3.management of angles class iii malocclusion
TRANSCRIPT
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MANAGEMENT OF ANGLES CLASS III MALOCCLUSION
By Collins C. AketchFriday, 19th April 2013
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What is Angle’s class iii?
• This condition represents a prenomalcy where the mandible is
in a mesial relation to the upper arch
• According to angle, Class iii molar relationship refers to a
condition where the mesiobuccal cusp of the upper 1st molar
occludes between the mandibilar 1st and 2nd molars
• The lower molar can be in the said mesial relationship to
varying degrees
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Features:Extra-oral Features
• A straight to concave profile
• Anteriorly divergent profile
• Long face (increased lower face height), which may
be pointed at the chin
• Mandible appears to be well developed (with an
obtuse gonial angle)
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Features cont:
Intraoral Features
• A Class iii molar relationship
• A Class iii canine relationship
• A reverse overjet with possibly labially inclined lower incisors
and lingually inclined upper icisors
• A posterior cross-bite unilateral or bilateral (or functional)
due to a constricted maxillary arch or a more forward
positioned lower arch
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Skeletal features:
i. Short retrognathic maxilla
ii. Long prognahtic mandible
iii. combination
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Etiology:
• Hereditary (main factor)
• Functional factors and soft tissues (Flat, low, anteriorly placed
tongue that lies low in the oral cavity / macroglossia)
• Compulsive habit of protruding the mandible
• Unilateral or bilateral hyperplasia of mandibular condyle can
cause the Class III malocclusion.
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Etiology cont…• Occlusal forces created by the abnormal eruption may
produce unfavorable incisal guidance
• Premature loss of deciduous molars may also cause
mandibular displacement with an occlusal guidance from
teeth
• Anteroposterior deficiency of the maxilla can occur in cases of
cleft lip and palate
• Trauma to the mid-face during the growth phase
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Correction of class iii
• Growth modification
• Orthodontic correction
• Surgery
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• Should be identified and corrected early
• Treatment is highly dependent on the
patient’s age and hence;
- Preadolescent
- Adolescent
- Adult
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PRE-ADOLESCENT CHILDA) FRANKEL III APPLIANCE
• Stretches the soft tissue envelop around the maxilla in an
attempt to stimulate the forward growth of the maxilla. Does
not allow the mandible to advance forward.
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B) THE CHIN CUP
• Applies forces, directed along the direction of growth of the
condyle. Inhibits the forward growth of the mandible
• Capable of moving the chin down and back.
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C) ANTERIOR FACEMASK
• Promotes maxilla to grow anteriorly and/or rotate
downwards. This causes a reciprocal downward and backward
rotation of the mandible.
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D) RME WITH ANTERIOR FACEMASK
• RME is used to split the mid-palatal suture causing a
downward and forward movement of the maxilla.
• During this instance the teeth are disoccluded.
• A facemask is used to pull the maxilla further forward.
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E) 3-D SCREWS
• Capable of expanding the maxilla in all the three directions.
• Appliances, both removable and cemented can be used to
correct pseudo Class iii malocclusions and thus prevent their
progression to a full-fledged malocclusion.
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THE ADOLESCENT CHILD• Limited to orthodontic camouflage or orthodontic
decompensation in an effort to prepare the patient for
surgery.
• Camouflage can be achieved by proclining the maxillary
anteriors and tipping the mandibular incisors lingually
• Single arch extractions, extraction only in the mandibular
arch, are frequently done to create space for the retraction of
the mandibular anterior segment
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ADULTHOOD
• Emphasis is more on orthognathic surgery.
Bilateral sagittal split osteotomy with retraction of the
mandible
Segmental retraction
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Thank You!