Orthodontic correction of a class III malocclusion in an adolescent patient with a bonded RPE and protraction face mask

Reverse Forsus vs. facemask/rapid palatal expansion appliances in growing subjects with mild class III malocclusions : A randomized controlled clinical study

PURPOSE

To investigate the skeletal, dental, and soft tissue effects of reverse Forsus (RF; 3M Unitek, Monrovia, CA, USA) and facemask/rapid palatal expansion (FM/RPE) appliances in growing subjects with class III malocclusions.

METHODS

The data of this prospective randomized controlled trial (RCT) were derived from pre- and posttreatment/observation lateral cephalograms of 45 subjects with mild class III malocclusions: group 1 (8 girls, 7 boys; mean age 10.54 years) received a FM/RPE appliance; group 2 (6 girls, 9 boys; mean age 10.49 years) received the RF appliance; and an untreated control group (7 girls, 8 boys; mean age 10.66 years) was matched to the treatment groups with regard to sagittal skeletal and dental classifications. Angular and linear measurements were evaluated using lateral cephalograms. Statistical analyses were performed by one-way analysis of variance, Kolmogorov-Smirnov test, Kruskal-Wallis, paired-samples t‑test, and Wilcoxon test, whereby p < 0.05 was accepted to be statistically significant.

RESULTS

The intermaxillary (ANB), interdental (overjet), and sagittal lip relations in the FM/RPE and RF groups showed significant improvements compared to the control group (p < 0.05). Although the anterior and inferior traction of the maxilla was greater in the FM/RPE group compared to the RF group (p < 0.05), both treatment groups showed similar clockwise rotation of the mandible compared to the control group. While significantly more proclination of maxillary incisors occurred in the RF group compared to the FM/RPE and control groups (p < 0.05), both treatments led to significantly retroclined mandibular incisors compared to the control group (p < 0.001).

CONCLUSION

Both therapies led to intermaxillary and interdental improvements. The RF appliance had a limited effect on the maxilla and it mostly had dentoalveolar effects when compared to FM/RPE therapy.

Treatment of an Adult Skeletal Class III Patient with Surgically Assisted Rapid Palatal Expansion and Facemask

This case report presents the treatment of a 21-year-old male patient with class III skeletal malocclusion, an open bite, and vertical growth pattern. He was managed with surgically assisted rapid palatal expansion (SARPE) along with an orthopedic facemask. The duration of treatment was 16 months. Significant improvement and favourable outcome were observed concerning both facial appearance and paraclinical parameters after completion of treatment.

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.

Management of skeletal Class III malocclusion with unilateral crossbite on a growing patient using facemask-bonded rapid palatal expander and fixed appliances

Facemask (FM) and bonded rapid palatal expander (RPE) are part of growth modification treatments for correcting skeletal Class III pattern with retrognathic maxilla. This orthopaedic treatment is usually preceded by fixed appliances to achieve aesthetic dental alignment and improve interdigitation. This case report reviews treatment of Class III malocclusion with unilateral crossbite in a 12-year-old boy using FM and bonded RPE, followed by fixed appliances. Choice of FM and bonded RPE was in line with indication which was mild Class III malocclusion with retrognathic maxilla. Execution of treatment was made considering treatment biomechanics and patient cooperation. This orthopaedic treatment was followed by orthodontic treatment specifically aimed to correct unilateral crossbite, canine relationship yet to reach Class I, lower midline shift, as well as unintended dental consequences of using bonded RPE, namely posterior open bite and deepening curve of spee. Posttreatment facial profile and smile are more esthetic. Occlusion is significantly improved both functionally and aesthetically.

Sutural Distraction Osteogenesis (SDO) Versus Osteotomy Distraction Osteogenesis (ODO) for Midfacial Advancement: A New Technique and Primary Clinical Report

A new technique of osteotomy distraction osteogenesis (ODO) and sutural distraction osteogenesis (SDO) by the use of bone-borne traction hooks is presented. The technique of osteotomy plus distraction osteogenesis is suitable for adult patients. The technique of sutural distraction osteogenesis is suitable for young patients, ages 6 through 12 years. The distraction system consists of a face-bow, orthodontic elastics, and bone-borne traction hooks. The bone-borne traction hooks are made of titanium, with two traction hooks running laterally or downwardly. When a Le Fort III osteotomy is needed, bone-borne traction hooks are inserted through the nostrils into a bone hole drilled at the lateral-inferior pyriform aperture. When no osteotomy is needed, only the bone-borne traction hooks are placed. Heavy elastics were used in the technique of osteotomy distraction osteogenesis for Le Fort III osteotomy adult patients, whereas light forces and thus light elastics were used for younger patients. Three adult patients and four children were treated by osteotomy distraction and sutural distraction, respectively. All seven patients with midfacial hypoplasia established a harmonious facial profile and normal occlusal relationships. Radiographic examination showed balanced advancement of the midfacial skeleton. It is suggested that the treatment of midfacial hypoplasia in children by the technique of sutural distraction osteogenesis is to be preferred because of its simplicity and relative noninvasiveness. Thus, the authors suggest that midfacial hypoplasia should be treated at a younger age by this technique, potentially eliminating the need for a Le Fort III osteotomy at an older age.

Long-term stability of skeletal Class III patients treated with splints, Class III elastics, and chincup

Long-term results from orthopedic management of skeletal Class III malocclusions are sparse. The purpose of this study was to evaluate the stability of results after facial growth and treatment with splints, Class III elastics, and chincup (SEC III) and to investigate the main determinants of relapse. Data from pretreatment, posttreatment, and long-term (at least 3 years after retention) serial cephalograms of 52 patients who received SEC III treatment were studied: only those with long-term data when growth had ceased (women over 18 and men over 21 years of age) were selected. At the end of the follow-up period (an average of 9 years), only 6 of the 52 patients had clinical relapse (overjet <or= 0). Low Wits appraisal, ANB angle, and overbite, and high SNB angle were the best predictors of relapse at the end of the treatment. Significantly greater decreases of the Wits appraisal and increases of ramus length during the follow-up were further associated with relapse. SEC III is a reliable treatment for skeletal Class III malocclusions. Long-term stability can be enhanced by a deeper overbite and the best possible skeletal correction. The results suggest that the correction occurs with no mandibular rotation but might be better with forward rotation.