Class III Malocclusion

Why is treating class III malocclusion a challenge?

1- Using intraoral appliances to stop mandibular
growth is less successful.

2. The future growth prediction of such patients both

in magnitude and direction is difficult.

3 .
There's a high tendency of relapse.

4. Retentive appliances have to be used to maintain the

post treatment results but since the patient may not
wear it regularly that's also a problem.

Let's see what we have to treat...

Clinical Features
"
=
;
EXTRAORAL FEATURES

A straight to concave profile

Anteriorly divergent Increased lower face
profile height

Obtuse gonial angle

I
.
.

INTRAORAL FEATURES

Class III molar and canine Reverse overjet

relationship

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 Treatment

The type of treatment depends on the age of the

patient and can be divided into..

< >
Pre- adolescent stage Adulthood stage

:
Adolescent stage

Pre- adolescent stage

Stretches the
soft tissue
envelop
around the
maxilla.

>
A. FRANKEL III APPLIANCE

>
Does not allow
Stimulates the mandible to
forward growth advance forward
of the maxilla.
2. Applies forces along the direction
of growth of the condyle.

2. Inhibits the forward

growth of the mandible
3. Can rotate the mandible
downward and backward if
needed, or
a
>

4. Can prevent downward growth

by vertical pull.
B. THE CHIN CUP
5. In the mixed dentition period, an
attempt is generally made to
correct the anterior crossbite with
the use of chin-cup.

Maxilla grows anteriorly

and downwards.

e. ANTERIOR FACEMASK
Or Reverse pull
:
This causes a downward
headgear
& backward rotation of
the mandible.
D. RME (RAPID MAXILLARY EXPANSION)
WITH ANTERIOR FACEMASK
Causes growth by splitting
the mid-palatal suture.

Causes a
downward v
Mt
and forward
movement of
the maxilla.

E .
3D SCREWS

Expands the maxilla in

all three directions.

Good for pseudo Class

1II malocclusions
 Adolescent stage

ORTHODONTIC CAMOUFLAGE +
EXTRAORAL APPLIANCES
(preparation stage for
orthognathic surgery)
'

Jet
i. Procline the >
maxillary anteriors
.

2- Retrocline the Class III

mandibular anteriors Lower arch
yellow
extraction
elastics
3. Extractions done in
lower arch only.

Adulthood stage

ORTHOGNATHIC SURGERY

The two commonly used procedures are:

1. Bilateral sagittal split osteotomy with

retraction of the mandible.

2 .
Le-Fort I down fracture.

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Nerina