Long-term stability of a Class III malocclusion with severe anterior open bite and bilateral posterior crossbite in a hyperdivergent patient

Treatment of Open Bite Based on Skeletal Anchorage Using Extrusion Lever Arms and Class III Elastics

A 26-year-old woman had a masticatory dysfunction, straight profile, retrognathic maxilla and mandible, and Angle's class I with a tendency to class III malocclusion on both sides, with bilateral posterior crossbites and a 4 mm anterior open bite. Orthognathic surgery and orthodontic camouflage with and without tooth extraction were considered as treatment options. The patient's preferred method of treatment was orthodontic camouflage without extraction. The transpalatal arch had been placed for the bilateral molars' derotation. After 3 months, the upper segmented fixed appliance was implanted to address the posterior crossbites in the premolar's region. One mini-implant was inserted into the anterior palatum after the transpalatal arch was removed, and a supporting device was attached to the first permanent molars to give indirect skeletal stability. Orthodontic treatment's active phase lasted 23 months, and all treatment objectives were achieved during that time: the desired facial profile, adequate occlusion, appropriate overbite, and overjet.

Skeletal Class III Malocclusion with Lateral Open Bite and Facial Asymmetry Treated with Asymmetric Lower Molar Extraction and Lingual Appliance: A Case Report

A skeletal Class III malocclusion with open bite tendency is considered very difficult to treat orthodontically without surgery. This case report describes the lingual orthodontic treatment of an adult skeletal Class III patient with mandibular deviation to the left side, lateral open bite, unilateral posterior crossbite, zero overbite and negative overjet. The lower incisors were already retroclined to compensate with the skeletal discrepancy. The patient was treated by asymmetric molar extraction in the mandibular arch to retract the lower incisors and correct the dental midline, with the help of intermaxillary elastics. Lingual appliance was used with over-torqued lower anterior teeth’s brackets to control the torque of mandibular incisors. After a 30-month treatment, satisfactory smile and facial esthetics and good occlusion was achieved. A 12-month follow-up confirmed that the outcome was stable. Asymmetric molar extraction could be a viable option to retract mandibular incisors in Class III malocclusion with lower dental midline deviation.