Orthodontic Camouflage in Skeletal Class III Malocclusion: A Contemporary Review

Abstract

Early orthopedic intervention can be effective in normalizing skeletal class III malocclusions if patients are treated in a timely manner. There are a large number of skeletal class III patients that either decline or cannot afford surgical treatment. The only alternative is 'Orthodontic camouflage' through comprehensive treatment with fixed appliances. The ultimate judgment as to whether orthodontic treatment alone, to camouflage a skeletal problem, would be an acceptable result, or whether orthognathic surgery to correct the jaw discrepancy would be required, must be made by the patient and parents. Class III camouflage logically would be the reverse of class II camouflage, based on retracting the lower incisors, advancing the upper incisors, and surgically reducing the prominence of the chin, in addition, rotating the mandible downward and backward, when the chin is prominent, can be considered a form of camouflage. Even though timing of orthodontic treatment has always been somewhat controversial, it is an agreement in the literature that prognosis is still obscure until growth is completed. A cephalometric analysis is needed to quantitatively record the severity of the class III malocclusion and to determine the underlying cause of the deformity. Although it is agreed that camouflage line of treatment is not an ideal line of treatment, but it serves its purpose very well in mild range of skeletal dysplasia's and in conditions where patient is either unwilling for orthognathic surgery or in cases were surgery is contraindicated.

Management of Class III malocclusion by orthodontic clockwise rotation of maxillo-mandibular complex – A case report

“…16 Orthodontic camouflage in many Class III cases addresses the sagittal problems, but seldom on the improvement of vertical deficiency. 15,17,18 The extrusion of maxillary arch obtained in our case developed the alveolar vertical bone height and subsequently improved the incisor visibility and smile arc as reported previously. 19 The clockwise rotation achieved with the mandible was due to extrusion of maxillary and mandibular dentition which was advantageous in increasing the growth pattern, reduction in chin prominence and improving smile arc as proposed by Eric Liou et al 9 Extrusion of maxillary dentition in the anterior segment initially was another advantage in this case as it improved the smile features and bite raisers in the maxillary molar region prevented the extrusion and thereby tipping the occlusal plane in a clockwise manner.…”

Advantages of using micro-implant during camouflaged treatment of the non-growing Class III malocclusion: case report with in-detail discussion

“…Zere et al systematized cephalometric criteria that potentially may be used as predictors for the successful outcome of Class III orthodontic camoufl aged treatment [3]: • normal values of maxillomandibular differential and gonial angle [3]. Such predictors set may be expanded by the following parameters grouped within contemporary review: liner distance from condylion to A point and Gnathion; ratio of midfacial length to mandibular length; ratio of mandibular ramus height to mandibular body length [17]. Nevertheless, synthesis of the available evidences revealed no specifi c cephalometric cut-off levels that could be validated in full manner as markers to differentiate decision for using either orthognathic or camoufl aged orthodontic treatment for Class III malocclusion cases [18].…”

Management of skeletal Class III with facial asymmetry using skeletal anchorage: 4-year follow-up

“…Camouflage treatment option was not considered for this patient, because it would not treat the true maxillary hypoplasia and would not result in facial fullness in the middle third of face. 12 Also, the mandibular asymmetry would not have been addressed. Surgical treatment option was excluded because of the patient's biological age and her unwillingness for a future major surgical intervention.…”