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Class III malocclusion treatment planning in the non-growing patient can represent a challenge. The options of whether to attempt orthodontic camouflage or to treat with orthognathic surgery are affected by numerous factors, including the severity of the underlying skeletal relationship, the dento-alveolar compensation already present, the facial aesthetics, the patient's concerns and expectations, and the anatomical limits of orthodontic tooth movement. Numerous studies have tried to provide guidance by looking at the differences between groups of patients to determine whether they should be treated orthodontically or surgically. However, owing to the retrospective nature of these studies and their heterogeneity, they prove less helpful than desired. In this narrative review, the authors will look at these studies to provide some guidance for the orthodontist.
CPD/Clinical Relevance:
Treatment planning in Class III malocclusions can be challenging owing to the numerous factors that must be considered.
Article
A Class III malocclusion can be defined using Angle's molar relationship and is usually associated with a Class III incisor relationship: the lower incisor edges occluding anteriorly to the cingulum plateau of the upper incisors.1 The reported prevalence of Class III malocclusion ranges from 0% to 39%, depending on ethnic population, with a global mean of 6–11%.2,3,4 It is more prevalent in East Asian and Middle Eastern populations, with lower numbers reported in European, African and South Asian populations.2
Class III malocclusion is not just one entity, but presents with a varied phenotype, making the management difficult. It can be characterized by a number of dental and skeletal features, including mandibular prognathism, maxillary hypoplasia, acute cranial base angle, shorter anterior cranial base, long posterior cranial base, protrusive mandibular dentition, retrusive maxillary dentition or combinations of any of the above.5,6,7,8,9 The management of Class III malocclusions is complicated further by uncertainty pertaining to growth. Pubertal growth in patients with a Class III malocclusion appears to occur later and go on longer than in their Class I peers.10,11 Combined, these factors complicate treatment planning for Class III malocclusions.
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