Early class III management in deciduous dentition using reverse twin block

John J, M. Hegde A, Usman A. R.M.S. bite corrector: A novel appliance for the correction of mandibular prognathism in growing children-Part one: Skeletal and dental changes

Introduction and Aim: Mandibular prognathism is one of the most challenging conditions in clinical dental practice. No appliance has yet been introduced to manage this strenuous condition. Hence, a modified appliance, R.M.S. (removable acrylic splint) bite corrector was fabricated combining the principles of three conventional appliances. The aim was to evaluate the skeletal and dental changes following R.M.S bite corrector in growing children with mandibular prognathism, using lateral cephalograms.   Materials and Methods: Twenty children between the age group 9 - 13 years, presenting with class III malocclusion with prognathic mandible were selected. R.M.S bite corrector was fabricated, which consist of reverse twin block with RME (Rapid Maxillary Expansion) incorporated in the upper block. Hooks integrated in the molar region of the upper block, and between the lateral incisors and canines in the lower block. A gradual increasing force was delivered by engaging intraoral intermaxillary elastics. After 10 months, skeletal, dental, and dentoalveolar parameters and linear measurements of jaw bases were compared using pre- and post-operative lateral cephalograms.   Results: After 10 months, skeletal changes included a significant retrusion of the mandible and maxillary protraction. Dental changes comprised of an increase in proclination of maxillary and mandibular incisors, which was not significant. A significant increase in the length of the maxillary base, non-significant change in the linear measurements of the mandibular base and ramal length leading to relocation of the mandible in a relatively new position with better esthetics.   Conclusion: Desirable skeletal and dental changes were observed following R.M.S. bite correction.  

M. Effectiveness of Management of Skeletal Class III Malocclusion during Primary, Mixed, and Permanent Dentition Period – A Literature Review

Skeletal class III malocclusion is one of the most challenging conditions in clinical dental practice. Various treatment options are available for the management of the condition such as reverse twin block appliance, facemask appliance, chin cup therapy, bone anchorage maxillary protraction device, and tandem traction bow appliance. However, treatment timing is controversial. There are various advantages and disadvantages following the correction of skeletal class III malocclusion during primary, mixed and permanent dentition period. Hence, this review aims to compile the available literature regarding the effectiveness of correction of skeletal class III malocclusion during primary, mixed, and permanent dentition.

Treatment Modalities for Early Management of Class III Skeletal Malocclusion: A Case Series

The characteristic features of Class III malocclusion are present at an early age, usually between 3 and 5 years of age. If left untreated, the Class III malocclusion or severe anterior crossbite may worsen, with the majority of these patients ultimately requiring orthognathic surgery as adults. The treatment in all developing Class III cases should be undertaken as soon as the abnormality is diagnosed to prevent it from becoming permanent and resulting in a full-blown Class III malocclusion. It provides more pleasing facial esthetics (the lip posture and facial appearance), thus improving the psychosocial development of a child. Various treatment options available for the management of developing Class III malocclusion are as follows: (1) functional appliances such as reverse twin block, Frankel appliance, and the removable mandibular retractor; (2) orthopedic appliances such as chin cap and face mask; and (3) orthodontic appliances, namely removable maxillary expansion plate or fixed orthodontic appliance with expanded upper arch wire. A treatment plan may be chosen depending on the amount of maxillary growth restriction, mandibular plane angle, the soft-tissue profile, and the age of the patient. This article discusses the various treatment options and the decision-making for different clinical cases based on the clinical features with a description of four different treatment approaches.