Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion

Manuel Gustavo Chávez Sevillano,Cátia Cardoso Abdo Quintão,Luciane Macedo De Menezes,Livia Kelly Ferraz Nunes,José Augusto Mendes Miguel,Gina Judith Flores Diaz

doi:10.1155/2020/8854588

Abstract

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

Highlights

The diagnosis, treatment, and prognosis of class III malocclusion are often a challenge for orthodontists [1]
Class III malocclusion with a closed mandibular plane angle is characterized by poor vertical growth of the maxillary posterior segment, and, as a consequence, there is a deficiency in the posterior vertical dimension
There are certain types of Class III malocclusions with an imbalance between the vertical growth of the mandibular ramus and the vertical growth of the maxilla in the posterior region, which is hypodeveloped causing a deficiency of vertical descent of the occlusal plane

Summary

Introduction

The diagnosis, treatment, and prognosis of class III malocclusion are often a challenge for orthodontists [1]. The main features of skeletal class III anatomy include mandibular prognathism, maxillary atresia, anterior crossbite, and a reduced skull base angle [2]. Class III malocclusion with a closed mandibular plane angle is characterized by poor vertical growth of the maxillary posterior segment, and, as a consequence, there is a deficiency in the posterior vertical dimension. In such cases, the occlusal plane, in the posterior region, presents a clockwise rotation, with a lack of proportion of the vertical maxillary growth and the mandibular ramus, with an excessive counterclockwise rotation of the mandible. There can be an anterior crossbite with negative overbite [2, 4, 5]

Results

Discussion

Conclusion