This document provides an overview of Class 3 malocclusion, including its typical dental, skeletal, and soft tissue presentations. It discusses the classification of Class 3 as mild, moderate, or severe based on the degree of skeletal vs. dental discrepancy. Treatment options include growth modification with devices like facemasks, dental camouflage techniques like extractions, and orthognathic surgery to correct severe skeletal discrepancies.

1. CLASS 3 MALOCCLUSION
Shahzad Hussain
Final year BDS
Roll no 48

2. Content:
1) Introduction
2) Dental assesment
3) Skeletal Assesment
4) Etiology
5) Soft Tissue Effects
6) CEPH
7) Dental Features
8) Occlusal Features
9) Classification
10) Treatment Planning
11) Growth Modification
12) Camoflauge
13) Orthoganathic Surgery
14) References

3. Introduction:
 The Skeletal Class III malocclusion is characterized by mandibular
prognathism, maxillary deficiency or both.
 Clinically, these patients exhibit a concave facial profile, a retrusive
nasomaxillary area and a prominent lower third of the face.
 The lower lip is often protruded relative to the upper lip.
 overjet and overbite can range from reduced to reverse.
 there is a definite familial and racial tendency to mandibular
prognathism.
 For many Class III malocclusions, surgical treatment can be the best
alternative.

4. Introduction(cont)
 Depending on the amount of skeletal discrepancy,
surgical correction may consist of mandibular
setback, maxillary advancement or a combination of
mandibular and maxillary procedures.
 . After surgical correction of the skeletal
discrepancy, the occlusion is usually finished
orthodontically to a Class I relationship.
 . Sometimes a Class III relationship is caused by a
forward shift of the mandible to avoid incisal
interferences. This is a pseudo-Class III
malocclusion

5. Typical Presentation OF Class 3
Malocclusion

6. Dental Assesment :

7. Skeletal Pattern:

8. Etiology:
 Early closure of the nasomaxillary complex sutures in
certain syndromes.
 Hereditary ,small size maxilla and big size mandible.
 Collapsed maxilla for cleft lip and palate patients.
 Mouth breathing individuals.
 Environmental,collapse of maxilla occur when
extraction of multiple permanent teeth occur early in
life.

9. the problem may be limited to dentition
alone by:
Proclination of Lower
anterior teeth
Retroclination of upper
anterior teeth
Combination of Both.

10. Soft Tissue Effects:
The soft tissue surrounding play a very minor effect in the etiology of
class III malocclusion when compared with their effect in class II
malocclusion.
Where the lips competent, the lips and tongue induse retroclination of
the lower incisors and prolination of the upper incisors (dentoalveolar
compensation). Where the lower anterior facial height is increased the
lower lips are frequently incompetent, with an adaptive tongue thrust on
swallowing which may procline the lower incisors.
In sagittal direction except in sever skeletal III cases with mandibular
protrusion ,lower lip will act to retroclined the lower anterior teeth and
change their inclination.

11. Dental Factors

12. CEPH

13. Dental Features:
The lower incisor edge lie anterior to the cingulum plateau of the upper incisors,
the overjet is reduced or reversed' (british standards institute classification)
The overbite may be increased ,average ,or reduced. Where the vertical facial
proportions are increased ,there is often an anterior open bite.
Frequently, the upper incisors are proclined and the lower incisors retroclined,
compensating for the underlying classIII skeletal pattern.
Upper arch crowding is common, often because of a short and narrow dental base,
while the lower arch is more commonly aligned or spaced.
Crossbite of the labial and/or buccal segments are common, resulting from the
underlying classIII occlusal discrepancy as well as from differences in the length and
width of the arches. Cross bite may be associated with a mandibular displacement
particularly where a unilateral buccal segment crossbite exists. In the case of anterior
cross bite, the possibility of displacement should be assessed by checking if
relationship

14. Occlusal Features

15. Classification
 mild CL III 'dental' :
O.J. is purely dental due to different axial inclination of U/L
anterior teeth or one of them ,O.J.=(0,-1,-2 mm)
 moderate CLIII 'dento-skeletal' :
In which the cause of the reverse O.J. may be attributed partly
to jaws and the other part to teeth together O.J (-1,-2,-3 mm)
 sever CL III 'SKELETAL' :
In which the cause of the reverse O.J. is a result of improper
positions i.e. the maxilla is retruded and the mandible is
protruded 'one of them or both '. in this situation orthognathic
surgery is the solution of this discrepancy with the help of the
orthodontist and OMF surgeon.

16. Treatment Planning
Consider the degree of
Antero posterior and vertical skeletal discrepancy,
the potential direction and extent of future facial
growth,
incisor inclinations, the amount of overbite,
the ability to achieve edge to-edge incisor
relationship,
and the degree of upper and lower arch crowding

17. Treatment Planning (cont)
According to the classification the treatment of
type 3 by surgery while type 1&2 the postural
can be treated orthodontically alone after
removing or treating the cause by
1. proclination of upper anterior teeth
2. retroclination of lower anterior teeth
3. The amount of both movement may be
limited or accepted or one of them

18. Growth Modification:
This is the First stage of treatment
It Includes
1. FR3
2. Reverse Pull Headgear
3. Class 3 elastics

19. Growth Modification:

20. Camoflauge:
This is the Second comprehensive stage of the Class
3 treatment
It Includes Dental Compensations in an order to mask
the effects produced by class 3 malocclusion
It includes treatment by extraction in the late
permanent dentition years
Classical extraction protocol includes
1. Lower First Premolar
2. Lower First Premolar and Upper 2nd premolar
3. Lower Incisor

21. Orthoganathic Surgery:
This is usually the treatment if the patient
has completed his growth and the skeletal
discrepency cannot be masked with
camoflauge.
Extraction protocoal for surgery is
1. Upper First Premolar

22. References:
Contemporary Orthodontics

23. Thank You