EARLY TREATMENT OF CLASS III MALOCCLUSION
DOI:
https://doi.org/10.32782/3041-1394.2024-3.4Keywords:
Class III malocclusions, early treatment, functional treatmentAbstract
This article reviews the literature on the best time to start Class III treatment and the skeletal and dentoalveolar effects that can be achieved with functional/orthopedic treatment of this malocclusion. The authors’ clinical experience is also reflected through the clinical guidelines for the use of anterior traction with a face mask, the use of a chin cup for the treatment of mandibular prognathia, treatment with the Fränkel Functional Regulator 3, and the use of Class III orthodontic plates.
References
Echarri, P. (2002). Diagnóstico en ortodoncia. Tratamiento interdisciplinario. 1st Edition. Barcelona (Spain): Nexus Ediciones.
Campbell, P.M. (1983). The dilemma of Class III treatment. Early or late? Angle Orthod. Jul; 53 (3): 175–91. DOI: 10.1043/0003-3219(1983)053<0175: TDOCIT>2.0.CO;2.
Chang, H.P., Kinoshita, Z., & Kawamoto, T. (1992). Craniofacial pattern of Class III deciduous dentition. Angle Orthod. Summer; 62 (2): 139–44. DOI: 10.1043/0003-3219(1992)062<0139:CPOCID>2.0.CO;2.
Delaire, J. (1971). Considérations sur la croissance faciale (en particulier du maxillaire supérieur). Deductions thérapeutiques [Considerations on facial growth (particularly of the maxilla). Therapeutic deductions]. Rev Stomatol Chir Maxillofac. Jan – Feb; 72 (1): 57–76. French.
Guyer, E.C., Ellis, E.E. 3rd, McNamara, J.A. Jr., & Behrents R.G. (1986). Components of class III malocclusion in juveniles and adolescents. Angle Orthod. Jan; 56 (1): 7–30.
Williams, S., Andersen, C.E. (1986). The morphology of the potential Class III skeletal pattern in the growing child. Am J Orthod. Apr; 89 (4): 302–11. DOI: 10.1016/0002-9416(86)90052-7.
McNamara, J.A. Jr., Baccetti, T., Franchi, L., & Chapter 6. Class III malocclusion. In: McNamara J.A. Jr., Brudon W.L., editors. Orthodontics and dentofacial orthopedics. Ann Arbor (MI, USA): Needham Press, Inc.; pp. 85–95.
Lew, K.K. (2001). Malocclusion status in Singapore school children. Cited in: Lew K.K.K., Foong W.C. Horizontal skeletal typing in an ethnic Chinese population with true Class III malocclusion. Br J Orthod. 1993, Feb; 20 (1): 19–23. DOI: 10.1179/bjo.20.1.19.
Endo, T. (1971) [An epidemiological study of reversed occlusion. I. Incidence of reversed occlusion in children 6 to 14 years old]. Nihon Kyosei Shika Gakkai Zasshi. Jun; 30 (1): 73–7. Japanese.
Susami, R., Asai, Y., Hirose, K., Hosoi, T., & Hayashi, I. (1972). [Prevalence of malocclusion in Japanese school children. 4. The frequency of mandibular overjet]. Nihon Kyosei Shika Gakkai Zasshi. Dec; 31 (2): 319–24. Japanese.
Kitai, N., Takada, K., Yasada, Y., Adachi, S., & Sakuda, M. (1989). School health data base and its application. J Kin – To Orthod Soc.; 24: 33–8.
Mills, L.F. (1966). Epidemiologic studies of occlusion. IV. The prevalence of malocclusion in a population of 1,455 school children. J Dent Res. Mar – Apr; 45 (2): 332–6. DOI: 10.1177/00220345660450022001.
Brunelle, J.A., Bhat, M., & Lipton, J.A. (1996). Prevalence and distribution of selected occlusal characteristics in the US population, 1988–1991. J Dent Res. Feb; 75 (2 Suppl): 706–13. DOI: 10.1177/002203459607502S10.
Proffit, W.R., Fields, H.W. Jr, & Moray, L.J. (1998). Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. Int J Adult Orthodon Orthognath Surg.; 13 (2): 97–106.
Tollaro, I., Baccetti, T., Bassarelli, V., & Franchi, L. (1994). Class III malocclusion in the deciduous dentition: a morphological and correlation study. Eur J Orthod. Oct; 16 (5): 401–8. DOI: 10.1093/ejo/16.5.401.
Mitani, H. (1981). Prepubertal growth of mandibular prognathism. Am J Orthod. Nov; 80 (5): 546–53. DOI: 10.1016/0002-9416(81)90249-9.
Mitani, H., Sato, K., & Sugawara, J. (1993). Growth of mandibular prognathism after pubertal growth peak. Am J Orthod Dentofacial Orthop. Oct; 104 (4):330–6. DOI: 10.1016/S0889-5406(05)81329-0.
Miyajima, K., McNamara, J.A. Jr, Sana, M., & Murata, S. (1997). An estimation of craniofacial growth in the untreated Class III female with anterior crossbite. Am J Orthod Dentofacial Orthop. Oct; 112 (4): 425–34. DOI: 10.1016/s0889-5406(97)70051-9. PMID: 9345155.
Baccetti, T., McGill, J.S., Franchi, L., McNamara, J.A. Jr., & Tollaro, I. (1998). Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy. Am J Orthod Dentofacial Orthop. Mar; 113 (3): 333–43. DOI: 10.1016/s0889-5406(98)70306-3.
Franchi, L., Baccetti, T., & McNamara, J.A. Jr. (1998). Shape-coordinate analysis of skeletal changes induced by rapid maxillary expansion and facial mask therapy. Am J Orthod Dentofacial Orthop. Oct; 114 (4): 418–26. DOI: 10.1016/s0889-5406(98)70187-8.
Riolo, M.L., Moyers, R.E., McNamara, J.A. Jr., & Hunter, Ws. (1974). An atlas of craniofacial growth. Cephalometric standards from the University School Growth Study, the University of Michigan. Monograph 2, Craniofacial Growth Series, Center for Human Growth and Development. Ann Arbor (MI, USA): University of Michigan.
Rakosi, T. (1997). Treatment of Class IIImalocclusion. In: Graber TM, Rakosi T., Petrovic A.G., editors. Dentofacial orthopedics with functional appliances. 2nd Edition. St. Louis (MO, USA): Mosby; pp. 461–80.
Kovero, O., Könönen, M., & Pirinen, S. (1997). The effect of professional violin and viola playing on the bony facial structures. Eur J Orthod. Feb; 19 (1): 39–45. DOI: 10.1093/ejo/19.1.39.
Mitani, H. (2002). Early application of chincap therapy to skeletal Class III malocclusion. Am J Orthod Dentofacial Orthop. Jun; 121 (6): 584–5. DOI: 10.1067/mod.2002.124170.
Pangrazio-Kulbersh, V., Berger, J., & Kersten, G. (1998). Effects of protraction mechanics on the midface. Am J Orthod Dentofacial Orthop. Nov; 114 (5): 484–91. DOI: 10.1016/s0889-5406(98)70167-2.
da Silva Filho, O.G., Magro, A.C., & Capelozza Filho, L. (1998). Early treatment of the Class III malocclusion with rapid maxillary expansion and maxillary protraction. Am J Orthod Dentofacial Orthop. Feb; 113 (2): 196–203. DOI: 10.1016/s0889-5406(98)70292-6.
Melsen, B., Melsen, F. (1982). The postnatal development of the palatomaxillary region studied on human autopsy material. Am J Orthod. Oct; 82 (4): 329–42. DOI: 10.1016/0002-9416(82)90467-5.
Shanker, S., Ngan, P., Wade, D., Beck, M., Yiu, C., Hägg, U., & Wei, S.H. (1996). Cephalometric A point changes during and after maxillary protraction and expansion. Am J Orthod Dentofacial Orthop. Oct; 110 (4): 423–30. DOI: 10.1016/s0889-5406(96)70046-x.
Tollaro, I., Baccetti, T., & Franchi, L. (1996). Craniofacial changes induced by early functional treatment of Class III malocclusion. Am J Orthod Dentofacial Orthop. Mar; 109 (3): 310–8. DOI: 10.1016/s0889-5406(96)70154-3.
Lavergne, J., & Gasson, N. (1977). Operational definitions of mandibular morphogenetic and positional rotations. Scand J Dent Res. Mar; 85 (3): 185–92. DOI: 10.1111/j.1600-0722.1977.tb00552.x.
Baccetti, T., Franchi, L., & McNamara, J.A. Jr. (2000). Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop. Oct; 118 (4): 404–13. DOI: 10.1067/mod.2000.109840. PMID: 11029736.
Bjork, A. (1964). Sutural growth of the upper face studied by the implant method. Trans Eur Orthod Soc.; 40: 1–17.
Sandborn, R.T. (1955). Differences between the facial skeletal patterns of Class III malocclusion and normal occlusion. Angle Orthod. Oct; 25 (4): 208–22.
Klempner, L.S. (2003). Early orthopedic Class III treatment with a modified tandem appliance. J Clin Orthod. Apr; 37 (4): 218–23; quiz 204.
Echarri, P. (2004). Capítulo 13. Tratamiento ortodóncico y ortopédico de la mordida cruzada anterior. Placas de Clase III. Tracción anterior. Mascarilla facial. Mentonera con anclaje temporal y mentonera inversa. En: Echarri P, editor. Tratamiento ortodóncico y ortopédico deprimera fase en dentición mixta. Barcelona (Spain): Nexus Ediciones; pp.251–71.
Proffit, W.R. (1986). Treatment of skeletal problems in preadolescent children. In: Proffit WR. Contemporary orthodontics. St. Louis (MO, USA): Mosby; pp. 382–6.
Fränkel, R. (1970). Maxillary retrusion in Class III and treatment with the function corrector III. Trans Eur Orthod Soc; 46: 249–59.
McNamara, J.A. Jr. (2001). Chapter 23. The function regulator (FR-3) of Fränkel. In: McNamara J.A. Jr., Brudon W.L., editors. Orthodontics and dentofacial orthopedics. Ann Arbor (MI, USA): Needham Press, Inc. pp. 387–94.
McNamara, J.A. Jr., & Huge, S.A. (2001). The functional regulator (FR-3) of Fränkel. Am J Orthod. 1985 Nov; 88 (5): 409–24. DOI: 10.1016/0002-9416(85)90068-5.
Robertson, N.R. (1983). An examination of treatment changes in children treated with the function regulator of Fränkel. Am J Orthod. Apr; 83 (4): 299–310. DOI:10.1016/0002-9416(83)90225-7.
Kerr, W.J., & Tenhave, T.R. (1988). A comparison of three appliance systems in the treatment of Class III malocclusion. Eur J Orthod. Aug; 10 (3): 203–14. DOI: 10.1093/ejo/10.3.203.
Kerr, W.J., Tenhave, T.R., & McNamara, J.A. Jr. (1989). A comparison of skeletal and dental changes produced by function regulators (FR-2 and FR-3). Eur J Orthod. Aug; 11 (3): 235–42. DOI: 10.1093/oxfordjournals.ejo.a035991.
Ulgen, M., & Firatli, S. (1989). The effects of the Fränkel’s function regulator on the Class III malocclusion. Am J Orthod Dentofacial Orthop. 1994 Jun; 105 (6): 561–7. DOI: 10.1016/S0889-5406(94)70140-7.
Baik, H.S., Jee, S.H., Lee, K.J., & Oh, T.K. (2004). Treatment effects of Fränkel functional regulator III in children with class III malocclusions. Am J Orthod Dentofacial Orthop. Mar; 125 (3): 294–301. DOI: 10.1016/j.ajodo.2003.04.016.
Garattini, G., Levrini, L., Crozzoli, P., & Levrini, A. (1998). Skeletal and dental modifications produced by the Bionator III appliance. Am J Orthod Dentofacial Orthop. Jul; 114 (1): 40–4. DOI: 10.1016/s0889-5406(98)70235-5.
Delaire, J. (1971). Confection du “masque orthopédique” [Manufacture of the “orthopedic mask”]. Rev Stomatol Chir Maxillofac. Jul – Aug; 72 (5): 579–82. French.
Delaire, J., Verdon, P., Lumineau, J.P., Cherga-Négréa, A., Talmant, J., & Boisson, M. (1972). Quelques résultats des tractions extra-orales à appui fronto-mentonnier dans le traitement orthopédique des malformations maxillo-mandibulaires de classe 3 et des séquelles osseuses des fentes labiomaxillaires [Some results of extra-oral tractions with front-chin rest in the orthodontic treatment of class III maxillomandibular malformations and of bony sequelae of cleft lip and palate]. Rev Stomatol Chir Maxillofac. Dec; 73 (8): 633–42. French.
Petit, H. (1983). Adaptations following accelerated facial mask therapy. Clinical alterations of the growing face. In: McNamara J.A. Jr., Ribbens K.A., Howe R.P., editors. Monograph 14, Craniofacial Growth Series. Ann Arbor (MI, USA): Center for Human Growth and Development, University of Michigan. pp. 48–59.
McNamara, J.A. Jr., Baccetti, T., & Franchi, L. (2001). Chapter 22. The facial mask. In: McNamara J.A. Jr., Brudon W.L., editors. Orthodontics and dentofacial orthopedics. Ann Arbor (MI, USA): Needham Press, Inc.; pp. 375–85.
Nanda, R. (1978). Differential response of midfacial sutures and bones to anteriorly directed extraoral forces in monkeys. J Dent Res. 57: 362.
Sung, S.J., & Baik, H.S. (1998). Assessment of skeletal and dental changes by maxillary protraction. Am J Orthod Dentofacial Orthop. Nov; 114 (5): 492–502. DOI: 10.1016/s0889-5406(98)70168-4.
Baik, H.S. (1995). Clinical results of the maxillary protraction in Korean children. Am J Orthod Dentofacial Orthop. Dec; 108 (6): 583–92. DOI: 10.1016/s0889-5406(95)70003-x.
Jackson, G.W., Kokich, V.G., & Shapiro, P.A. (1979). Experimental and postexperimental response to anteriorly directed extraoral force in young Macaca nemestrina. Am J Orthod. Mar; 75 (3): 318–33. DOI: 10.1016/0002-9416(79)90278-1.
Nanda, R. (1978). Protraction of maxilla in rhesus monkeys by controlled extraoral forces. Am J Orthod. Aug; 74 (2): 121–41. DOI: 10.1016/0002-9416(78)90080-5.
Jäger, A., Braumann, B., Kim, C., & Wahner, S. (2001). Skeletal and dental effects of maxillary protraction in patients with angle class III malocclusion. A meta-analysis. J Orofac Orthop. Jul; 62 (4): 275–84. English, German. DOI: 10.1007/pl00001935.
Kajiyama, K., Murakami, T., & Suzuki, A. (2000). Evaluation of the modified maxillary protractor applied to Class III malocclusion with retruded maxilla in early mixed dentition. Am J Orthod Dentofacial Orthop. Nov; 118 (5): 549–59. DOI: 10.1067/mod.2000.110169.
Kambara, T. (1977). Dentofacial changes produced by extraoral forward force in the Macaca irus. Am J Orthod. Mar; 71 (3): 249–77. DOI: 10.1016/0002-9416(77)90187-7.
Kang, H.S. (1988). A laser holographic study on the initial reaction of maxillofacial complex to maxillary protraction. Korean J Orthod. Nov; 18 (2): 367–81.
Keles, A., Tokmak, E.C., Erverdi, N., & Nanda, R. (2002). Effect of varying the force direction on maxillary orthopedic protraction. Angle Orthod. Oct; 72 (5): 387–96. DOI: 10.1043/0003-3219(2002)072<0387:EOVTFD>2.0.CO;2. PMID: 12401046.
McNamara, J.A. Jr. (1987). An orthopedic approach to the treatment of Class III malocclusion in young patients. J Clin Orthod. 1987 Sep; 21 (9): 598–608. Erratum in: J Clin Orthod Nov; 21 (11): 804.
Mermigos, J., Full, C.A., & Andreasen, G. (1990). Protraction of the maxillofacial complex. Am J Orthod Dentofacial Orthop. Jul; 98 (1): 47–55. DOI: 10.1016/0889-5406(90)70031-7.
Ngan, P., Wei, S.H., Hagg, U., Yiu, C.K., Merwin, D., & Stickel, B. (1992). Effect of protraction headgear on Class III malocclusion. Quintessence Int. Mar; 23 (3): 197–207.
Ngan, P., Hägg, U., Yiu, C., Merwin, D., & Wei, S.H. (1996). Soft tissue and dentoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop. 1996 Jan; 109 (1): 38–49. DOI: 10.1016/s0889-5406(96)70161-0. Erratum in: Am J Orthod Dentofacial Orthop Apr; 109 (4): 459.
Ngan, P. (2002). Biomechanics of maxillary expansion and protraction in Class III patients. Am J Orthod Dentofacial Orthop. Jun; 121 (6): 582–3. DOI: 10.1067/mod.2002.124168.
Miyasaka-Hiraga, J., Tanne, K., & Nakamura, S. (1994). Finite element analysis for stresses in the craniofacial sutures produced by maxillary protraction forces applied at the upper canines. Br J Orthod. Nov; 21 (4): 343–8. DOI: 10.1179/bjo.21.4.343.
Grandori, F., Merlini, C., Amelotti, C., Piasente, M., Tadini, G., & Ravazzani P. (1992). A mathematical model for the computation of the forces exerted by the facial orthopedic mask. Am J Orthod Dentofacial Orthop. May; 101 (5): 441–8. DOI: 10.1016/0889-5406(92)70118-t.
Saadia, M., & Torres, E. (2000). Sagittal changes after maxillary protraction with expansion in class III patients in the primary, mixed, and late mixed dentitions: a longitudinal retrospective study. Am J Orthod Dentofacial Orthop. Jun; 117 (6): 669–80.
Saadia, M., & Torres, E. (2001). Vertical changes in Class III patients after maxillary protraction with expansion in the primary and mixed dentitions. Pediatr Dent. Mar – Apr; 23 (2): 125–30.
Sarnäs, K.V., & Rune, B. (1987). Extraoral traction to the maxilla with face mask: a follow-up of 17 consecutively treated patients with and without cleft lip and palate. Cleft Palate J. Apr; 24 (2): 95–103.
Simonsen, R. (1982). The effect of face mask therapy. Am J Orthod. Nov; 82 (5): 439. DOI: 10.1016/0002-9416(82)90206-8.
Suda, N., Ishii-Suzuki, M., Hirose, K., Hiyama, S., Suzuki, S., & Kuroda, T. (2000). Effective treatment plan for maxillary protraction: is the bone age useful to determine the treatment plan? Am J Orthod Dentofacial Orthop. Jul; 118 (1): 55–62. DOI: 10.1067/mod.2000.104491.
Turley, P.K. (2002). Managing the developing Class III malocclusion with palatal expansion and facemask therapy. Am J Orthod Dentofacial Orthop. Oct; 122 (4): 349–52. DOI: 10.1067/mod.2002.127295.
Wisth, P.J., Tritrapunt, A., Rygh, P., Bøe, O.E., & Norderval, K. (1987). The effect of maxillary protraction on front occlusion and facial morphology. Acta Odontol Scand. Jun; 45 (3): 227–37. DOI: 10.3109/00016358709098862.
Cozzani, G. (1981). Extraoral traction and class III treatment. Am J Orthod. Dec; 80 (6): 638–50. DOI: 10.1016/0002-9416(81)90266-9.
Haas, A.J. (1970). Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod. Mar; 57 (3): 219–55. DOI: 10.1016/0002-9416(70)90241-1.
Echarri, P. Ficha clínica 3. Tracción anterior y arco utilitario. Ortod Clin. 2003; 6 (1): 9–12.
Nanda, R. (1980). Biomechanical and clinical considerations of a modified protraction headgear. Am J Orthod. Aug; 78 (2): 125–39. DOI: 10.1016/0002-9416(80)90055-x.
Chong, Y.H., Ive, J.C., & Artun, J. (1996). Changes following the use of protraction headgear for early correction of Class III malocclusion. Angle Orthod.; 66 (5): 351–62. DOI: 10.1043/0003-3219(1996)066<0351: CFTUOP>2.3.CO;2.
Takada, K., Petdachai, S., & Sakuda, M. (1993). Changes in dentofacial morphology in skeletal Class III children treated by a modified maxillary protraction headgear and a chin cup: a longitudinal cephalometric appraisal. Eur J Orthod. Jun; 15 (3): 211–21. DOI: 10.1093/ejo/15.3.211.
Turley, P.K. (1988). Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear. J Clin Orthod. May; 22 (5): 314–25.
Wang, F. (1996). Inverted labial bow appliance for Class III treatment. J Clin Orthod. Sep; 30 (9): 487–92.
Langlade, M. (1986). Les frondes mentonnières. In: Langlade M. Thérapeutique Orthodontique. Paris (France): Maloine S.A. Éditeur; pp. 301–10.
Graber, L.W. (1977). Chin cup therapy for mandibular prognathism. Am J Orthod. Jul; 72 (1): 23–41. DOI: 10.1016/0002-9416(77)90122-1.
Sakamoto, T., Iwase, I., Uka, A., & Nakamura, S. (1984). A roentgenocephalometric study of skeletal changes during and after chin cup treatment. Am J Orthod. Apr; 85 (4): 341–50. DOI: 10.1016/0002-9416(84)90191-x.
Ritucci, R., & Nanda, R. The effect of chin cup therapy on the growth and development of the cranial base and midface. Am J Orthod Dentofacial Orthop. 1986 Dec; 90 (6): 475–83. DOI: 10.1016/0889-5406(86)90107-1.
Matsui, Y. (1965). Effect of chin cap on the growing mandible. J Japan Orthod Soc. 24 (2): 165–81.
Mirzen Arat, Z., Okan Akçam, M., & Gökalp, H. (2003). Long-term effects of chin-cap therapy on the temporomandibular joints. Eur J Orthod. Oct; 25 (5): 471–5. DOI: 10.1093/ejo/25.5.471.
Ishii, H., Morita, S., Takeuchi, Y., & Nakamura, S. (1987). Treatment effect of combined maxillary protraction and chincap appliance in severe skeletal Class III cases. Am J Orthod Dentofacial Orthop. Oct; 92 (4): 304–12. DOI: 10.1016/0889-5406(87)90331-3.
Westwood, P.V., McNamara, J.A. Jr., Baccetti, T., Franchi, L., & Sarver, D.M. (2003). Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop. Mar; 123 (3): 306–20. DOI: 10.1067/mod.2003.44.
Ferro, A., Nucci, L.P., Ferro, F., & Gallo, C. (2003). Long-term stability of skeletal Class III patients treated with splints, Class III elastics, and chincup. Am J Orthod Dentofacial Orthop. Apr; 123 (4): 423–34. DOI: 10.1067/mod.2003.70.
Sugawara, J., Asano, T., Endo, N., & Mitani, H. (1990). Long-term effects of chincap therapy on skeletal profile in mandibular prognathism. Am J Orthod Dentofacial Orthop. Aug; 98 (2): 127–33. DOI: 10.1016/0889-5406(90)70006-X.
