TREATMENT OF
CLASS III MALOCCLUSION
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.co...
“Class III malocclusion occurred when
the lower teeth occluded mesial to their
normal relationship the width of one
premol...
CLASSIFICATION

• TWEED (1966)
CLASS III MALOCCLUSION

PSEUDO CLASS III

SKELETAL CLASS III

Normal Mandible

Large Ma...
•MOYERS
ACCORDING TO THE CAUSE :

Osseous
Muscular
Dental

Anterior Positioning : Tooth contact relationship which
forc...
• FREQUENCY OF CLASS III MALOCCLUSION
7 to 13 Years
1) Caucasians

1 to 4 %

14 to 18 Years
2) African – Americans

3) Asi...
ETIOLOGY
 McGuigan (1966) – Inheritance of class III
malocclusion in Hapsburg Family, having the
distinct characteristics...
Enlarged tonsils and naso-respiratory diseases – Results in
anterior tongue posturing.
Premature loss of decidious molars ...
COMPONENTS OF CLASS III MALOCCLUSION

• Vertical components :
• Vertical Deficient
• Vertical Normal
• Vertically excess

...
DENTAL ASSESSMENT FOR DIAGNOSING CLASS III MALOCCLUSION

www.indiandentalacademy.com
Class III Skeletal Growth Pattern
1) Cranial Base
 Angle – More Acute
 Middle Cranial Fossa  Posterior and Superior
Ali...
Indication and Contraindication for
Early Class III treatment
TURPIN et al (1981)
Positive Factors :

Good Facial estheti...
Treatment of Pseudo class III
Malocclusion
Clinical Features :
 Anterior cross bite with premature tooth
contact with CO-...
Treatment of Skeletal class III malocclusion
1) Pre-Adolescence (Growth Remaining)
a) Functional Appliance Therapy
 Frank...
CHIN CUP THERAPY
 Indication  Normal maxilla and prognathic
mandible
 Effect of Mandibular growth
• Redirection of Mand...
Force magnitude and Direction
TYPES
• Occipital Pull
• Vertical Pull
Orthopaedics force of 300-400 grams / 14 hours a day...
FACE MASK THERAPY

Delaire et al , (1960) : Revived interest in using
face mask for Maxillary protraction

Petite : Later ...
COMPONENTS

Forehead Pad
Midline frame work

Hooks
Chin Pad
www.indiandentalacademy.com
Maxillary protraction below centre of
resistance produces anticlockwise
rotation of the maxilla

Protraction elastics atta...
CONSTRUCTION OF ANCHORAGE SYSTEM
1) Metallic banded palatal expansion appliance
2) Acrylic bonded palatal expansion applia...
Cokish and Shapio ( 1979) :-

- Anticlockwise maxilla
- Clockwise rotation of mandible
Kambala et al (1977) : Maxilla disp...
Thank you
For more details please visit
www.indiandentalacademy.com

www.indiandentalacademy.com
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Treatment of class iii malocclusion /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in

continuing dental education , training dentists

in all aspects of dentistry and offering a wide

range of dental certified courses in different

formats.

Indian dental academy provides dental crown &

Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit

www.indiandentalacademy.com ,or call
0091-9248678078

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Treatment of class iii malocclusion /certified fixed orthodontic courses by Indian dental academy

  1. 1. TREATMENT OF CLASS III MALOCCLUSION INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. “Class III malocclusion occurred when the lower teeth occluded mesial to their normal relationship the width of one premolar or even more in extreme cases”. - Angle (1899) www.indiandentalacademy.com
  3. 3. CLASSIFICATION • TWEED (1966) CLASS III MALOCCLUSION PSEUDO CLASS III SKELETAL CLASS III Normal Mandible Large Mandible Underdeveloped Maxillae Underdeveloped or Normal Maxillae www.indiandentalacademy.com
  4. 4. •MOYERS ACCORDING TO THE CAUSE : Osseous Muscular Dental Anterior Positioning : Tooth contact relationship which force the mandible into a forward position.(Pseudo Class III) www.indiandentalacademy.com
  5. 5. • FREQUENCY OF CLASS III MALOCCLUSION 7 to 13 Years 1) Caucasians 1 to 4 % 14 to 18 Years 2) African – Americans 3) Asian 4.2% 5 to 8% Maxillary deficiency 4) Japanese 4 % Younger / 14 % Older 5) Chinese 3 % Younger / 13 % Older www.indiandentalacademy.com 9.4%
  6. 6. ETIOLOGY  McGuigan (1966) – Inheritance of class III malocclusion in Hapsburg Family, having the distinct characteristics of prognathic lower jaw.  Litton et al (1970) – Dental characteristics of class III are related to genetic inheritance.  Functional factors – Anteriorly positioned tongue believed to be a local epigenetic factor.  Mental diseases – Compulsive habits of www.indiandentalacademy.com protruding the mandible.
  7. 7. Enlarged tonsils and naso-respiratory diseases – Results in anterior tongue posturing. Premature loss of decidious molars – Results in anterior mandibular displacement. Tongue thrusting habit – Prevents eruption of buccal segments, thus causing auto-rotation of mandible into excessive intra occlusal space. www.indiandentalacademy.com
  8. 8. COMPONENTS OF CLASS III MALOCCLUSION • Vertical components : • Vertical Deficient • Vertical Normal • Vertically excess •Anterio Posterior components : • Maxillary Deficient • Mandibular excess • Combined Maxillary deficient and mandibular excess www.indiandentalacademy.com
  9. 9. DENTAL ASSESSMENT FOR DIAGNOSING CLASS III MALOCCLUSION www.indiandentalacademy.com
  10. 10. Class III Skeletal Growth Pattern 1) Cranial Base  Angle – More Acute  Middle Cranial Fossa  Posterior and Superior Alignment 2) Maxilla  Decreased horizontal maxillary growth when compared with the patients with class I malocclusion. 3) Mandible  Gonial Angle  Obtuse  Anteriorly placed  Dentoalveolar compensation  Proclination of upper incisors, Retroclination of lower incisors. www.indiandentalacademy.com
  11. 11. Indication and Contraindication for Early Class III treatment TURPIN et al (1981) Positive Factors : Good Facial esthetics Mild skeletal disharmony No familial prognathism Ant-Post functional shift Convergent facial types Negative Factors : Poor facial esthetics Severe skeletal disharmony Growth complete www.indiandentalacademy.com
  12. 12. Treatment of Pseudo class III Malocclusion Clinical Features :  Anterior cross bite with premature tooth contact with CO-CR discrepancy Treatment : 1) Reverse SS crown 2) Tongue Blade 3) Fixed Appliance www.indiandentalacademy.com
  13. 13. Treatment of Skeletal class III malocclusion 1) Pre-Adolescence (Growth Remaining) a) Functional Appliance Therapy  Frankel III regulator Two separate studies concluded ; 1) Dento alveolar effect 2) Downward and Backward rotation of Mandible www.indiandentalacademy.com
  14. 14. CHIN CUP THERAPY  Indication  Normal maxilla and prognathic mandible  Effect of Mandibular growth • Redirection of Mandibular growth vertically • Backward repositioning of mandible • Remodeling of mandible with closure of gonial angle.  Effect of Maxillary Growth www.indiandentalacademy.com
  15. 15. Force magnitude and Direction TYPES • Occipital Pull • Vertical Pull Orthopaedics force of 300-400 grams / 14 hours a day. Treatment Timing Primary to early mixed dentition Stability Sugarwara et al :- Though skeletal changes were greatly improved initially they were however not www.indiandentalacademy.com maintained.
  16. 16. FACE MASK THERAPY Delaire et al , (1960) : Revived interest in using face mask for Maxillary protraction Petite : Later modified Delaire’s concept by increasing the force and thus decreasing the treatment time. www.indiandentalacademy.com
  17. 17. COMPONENTS Forehead Pad Midline frame work Hooks Chin Pad www.indiandentalacademy.com
  18. 18. Maxillary protraction below centre of resistance produces anticlockwise rotation of the maxilla Protraction elastics attached near the maxillary canine with a downward and forward pull of 30 degrees to the occlusal plane minimize bite opening. Force : 300 to 600 grams per side depending on age. Time : 10 to 12 Hrs / Day Duration : 3 to 6 months www.indiandentalacademy.com
  19. 19. CONSTRUCTION OF ANCHORAGE SYSTEM 1) Metallic banded palatal expansion appliance 2) Acrylic bonded palatal expansion appliance Skeletal Effect of Maxillary Protraction Lacrimo Maxillary Fronto maxillary Naso Maxillary Ethmomaxillary Zygomatico maxillary Zygomatico Temporal Pterygo palatine Intermaxillary www.indiandentalacademy.com
  20. 20. Cokish and Shapio ( 1979) :- - Anticlockwise maxilla - Clockwise rotation of mandible Kambala et al (1977) : Maxilla displaced anteriorly with changes in the circum maxillary sutures with forward and downward movement of maxilla Does it make a different if protraction was initiated during expansion or after expansion ? Beik (1984) : Found that greater forward movement of maxilla was initiated during maxillary expansion STABILITY : - Effects on maxilla remain stable for 1 – 2 years after treatment - In some studies maxilla and mandible reverted back to original position. www.indiandentalacademy.com
  21. 21. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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