Class ΙΙΙ malocclusion treatment, Surgery or camouflage ? Dr Firas Elayyan

Searching Pubmed and google scholar Key word :Class ΙΙΙ malocclusion treatment Search orthodontic journals available on the internet Most of results are single study cases and retrospective studies No RCT’s

1-The dilemma of class ΙΙΙ treatment Early or late? Campell P.M. AO (1983); 53(3):175-191 Clinical study Case reports of 14 patients Result: The conclusion is that the important benefits of early treatment should not be denied because of concerns that a few may still require further treatment later.

2-Treatment decision in adult patients with class ΙΙΙ malocclusion : Orthodontic therapy or orthognathic surgery? Stellzig-Eisenhauer et al AJODO (2002);122: 27-38 Retrospective study 175 cephalograms

2-Treatment decision in adult patients with class ΙΙΙ malocclusion : Orthodontic therapy or orthognathic surgery? Stellzig-Eisenhauer et al (2002) -Result :The resulting equation was: Individual score = -1.805 + 0.209. Wits+0.044. S-+ 5.689.M/M ratio-0.056.Go(lower) The critical score is -0.023 >-0.023 : Orthodontic treatment <-0.023 : Orthognathic SX

3-Class lll malocclusion: Surgery or orthodontics? Kerr WJ et al BJO (1992) 19; 21-24 Clinical study Case reports of 40 patients Result : The most significant differences between the groups were in angle ANB, M/M ratio, lower incisor inclination and Holdaway angle. Threshold values for angle ANB and lower incisor angulation below which surgery was almost always carried out were-4 and 83 degrees, respectively.

4-Cephalometric predictors of Long-term stability in the Early Treatment of class lll Malocclusion Young-Min Moon et al. AO ( 2005);75:747-753 Retrospective study ( 5.7 years) Sample size : 45 Study Design : records of chin cap-FA follow up of 5.7 years Results: Generally, the subjects with a smaller gonial angle and a more hypodivergent skeletal pattern had good prognosis after the early treatment of Class III malocclusion.

Zentner A. et al EJO (2001) 23(4): 383-392 Retrospective study 5-Morphological parameters as predictors of successful correction of class lll malocclusion Zentner A. et al EJO (2001) 23(4): 383-392 Retrospective study 80 cephalograms Result : With the exception of the percentage midfacial length/mandibular length ratio, the net sum of maxillary and mandibular length differences, the mandibular ramus height/mandibular body length ratio and the gonion angle, most cephalometric parameters of pre-treatment craniofacial morphology assessed were poor predictors of successful correction of Class III malocclusions.

6-Predictors of relapse in orthodontically-trated class lll malocclusion Battagel J.M. BJO( 1994) 21(1):1-13 Retrospective study 64 patient records (31 non-extracion,33 extraction) Result :The capacity for predicting the observed outcome of therapy was assessed in three ways: correlation coefficients, the number of cephalometric measurements exceeding two standard deviations from a control group mean, and discriminant analysis. Only the latter proved an effective indicator of relapse, with a separate discriminant model being necessary for each sub-group.

Baccetti et al. AJODO (2003); 126:16-22 Retrospective study 42 patints 7-Cephalometric variables predicting the long-term success or failure of combined rapid maxillary expansion and facial mask therapy Baccetti et al. AJODO (2003); 126:16-22 Retrospective study 42 patints Result Orthopedic treatment of Class III malocclusion might be unfavorable over the long term when a patient's pretreatment cephalometric records exhibit a long mandibular ramus (ie, increased posterior facial height), an acute cranial base angle, and a steep mandibular plane angle.

8-Long-term effects of class ΙΙΙ treatment with RME and facemask therapy followed by fixed appliance Westwood et al. AJODO (2003); 123:306-320 Long Retrospective study 34 patients and 22 as control group. Result: RME/FM therapy was shown to be effective treatment of correcting class ΙΙΙ malocclusion in the long term. The favourable skeletal effects induced before the pubertal growth spurt led to establishment of positive overbite and overjet relation. The occlusal relation generally withstood subsequent class craniofacial growth throughout attainment of skeletal maturity.

20 child (Mean age: 5.1 years) Result 9-A retrospective comparison of functional appliance treatment of class lll in the decidous and mixed dentition Baccetti T and Tollaro EJO(1998); 20(3):309-17 Retrospective study 20 child (Mean age: 5.1 years) Result The optimum timing to improve skeletal relationships in Class III malocclusions by means of a functional appliance appears to be in the deciduous dentition.

Seminars in Orthodontics (1997);3:244-254 Clinical study ( Review) 10-Facial growth of Skeletal class lll Malocclusion and the Effects, Limitations, and Long-Term Dentofacial Adaptations to Chincap therapy Sugawara and Mitani Seminars in Orthodontics (1997);3:244-254 Clinical study ( Review) Result the skeletal profile is greatly improved during the initial stages of chincap therapy. However, such changes are rarely maintained during pubertal growth period. Treatment with chincap appliances seldom alters the inherited prognathic characteristics of skeletal Class III profiles after completion of growth.