Authors' response

Abstract

We appreciate the interest and the insightful comments on our case report. The patient had a centric occlusion–centric relation discrepancy with the interference of the incisors resulting in a forward shift of the mandible along with the preexisting skeletal Class III relationship. Thus, Class III malocclusion and facial profile can be exaggerated when the lateral cephalogram at centric occlusion (Ceph-CO) is the only record used for diagnosis. As mentioned, clinical evaluation as well as functional wax bite and/or bite registration of centric occlusion (maximum intercuspation) and centric relation (premature contact) position using orthodontic cast with articulators can provide important diagnostic information. We also evaluated the lateral cephalogram of the premature contact position (Ceph-CR) in addition to the conventional Ceph-CO (Fig 4) for a couple of reasons. First, compared with Ceph-CO, Ceph-CR makes it possible to determine the discrepancies of profile, facial proportions, mandibular position, and presence of asymmetry (changes in the mandibular border) owing to the functional interference. Second, Ceph-CR is used to estimate the final mandibular position and changes in profile similar to the visualized treatment objective. Clinically, 2-4 mm of occlusal freeway is necessary for occlusal stability. Because the freeway of 5 mm was present at the premolar region using Ceph-CR, maximum of 1-2 mm of mandibular molar uprighting and/or maxillary extrusion was planned to not encroach the freeway space during the application of the extrusive mechanics.1Yabushita T. Zeredo J.L. Toda K. Soma K. Role of occlusal vertical dimension in spindle function.J Dent Res. 2005; 84: 245-249Crossref PubMed Scopus (28) Google Scholar, 2Hisano M. Chung C.R. Soma K. Nonsurgical correction of skeletal Class III malocclusion with lateral shift in an adult.Am J Orthod Dentofacial Orthop. 2007; 131: 797-804Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Overall, the final position of the mandible is estimated and/or planned to be in between Ceph-CR and Ceph-CO. We apologize for the confusion regarding the cephalometric summary (Table). The column indicated as “progress” represents the values for Ceph-CR and/or interference position (Fig 4) rather than the progress of treatment per se. These values were intended to show the discrepancies between the Ceph-CR and Ceph-CO. IMPA as well as E-line and relative values can be affected by the clockwise rotation of the mandible. Indeed, the mandibular incisors were retroclined after treatment (Fig 9). An error representing posttreatment IMPA value was noted in the manuscript. The corrected value for posttreatment IMPA is 70.9 and not 75.9. As for the upper lip to E-line, the upper lip was mostly unchanged in Ceph-CR compared with Ceph-CO and moved slightly forward after the mild protrusion of the maxillary incisors. However, because of the overall rotation of the mandible resulting in posterior and inferior change of soft tissue pogonion, numeric changes in cephalometry relative to the E-line indicated more dramatic changes from −3.7 mm to −0.8 mm. We thank the authors for pointing out an important issue and hope the answers help the readers understand the clinical aspects of skeletal Class III overclosure cases more in detail. Skeletal Class III malocclusion with a reverse smileAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 158Issue 4PreviewA case report by Jang et al (Jang W, Shin C, Hwang S, Kim KH, Jackson T, Nguyen T, et al. Nonsurgical treatment of an adult with a skeletal Class III malocclusion combined with a functional anterior shift, severely overclosed vertical dimension, and a reverse smile. Am J Orthod Dentofacial Orthop 2020;157:561-70) in the April issue reported the treatment of a 17-year-old female patient with a chief concern of crossbite and crowding. It is of great insight to the clinician for treating skeletal Class III malocclusion in adult patients with combined factors of skeletal, dental, and functional origin by applying sequential vertical and sagittal control for camouflage treatment based on precise diagnosis and treatment planning. Full-Text PDF