Orthotown December 2017 - 16

for a positive overjet of 2mm if possible. Ten years old is way too young to start fi xed appliances
on a Class III patient, especially with a boy who will have the mandibular growth spurt around
two years later than girls.
Asymmetry of the mandible is genetic in nature and cannot be corrected without orthognathic
surgery. In Cambodia, almost all patients refuse surgery and treating those asymmetric cases
with orthodontics alone is time consuming. If going for ortho alone you have to be clear with
the patient that it is a compromise treatment.
For treating your case I have unfortunately no solution. Whatever you do, the mandible will
continue to grow and you will not be able to finish the case, or if you do, you will have relapse right away.
On this case, I would say bite the bullet, explain to the parent that if the Delaire therapy
was successful, the fi xed appliance treatment is not and has to be discontinued until the end of
growth. Not comfortable to do but beats the alternative of trying to do ortho on the case for X
years and not be able to finish.
P.S. Whatever you do, do not extract. ■

10/4/2017

I have to agree with everything already said. Way too early for comprehensive treatment in
a Class III prognathism case. The transverse needs to be corrected now. It appears there is still
a functional shift going on. Fix the transverse and debond. Wait for growth to stop if not slow
and re-evaluate for further treatment.
Bite the bullet and tell the parents that growth is unfavorable and you need to wait it out. ■

justinudm
Member Since: 09/29/14
Post: 5 of 11

10/5/2017

Tough case. I can't tell from the records, but if the unilateral crossbite is from the lower being
asymmetric, then upper expansion will be difficult and in my hands, it never works out very
well. It may seem odd, but sometimes I have left a molar in crossbite as it just seems to fit and is
more stable in that location. Remember setting up dentures in posterior crossbite? Whenever I
expand in a case like this, I find the upper anterior flattens and my underbite gets worse, and an
open bite starts. I believe you are seeing that.
If I were treating this, I would remove the arches and let the case settle for a couple of
appointments. Then regroup. I would go to small SS round wires and try some elastics to pull
the teeth into occlusion. Maybe some lower Class I chain. Try and get the lower tipped back a
little. Let the right-side posterior find its place. It may not end up on the cover of a journal, but
you may avoid surgery and give the patient a nice result. I tell patients that my goals are aesthetics,
function, and stability. In this case, pick two. ■

emac
Member Since: 11/21/11
Post: 6 of 11

10/9/2017

De Clerck miniplates would be an option at his age and eruption for an improvement and
an attempt at improving the Class III. However, if he won't wear elastics, then it's a waste of
everyone's time and money. ■

jwkortho
Member Since: 11/24/08
Post: 7 of 11

10/9/2017

I agree that this is great treatment in the right situation. In cases of true mandibular prognathism, all you would be doing is creating a bimax prognathism (i.e. Homer Simpson face.)
For the best facial aesthetics with a mandibular prognathism, the case will need a mandibular
set back. This case, when you look at the ceph, is actually a maxillary retrognathia. I would love
to see a smiling profile picture to confirm this. If the maxilla is retrognathic, then yes to bone
plates if the patient will wear elastics.

justinudm
Member Since: 09/29/14
Post: 8 of 11

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