Written by : Dr. Rania Alraddadi ..
I just wante d to summarize what we discussed today regarding the treatment decision in borderline Class III cases:
Surgery vs. Camouflage:
Factors to consider:
1- Extra oral exam including both profile and frontal views (is the mandible big? In AP? In transverse including the symmetry and In vertical?).
2- Family history.
3- Diagnosis (is it the maxilla or the mandible?) as we know mandibular prognathism – depending on the severity – has less chance of successful camouflage, but ofcourse we can not generalize.
3- Severity of the discrepancy judged from the canines and not the incisors.
4- Inclination of lower incisors (if IMP is <83 more towards surgical option). Kerr et al, Br J Orthod. 1992 Feb;19(1):21-4.
5- Width of symphysis (can we afford to allow retroclination if we opted for camouflage?)
6- Other factors such as surgery cost, convenience and availability and skill of the surgeon.
You will come across some articles that use the ANB and the Wits appraisal as guidelines but as we discussed today, these have their limitations.
Here is a slide as well that illustrates the Holdaway angle as another criteria to aid in treatment decision along with the references.
Finally I want to add that at the end of the day it might not be wise to follow rigid numbers as the clinical judgment/patient’s concerns is the key. These are only an attempt to make the subjective decision we take in the clinic somehow more objective.