CASE REPORT

Class III malocclusion treated with distalization of

the mandibular dentition with miniscrew
anchorage: A 2-year follow-up
Kun Chena and Yang Caob
ShenZhen, Hong Kong, and Guangzhou, China

This case report describes the orthodontic camouflage treatment for a 16-year-old Chinese girl with a Class III
malocclusion. The treatment included extractions of the mandibular second molars, fixed appliance therapy, and
miniscrew-aided mandibular arch distalization. Pretreatment, posttreatment, and 2-year follow-up records are
shown. The anterior negative overjet and the Class III molar and canine relationships were corrected. The pa-
tient’s facial profile was greatly improved. The mandibular third molars erupted into the second molar spaces,
with acceptable intercuspation with the maxillary dentition. (Am J Orthod Dentofacial Orthop 2015;148:1043-53)

T
he treatment options associated with skeletal Class
III problems in the late adolescent and adult denti-
tion often involve surgical intervention or ortho-
dontic camouflage treatment. A skeletal Class III
malocclusion usually results from mandibular progna-
thism, maxillary deficiency, or a combination of both.1
Surgical intervention can correct the skeletal discrepancy
in the sagittal, vertical, and transverse dimensions.2 In
mild and moderate skeletal Class III cases, camouflage
treatment can reposition the teeth to disguise the skel-
etal discrepancy and obtain better occlusion, function,
and esthetic results.3
In camouflage treatment, an anterior crossbite is cor-
rected by retroclination of the mandibular incisors and
proclination of the maxillary incisors. Usually, the
mandibular premolars are extracted to relieve crowding,
alleviate mandibular incisor protrusion, and correct the
molar relationship.4 Distalization of the mandibular
dentition is an alternative to premolar extraction to cor-
rect a Class III malocclusion.3 Retraction of the lower lip
a
Private practice, ShenZhen, China; part-time clinical lecturer, Faculty of
Dentistry, University of Hong Kong, Hong Kong, China.
b
Associate professor, Department of Orthodontics, Guanghua School of Stoma-
tology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, China.
All authors have completed and submitted the ICMJE Form for Disclosure of Po-
tential Conflicts of Interest, and none were reported.
Supported by the National Natural Science Foundation of China (www.nsfc.gov.
cn) (number 81170990) and Guangdong Provincial Science & Technology Pro-
jects (http://www.gdstc.gov.cn/) (number 2011B090400097).
Address correspondence to: Yang Cao, No. 56 Lingyuanxi Road, Guangzhou,
Guangdong 510060, China; e-mail, caoyang34@163.com.
Submitted, August 2014; revised and accepted, March 2015.
0889-5406/$36.00
Copyright Ó 2015 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2015.03.034
follows the distalization of the mandibular incisors.
Whether the mandibular incisors are tipped back or re-
tracted with bodily movement significantly affects the
morphologic change of the labiomental fold.5
It had been difficult to distalize the mandibular
dentition before the miniscrew was popularly used in or-
thodontics. With the help of a miniscrew inserted in the
retromolar or premolar region, the mandibular dentition
can be successfully distalized to a great extent.6-8
In this case report, miniscrew anchorage was applied
to distalize the mandibular dentition to correct the ante-
rior crossbite, establish a Class I molar relationship, and
correct the concave profile.
DIAGNOSIS
The patient was a 16-year-old Chinese girl with the
chief complaint that her “lower front teeth bite in front
of the upper teeth.” By comparing the lateral cephalo-
metric radiographs taken 1 year before and on the day
of consultation, no further mandibular growth was ex-
pected, and orthodontic treatment was initiated. Her
medical and dental histories were noncontributory.
The pretreatment facial photographs showed a
mandibular prognathic profile with an acceptable mid-
face convexity and high tension in the labiomental
fold. From the front view, no asymmetry was identified.
The intraoral photographs showed Class III canine and
molar relationships and an anterior crossbite at centric
occlusion. Other findings included a deep curve of Spee
in the mandibular arch and mild crowding in both arches.
The mandible was able to move back slightly with the in-
cisors edge to edge at centric relation (Figs 1-3).
1043
1044
Fig 1. Pretreatment extraoral and intraoral photographs.
The panoramic radiograph showed a permanent
dentition with the maxillary left third molar and mandib-
ular third molars in the forming stage. The mandibular
third molars were slightly mesially inclined. The cephalo-
metric analysis showed a skeletal Class III relationship
with mandibular prognathism and a slightly decreased
mandibular plane angle. The maxillary incisor positions
and proclinations were in the normal range in relation
to the maxillary palatal plane. The mandibular incisor
was slightly retroclined; therefore, the interincisal angle
was slightly increased. (Fig 4; Table). The patient was
diagnosed with an Angle Class III malocclusion with
mild crowding on a Class III skeletal base with mandib-
ular prognathism in the anteroposterior dimension.
TREATMENT OBJECTIVES
The orthodontic treatment aimed to correct the dental
crowding, the anterior crossbite, the Class III canine and
December 2015  Vol 148  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Chen and Cao
molar relationships, and the prognathic profile. Retrac-
tion of the mandibular incisors would help to form a
relaxed labiomental fold and correct the concave profile.
TREATMENT ALTERNATIVES
Several treatment options were proposed to the pa-
tient. First, orthognathic surgery was suggested to set
back the mandible; this would lead to a harmonized pro-
file. However, the patient refused the surgical plan for
financial reasons and the potential risk.
The second option was orthodontic camouflage
treatment with extraction of the premolars. This plan
could easily resolve the anterior crossbite, but the
mandibular incisors would be tipped back even worse
after closing the extraction spaces.9 With the incisors
tipped back, the high tension in the labiomental fold
would not be improved. Alternatively, orthodontic cam-
ouflage treatment can be carried out with extraction of
Chen and Cao 1045

Fig 2. Pretreatment dental casts.

Fig 3. Pretreatment occlusion at centric relation.

mandibular molars, usually the third molars. Then the
mandibular arch could be distalized with miniscrews to
correct the anterior crossbite. In this patient, the
mandibular third molars were deeply impacted and close
to the inferior alveolar nerve; it would be difficult to sur-
gically remove them. Instead of the third molars, the
mandibular second molars could be extracted if the third
molars could substitute for the second molars in the long
term. The panoramic radiograph showed that the
mandibular third molars were forming and slightly
mesially inclined. They would possibly erupt into the
second molars’ former positions after extraction of
the second molars.10 After discussing this option with
the patient, camouflage treatment with extraction of
the mandibular second molars was adopted, and consent
was obtained from the patient.
Therefore, the treatment plan involved resolving the
dental crowding in the maxillary arch by slightly proclin-
ing the incisors. In the mandibular arch, the predicted
amount of distalization was over 4 mm on both sides.

American Journal of Orthodontics and Dentofacial Orthopedics December 2015  Vol 148  Issue 6
1046 Chen and Cao

Fig 4. Pretreatment panoramic radiograph, cephalogram, and tracing.

This would help to resolve the crowding, level the curve

Table. Cephalometric measurements of Spee, and correct the anterior crossbite.
Pretreatment Posttreatment Norm
Sagittal TREATMENT PROGRESS
SNA ( ) 85 85 85 6 3.5 After extraction of the mandibular second molars,
SNB ( ) 87 85.9 79 6 3.0
ANB ( ) 2.0 0.9 3 6 2.0
both arches were bonded and aligned with sequential
Wits (mm) 9.7 6.5 4.5 6 3.0 nickel-titanium wires. Class III elastics (1/4 in, 3.5-oz;
Vertical Ormco, Orange, Calif) were used for a month on an
Mandibular plane 23.2 25.5 26.0 6 4.5 0.018-in Australian wire. A miniscrew implant (Orlus
angle ( ) 1O16108, 1.6 3 8 mm; Ortholution, Gyeonggi-do, Ko-
N-ANS (mm) 52.9 53 54
ANS-Me (mm) 59.7 62.3 64
rea) was inserted in the mandibular buccal shelf region
LFH (%) 53.02 54.03 55 distal to the first molar on each side under local anes-
Dental thesia. A nickel-titanium coil spring was applied from
U1-MxP ( ) 118.6 122.8 118 6 6.0 the miniscrew to distalize the mandibular arch en masse
L1-MnP ( ) 92.7 86.3 97 6 7.0 with a continuous force of about 250 g on a
U1/L1 ( ) 132.7 128.1 125 6 8.0
U1-NA (mm) 8 8.64 5 6 2.0
0.0160 3 0.022-in nickel-titanium archwire. The
L1-NB (mm) 6.76 3.56 6 6 2.5 mandibular occlusal plane was rotated counterclockwise
Nasolabial angle ( ) 82 80.5 110 6 2.5 because of a moment created by the retraction force (Fig
Soft tissue 5). Distalization was discontinued until the molars were
E-line–lower lip (mm) 0 2.0 4.0 6 4.5 overretracted to reach an end-to-end Class II molar

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Chen and Cao
Fig 5. Extraoral and intraoral photographs during orthodontic treatment.
relationship. Vertical elastics (3/16 in, 3.5 oz; Ormco)
were applied on both sides to correct the open bite in
the molar region and the deep anterior overbite. We sug-
gested that the patient should have the maxillary left
third molar extracted to align the second molar, but
she refused. Then the maxillary molars were intruded
to leave enough vertical space for the mandibular third
molars to erupt with the help of miniscrews inserted at
the palatal side of the maxillary molars (Orlus
1O18309, 1.8 3 9 mm; Ortholution).
The orthodontic treatment lasted for 26 months. At
the end of treatment, normal incisor overjet and overbite,
and canine and molar Class I relationships were reached.
After debonding and removing all miniscrews, we pre-
scribed maxillary wraparound and mandibular Hawley re-
tainers for the patient’s full-day wear for the first
6 months and nighttime wear for the next 18 months.
The maxillary wraparound retainer was used to prevent
overeruption of the maxillary second molars.
TREATMENT RESULTS
The posttreatment records showed improvement of
the lower third of the facial profile. The lower lip was
significantly retracted with a deepened labiomental
fold. Dental crowding in both arches was alleviated.
The anterior crossbite was corrected. The occlusion
was improved to achieve Class I molar and canine rela-
tionships on both sides (Figs 6-8). Incisal guidance in
American Journal of Orthodontics and Dentofacial Orthopedics
1047
anterior excursion and canine guidance in lateral
movement were achieved (Fig 9).
The transverse dimension was changed slightly after
treatment. In the maxillary arch, the intercanine width
was constricted from 41.5 to 39 mm, whereas the inter-
molar width was slightly changed from 57.5 to 57 mm.
In the mandibular arch, the intercanine width was con-
stricted from 31 to 29 mm, and the intermolar width was
expanded from 49 to 52 mm because of the distalization
of the molars (Figs 6 and 7).
The posttreatment panoramic radiograph showed no
significant root resorption or other pathologic finding.
The mandibular third molars were in the eruption stage.
From the cephalometric analysis, the SNB angle was
reduced by 1.1 ; this helped to increase the ANB angle
and the Wits appraisal value. Vertically, the mandibular
plane angle was slightly increased by 2.3 . The maxillary
incisors were proclined, and the mandibular dentition
was retracted. The mandibular incisors and molars
showed a slight extrusion and a translational retraction.
The retraction of the mandibular incisors led to a 2-mm
retraction of the lower lip in relation to the E-line (Figs 8
and 10; Table).
After 2 years of retention, the occlusion was stable.
Overjet and overbite, as well as the molar and canine re-
lationships, remained unchanged. The panoramic radio-
graph showed that the mandibular third molars were in
contact with mandibular first molars. The intercuspation
December 2015  Vol 148  Issue 6
1048 Chen and Cao

Fig 6. Posttreatment extraoral and intraoral photographs.

of mandibular third molars with the maxillary molars
was acceptable (Fig 11).
DISCUSSION
The patient’s concave profile and anterior crossbite
mainly resulted from the mandibular prognathism in
the anteroposterior direction. In mild and moderate skel-
etal Class III patients, both surgical treatment and ortho-
dontic camouflage treatment can have a successful
result.2,11 Since this patient’s mandibular prognathism
was moderate, together with her preference,
orthodontic camouflage treatment was carried out
instead of an orthognathic surgical plan.
The camouflage treatment of this Class III malocclu-
sion included distal movement of the mandibular
incisors with or without mesial movement of the maxil-
lary incisors.11,12 The patient’s upper lip had a balanced
position, so the maxillary incisors could not be
overproclined to accommodate the mandibular
incisors. Miniscrew anchorage was applied to retract
the mandibular dentition to achieve a Class I incisor
relationship. In addition to the tooth movement, the
improvement of the anteroposterior mandibular
functional deviation contributed to the correction of
the anterior crossbite as well.
Distalization of the mandibular arch with miniscrews
to correct a skeletal Class III malocclusion has been re-
ported by several orthodontists.6-8 Miniscrews can be
placed in the mandibular premolar region8 or the retro-
molar region.7 Placement of a miniscrew in the retromo-
lar region enables long-distance distalization of the

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Chen and Cao
Fig 7. Posttreatment dental casts.
mandibular arch, whereas the distance between the roots
restricts the amount of tooth movement when mini-
screws are placed interdentally.13 Extraction of the
mandibular second molars in this patient provided
enough space for the arch distalization, with the retrac-
tion force originating from the miniscrews in the retro-
molar area. The cephalogram showed the retraction of
the mandibular incisors, leading to the distal movement
of Point B, which in turn helped to deepen the labiomen-
tal fold, retract the lower lip, and improve the lower third
of the facial profile.8 This finding was similar to the study
of Jacobs et al14 in that after extraction of the mandib-
ular second molars, the mandibular incisors showed a
slight retrusion and a translational retraction. On the
contrary, if the patient had been treated with extraction
of the premolars, the mandibular incisors would have
been lingually tilted to compromise the overjet; the
tipping movement would have contributed less to the
deepening of the labiomental fold.9
To correct the concave profile and the protrusive
mandible, the orthodontic treatment plan should in-
crease the anterior facial height and rotate the mandible
clockwise; this will make the chin less prominent. How-
ever, miniscrew anchorage in the retromolar region to
distalize the mandibular dentition will complicate the
intrusion of the molars and the rotation of the mandib-
ular occlusal plane. The retraction force applied to the
tooth crown was backward and in a gingival direction.
Under the traction of the intrusive vector, the posterior
teeth might be distalized with tipping and intrusion
movements.7 This explained the molar open bite when
American Journal of Orthodontics and Dentofacial Orthopedics
1049
the distalization was finished. Using vertical elastics in
the molar region in the later stage, the posterior alveolar
vertical dimension was slightly increased; this was shown
in the superimpositions of the cephalometric tracings
(Fig 10). The clockwise rotation of the mandible made
the chin look less prominent. The posttreatment
maxillary-mandibular plane angle was still within the
normal range, showing that the vertical dimension was
well controlled.
In the transverse dimension, there is usually an arch
width discrepancy between the maxillary and mandib-
ular arches in patients with a Class III malocclusion.15
To achieve a proper positive overjet in the molar region,
the treatment plan should involve maxillary expansion
and mandibular constriction. The mandibular first mo-
lars were planned to be retracted to the original
second molar positions, so the treatment should not
expand the arch width at the molar region; otherwise,
the first molar would cause a decreased overjet. Howev-
er, the retraction force applied on the canine brackets
tended to expand the arch width in the posterior region.7
Meanwhile, the intrusion force on the molar buccal sur-
face expressed a crown buccal torque, which also tended
to increase the intermolar width.7 Considering these side
effects, the archwires were constricted in the mandibular
molar region. The posttreatment records showed a pos-
itive molar overjet despite the slight increase in the
mandibular intermolar width, proving that the mandib-
ular arch width and molar torque were under control. In
the maxillary arch, the molars were buccally inclined
before treatment, so maxillary expansion was
December 2015  Vol 148  Issue 6
1050
Fig 8. Posttreatment panoramic radiograph, cephalogram, and tracing.
contraindicated, and the intermolar width was main-
tained. The intercanine width was reduced in both arches
after aligning the buccally displaced canines into the
arches.
Kim16 proposed extraction of the mandibular
second molars instead of the third molars in patients
whose third molars were developing normally. Extrac-
tion of the mandibular second molars provides space
to retract the mandibular arch. Extraction of the
mandibular second molars keeps the dentition whole af-
ter the third molars are well aligned, compared with
treatment with premolar extractions. The eruption of
the mandibular third molars should be carefully moni-
tored and reinforced. Researchers have found that suc-
cessful eruption of the third molars after extraction of
the second molars is quite high (up to 96%) and deter-
mined the favorable factors for second molar extrac-
tion.17 In a study reviewing the eruption of 74
mandibular third molars after extraction of the
second molars, the authors learned that most mandib-
ular third molars uprighted and replaced the
December 2015  Vol 148  Issue 6 American Journal of Orthodontics and Dentofacial Orthopedics
Chen and Cao
second molars automatically, whereas eruption was un-
successful in older patients with higher Nolla develop-
mental stages. It was also reported that the increased
angle of the mandibular third molar to the mesial tooth’s
long axis before removing the second molar was a poor
prognosis indicator.18
This patient’s pretreatment condition was in favor of
second molar extraction. First, she was an adolescent,
and her mandibular third molars were in the crown for-
mation stage. Second, the mandibular third molars were
slightly mesially inclined and in contact with the
second molars. With these favorable factors, the
second molars were extracted instead of the third molars
to reduce the surgical complexity. Another advantage of
extraction of the mandibular second molars rather than
the third molars was that it was easier to distalize 12
teeth rather than 14 teeth.
Upon the completion of active orthodontic treat-
ment, the mandibular third molars had not fully erupted.
To maintain the vertical space for them, a maxillary
wraparound retainer was prescribed to hold the vertical
Chen and Cao 1051

Fig 9. Posttreatment intraoral photographs showing anterior and lateral functional guidance.

Fig 10. Superimpositions of the cephalometric tracings before and after treatment.

position of second molars. We proposed that the patient
should have the maxillary left third molar extracted to
prevent the continuing overeruption and distal tipping
of second molar, but she refused.
After 2 years, both mandibular third molars had erup-
ted into the former second molar spaces. The panoramic
radiograph shows that the mandibular third molars had
contact with the first molars at this stage. Most probably,
this will be further improved automatically, as reported in
several studies.10,17 The intraoral photographs show that
the intercuspation of the mandibular third molars to the
maxillary second molars was acceptable. Simple
uprighting mechanics were proposed for better molar
occlusion, but the patient declined.

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1052 Chen and Cao

Fig 11. Extraoral and intraoral photographs, periapical x-ray of the mandibular incisors, and cone-
beam computed tomography image of the incisors at the 2-year retention follow-up.

The mandibular functional shift contributed to the
anterior crossbite. The functional setback of the
mandible during orthodontic treatment also helped to
correct the reverse overjet. Although no accurate pre-
treatment cephalogram at centric relation was available,
the cephalometric superimposition showed that the ma-
jor contribution to the anterior crossbite correction was
the mandibular arch distalization rather than the
mandibular setback. The functional shift would play a
role in the change of the ANB angle measurement and
other parameters related to the esthetic line. However,
the recontouring of Point B and the labiomental fold
were mainly attributed to the retraction and transitional
distalization of the mandibular incisors.
The traction force tends to distalize the mandibular
posterior teeth with a tipping movement, which is due
to the play between the archwire and the brackets. The
tipped mandibular molars are assumed to be a risk factor
for posttreatment relapse. Chung et al6 reported signifi-
cant relapse after 8 months of retention in a Class III
patient treated with distalization of the mandibular
dentition because of obvious mandibular molar distal
tipping. Therefore, it is important to prevent the tip-
back movement of the mandibular molars after
distalization for better stability. In our patient, the whole
arch distalization was finished when the Class II molar
relationship was reached. The molar was intruded tempo-
rarily because of the gingivally directed traction force.
Thus, vertical elastics from the maxillary arch to the
mandibular molars were applied. With this vertical force,
the tipped-back mandibular molars were uprighted; then
the Class II molar relationship was corrected to a Class I
relationship. The occlusion was stable after 2 years of
retention, showing that the tipping control of the
mandibular molars contributed to the posttreatment sta-
bility of the mandibular distalization. Lima and Lima19

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Chen and Cao
reported treating a Class III malocclusion with an open
bite using directional force from J-hook headgear to
intrude and bodily distalize the mandibular molars; the
treatment result was stable after 4 years of retention.
Our treatment method had a similar effect on the
mandibular molars and showed similar posttreatment
stability of the mandibular arch distalization.
The anatomy of the mandible at the incisor region
places a limitation on the amount of retraction because
of the risks of dehiscence and loss of bone support. Over-
retraction of the mandibular incisors would lead to loss
of alveolar bone integrity and bony support. The cone-
beam computed tomography image showed that the
mandibular incisors were centralized in the alveolar
bone envelope. Normal alveolar height was identified
from the periapical radiograph (Fig 11). This evidence
showed that the extent of incisor retraction did not
exceed the biologic limitation.
CONCLUSIONS
This case report demonstrates that in a moderate
Class III case, miniscrew anchorage can be used with a
fixed appliance to retract the mandibular dentition after
extraction of the mandibular second molars. The retrac-
tion of the mandibular arch corrected the anterior nega-
tive overjet and the Class III molar relationship;
moreover, the lower third of the facial profile was greatly
improved with retraction of the lower lip and the deep-
ened labiomental fold.
REFERENCES
1. Jacobson A, Evans WG, Preston CB, Sadowsky PL. Mandibular
prognathism. Am J Orthod 1974;66:140-71.
2. Chew MT. Soft and hard tissue changes after bimaxillary surgery in
Chinese Class III patients. Angle Orthod 2005;75:959-63.
3. Lin J, Gu Y. Preliminary investigation of nonsurgical treatment of
severe skeletal Class III malocclusion in the permanent dentition.
Angle Orthod 2003;73:401-10.
4. Niwa K, Kushimoto K, Yamamaoto T. Mandibular first premolar
teeth extraction in skeletal Class III malocclusion. Gifu Shika Gak-
kai Zasshi 1990;17:330-8.
American Journal of Orthodontics and Dentofacial Orthopedics
1053
5. Park JU, Baik SH. Classification of Angle Class III malocclusion and
its treatment modalities. Int J Adult Orthodon Orthognath Surg
2001;16:19-29.
6. Chung KR, Kim SH, Choo H, Kook YA, Cope JB. Distalization of the
mandibular dentition with mini-implants to correct a Class III
malocclusion with a midline deviation. Am J Orthod Dentofacial
Orthop 2010;137:135-46.
7. Oh YH, Park HS, Kwon TG. Treatment effects of
microimplant-aided sliding mechanics on distal retraction of
posterior teeth. Am J Orthod Dentofacial Orthop 2011;139:
470-81.
8. Yanagita T, Kuroda S, Takano-Yamamoto T, Yamashiro T. Class III
malocclusion with complex problems of lateral open bite and se-
vere crowding successfully treated with miniscrew anchorage
and lingual orthodontic brackets. Am J Orthod Dentofacial Orthop
2011;139:679-89.
9. Abu Alhaija ES, Al-Khateeb SN. Skeletal, dental and soft tissue
changes in Class III patients treated with fixed appliances and
lower premolar extractions. Aust Orthod J 2011;27:40-5.
10. De-la-Rosa-Gay C, Valmaseda-Castellon E, Gay-Escoda C. Spon-
taneous third-molar eruption after second-molar extraction in or-
thodontic patients. Am J Orthod Dentofacial Orthop 2006;129:
337-44.
11. Janson G, de Souza JE, Alves AF, Andrade P Jr, Nakamura A,
Freitas MR, et al. Extreme dentoalveolar compensation in the
treatment of Class III malocclusion. Am J Orthod Dentofacial Or-
thop 2005;128:787-94.
12. Gelgor IE, Karaman AI. Non-surgical treatment of Class III maloc-
clusion in adults: two case reports. J Orthod 2005;32:89-97.
13. Lee JS, Kim JK, Park YC, Vanarsdall RL Jr. Applications of ortho-
dontic mini-implants. Hanover Park, Ill: Quintessence; 2007.
14. Jacobs C, Jacobs-Muller C, Hoffmann V, Meila D, Erbe C, Krieger E,
et al. Dental compensation for moderate Class III with vertical
growth pattern by extraction of the lower second molars. J Orofac
Orthop 2012;73:41-8.
15. Slaj M, Spalj S, Pavlin D, Illes D. Dental archforms in dentoalveolar
Class I, II and III. Angle Orthod 2010;80:919-24.
16. Kim YH. Anterior open bite and its treatment with multiloop edge-
wise archwire. Angle Orthod 1987;57:290-321.
17. Gooris CG,  Artun J, Joondeph DR. Eruption of mandibular third
molars after second-molar extractions: a radiographic study. Am
J Orthod Dentofacial Orthop 1990;98:161-7.
18. Ryu YK. The study on third molar changes following second molar
extraction (1). Taehan Chikkwa Uisa Hyophoe Chi 1990;28:
1069-79.
19. Lima CE, Lima MT. Directional force treatment for an adult with
Class III malocclusion and open bite. Am J Orthod Dentofacial Or-
thop 2006;129:817-24.
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