Tips by Prof. Ali Habeeb ..
Summerized by : Dr. Hani Alhebshi
First :Seek the cause of class III discrepancy , whether it is skeletal or dental ? Using clinical examination and diagnostic records ; A deficiency in maxilla ,a prognathism in the mandible or both can be addressed.Checking functional shift or Psudo Class III by guiding mandible to Centric relation.
Second : The developmental age of the patient will determine the way of management.
- In Skeletal maxillary deficiency in an early age (7-10 approximately) FACEMASK is used providing that permanent molars and incisors have erupted .Some clinicians use also facemasks in prognathic manible cases because they think it will cause mandiblular downward and backward rotation so that Class III relation is corrected too.
- In Skeletal mandibular prognathism : CHIN CUP can be used in some cases but it is hardely effective in controlling continues mandibular growth. Most probably, patient will need a phase 2 treatment after growth stops.
If patient has a family history of Class III ,This infomation is used as a PREDICTION method that make us expect that patient MIGHT have his mandible to continue growing.
That DOESN’T MEAN that we delay treatment untill growth stops , because patient might need intervention to correct other problems like crowding , impacted canines …. etc.
- If Skeletal ClassIII in patient with stopped growth ( approximately 18 – 20 ) . SURGICAL PLAN or CAMOUFLAGE are considered according to several factors. (**See this link **).
- According to the cause , double or single jaw surgery is adopted. For example , If the maxilla is clearly deficient and normal lower lip and mandibular position , a maxillary advancement is preferred.
- If GENIOPLASTY is planned then Surgical Option is given the priority over the Camouflage option.
- In DENTAL Class III or Psudo Class III cases , Camouflage usually is done mostly by extraction in the lower arch only unless there is a bimaxillary protrusion that necessitate extraction on the upper as well. The camouflage option should be taken after close monitoring of symphesis bone thickness whether it allow retraction of lower incisors or not?
The Severity of Class III cases can be determined by the amount of AP relationship of canines not the incisors.Camouflage can be used in severe class III canines cases if the skeletal base and patient profile can allow for an acceptable and reasonable result.
Any case should be thought of in THREE PLANES , Anteroposterior , Transverse and Vertical .