Aim: Skeletal class III malocclusion are the most challenging orthodontic problem to treat. Diagnosis and treatment in early stage was important to boost self-esteem of patient. Our aim was to correct skeletal relationship and anterior crossbite to enhance the growth of maxilla.
Background: Class III malocclusion can be due to retrognathic maxilla, prognathic mandible or combination. Complexity of class III malocclusion depends upon abnormal growth pattern of maxilla and mandible. Maxilla growth ceases around 8–10 years and mandible continue till 16 years. Early intervention boosts self-esteem of the patient.
Case description: This case presents with clinical feature of retrognathic maxilla at the age of six years. The patient had concave profile with incompetent lips. The mentolabial sulcus was normal and obtuse nasolabial angle with high clinical Frankfurt mandibular angle (FMA). There was reverse overjet of 1 mm. Cephalometric analysis showed a class III skeletal pattern with retrognathic maxilla and orthognathic mandible with increase in lower facial height and increases in gonial angle. The rapid maxillary expansion (RME) with reverse pull face mask was planned. The expansion screw was activated to loosen the circumaxillary suture.
Conclusion: After active treatment anterior crossbite was corrected. The patient sagittal discrepancy was improved. Early mixed dentition period is the best time to begin class III treatment.
Clinical significance: Early treatment with maxillary protraction and palatal expansion can correct most anterior–posterior skeletal discrepancy.
Jacobson A, Evans WG, Preston CB, et al. Mandibular prognathism. Am J Orthod 1974;66(2):140–171. DOI: 10.1016/0002-9416(74)90233-4.
Guyer EC, Ellis EE, McNamara JA, Jr, et al. Components of class III malocclusion in juveniles and adolescents. Angle Orthod 1986;56(1):7–30. DOI: 10.1043/0003-3219(1986)0562.0.CO;2.
McNamara JA Jr. An orthopedic approach to the treatment of class III malocclusion in your patients. J Clin Orthod 1987;21(9):598–608.
Ast DB, Carlos JP, Cons NC. The prevalence and characteristics of malocclusion among senior high school students in upstate New York. Am J Orthod 1965;51(6):437–445. DOI: 10.1016/0002-9416(65)90241-1.
Irie M, Nakamura S. Orthopedic approach to severe skeletal class III malocclusion. Am J Orthod 1975;67(4):377–392. DOI: 10.1016/0002-9416(75)90020-2.
Haas AJ. Palatal expansion: Just the beginning of dentofacial orthopedics. Am J Orthod 1970;57(3):219–255. DOI: 10.1016/0002-9416(70)90241-1.
Sugawara J, Asano T, Endo N, et al. Long-term effects of chincap therapy on skeletal profile in mandibular prognathism. Am J Orthod Dentofac Orthop 1990;98(2):127–133. DOI: 10.1016/0889-5406(90)70006-X.
MacGregor FC. Social psychological implications of dentofacial disfigurement. Angle Orthodontist 1970;40(3):231–233. DOI: 10.1043/0003-3219(1970)0402.0.CO;2. 1990;98:127-33.
Ishii H, Morita S, Takeuchi Y, et al. Treatment effect of combined maxillary protraction and chincap therapy in severe skeletal class III cases. Am J Orthod Dentofacial Orthop 1987;92(4):304–312. DOI: 10.1016/0889-5406(87)90331-3.
Delaire J, Verson P, Lumineau JP, et al. Quelques resultats des tractions extra-orales a appui fronto-mentonnier dans de traitement orthopedique des malformations maxillo mandibulaires de classe III et des sequelles osseuses des fente labio-maxillaires. Rev Stomat 1972;73:633–642.
Hata S, Itoh T, Nakagawa K, et al. Biomechanical effects of maxillary protraction on the craniofacial complex. Am J Orthod Dentofac Orthop 1987;91(4):305–311. DOI: 10.1016/0889-5406(87)90171-5.
Nanda R. Protraction of maxilla in rhesus monkeys by controlled extraoral forces. Am J Orthod 1978;74(2):121–141. DOI: 10.1016/0002-9416(78)90080-5.
Jackson GW, Kokich VG, Shapiro PA. Experimental and postexperimental response to anteriorly directed extraoral force in young Macaca nemestrina. Am J Orthod 1979;75(3):318–333. DOI: 10.1016/0002-9416(79)90278-1.
Nanda R, Hickory W. Zygomaticomaxillary suture adaptations incident to anteriorly directed forces in rhesus monkeys. Angle Orthod 1984;54(3):199–210. DOI: 10.1043/0003-3219(1984)0542.0.CO;2.
Itoh T, Chaconas SJ, Caputo AA, et al. Photoelastic effects of maxillary protraction on the craniofacial complex. Am J Orthod 1985;88(2):117–124. DOI: 10.1016/0002-9416(85)90235-0.
Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod 1970;58(1):41–66. DOI: 10.1016/0002-9416(70)90127-2.
Bishara SE, Staley RN. Maxillary expansion: clinical implications. Am J Orthod 1987;91(1):3–14. DOI: 10.1016/0889-5406(87)90202-2.