Aesthetic and functional outcomes using a multiloop edgewise archwire for camouflage orthodontic treatment of a severe Class III open bite malocclusion

Occasionally, orthodontists will be challenged to treat malocclusions and skeletal disharmonies, which by their complexity one might think that the only treatment alternative is the surgical-orthodontic approach. A male patient, aged 17 years old, was diagnosed with a skeletal Class III malocclusion, anterior open bite and negative overjet. An unpleasant profile was the patient’s ‘chief complaint’ showing interest in facial aesthetics improvement. Nevertheless, the patient and his parents strongly preferred a non-surgical treatment approach. He was treated with a multiloop edgewise archwire to facilitate uprighting and distal en-masse movement of lower teeth, correct the Class III open bite malocclusion, change the inclination of the occlusal plane and obtain the consequent morphological-functional adaptation of the mandible. The Class III malocclusion was corrected and satisfactory changes in the patient’s profile were obtained. Active treatment was completed in 2 years, and facial result remained stable at 2 years 6 months after debonding.     

Orthodontic camouflage of a late adolescent patient with Class III malocclusion

This paper concerns orthodontic treatment of a 11-year-old female having an Angle Class III malocclusion with incisor edge-to-edge occlusion, a skeletal Class III jaw base relationship and a normal mandibular plane angle. When she was 13 years old, the mandibular third molars were extracted and the remaining mandibular molars were distalized. Good occlusion and facial esthetics were achieved. These results have been maintained for 4 years following completion of active treatment.     

Accuracy,confidence and consistency in diagnosing Class III malocclusion with diagnostic records: a two‐center study

The objective of this study was to determine the accuracy, confidence and consistency in diagnosing the Class III malocclusion in children by diagnostic records. Ten orthodontists from the state of West Virginia and 20 from the state of Ohio were asked to classify the dental and skeletal occlusion of eight patients. Six of the cases were patients with Class III malocclusion. Two cases, one with a Class II division 1 malocclusion and one with a Class I malocclusion, were used as distractors. Diagnosis of these cases was established by four published cephalometric analyses, which served as the ‘gold standard’, to determine the number of correct responses from the participants. Four faculty members were employed to confirm the cephalometric and clinical diagnosis of these cases with a full set of records. Participants were asked to diagnose the cases using only study casts and facial profile photographs for the first time. After an interval of 30 days, the procedure was repeated with the addition of lateral cephalograms and tracings. The accuracy in diagnosing malocclusion was determined by the percentage of correct responses. The level of confidence was determined by calculating the median of a 5‐point graded response utilizing the following confidence values: 1=not at all, 2=slightly, 3=moderately, 4=very, 5=absolutely. Differences between ‘with’ and ‘without’ lateral cephalograms were analyzed non‐parametrically using the Wilcoxon matched‐pairs signed‐ranks test. The results from both centers show the accuracy in dental classification of Class III malocclusion was quite good (83%±17.1% in the West Virginia group and 93%±14.1% in the Ohio group). The accuracy in skeletal classification was poor (72%±16.3 in the West Virginia group and 53%±7.03 in the Ohio group). The addition of lateral cephalograms and tracings did not improve the accuracy of dental or skeletal classification. However, clinicians felt more confident in their diagnoses with the information provided by lateral cephalograms and tracings. The consistency in dental and skeletal classification was fair and poor, respectively. These results suggest that clinicians are not consistent in diagnosing the Class III malocclusion and that skeletal classification of Class III malocclusion in children could be difficult. The addition of lateral cephalograms and tracings do not contribute to the accuracy of diagnosis.     

两种不同拔牙方式矫治成人骨性反牙合的硬软组织改变的对比研究

目的：探讨下颌单颌拔牙与双颌拔牙矫治成人骨性反牙合的硬软组织改变的差异。方法：选取成人骨性反牙合患者31例,其中拔除4个前磨牙矫治（甲组）13例,下颌单颌拔除2个前磨牙矫治（乙组）18例。应用X线头影测量对矫治前后的硬软组织变化进行测量。结果：两组SNA、SNB、ANB矫治前后的变化无明显差异。甲组下切牙内收与下唇的变化更为显著,下唇凸度明显减小,甲组面型侧貌改变较乙组更为显著。结论：单颌拔牙模式适用于上颌无拥挤或轻度拥挤的轻中度骨性反牙合患者;双颌拔牙模式适用于上颌伴中重度拥挤的中度骨性反牙合患者。     

Clinical effectiveness of chin cup treatment for the management of Class III malocclusion in pre-pubertal patients: a systematic review and meta-analysis

Background

Chin cup is regarded as the oldest orthodontic appliance for the management of Class III malocclusion. To assess its clinical effectiveness in pre-pubertal patients, a meta-analysis on specific cephalometric values is attempted.

Methods

Detailed electronic and hand searches with no restrictions were performed up to July 2014. Only randomized controlled trials (RCTs) and cohort studies, i.e. prospective controlled trials (pCCTs) and (retrospective) observational studies (OS), were included. Analyses were performed by calculating the standard difference in means and the corresponding 95% confidence intervals, using the random effects model. Data heterogeneity and risk of bias assessment of the included studies were also performed. Study selection, data extraction and risk of bias assessment were performed twice. The level of significance was set at P ≤ 0.05 for all tests, except for heterogeneity (P ≤ 0.1).

Results

Seven treated groups from five studies (no RCTs, four pCCTs, one OS) were eligible for inclusion, assessing only the short-term occipital pull chin cup effects. In total, 120 treated patients (mean age: 8.5 to 11 years) compared with 64 untreated individuals (mean age: 7.3 to 9.89 years) were assessed by means of 13 cephalometric variables. The overall quality of these studies was low to medium. In comparison to untreated individuals, the SNB and gonial angles decreased significantly following chin cup use, whereas ANB, Wits appraisal, SN-ML, N-Me and overjet increased. For the rest of the variables, no statistically significant differences were detected.

Conclusions

Although the occipital chin cup affects significantly a number of skeletal and dentoalveolar cephalometric variables, indicating an overall positive effect for the treatment of Class III malocclusion, data heterogeneity and between-studies variance impose precaution in the interpretation of the results.

Electronic supplementary material

The online version of this article (doi:10.1186/s40510-014-0062-9) contains supplementary material, which is available to authorized users.     

Aspects of Orthodontic‐Prosthetic Rehabilitation of Dentofacial Anomalies

Skeletal class III malocclusion is one of the most difficult dentofacial anomalies, characterized by deviation in the development of the mandible and maxilla in the sagittal plane, where the mandible is dominant in relation to the maxilla. In patients with class III malocclusion, anomalies in the dentoalveolar level and esthetic discrepancies are also frequent. The etiology of class III malocclusion is multifactorial due to the interaction of hereditary and environmental factors. Rehabilitation and treatment of malocclusion is one of the major goals of modern dentistry. This article presents the orthodontic‐prosthetic therapy and rehabilitation of a 45‐year‐old patient with an abnormal occlusal vertical dimension and a skeletal class III malocclusion. The patient came to the clinic complaining about degraded esthetics and disordered functions of the orofacial region (functions of eating, swallowing, speech) and also pain in the temporomandibular joint. After the diagnosis was made, the patient was first referred to orthodontic treatment with fixed orthodontic appliances (self‐ligating brackets system Rot 0.22). Upon completion of the orthodontic treatment, the patient was sent for further prosthetic treatment. Fixed prosthetic restorations were made in the upper and lower jaw, thus achieving a satisfactory result in terms of esthetics and function of the stomatognathic system.     

Two-phase treatment in a patient with a skeletal Class III malocclusion: Early orthopedic treatment and subsequent camouflage treatment with temporary anchorage devices

In this case report, we describe the outcome of a two-phase orthodontic approach used to treat a 4-year and 8-month-old girl who exhibited excessive negative overjet and skeletal Class III jaw relationship. In Phase I treatment, growth modification using a protraction headgear appliance was used to normalize maxillomandibular growth. A forward growth of the maxilla and a normal overjet were achieved. During pubertal growth period, a skeletal Class III jaw relationship persisted due to differential jaw growth. A Phase II camouflage treatment with the help of temporary anchorage devices (TADs) was used to distalize the mandibular dentition. Good occlusion and facial esthetics were achieved, and the outcome has been maintained for 2 years after completion of the active treatment.     

Clinical predictive factors for temporomandibular disorders following combined orthodontic and orthognathic surgical treatment in patients with Class III malocclusion

Objective: The aim of this study was to identify clinical factors predisposing to the development or worsening of temporomandibular disorders (TMDs) following orthodontic surgical treatment for Class III malocclusion.

Methods: A retrospective cohort study was performed on 88 patients with Class III malocclusion having undergone a combined orthodontic and orthognathic surgical treatment. Temporomandibular joint and masticatory muscle examinations were available prior to treatment and one year post-operatively. Multivariate logistic regression was used to predict the development of post-operative TMDs, and linear regression was used to predict the worsening of TMDs using Helkimo indices.

Results: Patients with Class III malocclusion presenting with pre-treatment anamnestic TMJ clicking (OR = 5.8; p = 0.03) and undergoing bimaxillary osteotomy procedures (OR = 18.6; p = 0.04) were more at risk for the development of TMDs.

Discussion: TMDs must be evaluated, monitored, and managed with caution in patients with Class III malocclusion presenting with pre-treatment joint clicking and who are planned for bimaxillary osteotomies.     

Early treatment of Class III malocclusion: 10-year clinical follow-up

Angle Class III malocclusion has been a challenge for researchers concerning diagnosis, prognosis and treatment. It has a prevalence of 5% in the Brazilian population, and may have a genetic or environmental etiology. This malocclusion can be classified as dentoalveolar, skeletal or functional, which will determine the prognosis. Considering these topics, the aim of this study was to describe and discuss a clinical case with functional Class III malocclusion treated by a two-stage approach (interceptive and corrective), with a long-term follow-up. In this case, the patient was treated with a chincup and an Eschler arch, used simultaneously during 14 months, followed by corrective orthodontics. It should be noticed that, in this case, initial diagnosis at the centric relation allowed visualizing the anterior teeth in an edge-to-edge relationship, thereby favoring the prognosis. After completion of the treatment, the patient was followed for a 10-year period, and stability was observed. The clinical treatment results showed that it is possible to achieve favorable outcomes with early management in functional Class III malocclusion patients.     

Efficacy of short-term chincup therapy for mandibular growth retardation in Class III malocclusion: A systematic review

Objective:To assess the efficacy of chincup therapy for mandibular growth retardation in early orthopedic treatment of Class III malocclusion.Materials and Methods:An electronic search for articles reporting randomized clinical trials, controlled clinical trials, and cohort studies testing the efficacy of chincup appliance for Class III malocclusion published up to the present was done through four databases: Cochrane Central Register of Controlled Trials (CENTRAL; to March 2010), MEDLINE (1950–March 2010), EMBASE (1980–March 2010), and CBM (1978–March 2010). Study quality assessment and data extraction were done by two reviewers independently. Meta-analysis was done with the assistance of Revman 5.01.Results:The search resulted in 50 articles. After selection following the established criteria, four cohort studies qualified for the final review analysis. The results showed that chincup therapy decreased SNB angle and increased ANB angle; the total pooled weighted mean difference values (95% confidence interval) were −1.18 (−1.69, −0.67; P < .00001) and 1.90 (0.60, 3.21; P  =  .004), respectively. Two studies showed a increase in Gonial angle (P < .05) but no significant change in the mandibular length (Cd-Gn; P  =  .059 and .39, respectively). One study indicated that chincup therapy exerted no effect on mandibular growth retardation, and mandibular growth continued after the treatment in a downward direction.Conclusion:There are insufficient data in these studies to make clear recommendations regarding the efficacy of chincup therapy in the retardation of mandibular growth.     

Relapse patterns of two-jaw surgical correction in patients with skeletal Class III malocclusion and different vertical facial types

The aim of this study was to evaluate postoperative relapse after the surgical correction of skeletal Class III deformities of various facial patterns as a guide to surgical planning. A retrospective cohort study of 90 consecutive patients with skeletal Class III malocclusion who underwent bimaxillary surgery was performed. The surgical outcomes and postoperative stability were compared. The primary predictor variable was vertical facial type, which was classified into three groups according to the Frankfort mandibular plane angle (FMA). The primary outcome of angular and linear measurements was obtained using serial cone beam computed tomography scans obtained at time points of preoperative, 1 week after surgery, and orthodontic debonding. No significant difference in skeletal relapse was observed in patients with the different vertical facial types. The mandible displayed a forward and upward relapse in all three groups postoperatively. The patients with a low FMA exhibited a more consistent mandibular relapse pattern than those with a normal or high FMA. These findings suggest that bimaxillary surgery is clinically stable for mandibular prognathism regardless of the vertical facial pattern. However, 1–1.5 mm of overcorrection in the mandible setback should be considered in patients with a low FMA, because of the greater facial depth and consistent forward and upward mandibular relapse pattern.     

Variables associated with stability after Le Fort I osteotomy for skeletal class III malocclusion

The purpose of this study was to assess skeletal stability and predictors of relapse in patients undergoing an isolated Le Fort I osteotomy. A retrospective cohort study of 92 subjects undergoing Le Fort I osteotomy for Class III malocclusion was implemented. Predictor variables were demographic and perioperative factors. The primary outcome variable was postoperative skeletal position with relapse defined as >2 mm sagittal and/or vertical change at A-point on serial lateral cephalograms at immediate postoperative, 1 year, and latest follow-up time points. Mean advancement at A-point was 6.28 ± 2.63 mm and mean lengthening was 0.92 ± 1.76 mm. Eight subjects (8.70%) had relapse (>2 mm) in the sagittal plane, and two subjects (2.17%) in the vertical plane. No subjects required reoperation for relapse as overbite and overjet remained in an acceptable range due to dental compensation. In regression analysis, magnitude of maxillary advancement was an independent predictor of relapse in the sagittal plane (P = 0.008). There were no significant predictors of relapse in the vertical plane. This study suggests that isolated Le Fort I osteotomy for correction of skeletal Class III malocclusion is a stable procedure and that greater advancement is an independent risk factor for sagittal relapse.     

Factors associated with long-term vertical skeletal changes induced by facemask therapy in patients with Class III malocclusion

Objectives:This study investigated the long-term vertical skeletal changes induced by facemask therapy in patients with Class III malocclusion and different vertical skeletal patterns.Materials and Methods:A total of 54 patients (20 boys and 34 girls; mean age, 7.7 ± 2.0 years) with Class III malocclusion who were successfully treated with facemask therapy were included in this study. Vertical skeletal changes (overbite depth indicator, angle between the Sella-Nasion (SN) plane and Gonion-Gnathion (GoGn) line, angle between the Frankfort horizontal (FH) plane and mandibular plane, gonial angle, and angle between the SN plane and palatal plane) were measured on lateral cephalograms from before treatment (T0) to after facemask therapy (T1) and from T0 to after retention (T2). Multivariate linear regression analysis was used to study the associations of the patients'' skeletal patterns with the short-term (T0–T1) and long-term (T0–T2) vertical skeletal changes as a result of facemask therapy.Results:The mean treatment period of facemask therapy (T0–T1) was 1.4 ± 0.6 years, and the mean retention period (T1–T2) was 6.9 ± 2.6 years. Age at T0 was significantly correlated with vertical skeletal changes from T0 to T1. Differences in the treatment results between sexes were not significant. The angle between point A-point B line and mandibular plane to mandibular plane angle at T0 and the angle between the FH plane and mandibular plane at T0 were significant predictors for short-term and long-term changes. Changes in the Sella-Nasion-point A from T0 to T1 and from T1 to T2 significantly affected vertical changes in the short term and long term, respectively.Conclusions:Vertical skeletal changes as a result of facemask therapy are significantly associated with severity of the skeletal Class III malocclusion and mandibular plane angulation before treatment and the amount of forward maxillary growth during the treatment and retention periods.     

Camouflage treatment of skeletal Class III malocclusion with asymmetry using a bone-borne rapid maxillary expander

This case report presents the successful use of palatal mini-implants for rapid maxillary expansion and mandibular distalization in a skeletal Class III malocclusion. The patient was a 13-year-old girl with the chief complaint of facial asymmetry and a protruded chin. Camouflage orthodontic treatment was chosen, acknowledging the possibility of need for orthognathic surgery after completion of her growth. A bone-borne rapid expander (BBRME) was used to correct the transverse discrepancy and was then used as indirect anchorage for distalization of the lower dentition with Class III elastics. As a result, a Class I occlusion with favorable inclination of the upper teeth was achieved without any adverse effects. The total treatment period was 25 months. Therefore, BBRME can be considered an alternative treatment in skeletal Class III malocclusion.