Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics

Abstract

BackgroundOne of the most controversial issues in treatment planning of class III malocclusion patients is the choice between orthodontic camouflage and orthognathic surgery. Our aim was to delineate diagnostic measures in borderline class III cases for choosing proper treatment.MethodsThe pretreatment lateral cephalograms of 65 patients exhibiting moderate skeletal class III were analyzed. The camouflage group comprised of 36 patients with the mean age of 23.5 (SD 4.8), and the surgery group comprised of 29 patients with the mean age of 24.8 years (SD 3.1). The camouflage treatment consisted of flaring of the upper incisors and retraction of the lower incisors, and the surgical group was corrected by setback of the mandible, maxillary advancement, or bimaxillary surgery. Mann-Whitney U test was used to compare the variables between the two groups. Stepwise discriminant analysis was applied to identify the dentoskeletal variables that best separate the groups.ResultsHoldaway H angle and Wits appraisal were able to differentiate between the patients suitable for orthodontic camouflage or surgical treatment. Cases with a Holdaway angle greater than 10.3° and Wits appraisal greater than − 5.8 mm would be treated successfully by camouflage, while those with a Holdaway angle of less than 10.3° and with Wits appraisal less than − 5.8 mm can be treated surgically. Based on this model, 81.5% of our patients were properly classified.ConclusionsHoldaway H angle and Wits appraisal can be used as a critical diagnostic parameter for determining the treatment modality in class III borderline cases.

Non-Surgical Orthodontic Treatment of Class III Adult with Posterior Crossbite, Anterior Open Bite and Asymmetric Occlusion, Using TADs and Auxiliary Wires: A Case Report

“…Lately, Islami et al [22], concluded that Holdaway angle and Wits appraisal were able to differentiate between the patients suitable for orthodontic camouflage or surgical treatment. Cases with a Holdaway angle greater than 10.3˚ and Wits appraisal greater than −5.8 mm would be treated successfully by camouflage, while those with a Holdaway angle of less than 10.3˚ and with Wits appraisal less than −5.8 mm can be treated surgically For this patient, the etiology of his Class III malocclusion was expressed through maxillary retrusion and mandibular protrusion.…”

Diagnosis and Treatment Considerations of Orthodontic Miniscrews in Camouflage Treatment of Adult Class III Malocclusions by Distalization of the Mandibular Dentition- A Review of Literature

“…The extent to which this happens is highly variable and to a large extent unpredictable. Some articles have mentioned criteria by which a decision can be made regarding camouflage versus surgical treatment of Class III cases [19,20,21]. The case selection criteria for distalisation are varied in the literature probably due to the different treatment modalities usedskeletal anchorage, proclination of the upper anterior teeth, retroclination of the lower anterior teeth by class III elastics, or lower premolar extractions [17,18].…”

Hard and Soft Tissue Changes in Patients with Borderline Class III Malocclusion after Maxillary Advancement or Mandibular Setback Surgery: A Cross-Sectional Study

“…Class III malocclusion is a complex condition in terms of diagnosis and treatment planning [1,2]. In the recent years, the demand of class III patients for surgical correction of their malocclusion has greatly increased [3][4][5][6][7].…”