Surgical treatment of dental and skeletal Class III malocclusion

Orthodontic preparation for surgical treatment of skeletal Class III malocclusion involves joint planning with an oral and maxillofacial surgeon to address the functional and esthetic needs of the patient. In order to allow surgical manipulation of the jaws in the preoperative phase, the need to achieve a negative overjet through incisor decompensation often leads the orthodontist to extract the upper first premolars. This report illustrates an orthodontic preparation case where due to specific factors inherent in the patient's psychological makeup retroclination of the upper incisors and proclination of the mandibular incisors was achieved without removing any teeth. This case was presented to the Brazilian Board of Orthodontics and Facial Orthopedics (BBO) in partial fulfillment of the requirements for obtaining the BBO Diploma.

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

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105381 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5381

Author(s):

Vo Truong Nhu Ngoc ◽

Nguyen Thi Thu Phuong ◽

Nguyen Viet Anh

Keyword(s):

Case Report ◽

Open Bite ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class ◽

Facial Esthetics ◽

Lingual Appliance ◽

Lower Incisors ◽

Mandibular Incisors ◽

Molar Extraction

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.

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Non-surgical treatment of skeletal class III malocclusion

BMJ Case Reports ◽

10.1136/bcr-2013-202326 ◽

2014 ◽

Vol 2014 (apr10 1) ◽

pp. bcr2013202326-bcr2013202326

Author(s):

R. M. Kapadia ◽

A. P. Shah ◽

S. D. Diyora ◽

V. J. Rathva

Keyword(s):

Surgical Treatment ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class ◽

Non Surgical Treatment

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Combined Orthodontic-surgical Treatment for Skeletal Class III Malocclusion with Multiple Impacted Permanent and Supernumerary Teeth: Case Report

The Open Dentistry Journal ◽

10.2174/1874210601408010043 ◽

2014 ◽

Vol 8 (1) ◽

pp. 43-48

Author(s):

Dai Juan and Feng Xue

Keyword(s):

Surgical Treatment ◽

Primary Teeth ◽

Treatment Protocol ◽

Deciduous Teeth ◽

Class Iii ◽

Class Iii Malocclusion ◽

Supernumerary Teeth ◽

Sagittal Split Ramus Osteotomy ◽

Impacted Teeth ◽

Skeletal Class

In this report we describe a combined orthodontic and surgical treatment for a 14-year-old boy with severe skeletal class III deformity and dental problem. His upper posterior primary teeth in the left side were over-retained and 6 maxillary teeth (bilateral central incisors and canines, left first and second premolars) were impacted, together with 5 supernumerary teeth in both arches. The treatment protocol involved extraction of all the supernumerary and deciduous teeth, surgical exposure and orthodontic traction of the impacted teeth, a bimaxillary orthognathic approach including Lefort I osteotomy. Bilateral sagittal split ramus osteotomy (BSSRO) and genioplasty was performed to correct skeletal problem. After treatment, all of the impacted teeth were brought to proper alignment in the maxillary arch. A satisfied profile and good posterior occlusion was achieved. Treatment mechanics and consideration during different stages are discussed.

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Combined Orthodontic and Surgical Treatment of Skeletal Class III Malocclusion: A Case Report

Dental and Medical Problems ◽

10.17219/dmp/63536 ◽

2016 ◽

Vol 53 (3) ◽

pp. 424-429

Author(s):

Patrycja Downarowicz ◽

Beata Kawala ◽

Rafał Nowak

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class

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Effects of Presurgical Mandibular Incisor Decompensation on Long-Term Outcomes of Class III Surgical Orthodontic Treatment

Journal of Clinical Medicine ◽

10.3390/jcm10132870 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2870

Author(s):

Jung-Sub An ◽

Wonchae Jeong ◽

Liselotte Sonnesen ◽

Seung-Hak Baek ◽

Sug-Joon Ahn

Keyword(s):

Orthodontic Treatment ◽

Group Differences ◽

Class Iii ◽

Class Iii Malocclusion ◽

Long Term Outcomes ◽

Mandibular Incisor ◽

Skeletal Class ◽

Lateral Cephalograms ◽

Mandibular Incisors

This research aimed to evaluate the effects of presurgical mandibular incisor decompensation on long-term outcomes of Class III surgical orthodontic treatment. Thirty-five patients with skeletal Class III malocclusion who received conventional surgical orthodontic treatment were included. Mandibular incisor brackets with −6° of inclination were placed normally in 18 patients (NB group) and inversely in 17 patients (RB group). Between-group differences and relationships between incisal and skeletal variables were analyzed based on lateral cephalograms at pretreatment, presurgery, postsurgery, posttreatment, and retention. Mandibular incisors were more labially inclined in the RB group than in the NB group from presurgery to retention. No significant between-group differences were observed in presurgical and postsurgical skeletal relationships. The NB group exhibited a larger overjet with deficient interincisal contact at postsurgery than the RB group. Skeletal Class III relationship was also more severe in the NB group at retention. More lingually inclined mandibular incisors at presurgery and larger overjet at postsurgery were correlated with a more severe skeletal Class III relationship at retention. Thus, establishing appropriate postsurgical overjet by sufficient presurgical mandibular incisor decompensation may play a significant role in postsurgical stability of Class III surgical orthodontic treatment.

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Correlation between periodontal soft tissue and hard tissue surrounding incisors in skeletal Class III patients

The Angle Orthodontist ◽

10.2319/060117-367.1 ◽

2017 ◽

Vol 88 (1) ◽

pp. 91-99 ◽

Cited By ~ 4

Author(s):

Jeong-Ho Park ◽

Ji-Yeon Hong ◽

Hyo-Won Ahn ◽

Su-Jung Kim

Keyword(s):

Soft Tissue ◽

Plate Thickness ◽

Class Iii ◽

Class Iii Malocclusion ◽

Hard Tissue ◽

Skeletal Class ◽

Anterior Teeth ◽

Tissue Factors ◽

Gingival Biotype ◽

Mandibular Incisors

ABSTRACT Objectives: To investigate the association between the periodontal soft tissue, alveolar bone and dental parameters surrounding the incisors at baseline in patients with skeletal Class III malocclusion. Materials and Methods: The study sample comprised 154 teeth from 28 patients with skeletal Class III malocclusion (19 men and 9 women, 21.15 ± 4.02 years). Periodontal soft tissue examination and hard tissue measurements with cone-beam computed tomography (CBCT) were performed. Factor analysis was used to reduce the CBCT variables, and correlation analysis between the hard tissue factors and soft tissue parameters was performed. Differences in hard tissue parameters between thick and thin gingival types were evaluated. Results: CBCT measurements were reduced to three hard tissue factors: lingual plate, coronal-buccal plate, and apical-buccal plate. Keratinized gingiva width and thickness were positively correlated with the coronal-buccal plate factor and negatively correlated with the apical-buccal plate factor. In the thin gingival biotype, mandibular incisors were more proclined, and the apical part of the buccal alveolar plate and the coronal part of lingual alveolar plate were thicker than in the thick gingival biotype. Conclusions: In the anterior teeth in cases of skeletal Class III malocclusion, hard tissue structures on the buccal side can be grouped based on coronal and apical factors that are significantly correlated with keratinized gingival width and thickness. Thick and thin gingival biotypes exhibited differences in tooth inclination and alveolar plate thickness with regard to the mandibular incisors.

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Alveolar Bone Loss around Incisors in Surgical Skeletal Class III Patients

The Angle Orthodontist ◽

10.2319/070308-341.1 ◽

2009 ◽

Vol 79 (4) ◽

pp. 676-682 ◽

Cited By ~ 61

Author(s):

Yoonji Kim ◽

Je Uk Park ◽

Yoon-Ah Kook

Keyword(s):

Bone Loss ◽

Orthognathic Surgery ◽

Alveolar Bone ◽

Alveolar Bone Loss ◽

Class Iii ◽

Class Iii Malocclusion ◽

Bone Thickness ◽

Skeletal Class ◽

Lingual Side ◽

Mandibular Incisors

Abstract Objective: To test the hypothesis that there is no difference in the vertical alveolar bone levels and alveolar bone thickness around the maxillary and mandibular central incisors in surgically treated skeletal Class III malocclusion patients. Materials and Methods: The study sample comprised 20 Korean patients with skeletal Class III malocclusion with anterior crossbite and openbite (9 male, 11 female, mean ages 24.1). Three-dimensional cone beam computed tomography images were taken at least 1 month before the orthognathic surgery, and sagittal slices chosen at the labio-lingually widest point of the maxillary and mandibular right central incisor were evaluated. Measurement of the amount of vertical alveolar bone levels and alveolar bone thickness of the labial and lingual plate at the root apex was made using the SimPlant Pro 12.0 program. Results: The mandibular incisors showed reduced vertical alveolar bone levels than the maxillary incisors, especially on the lingual side. The alveolar bone thickness was significantly greater on the lingual side in the maxillary incisors, whereas the mandibular incisors exhibited an opposite result (P < .05). The percentage of vertical bone loss to root length showed a statistically significant difference between the upper labial and lower labial alveolar bone and also between the upper lingual and lower lingual alveolar bone, showing more bone loss in the lower incisors (P < .001). Conclusions: The hypothesis is rejected. For the skeletal Class III patients undergoing orthognathic surgery, special care should be taken to prevent or not aggravate preexisting alveolar bone loss in the anterior teeth, especially in the mandible.

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Long-term dental stability after orthognathic surgery: a systematic review

European Journal of Orthodontics ◽

10.1093/ejo/cjaa022 ◽

2020 ◽

Author(s):

Delphine Mulier ◽

Lesly Gaitán Romero ◽

Alberto Führer ◽

Catalina Martin ◽

Sohaib Shujaat ◽

...

Keyword(s):

Systematic Review ◽

Surgical Treatment ◽

Class Ii ◽

Current Evidence ◽

Class Iii ◽

Skeletal Class ◽

Long Term Follow Up ◽

Mandibular Incisors

Summary Background Long-term dental stability is one of the main objectives following combined orthodontic and orthognathic surgical treatment. It is influenced by multiple factors such as surgical, patient-related, and orthodontic aspects. While recent reviews mainly focus on short-term dental changes (0.5–2 years), longer follow-up dental stability remains hardly reviewed. Objectives The aim of this study was to evaluate long-term stability of dental and dentolabial changes following combined orthodontic and orthognathic surgical treatment with a minimum follow-up period of 5 years. Search methods A systematic search was conducted up to December 2019 using Pubmed, Embase, Web of Science, and Cochrane Central. Selection criteria Randomized controlled trials (RCTs), prospective and retrospective cohort studies, and case series with a minimum of 10 patients, which reported long-term dental stability following combined orthodontic and orthognathic treatment, were included. Data collection and analysis Long-term changes were assessed for overjet, overbite, maxillary, and mandibular incisors’ position and relationship of lip position to maxillary and mandibular incisors. Risk of bias was assessed according to the Cochrane Handbook. Results Following the screening of 3178 articles, 11 studies were included (2 RCT, 9 retrospective) with a postoperative follow-up period ranging from 5 to 15 years. A decrease in overjet was observed for patients with skeletal class III malocclusion, whereas overjet increased in class II patients at long-term follow-up. Overbite increased in class II patients, whereas class III showed variable results. The lower incisor position was more stable vertically than horizontally; the latter showing more outcome variability. Dentolabial changes corresponded to the normal ageing process and results were not clinically significant after long-term follow-up. Conclusion Current evidence suggests variability of dental and dentolabial stability in both skeletal class II and III patients. Further prospective studies are required to develop guidelines for long-term follow-up assessment using computer tomography or cone-beam computed tomography imaging, before final conclusions can be drawn. Registration The protocol for this systematic review (CRD42020133844) was registered in the International Prospective Register of Systematic Reviews (PROSPERO).

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Accuracy of Two Cephalometric Analyses in the Treatment of Patients with Skeletal Class III Malocclusion

Brazilian Dental Journal ◽

10.1590/0103-6440201300360 ◽

2015 ◽

Vol 26 (2) ◽

pp. 186-192 ◽

Cited By ~ 2

Author(s):

João Frank Carvalho Dantas ◽

Sergio Henrique Gonçalves de Carvalho ◽

Luciana Soares de Andrade Freitas Oliveira ◽

Danilo Batista Martins Barbosa ◽

Raphael Freitas de Souza ◽

...

Keyword(s):

Surgical Treatment ◽

Surgical Procedures ◽

Reasonable Agreement ◽

Treatment Plan ◽

Deformity Correction ◽

Clinical Decision ◽

Class Iii ◽

Class Iii Malocclusion ◽

Skeletal Class ◽

Dentofacial Deformity

The aim of the present study was to compare the treatment plan outlined from the diagnosis obtained by two different cephalometric analyses with the clinical decision made for surgical treatment of patients with skeletal Class III malocclusion. For this purpose, 82 skeletal Class III patients were evaluated, divided into three groups according to the surgical procedure performed for dentofacial deformity correction. Their preoperative cephalometric radiographs were submitted to McNamara and Steiner cephalometric analyses. The association of variables was evaluated by Kappa correlation (α=5%). The agreement between indication of surgical procedures performed based on clinical decision and surgical treatment indicated based on the evaluation of McNamara and Steiner cephalometric analyses were not significant (p=0.609 and p=0.544, respectively). McNamara and Steiner analyses showed reasonable agreement with each other as to the diagnosis, but did not agree with the clinical decision to treat skeletal CIII patients. Both tests were equally inaccurate in the indication of the surgical treatment.

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