Surgical Management of Skeletal Class III with Anterior Open Bite
Department of Orthodontics and Dentofacial Orthopedics, A B Shetty Institute of Dental Science, Mangalore
A 17 year old female reported to the department with the chief complaint of gap between upper and lower front teeth. On extra oral examination, it revealed that the patient is having a concave facial profile with steep mandibular plane angle.
On intraoral examination, the maxillary and mandibular arches were U shaped; Molar relationship was Angle’s Class I bilaterally; Canine relationship was Class III and open bite of 3 mm.
On radiographic examination, the cephalometric values indicated the Class III Skeletal pattern due to deficient maxilla with vertical growth pattern. The Jarabak’s ratio showed increased anterior facial height. The upper incisors were proclined whereas the lower anterior were almost upright.
DIAGNOSIS
Skeletal Class III malocclusion due to retrognathic maxilla with anterior open bite .
TREATMENT OBJECTIVES
- Correction of Class III skeletal jaw base relationship
- To attain ideal overbite and overjet
- To achieve optimal facial balance and esthetics.
TREATMENT PLAN
Pre surgical orthodontics:
- Leveling and aligning
- Retraction of upper anteriors.
Surgical Plan:
- LeFort I Osteotomy and Advancement.
Post Surgical Orthodontics
- settling of occlusion.
DISCUSSION
The patient when reported to the department for the first time was already under the DENTOALVEOLAR COMPENSATION which is evident by the Molar Class I relationship with proclined upper anteriors and upright lower anteriors on a Skeletal Class III apical base. To manage the malar deficiency, Lefort I advancement was planned. But before proceeding to the surgery, the decompensation had to be done. Extraction of maxillary first premolars were done to create space for uprighting the maxillary anteriors and for their retraction. Reverse overjet was achieved after the retraction of the anterior as a part of decompensation.
Figure showing Pre Surgical Intra Oral Photographs
TREATMENT OUTCOME
Le fort I advancement was done which resulted in an improved skeletal apical base relationship.The ideal overjet and overbite was achieved. The Incisor and Canine relationship became Class I. The profile improved and the lips were competent. Cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. The post treatment panoramic radiographs showed good root parallelism. Pre and post treatment superimposition showed good soft tissue balance.
Figure showing Post Treatment Extra Oral Photographs
Figure showing Post Treatment Intra Oral Photographs
Figure showing Post Treatment Lateral Ceph and OPG
RELEVANT CEPHALOMETRIC VALUES:
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How to cite this article
Dr. Arjun Nayak US, Dr. K Saidath, Dr. Krishna Nayak. Surgical Management of Skeletal Class III with Anterior Open Bite. Guident. 2017 Jan;10(2). Available from: https://guident.in/articles/orthodontics/surgical-management-of-skeletal-class-iii-with-anterior-open-bite.html
