Class III malocclusion.

METHODS

The sample consisted of 40 patients with Class III malocclusion; 20 were treated with distalization via buccal miniscrews (age, 25.8 ± 7.9 years), whereas 20 were treated with ramal plates (age, 26.4 ± 6.1 years). Twenty-three linear and angular measurements were analyzed on pretreatment and posttreatment lateral cephalograms. The changes in each group and differences in treatment effects between the 2 groups were evaluated.

RESULTS

The mean amount of distalization at the crown and root levels of the mandibular first molars and the amount of distal tipping was 1.8 mm, 0.6 mm, and 5.4° in the buccal miniscrew group vs 3.6 mm, 2.0 mm, and 6.8° in the ramal plate group, respectively. In addition, 2.2° of counterclockwise rotation of the occlusal plane was observed in the buccal miniscrew group after 1.3 mm of molar intrusion (P <0.001). The distal movement of the lower lip was 0.6 mm in the buccal miniscrew group vs 2.3 mm in the ramal plate group.

CONCLUSIONS

The buccal miniscrew group showed more molar intrusion and counterclockwise rotation of the occlusal plane than in the ramal plate group. The ramal plate produced more distalization of the mandibular dentition with clockwise rotation of the mandible. Therefore, these results can be useful when selecting the type of temporary skeletal anchorage devices to treat patients with Class III malocclusion, depending on their vertical pattern.

Smile attractiveness in class III patients after orthodontic camouflage or orthognathic surgery

OBJECTIVE

The study's objective was to compare the smile attractiveness in patients with class III malocclusion treated with orthodontic camouflage or orthognathic surgery.

MATERIAL AND METHODS

The sample consisted of 30 patients with class III malocclusion treated without extractions divided into two groups, according to the treatment performed: G1, orthodontic camouflage, consisting of 15 patients (9 female; 6 male) with mean initial age of 21.26 years (SD = 7.39) and mean final age of 24.52 years (SD = 7.10). The mean treatment time was 3.26 years (SD = 1.50). G2, ortho-surgical, consisting of 15 patients (8 females; 7 males), with mean initial age of 23.12 years (SD=7.37), mean final age of 25.82 years (SD = 7.14) and mean treatment time of 2.71 years (SD = 0.90). The smile attractiveness was evaluated in black and white photographs of posed smiles taken before and after treatment, with a numerical rating scale from 1 to 10, with 1 being the least attractive and 10 the greatest smile attractiveness. The smiles were evaluated in a questionnaire by 111 participants, 67 orthodontists (mean age 41.31 years, SD = 9.44) and 44 laypeople (mean age 41.41 years, SD = 14.38). Intergroup comparison was performed with independent t test.

RESULTS

There was a significant improvement in the smile attractiveness with both camouflage and ortho-surgical treatments. The smile attractiveness was similar between the camouflage and surgical groups at the beginning. There was a significantly greater improvement in smile attractiveness with treatment in the surgical group than in the camouflage group, and at the end of treatment, the surgical group showed greater smile attractiveness than the camouflage group. Orthodontists considered the smiles more attractive both at the beginning and the end of treatment when compared to the assessment made by laypeople.

CONCLUSION

The ortho-surgical treatment promoted a greater improvement in the smile attractiveness, and at the final stage, a greater smile attractiveness than the orthodontic camouflage.

CLINICAL RELEVANCE

Smile attractiveness is an important characteristic of the final result of orthodontic treatment. Knowing which treatment protocol will provide a better improvement and outcome regarding smile esthetics is essential.

A comparative study on cephalometric differences in maxillofacial morphology between skeletal Class III cases with and without acromegaly: a pilot study

OBJECTIVES

The most typical maxillofacial feature of patients with acromegaly is mandibular protrusion. This study aimed to determine differences in maxillofacial morphology between skeletal Class III patients with and without acromegaly using cephalometric analysis.

METHODS

Cephalograms of 37 patients with acromegaly (Acro), 37 age-matched non-acromegalic patients with skeletal Class III malocclusion (C-III), and 37 age-matched Class I malocclusion patients (C-I; control) were retrospectively collected. The skeletal and dental morphology of each group was analyzed using cephalometric analysis, which included linear and angular measurements and facial profilograms. In addition, we analyzed diagnostic performance and cutoff values for discriminating acromegaly from skeletal Class III malocclusion using receiver operating characteristic (ROC) curve analysis.

RESULTS

The mandibular ramus height was larger in the Acro group than in the other groups. The increase in L1/MP in the Acro group, which represented labial inclination of the mandibular central incisors, was the most characteristic feature in this study. ROC curve analysis indicated that a cutoff value of 88.4° for L1/MP had the highest diagnostic performance in discriminating acromegaly from non-acromegalic Class III malocclusion.

CONCLUSIONS

Acromegaly was characterized by a greater degree of bimaxillary prognathism than was non-acromegalic Class III malocclusion. Focusing on labial inclination of the mandibular central incisors would be the most useful way to differentiate acromegaly from non-acromegalic Class III malocclusion.

Comparison of Profile Attractiveness between Class III Orthodontic Camouflage and Predictive Tracing of Orthognathic Surgery

Objective

The aim of this study was to compare the profile attractiveness between orthodontic camouflage of the Class III malocclusion and the predictive tracing simulating orthognathic surgery evaluated by dentists and laypeople. Settings and sample population. The sample consisted of 21 patients (9 male; 12 female) with Class III malocclusion treated with orthodontic camouflage and Class III intermaxillary elastics. Material and Methods. The mean initial age of the patients was 24.38 years (SD 3.32), and the mean ANB angle was −1.91° (SD 0.83°). Patients presented skeletal Class III and normal growth patterns. Initial and final lateral cephalograms of each patient were used. The initial cephalogram was used to perform the treatment simulation of orthognathic surgery, and its silhouette was compared to the silhouette obtained from the final cephalogram after Class III orthodontic camouflage. A subjective analysis of profile attractiveness was performed by 47 laypeople and 60 dentists, with scores from 1 (less attractive) to 10 (most attractive). Mann–Whitney tests were used to compare profile attractiveness between the orthodontic treatment and the predictive tracing groups and between dentists and laypeople.

Results

The predictive tracing of orthognathic surgery showed to be statistically significantly more attractive (mean score 4.57, SD 2.47) than that of the Class III camouflage orthodontic treatment (mean score 4.22, SD 2.40), with a mean numerical but significant difference of 0.35 (SD 2.01) (P < 0.001). Laypeople were more critical than dentists in evaluating profile attractiveness, but numerical difference between the groups was also small.

Conclusion

The profile silhouette of predictive tracing simulating orthognathic surgery showed to be more attractive than that of Class III camouflage orthodontic treatment; however, differences were small but statistically significant. Laypeople showed to be more critical than dentists.

Comparison of the facial profile attractiveness in Class III borderline patients after surgical or compensatory orthodontic treatment

Background

This study aimed to compare the facial profile attractiveness of Class III borderline patients after surgical or compensatory orthodontic treatment.

Material and Methods

The sample consisted of 60 borderline Class III malocclusion patients, divided into two groups: Group 1 (Surgical): 30 patients (16 male; 14 female) treated with orthodontic fixed appliances and bimaxillary orthognathic surgery. Mean initial age was 20.05 years (s.d.=2.40) and mean treatment time was 2.23 years (s.d.=0.82). Group 2 (Compensatory): 30 patients (13 male; 17 female) treated compensatorily with fixed appliances and Class III elastics. Mean initial age was 18.53 years (s.d.=4.35) and mean treatment time was 2.08 years (s.d.=0.67). Silhouettes of the facial profile were constructed obtained from the pretreatment and posttreatment lateral cephalograms and evaluated by orthodontists (N=41, 22 females and 19 males, mean age of 35.65 years), assigning scores from 1 (least attractive) to 10 (most attractive). Intergroup comparison of profile attractiveness was performed by Mann-Whitney test. For intragroup comparison of initial and final stages, the Wilcoxon test was used.

Results

At initial stage, the compensatory group presented a statistically significant greater attractiveness of the profile than the surgical group. With treatment, the surgical group presented significantly more improvement in facial profile than the compensatory group. At the final stage, profile attractiveness of surgical and compensatory groups was similar.

Conclusions

The facial profile attractiveness is similar in Class III patients after orthognathic surgery or compensatory orthodontic treatment. However, surgery provided more improvement in profile attractiveness than the compensatory treatment in Class III patients. Key words:Malocclusion, angle Class III, orthognathic surgery, corrective orthodontics.

[Early orthodontic treatment of the patients with Class III malocclusion combined with the arches discrepancies using the own design appliance. Clinical case]

A 6-year-old boy with a skeletal Class III malocclusion was treated with the use of the fixed own design orthodontic appliance. The device includes acrylic-splint with a three-sided (Bertoni) screw mounted in them, an arc element in the region of the front teeth for protractive action on them, metal hooks for the face mask. Orthodontic treatment using that appliance allowed to normalize the upper dental arche in the sagittal and transversal directions. Thus, conditions for normal growth and development of the dentofacial complex were created, which is the main goal of early orthodontic intervention.

Virtual orthodontic setup in orthodontic camouflage planning for skeletal Class III malocclusion

The purpose of this paper was to emphasize the importance of the orthodontic setup in treatment planning for skeletal Class III malocclusion correction in an adult patient with moderate lower anterior crowding and anterior crossbite associated with two supernumerary lower incisors.

Compensatory Class III malocclusion treatment associated with mandibular canine extractions

Skeletal Class III malocclusions are ideally treated with orthodontic-surgical approaches. However, if there are no significant soft tissue implications and the patient does not want to undergo orthognatic surgery, other treatment options may be considered. The current case report describes a compensatory alternative for Class III malocclusion treatment, by means of mandibular canine extractions. This treatment alternative provided facial profile and occlusal improvement, which remains stable seven years posttreatment.

Distalization of the mandibular dentition with a ramal plate for skeletal Class III malocclusion correction

The retromolar fossa is an anatomically suitable skeletal anchorage site. The aim of this report was to introduce a novel appliance for the correction of skeletal Class III malocclusions with mandibular dentition distalization. The placement site and the procedure of the ramal plate are described. The resulting force vectors are parallel to the functional occlusal plane leading to efficient molar distalization. This approach is demonstrated with 2 adult patients who refused a surgical treatment option. This ramal plate may be indicated for total arch distalization for nonextraction and nonsurgical cases.

Non-surgical Management of Skeletal Class III Malocclusion with Bilateral Posterior Crossbite: A Case Report

A 16-year-old female patient with skeletal Class III malocclusion and bilateral posterior cross bite complaining of difficulty in chewing was treated orthodontically without surgery (camouflage treatment). The treatment comprised of fixed orthodontic treatment with MBT prescription (0.022˝×0.028˝ slot) using quad helix appliance for bilateral expansion of maxillary arch and Class III elastics for occlusal correction. Post-treatment records showed normal overbite and overjet with acceptable occlusion. So with this treatment strategy of expanding the maxillary arch using a quad helix appliance and use of Class III elastics, we achieved a good result with optimal occlusion.

Factors influencing orthodontic treatment time for non-surgical Class III malocclusion

Objective:

To identify variables and their effect size on orthodontic treatment time of Class III malocclusion.

Material and Methods:

Forty-five Class III malocclusion cases were selected from 2008 patients' records. Clinical charts, cephalometric radiographs, and pre and posttreatment dental casts were evaluated. Age, sex, PAR index at T1 and T2, overjet, missing teeth, extractions, number of treatment phases, missed appointments, appliance breakages, and cephalometric variables SNA, SNB, ANB, Wits, SnGoGn, CoA, CoGn, IMPA, 1.PP were investigated by multiple linear regression analysis and stepwise method at p<0.05. The sample was also divided into two groups: Group 0-2 (patients who had missed two clinical appointments or less) and Group >2 (patients who missed more than 2 appointments), to detect the influence of this data on treatment time and the quality of the treatment (PAR T2).

Results:

Average treatment time was 30.27 months. Multiple regression analysis showed that missed appointment (R2=0.4345) and appliance breakages (R2=0.0596) are the only variables able to significantly predict treatment duration. Treatment time for patients who missed more than 2 appointments was nearly one year longer. However, no significant influence on PAR T2 was observed for those patients.

Conclusion:

Orthodontic treatment duration in Class III patients is mainly influenced by factors related to patient compliance. Patients who missed more appointments did not show worse orthodontic finishing, but longer treatment. No occlusal, cephalometric, or demographic variable obtained before treatment was able to give some significant prediction about treatment time in Class III patients.

Combination of expansion and orthognathic surgery in a severe hyperdivergent skeletal Class III malocclusion

Class III malocclusions with a severe hyperdivergent growth pattern are very complex to plan and treat. This case report describes the treatment of an adult with a skeletal Class III malocclusion with a midface deficiency, severe bilateral posterior crossbite, and a severe hyperdivergent growth pattern by a combination of a bonded rapid maxillary expansion appliance and surgical procedure of Le Fort I osteotomy for maxillary advancement.

Two-Step Extraction of the Lower First Molar for Class III Treatment in Adult Patient

The aim of this article is to describe a case report of Class III malocclusion treatment with lower first molar extraction. The 27-year-old Caucasian male patient presented a symmetric face with a straight profile, hyperdivergent growth pattern, molar and cuspid Class III relation, and an anterior crossbite as well as a mild crowding on cuspids area, in both upper and lower arches and a tendency to posterior crossbite. The treatment was performed by the use of Haas expansion appliance followed by an initial alignment and leveling of the upper and lower arches with a fixed edgewise appliance, extraction of lower teeth aiming the correction of the incisors proclination and end the treatment with a Class I molar relationship. It resulted in a significant change in the patient's profile, dentoalveolar Class III correction, upper arch expansion, leveling and alignment of the upper and lower arches, and improvement of tipping of the upper and lowers incisors. In cases of a dentoalveolar compensation in well positioned bone bases the treatment with fixed appliances is an alternative and extraction of lower teeth is considered.

Treatment effects of mandibular total arch distalization using a ramal plate

OBJECTIVE

The purpose of this study was to evaluate treatment effects after distalization of the mandibular dentition using ramal plates through lateral cephalograms.

METHODS

Pre- and post-treatment lateral cephalograms and dental casts of 22 adult patients (11 males and 11 females; mean age, 23.9 ± 5.52 years) who received ramal plates for mandibular molar distalization were analyzed. The treatment effects and amount of distalization of the mandibular molars were calculated and tested for statistical significance. The significance level was set at p < 0.001.

RESULTS

The mandibular first molar distalization at the crown and root were 2.10 mm (p < 0.001) and 0.81 mm (p = 0.011), respectively. In the evaluation of skeletal variables, there was a significant increase in the Wits appraisal (p < 0.001). In the evaluation of the soft tissue, there was no significant effect on upper lip position, but the lower lips showed a significant retraction of 2.2 mm (p < 0.001).

CONCLUSIONS

The mandibular molars showed a significant amount of distalization accompanied by limited extrusion and mesiobuccal rotation of the crowns. A ramal plate may be a viable device for mandibular total arch distalization in Class III patients who are reluctant to undergo orthognathic surgery.

Class III malocclusion treated with distalization of the mandibular dentition with miniscrew anchorage: A 2-year follow-up

This case report describes the orthodontic camouflage treatment for a 16-year-old Chinese girl with a Class III malocclusion. The treatment included extractions of the mandibular second molars, fixed appliance therapy, and miniscrew-aided mandibular arch distalization. Pretreatment, posttreatment, and 2-year follow-up records are shown. The anterior negative overjet and the Class III molar and canine relationships were corrected. The patient's facial profile was greatly improved. The mandibular third molars erupted into the second molar spaces, with acceptable intercuspation with the maxillary dentition.

Compensation of skeletal Class III malocclusion by isolated extraction of mandibular teeth: Part 2: Skeletal, dentoalveolar and soft tissue parameters in comparison with nonextraction Class III therapies

OBJECTIVES

To retrospectively compare two compensatory approaches taken in skeletal Class III patients during the main treatment stage, including a study group of multiband treatment plus isolated extraction of mandibular teeth and a control group of multiband treatment without extraction of teeth.

PATIENTS AND METHODS

The extraction group included 22 (12 female, 10 male) patients receiving compensatory multiband treatment for a mean of 3.47 ± 1.14 years and 16.22 ± 1.92 years old at debonding. The nonextraction group included 24 (14 female, 10 male) patients undergoing multiband treatment for 2.76 ± 1.28 years and 15.38 ± 1.46 years old at debonding. Lateral cephalograms obtained at baseline and upon completion of active treatment were traced for skeletal, dentoalveolar, and soft tissue parameters. Welch and Wilcoxon tests were used to analyze intergroup differences (initial values, final values, initial-to-final changes) and within-group differences (p < 0.05).

RESULTS

Upon completion of active treatment, the only significant intergroup differences were noted for U1NA and L1ML. Significant within-group changes over the courses of treatment were seen for SNB, MLNL, U1NA, U1NL, L1NB, L1ML, H-angle, ULipEL, and LLipEL (extraction group) or for SNB, ANB, individual ANB, Wits appraisal, U1NA, U1NL, H-angle, Naslab-a, ULipEL, and LLipEL (nonextraction group). Parameters that changed by significantly different amounts in both groups included Wits appraisal, L1NB, L1ML, and LLipEL.

CONCLUSION

The added value of isolated extraction therapy basically lies in increasing the potential for retruding the lower incisor inclinations, so that compensatory treatment becomes an option even in selected patients presenting with adverse occlusal situations that would otherwise require orthognathic surgery. Given the successful outcomes in both groups, which had been established by Peer Assessment Rating (PAR) scores, it was possible to define the skeletal, dentoalveolar, and soft tissue characteristics of successful treatment more precisely than before.

Dental compensation for skeletal Class III malocclusion by isolated extraction of mandibular teeth. Part 1: Occlusal situation 12 years after completion of active treatment

OBJECTIVES

The purpose of this work was to statistically evaluate the outcomes achieved by isolated extraction of mandibular teeth (second premolars or first molars) for Class III compensation.

MATERIALS AND METHODS

Part A of the study dealt with the quality of outcomes at the end of active treatment, using weighted Peer Assessment Rating (PAR) scores determined on the basis of casts for 25 (14 female and 11 male) consecutive patients aged 16 ± 1.7 years at the time of debonding. These results were compared to the scores in a randomly selected control group of 25 (14 female and 11 male) patients who were 14.7 ± 1.9 years old at debonding. Part B evaluated the long-term stability of the outcomes based on 12 (all of them female) patients available for examination after a mean of 11.8 years. The mean weighted PAR scores obtained in both study parts were analyzed for statistical differences using a two-tailed paired Student's t-test at a significance level of p ≤ 0.05.

RESULTS

Mean weighted PAR scores of 4.76 ± 3.94 and 3.92 ± 3.44 were obtained in the Class III extraction group and the control group, respectively, at the end of active treatment. This difference was not significant (p = 0.49). Among the 12 longitudinal patients, the mean score increased from 4 ± 3.46 at debonding to 6.25 ± 3.67 by the end of the 11.8-year follow-up period. This difference was significant (p = 0.0008).

CONCLUSION

Treatment of Class III anomalies by isolated extraction of lower premolars or molars can yield PAR scores similar to those achieved by standard therapies. These scores, while increasing significantly, remained at a clinically acceptable level over 11.8 years. Hence this treatment modality--intended for cases that border on requiring orthognathic surgery--may also be recommended from a long-term point of view.

Camouflage treatment of skeletal class III malocclusion with asymmetry using a bone-borne rapid maxillary expander

This case report presents the successful use of palatal mini-implants for rapid maxillary expansion and mandibular distalization in a skeletal Class III malocclusion. The patient was a 13-year-old girl with the chief complaint of facial asymmetry and a protruded chin. Camouflage orthodontic treatment was chosen, acknowledging the possibility of need for orthognathic surgery after completion of her growth. A bone-borne rapid expander (BBRME) was used to correct the transverse discrepancy and was then used as indirect anchorage for distalization of the lower dentition with Class III elastics. As a result, a Class I occlusion with favorable inclination of the upper teeth was achieved without any adverse effects. The total treatment period was 25 months. Therefore, BBRME can be considered an alternative treatment in skeletal Class III malocclusion.

Orthodontic decompensation and correction of skeletal Class III malocclusion with gradual dentoalveolar remodeling in a growing patient

An 8-year-old girl with a skeletal Class III malocclusion was treated in 2 phases. Maxillary expansion and protraction were carried out as the early intervention. However, her maxillary hypoplasia and mandibular hyperplasia deteriorated with age. The phase 2 comprehensive treatment began with proper mechanics when she was 12 years old with growth potential. In the maxillary arch, an auxiliary rectangular wire was used with a round main wire and an opening spring to create space for the impacted teeth and to bodily move the anterior teeth forward. Decompensation of mandibular incisors and correction of the Class III malocclusion were achieved by short Class III elastics with light forces and a gentle interaction between the rectangular wires and the lingual root-torque slots. The phase 2 active treatment period was 4 years 8 months. The 2-year follow-up indicated that our treatment results were quite stable.

Interdisciplinary management of an adult patient with a class III malocclusion

The coexistence of a skeletal class III deformity and partial edentulism poses a clinical challenge and requires a comprehensive evaluation followed by a multidisciplinary approach. This clinical report presents the integrated management of a class III malocclusion in a 50-year-old woman with partial edentulism. The patient received adjunctive orthodontic treatment with a rigid temporary anchorage device, a Le Fort I maxillary osteotomy, and prosthodontic rehabilitation with removable maxillary copings, an overdenture, and a mandibular partial removable dental prosthesis with precision attachments.

Angle Class III malocclusion treated with mandibular first molar extractions

A Class III malocclusion associated with dental asymmetry is a complex diagnostic and treatment problem in orthodontics. The goals of maintaining or improving the facial profile and achieving good function are decisive factors when considering whether to plan a surgical or a nonsurgical treatment approach. A fixed appliance in combination with extractions could be considered for nonsurgical management of this type of malocclusion in the permanent dentition. This article presents the results of an orthodontic approach to a Class III subdivision malocclusion in an adult treated with mandibular first molar extractions. The extractions provided the space needed to correct the overjet and overbite and to improve the intercuspation.

Orthodontic-prosthetic treatment of an adult with a severe Class III malocclusion

This case report describes the treatment of a 37-year-old woman with multiple restored and missing teeth, a Class III subdivision malocclusion, and complete dental crossbite. Treatment options included orthognathic surgery and an orthodontic-prosthetic approach. The patient opted for nonsurgical treatment with space opening for prosthetic replacement of the first maxillary molars.

Maxillary protraction after surgically assisted maxillary expansion

This case report describes the orthodontic treatment of a 32-year-old woman with a Class III malocclusion, whose chief compliant was her dentofacial esthetics. The pretreatment lateral cephalometric tracings showed the presence of a Class III dentoskeletal malocclusion with components of maxillary deficiency. After discussion with the patient, the treatment option included surgically assisted rapid maxillary expansion (SARME) followed by orthopedic protraction (Sky Hook) and Class III elastics. Patient compliance was excellent and satisfactory dentofacial esthetics was achieved after treatment completion.

Class III subdivision malocclusion corrected with asymmetric intermaxillary elastics

Correcting a Class III subdivision malocclusion is usually a challenge for an orthodontist, especially if the patient's profile does not allow for any extractions. One treatment option is to use asymmetric intermaxillary elastics to correct the unilateral anteroposterior discrepancy. However, the success of this method depends on the individual response of each patient and his or her compliance in using the elastics. The objectives of this article were to present a successful treatment of a Class III subdivision patient with this approach and to illustrate and discuss the dentoskeletal changes that contributed to the correction.

Orthognathic treatment for a patient with Class III malocclusion and surgically restricted mandible

This case report describes the orthodontic-surgical treatment of an adult with Down syndrome and a Class III skeletal malocclusion with posterior open bite, horizontal facial pattern, missing mandibular posterior teeth, and surgical restriction of the mandible.

Segmental LeFort I osteotomy for treatment of a Class III malocclusion with temporomandibular disorder

This article reports the case of a 19-year-old young man with Class III malocclusion and posterior crossbite with concerns about temporomandibular disorder (TMD), esthetics and functional problems. Surgical-orthodontic treatment was carried out by decompensation of the mandibular incisors and segmentation of the maxilla in 4 pieces, which allowed expansion and advancement. Remission of the signs and symptoms occurred after surgical-orthodontic intervention. The maxillary dental arch presented normal transverse dimension. Satisfactory static and functional occlusion and esthetic results were achieved and remained stable. Three years after the surgical-orthodontic treatment, no TMD sign or symptom was observed and the occlusal results had not changed. When vertical or horizontal movements of the maxilla in the presence of moderate maxillary constriction are necessary, segmental LeFort I osteotomy can be an important part of treatment planning.