CLASS III

MALOCCLUSION

YEOH WEN LI
IV YEAR BDS
ROLL NO 35
Contents
 Introduction
 Angle’s classification
 Class III malocclusion
 Etiology
 Features
 Diagnosis
 Treatment
 Conclusion
 Reference
Introduction
 Occlusion (Angle)
= the normal relation of the occlusal inclined planes of the teeth
when the jaws are closed

It is a complex phenomenon involving the teeth, periodontal

ligament, the jaws, the temporo-mandibular joint, the
muscles and the nervous system
Angle’s classification of malocclusion
 By Edward Angle in 1899
 Based on the mesio-distal relation of the teeth

 Maxillary 1st permanent molar is the key to occlusion

 He classified based on the relation of lower 1st permanent

molar to upper 1st permanent molar :

- class I
- class II
- class III
 Further classified into :

1. True class III

2. Pseudo class III
(forward shift to escape interferences )
 Class III, subdivision

Condition characterized by a class III molar relation on one

side,
and a class I relation on the other side
Ackerman-Proffit classification
Class III malocclusion
 Class III molar relation present :
mesiobuccal cusp of maxillary 1st permanent molar occludes
in the interdental space between the mandibular 1st and 2nd
molars

 Very easy to identify but difficult to treat

 Represents a pre-normalcy where the mandible is in a mesial
relation to the upper arch
 ETIOLOGY OF CLASS III MALOCCLUSION
( Moyer’s classification based on etiology )

~ true class III is a skeletal malocclusion of genetic origin

 Skeletal factors
1. Antero-posterior skeletal relationship
 Forwardly placed mandible
 Retropositioned maxilla
2. Relative width of upper and lower jaws
 Excessively large mandible
 Smaller than normal maxilla
 May result in unilateral or bilateral crossbite
3. Vertical dimension of the face
 Short face tends to have deep overbite; long face have anterior
open bite
 Oral musculature
 Lower incisors may be retroclined due to lower lip function
in conjunction with skeletal discrepancy

 Dental factors
- Common finding is spaced dentition in the lower jaw and
crowding in the upper jaw
 PSEUDO CLASS III
-Pre-normalcy
-Produced by forward movement
of mandible during jaw closure;

Also called “postural” or “habitual” class III malocclusion

-Causes :

•Presence of occlusal prematurities may deflect the mandible forward

•In case of premature loss of deciduous posteriors, child tends to move the
mandible forward to establish contact in anterior region

•Child with enlarged adenoids; tends to move mandible forward to prevent

tongue from contacting adenoids
 HYPOPLASTIC
MAXILLA (APERT’S
SYNDROME )

ACROMEGALY

RETROGNATHIC
MAXILLA

HAPSBURG JAW
Features of class III
 Patient has class III molar relation

 Incisors - edge to edge relationship, or

- anterior crossbite, or
- normal incisal relationship (not uncommon )
 Upper arch : narrow and short,
 the lower arch : broad

Thus, posterior crossbites are common.

This is exaggerated due to mesial sagittal relationship of
lower arch

Broader part of mandibular arch opposes the narrow part of

upper arch
 Teeth :
 upper arch teeth crowded (arch is narrow and short)
 mandibular arch teeth is often spaced

 Facial profile : concave;

due to presence of prominent chin
 Vertical growers exhibiting an increased intermaxillary
height

may have anterior open bite

 Pseudo class III :
• have occlusal prematurities
• Results in habitual forward positioning of mandible
• May exhibit forward path of closure
Skeletal features
 Short or retrognathic maxilla

 A long or prognathic mandible

 Combination of above

 ANB angle is negative with smaller SNA or greater SNB

 upper incisors tipped labially; lower incisors tipped lingually
Diagnosis
 Diagnostic procedure should help in determining the
type of class III malocclusion :
• Dental or skeletal
• True or pseudo

 clinical examination – include observation of path of

closure
 Study models
 Radiographs
 Lateral cephalogram – information on the skeletal
nature of the malocclusion
Pretreatment intraoral photographs
Treatment
 Should be recognized and treated early
 WHY?
1. At early age, it is possible to intercept the abnormal skeletal
pattern;
reduce the severity of the developing malocclusion

2. Anterior crossbites often results in retarded maxillary

growth

due to locking of maxilla within mandible

3. The occlusal forces on the mandibular incisors by
maxillary incisors in crossbite will encourage the
continued forward growth of mandible; worsens pre-
normalcy
 Class III
malocclusion

Growing patient Non growing patient

Skeletal class III Dental class III Dental class III Skeletal class III

Maxillary
retrognathism
( face mask to protract
maxilla)
Mild to moderate
class III Severe class III
Mandibular
prognathism and
maxillary (orthodontic
retrognathism camoflage by
extraction of some
( face mask followed teeth)
by chin cap/
myofunctional
appliances)

Mandibular
prognathism Maxillary retrognathism Mandibular prognathism
(chin cup therapy to
restrict maxilary growth) Orthodontic treatment (surgical maxillary (surgical mandibular
as needed advancement) setback)
 1. Interception during growth
(growth modulation procedures)
 GOALS :

 prevent progressive, irreversible, soft tissue or bony changes

 improve skeletal discrepancy and a more favourable environment
for future growth
 improve occlusal function
 minimize need for orthognathic surgery
 for more pleasing esthetics
 Indications Contraindications

•Good facial esthetics •Poor

•Mild skeletal disharmony •Severe

•No familial prognathism •Familial pattern established

•Symmetric condylar growth •Asymmetric

•Growing patients •growth complete

• with expected good cooperation •expected poor cooperation

 Frankel III

- A myofunctional appliance used during growth to intercept

class III due to maxillary skeletal retrusion
 Reverse activator

 Chin cup with a high pull headgear

 To intercept class III malocclusion due to mandibular
prognathism
 Reverse headgear (or face mask)
 Used in severe class III malocclusion due to maxillary
retrusion
 To protract maxilla
 2. Treatment of anterior cross bite

 Mild anterior cross bite :

Removable appliances;
lower anterior incorporate screws for
inclined planes anterior expansion
After expander is removed,
typically 3 months after palatal
expansion is completed, an acrylic
retainer that covers the palate is
needed to control relapse and to
stabilize the skeletal components
 3. Treatment of posterior cross bite
 By rapid maxillary expansion

Banded palatal expander with jack

screw
 4. Role of extraction
~ to camouflage class III skeletal discrepancy in non
growing patients

 In presence of lower arch length deficiency and

anterior cross bite :
 Extraction of lower 1st premolar
 Followed by fixed mechanotherapy
 Class III intermaxillary elastics to retract lower
anteriors

 In arch length deficiencies involving both arches :

- Extraction of 1st premolars in both upper and lower
arches
Class III intermaxillary
elastics to retract lower
anteriors
 5. Treatment of severe class III after
growth
 By surgical and corrective procedures

 Indication :
~patients with continued disproportionate sagittal and vertical
growth
~ class III with maxillary retrusion/mandibular prognathism with
divergent facial pattern

 Contraindications
~ surgical intervention in a growing maxilla that is already deficient
~ still growing true mandibular prognathism (must have at least 1
year of no significant growth )
 If due to maxillary deficiency
- Maxillary advancement procedures (eg : le Fort I osteotomy )

 if due to mandibular prognathism

- Mandibular setback procedures (ramus osteotomy)
- Mandibular inferior border osteotomy; to reduce chin height
or prominence
 6. Treatment of pseudo class III
 improves on removal of the cause of occlusal prematurities
 Remove abnormal anterior occlusal contacts :

1. Reverse stainless steel crown

 To correct single tooth in anterior crossbite
 Can be replaced with composite for esthetics

2. Tongue blade
 For single tooth anterior crossbite

3. fixed or removable appliance with inclined plane

 Correction of multiple teeth in anterior crossbite

4. Removable appliance with auxiliary springs

 Move 1 or 2 teeth in mixed dentition
References
 Orthodontics The Art and Science, 4th Edition, by S.I.
Bhalajhi

 Contemporary Orthodontics, 4th Edition, by William R.

Proffit

 Textbook of Orthodontics 3rd Edition, by TD Foster

 Textbook of Orthodontics by Samir E. Bishara

 Walther and Houston’s Orthodontic Notes 5th Edition by

M.L. Jones and R.C. Oliver
THANK YOU