Pacific Coast Society of Orthodontists Bulletin Summer 2021 - 9

PCSO News and Events
Editorial
Class III Correction
Treatment that effectively provides a stable
correction of Class III malocclusions is one that
Dr. Jae Hyun Park
PCSO Bulletin Editor-in-Chief
Noninvasive appliances and treatment modalities
have been widely used to treat Class III
patients with positive outcomes. Face masks
have been used for many years, showing initial
success on those younger than 10 years, but
there is some uncertainty about whether these
positive changes in occlusion will remain in
the long term because of the unknown growth
patterns that come with puberty.1
The result
of this process is forward displacement and
counterclockwise rotation of the maxilla with
backward displacement and clockwise rotation
of the mandible. Usually, Class III patients
show more significant increases in mandibular
length during their pubertal peak, possibly
because of the longer duration of the pubertal
peak than skeletal Class I subjects.2
It has been
reported that there is an approximately 75%
success rate of Class III orthopedic treatment
(rapid palatal expansion and face mask therapy)
after five years of retention.3
orthodontists strive to use on their patients.
Presently, several treatment options have great
potential, but optimal correction therapy is yet
to be defined. With various treatment modalities
for correcting Class III malocclusions, an indepth
comparison is needed to determine which
method has the fewest side effects and lowest
potential for relapse.
skeletal anchorage provides a stronger maxillary
protraction, a decrease in gonial angle, and
an anterior placement of the nasal and orbital
bones.4
Fixed orthodontic appliances along with Class III
elastics or temporary skeletal anchorage devices
(TSADs) on the mandible have also been valid
treatment options for Class III correction. However,
Class III elastics can cause a counterclockwise
rotation of the occlusal plane. Therefore, if the
patient does not show sufficient maxillary incisor
display and has an increased lower anterior facial
height, the Class III elastic approach should be
carefully monitored.
TSADs can be placed in various sites to distalize
the mandibular dentition. However, other than
TSADS placed in the buccal shelf, they might have
to be relocated to avoid contact with roots during
distalization. When mandibular third molars are
present, it is better to extract them concurrently
with miniscrew placement to benefit from the
regional acceleratory phenomenon.
Therefore, we
have to monitor the growth of Class III patients
very carefully.
We recently published the effects of using face
masks in concert with skeletal anchorage devices,
reporting the long-term success of the skeletal
changes, even after puberty was reached.1
This technique produced not only favorable
bone changes but also favorable soft-tissue
changes. Compared with a tooth-borne expander
and face mask, skeletal anchorage with a face
mask does not significantly decrease the nasolabial
angle, producing a more esthetic result
in the long run.4
With regard to bone change,
If the patient's growth is completed, the ideal
treatment for skeletal Class III correction might be
orthognathic surgery. Nowadays, with three-dimensional
imaging, the projected outcome can
be visualized before the procedure, and a splint
can be printed from this digital file to ensure
proper results. Significant soft-tissue changes
can also be visualized using surgical treatment
objectives.
Correction of Class III malocclusion is multifactorial,
depending on the skeletal pattern,
growth, genetics, and patient compliance with
treatment instructions. The factors for consideration
are much greater than those outlined
here and can vary from patient to patient
when they have Class III malocclusions. Further
research is needed to introduce alternative
treatment methods that will lead to patient
satisfaction and stable results. Even so, correction
of Class III is not easy, and more evidence
Summer 2021 PCSO Bulletin
9
Pacific Coast Society of Orthodontists Bulletin Summer 2021

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Summer 2021
