Treatment of Class III malocclusion: the key role of the occlusal plane

SUMMARY Class III malocclusion is orthodontic anomaly where mandibular arch is in mesial position to maxillary arch. Reasons for Class III malocclusion can be found in mandibular prognathism, maxillar retrognathism or combination of these two. In most cases of mandibular prognathism, it is necessary to postpone the treatment until the growth ceases. However, if certain conditions are accomplished it is possible to start early treatment of class III malocclusion to improve occlusal relations and provide more favorable environment for future growth. The aim of this study was to present treatment of two patients with Class III maloclussion in early mixed dentition, using two different appliances: Delaire mask and Frankel functional regulator type 3. The treatment with Delaire mask resulted in rotation of maxilla downward and forward due to the angle of extraoral part of the mask to the occlusal plane that was modified to be almost 45°. At the end of the treatment facial esthetics was significantly improved. Moving maxilla forward resulted in straight profile, whereas moving maxilla downward lead to coordination of upper, middle and lower facial third. The result of the treatment in patient who used Frankel functional regulator was correction of anterior crossbite by premaxilla development and incisors protrusion. Significant differences in SNA, SNB and ANB angle values at the beginning and at the end of the treatment were not found suggesting that most changes were dental but not skeletal

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Nonsurgical treatment of a hyperdivergent skeletal Class III patient with mini-screw–assisted mandibular dentition distalization and flattening of the occlusal plane

The Angle Orthodontist ◽

10.2319/040521-272.1 ◽

2021 ◽

Author(s):

Yiruo He ◽

Yangyang Wang ◽

Xinghai Wang ◽

Jiangyue Wang ◽

Ding Bai ◽

...

Keyword(s):

Treatment Plan ◽

Open Bite ◽

Nonsurgical Treatment ◽

Occlusal Plane ◽

Class Iii ◽

Class Iii Malocclusion ◽

Anterior Open Bite ◽

Skeletal Class ◽

Posterior Crossbite ◽

Mandibular Plane

ABSTRACT Treatment of hyperdivergent skeletal Class III malocclusion is challenging for orthodontists, and orthognathic-orthodontic treatment is usually required. This report presents the successful nonsurgical treatment of a 20-year-old man who had a skeletal Class III malocclusion with anterior open bite, anterior and posterior crossbite, hyperdivergent growth pattern, steep occlusal plane, early loss of three first molars, and an uncommon convex profile with a retruded chin. An orthodontic camouflage treatment plan was chosen based on the etiology and the patient's complaints. Tooth #37 was extracted. Miniscrews were used for uprighting and intruding of the lower molars, distalization of the lower dentition, and flattening of the occlusal plane. After 34 months of active treatment, Class I relationships, proper anterior overjet and overbite, flat occlusal plane, and an esthetic facial profile were achieved. The results demonstrated that the biomechanics involved in the nonsurgical treatment assisted with miniscrews to distalize the mandibular dentition and flatten the occlusal plane while keeping the mandibular plane stable was effective for treating this hyperdivergent skeletal Class III patient with a convex profile and anterior open bite.

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Multiloop Edgewise Arch-wire Technique for Skeletal Class III Openbite: A Case Report

Orthodontic Journal of Nepal ◽

10.3126/ojn.v7i2.20169 ◽

2018 ◽

Vol 7 (2) ◽

pp. 56-59

Author(s):

Dharma Laxmi Basukala

Keyword(s):

Case Report ◽

Morphological Characteristics ◽

Open Bite ◽

Occlusal Plane ◽

Fourth Quadrant ◽

Third Molars ◽

Class Iii ◽

High Angle ◽

Class Iii Malocclusion ◽

Skeletal Class

Skeletal Class III with openbite is one of the most difficult malocclusion to treat orthodontically. Generally, the morphological characteristics of this malocclusion are poor antero-posterior growth of the maxilla or excessive growth of the mandible with high angle. An 18-year-old male had Class III malocclusion with retrognathic maxilla and normal mandible with high angle. All third molars except on fourth quadrant were extracted to eliminate the posterior crowding. Multiloop Edgewise Arch-wire (MEAW) technique was used to upright the mesially inclined buccal teeth and to correct occlusal plane. In nine month time, anterior cross bite and open bite were corrected; normal overjet, overbite and Class I canine relation were achieved.

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Anterior Cranial Base Morphology in Mice with Midfacial Retrusion

The Cleft Palate-Craniofacial Journal ◽

10.1597/1545-1569_1994_031_0417_acbmim_2.3.co_2 ◽

1994 ◽

Vol 31 (6) ◽

pp. 417-428 ◽

Cited By ~ 10

Author(s):

Scott Lozanoff ◽

Stefan Jureczek ◽

Tracey Feng ◽

Raj Padwal

Keyword(s):

Cranial Base ◽

Procrustes Analysis ◽

Posterior Region ◽

Mouse Mutant ◽

Class Iii ◽

Class Iii Malocclusion ◽

Size Change ◽

Element Analysis ◽

Anterior Cranial Base

The role of the anterior cranial base in the morphogenesis of class III malocclusions remains uncertain. This study was conducted to determine whether morphologic deficiencies occur in the anterior cranial base in the Brachyrrhine (Br) mouse mutant showing severe midfacial retrusion, which is characteristic of a class III malocclusion. Crania from three groups of C3H/Hej, 3H1 Br/+, and 3H1+/+ mice, each consisting of 15 animals, were collected at 1, 3, and 5 days of age (total = 135). The anterior cranial base from each specimen was subjected to computerized reconstruction and ten landmarks were digitized from each model. The landmark configurations were compared using Procrustes analysis. Significant differences between models were determined at each age. In order to localize differences between forms, average landmark configurations derived from Procrustes analysis were subjected to finite-element analysis. Size-change values for the 3H1 Br/+ animals showed magnitudes that increased in an anteroposterior direction when compared to the 3H1 +/+ and C3H/Hej animals at all ages. The largest values were located posteriorly along the ossifying front of the presphenoid. In five of six comparisons, the size-change values separated into two distinct clusters. The posterior region of the anterior cranial base was divisible into two subclusters, one located superiorly and the other interiorly. These data suggest that midfacial retrusion in the Br mouse may be caused, in part, by growth deficiencies in the posterior region of the anterior cranial base, particularly the presphenoidal and sphenoethmoidal regions.

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Need for treatment in all skeletal class III cases – A dilemma ? A case report.

International Journal of Dental Research ◽

10.14419/ijdr.v5i2.8199 ◽

2017 ◽

Vol 5 (2) ◽

pp. 177

Author(s):

Monika Mahajan

Keyword(s):

Case Report ◽

Treatment Planning ◽

Significant Role ◽

Diagnosis And Treatment ◽

Facial Morphology ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class ◽

Need For Treatment

AbstractSkeletal malocclusion affects dental and facial tissues. A complicating factor for diagnosis and treatment of skeletal class III malocclusion is its multifactorial etiology. Genetics play an important role in determining the facial morphology of an individual. Prediction of a skeletal class III based on morphology can play an important step in orthodontic diagnosis and treatment planning. This case report further supports the significant role of genetics in skeletal class III malocclusion. As seen in our case the skeletal class III if left untreated does not detiorate but rather shows a decrease in ANB ie anterioposterior discrepancy. Hence the need for treatment should be analysed thoroughly in skeletal class III patients.

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The Occlusal Plane Inclination Analysis for Determining Skeletal Class III Malocclusion Diagnosis

Clinical Cosmetic and Investigational Dentistry ◽

10.2147/ccide.s248983 ◽

2020 ◽

Vol Volume 12 ◽

pp. 163-171 ◽

Cited By ~ 1

Author(s):

I Gusti Aju Wahju Ardani ◽

Ageng Wicaksono ◽

Thalca Hamid

Keyword(s):

Occlusal Plane ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class

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Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion

Case Reports in Dentistry ◽

10.1155/2020/8854588 ◽

2020 ◽

Vol 2020 ◽

pp. 1-12

Author(s):

Manuel Gustavo Chávez Sevillano ◽

Gina Judith Flores Diaz ◽

Luciane Macedo de Menezes ◽

Livia Kelly Ferraz Nunes ◽

José Augusto Mendes Miguel ◽

...

Keyword(s):

Treatment Option ◽

Orthodontic Treatment ◽

Vertical Dimension ◽

Posterior Region ◽

Occlusal Plane ◽

Class Iii ◽

Class Iii Malocclusion ◽

Effective Treatment Option ◽

Skeletal Class ◽

Dental Compensation

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

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Orthosurgical Management of Class III Malocclusion Emphasizing the Pivotal Role of CBCT

The Journal of Indian Orthodontic Society ◽

10.1177/0301574219888056 ◽

2020 ◽

Vol 54 (1) ◽

pp. 69-76

Author(s):

Gaurav Pratap Singh ◽

Karan Nehra ◽

Rajat Mitra ◽

Oonit Nakra ◽

Abhishek Singla

Keyword(s):

Computed Tomography ◽

Cone Beam Computed Tomography ◽

Root Resorption ◽

Cone Beam ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class ◽

Arduous Task ◽

Recent Innovation

Management of skeletal class III malocclusions in a nongrowing individual remains a challenging and arduous task for the orthodontist. The skeletal class III malocclusion is often not amenable to camouflage procedures and requires a surgical correction of the underlying skeletal bases to achieve esthetic and functional treatment results. These patients often require one or more extractions to remove the preexisting dentoalveolar compensations prior to the surgical procedure which is undertaken as part of presurgical orthodontics. Postsurgical orthodontics is often of limited duration and is concerned with the settling of occlusion and obtaining tight cuspal interdigitation. Cone-beam computed tomography is a recent innovation which has revolutionized imaging in dentistry. Within orthodontics, it has proven to be of great value in orthosurgical planning and evaluation of posttreatment results including root parallelism and root resorption. This case report describes orthosurgical management of class III malocclusion utilizing cone-beam computed tomography in treatment planning.

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