Abstract
Abstract Background The treatment of a skeletal Class III malocclusion with accompanying mandibular asymmetry is an orthodontic challenge. A skeletal Class III may be associated with a retrognathic maxilla, a prognathic mandible and a mandibular asymmetry can be of dental or skeletal origin or in various combinations. Timely treatment with appropriate biomechanics is crucial for an acceptable and stable result. Aims The aim of this article was to introduce a clinically effective asymmetric magnetic reverse Twin-block appliance (AMRTB) for growth modification treatment of an 11-year-old girl who presented with a skeletal Class III malocclusion and accompanying mandibular asymmetry. Methods The treatment was comprised of two phases, the first of which was growth modification using the AMRTB for the stimulation of maxillary growth, restraint of mandibular growth, and improvement of the mandibular asymmetry. This was followed by a second phase involving full fixed appliances to optimise the interdigitation and occlusion. Results The skeletal Class III relationship and mandibular asymmetry was successfully corrected after two years of treatment. A good facial appearance and pleasing smile aesthetics were achieved. The treatment result was stable after six years of follow-up. Conclusion This case demonstrated that the AMRTB was a clinically effective appliance for growth modification treatment in patients with a skeletal Class III malocclusion and mandibular asymmetry.
Highlights
A skeletal Class III malocclusion with accompanying mandibular asymmetry is a challenging and demanding orthodontic problem
These have included the application of a protraction facemask,[5] a chin cup,[6,7] a reverse twin block,[8] the Frankel appliance,[9] and Class III elastics in combination with temporary anchorage devices (TADs).[10]
There have been some reports on the modification of orthopaedic appliances – for example, a TAD-assisted facemask for maximising the skeletal effect and minimising the dentoalveolar effect15 – the TAD-assisted approaches are relatively invasive and involve the placement of miniplates or miniscrews with an increased patient cost
Summary
The treatment of a skeletal Class III malocclusion with accompanying mandibular asymmetry is an orthodontic challenge. Aims: The aim of this article was to introduce a clinically effective asymmetric magnetic reverse Twin-block appliance (AMRTB) for growth modification treatment of an 11-year-old girl who presented with a skeletal Class III malocclusion and accompanying mandibular asymmetry. Methods: The treatment was comprised of two phases, the first of which was growth modification using the AMRTB for the stimulation of maxillary growth, restraint of mandibular growth, and improvement of the mandibular asymmetry. This was followed by a second phase involving full fixed appliances to optimise the interdigitation and occlusion. Conclusion: This case demonstrated that the AMRTB was a clinically effective appliance for growth modification treatment in patients with a skeletal Class III malocclusion and mandibular asymmetry. (Aust Orthod J 2019; 35: 229-240)
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