Severe cases of mandibular prognathism can be treated with orthodontic therapy or surgical correction, but there are situations where only prosthetic improvement is possible. An understanding of class III patients is needed, including a vertical chewing pattern and the absence of anterior guidance. Additionally, it is relatively easy to increase occlusal vertical dimension to correct the anterior crossbite, but this approach can sometimes lead to unfavorable results, necessitating careful diagnosis and treatment planning. In this case report, oral rehabilitation was conducted in a patient with mandibular prognathism and asymmetry, utilizing implants and fixed dental prosthesis. Through a step-by-step treatment approach, the existing occlusal vertical dimension was maintained, and the final fixed dental prosthesis restoration was completed. Accordingly, it shows functional and aesthetically appropriate results, and reports on the patient's diagnosis and treatment process.
Skeletal Class III malocclusion is a relatively common form of malocclusion in Korea. In borderline cases where only mild skeletal discrepancy exists and if worsening of the facial profile is expected as a result of premolar extraction, mandibular full arch distalization with miniscrews is the treatment of choice. The purpose of this study was to investigate the pattern of tooth movement and evaluate the stability of mandibular full arch distalization and to identify correlation between stability and factors such as initial skeletal pattern, dental changes during treatment and alveolar bone in symphysis region using lateral cephalograms.
Surgical-orthodontic treatment is performed for the skeletal Class III patients with no remaining growth and too big a skeletal discrepancy (or camouflage treatment, and two jaw surgery is needed in order to have maximum effect in such patients. In two jaw surgery cases, surgical alteration of the occlusal plane is necessary to establish optimal function, esthetics and postoperative sability, therefore the establishment of the occlusal plane is essential in diagnosis and treatment. The object of this study is to evaluate the stability of the indiviual ideal occlusal plane bsaed on the architectural and structural craniofacial analysis of Delaires. Thus, the subjects of this study were 48 patients who underwent two jaw surgery, and divided in two groups. Each group were composed of 24patients, A group were operated with ideal occlusal plane and B group were not. Two groups were compared at the preoperative, immediate postoperative (average 4.3days), and long-term postoperative (average 1.3years) lateral cephalometric radiographs. The following results were obtained: 1. There was no significance in occlusal plane angulation between $T_2\;and\;T_3$. Average long term follow-up changes of occlusal Plane angle were $0.24^{\circ}{\pm}2.43$, with FH plane and $0.15{\circ}{\pm}2.16{\circ}$ with SN plane in all 48 patients. These results demonstrated that the occlusal plane after two jaw surgery in skeletal Class III malocclusion was stable. 2. There was no significance in postoperative stability of occlusal plane between A and B group. 3. There was no significance in postoperative stability of occlusal plane depending on surgeon and operative method within each group. 4. The postoperative changes of occlusal plane were correlated to the postoperative changes of jaw rather than tooth position. 5. There was no correlation between the postoperative changes of occlusal plane and maxillary impaction and mandibular setback with surgery.
The aims of this study were to investigate the differences in the early craniofacial morphology of Class III malocclusions with good, fair and poor occlusal stability and to elucidate a key determinant for distinguishing the cases. Lateral cephalograms of 30 subjects with Class III malocclusion in the mixed dentition were analyzed at the start of treatment (mean age of $8.58\pm1.47$). All subjects were reevaluated after a mean period of $7.50\pm1.94$ years comprising active treatment and retention. At this time, the samples were divided into three groups: good (10 subjects), fair (10 subjects) and poor (10 subjects) occlusal stability groups. According to the results of ANOVA, there were significant morphological differences in the early stage among the good, fair and poor occlusat stability groups, especially in variables that represented the vertical skeletal relationships. As well, there were already more dental compensations in the poor occlusal stability group. Stepwise discriminant analysis on the measurements at the time of first observation identified only one predictive variable: AB to mandibular plane angle(AB-MP). With this discriminant function, $83.3\%$of the original grouped cases were correctly classified and the canonical correlation coefficient was 0.857. In conclusion, AB-MP can be a possible predictor for the eventual prognosis of early Class III treatment. If it is below 60, the prognosis of early Class III treatment is expected to be poor, while if it is above 65, a good prognosis is expected.
Journal of the korean academy of Pediatric Dentistry
/
v.23
no.3
/
pp.736-745
/
1996
The conventional treatment of skeletal Class III malocclusion has been focused on application of orthopedic force primarily to the mandible. However, In Class III malocclusion with retrograde position or underdevelopment of Maxilla, this approach is not suitable treatment. These patients need an application of orthopedic forces via face-mask to the Maxilla to stimulate its growth and to change the direction of growth. In skeletal Class III patients who were treated by Face-Mask, the following results were obtained. 1. Forward growth of Maxilla was enhanced. 2. Labioversion of upper incisors and linguoversion of lower incisors were observed. 3. Mandible was rotated to clockwise direction and remodeling of B point was observed. 4. Anterior crossbite was corrected by combining of the above results.
Journal of the korean academy of Pediatric Dentistry
/
v.25
no.3
/
pp.604-612
/
1998
The majority of Class III malocclusion have maxillary retrusion. Thus, it becomes obvious that management of most skeletal Class III malocclusion cases should include maxillary protraction as major objective. Additionally, in Class III malocclusion with posterior crossbite, RME "disarticulates" the maxilla and initiates cellular response in the sutures, allowing a more positive reaction to protraction forces. Using facemask with RME helped in correction of skeletal Class III malocclusion by the anterior displacement of maxilla and maxillary dentition, and changing the direction of the growth of mandible. Thus, acceptable improvement in the Class III profile was performed.
The purpose of this stdudy was to evaluate the effect of maxillary protraction and the relapse of hard and soft tissue after maxillary protraction. For this study 29 patients who were treated with maxillary protractor and labiolingual archwire were selected. Their mean age was 9 years 4 months and mean treatment period was 8.5 months. Lateral cephalograms were taken at pretreatment, immediately after treatment and one to three months after removal of the maxillary protractor. They were traced on skeletodental and soft tissue structures based on Burstone's analysis and analyzed by Quick-Ceph Image Digitizing System(ORTHODONTIC PROCESSING). The mean and standard deviation between pretreatment and posttreatment and between posttreatment and retention period for each cephalometric variable were calculated. Student t-test was used to determine the statistical significance of the changes in each variable. Correlation coefficients between hard tissue and soft tissue were used to determine interrelationship. The results were as follows. 1. After maxillayy protraction, the maxilla and maxillary dentition moved antero-inferiorly, the mandibld and mandibular dentition moved postero-interiorly and palatal plane rotated antero-superiorly by $0.59^{\circ}$. 2. After maxillary protraction, the soft tissue of upper lip moved antero-interiorly with the movement of hard tissue but the antero-posterior position of lower lip was stable in spite of the change of hard tissue. The thickness of upper lip was decreased and that of lower lip was increased after maxillary Protraction. 3. During the retention period, the position of jaws was relatively stable but upper and lower anterior teeth and antero-superiorly rotated palatal plane relapsed to original position. 4. During the retention period, the soft tissue of lips was stable antero-posteriorly and moved mote inferiorly than posttreatment. 5. The correlation coefficients between the postion of upper and lower incisal edge and that position of lips were high, especially in horizontal change.
The purpose of this study was to find out and evaluate discrepancies between preorthodontic prediction values and actual postorthodontic values and factors contributing to it in 45 patients(17 male, 28 female) who were diagnosed as skeletal Class III ma)occlusion and received presurgical orthodontic treatment and orthognathic surgery at Yonsei university dental hospital. Lateral cephalograms were analysed at pretreatment(T1), orthodontic Prediction(T2), immediately before surgery(T3) and designated the landmark as coordinates or X and Y axes. The samples were divided according to ALD, upper and lower incisor inclination(Ul to SN, IMPA), COS, extraction, the position of extracted teeth and the statistical significance was tested to find out the factors contributing to the prediction. The results were as follows: 1. Differences between preorthodontic prediction values and actual postorthodontic values(T2-T3) were statistically significant(p<0.05) in the x coordinates of U6mbc, L1x and in y coordinates of U1i, U1x, U6me, U6mbc, L6mbc 2. The accuracy of prediction is relatively higher in horizontal changes compared to vortical changes. 3. The statistical significance(p<0.05) between prediction and actual values is observed more in the landmarks of the maxilla than the mandible. 4. Differences between prediction and actual values of incisor and first molar were statistically significant(p<0.05) according to extraction vs non-extraction, extraction type, ALD in the maxilla and according to ALD, IMPA in the mandible. Discrepancies between preorthodontic prediction values and actual postorthodontic values and factors contributing to the prediction must be considered in treatment planning of Cl III surgical patients to increase the accuracy of prediction. Furthermore future investigations are needed on the prediction of vortical changes.
The purpose of this study was to evaluate the amount and interrelationship of the soft tissue of nose and maxillary changes and to identify the nasal morphologic features that indicate susceptibility to nasal deflection in such a manner that they would be useful in presurgical prediction of nasal changes after maxillary advancement surgery in skeletal Class III malocclusion. The sample consisted of 25 adult patients (13 males and 12 females) who had severe anteroposterior skeletal discrepancy. The patients had received presurgical orthodontic treatment. They underwent a Le Fort I advancement osteotomy, rigid internal fixation, alar cinch suture and V-Y advancement lip closure. The presurgical and postsurgical lateral cephalograms and lateral and frontal facial photographs were evaluated. The computerized statistical analysis was carried out. Soft tissue of nose change to h point change ratios were calculated by regression equations. The results were as follows 1. The correlation of maxillary hard tissue horizontal changes and nasal soft tissue vortical changes were high and the ${\beta}_0$ for soft tissue to ADV were 0.228 at ANt, 0.257 at SNt. 2. The correlation of maxillary hard tissue and nasal soft tissue horizontal changes were high and the ${\beta}_0$ for soft tissue to ADV were 0.484 at ANt, 0.431 at SNt, 0.806 at Sn. 3. The correlation of maxillary hard tissue horizontal changes and width changes of ala of nose were high and the ${\beta}_0$ lot alar base width ratio to ADV were 0.002. 4. The DRI, Prominence of nose, Pre-Op CA is not a quantitative measure that can be used clinically to improve the predictability of vertical and horizontal nasal tip deflection. In this study, increases in nasal tip projection and anterosuperior rotation occur when there is an anterior vector of maxillary movement. These nasal changes were Quantitatively correlated to magnitude of maxillary(A point) movement.
The Purpose of this study was to evaluate the effect of the lower third molar on treatment time and distal en masse movement of the lower dentition in Giass III malocclusions. Thirty subjects (9 males and 27 females) were selected, all of whom were diagnosed as Glass III malocclusion and treated by fixed appliances without premolar and/or molar extraction. They were divided into three groups Group 1 consisted of 12 subjects. whose lower third molars were not extracted during the whole orthodontic treatment. Group 2 consisted of 8 subjects. whose lower third molars were extracted after WEAW application and before removal of the orthodontic appliances. Group 3 consisted of 10 subjects whose lower third molars were extracted before MEAW application. For each subject. overall treatment time and duration of MEAW application were determined. In addition. pre-treatment and post-treatment lateral cephalometric radiographs were analyzed. All data were Processed statistically with ANOVA, and the conclusions were as follows: There was no significant difference among the groups in overall treatment time However, duration of MEAW application was longer in Group 2 than in Group 1 or Group 3. The overjet that was established after orthodontic treatment was largest in Group 3, in which the lower third molars were extracted befor MEAW application. After orthodontic treatment, IMPA decreased in Group 3. but increased in Group 1 and Group 2. There was no significant difference among the three groups in the translation of lower second molars However the tipping movement of lower second molars was significantly different, highest in Group 2 and lowest in Group 1 Therefore. it is thought to be better for the orthodontic treatment of Class III malocclusions to extract the lower third molars before MEAW application. In Group 2, the mandibular plane angle was decreased as a result of forward rotation of the mandible This skeletal change was thought to bring about the difficulty of treatment.
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