A study of Class III treatment: orthodontic camouflage vs orthognathic surgery

Publications

Share / Export Citation / Email / Print / Text size:

Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine

GET ALERTS

ISSN: 2207-7472
eISSN: 2207-7480

DESCRIPTION

9
Reader(s)
10
Visit(s)
0
Comment(s)
0
Share(s)

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue / page

Archive
Volume 38 (2022)
Volume 37 (2021)
Volume 36 (2020)
Volume 35 (2019)
Volume 34 (2018)
Volume 33 (2017)
Volume 32 (2016)
Volume 31 (2015)
Related articles

VOLUME 31 , ISSUE 2 (November 2015) > List of articles

A study of Class III treatment: orthodontic camouflage vs orthognathic surgery

Katherine Georgalis / Michael G. Woods *

Citation Information : Australasian Orthodontic Journal. Volume 31, Issue 2, Pages 138-148, DOI: https://doi.org/10.21307/aoj-2020-148

License : (CC BY 4.0)

Published Online: 15-August-2021

ARTICLE

ABSTRACT

Aim: To evaluate the differences in pretreatment and post-treatment characteristics of Class III patients treated with orthodontic camouflage or orthognathic surgery, and to compare the range of skeletal, dental and soft tissue changes that are likely to occur with treatment, with particular reference to the influence of extractions on the resultant incisor angulations.

Method: Pretreatment and post-treatment cephalograms of 31 Class III orthodontically-camouflaged patients and 36 Class III surgical patients (without genioplasty) were obtained from one specialist practice. From the surgical group, 26 pre-surgical lateral cephalograms were also obtained. Inclusion criteria for the two groups were at least three of the following: (1) an ANB angle of 1 degree or less, (2) a Wits appraisal less than -4 mm, (3) an incisal overjet ≤ 0 mm, and (4) a Class III molar relationship. All lateral cephalograms were traced and digitised and a number of skeletal, dental and soft tissue variables were measured. The camouflage and surgical groups were also divided into premolar extraction and non-extraction subgroups to allow for a specific analysis of extraction effects.

Results: Before treatment, the surgical group demonstrated, on average, a more severe skeletal discrepancy and increased dental compensations, compared with the orthodontically camouflaged group. After treatment, the mean SNA angle was greater, the ANB angle was more positive, the Wits appraisal was closer to ideal and the lower incisors were less retroclined in the surgery group. There was a small mean reduction in horizontal chin projection in the surgery group compared with a small increase in the camouflage group. The mentolabial fold and the lower lip curve were deeper, on average, and the lips less retrusive after surgery. There was a mean increase in upper incisor proclination during treatment in both the surgical and camouflage groups with a greater increase in the camouflage group. There was a significant reduction in upper incisor proclination and a subsequent greater increase in the ANB angle associated with upper premolar extractions in the surgical group compared with the non-extraction group. Lower premolar extractions in the camouflage group resulted only in a deeper mentolabial fold compared with those treated without lower extractions.

Conclusions: Class III patients selected for surgical treatment are likely to have more severe pretreatment dental and skeletal discrepancies than those selected for camouflage treatment. Surgical treatment is associated with significant decompensation of the lower incisors but, ultimately, not the upper incisors. Class III patients treated with either camouflage or surgery treatment are likely to finish with slightly proclined upper incisors. Generally, surgical treatment results in greater skeletal change, involving normalisation of the skeletal base relationship, a reduction in chin prominence, fuller lips, and a more favourable lip and chin contour.

Content not available PDF Share

FIGURES & TABLES

REFERENCES

1. Alexander AE, McNamara JA Jr, Franchi L, Baccetti T. Semilongitudinal cephalometric study of craniofacial growth in untreated Class III malocclusion: discussion. Am J Orthod Dentofacial Orthop 2009;135:700.e1-14.

2. Miyajima K, McNamara JA Jr, Sana M, Murata S. An estimation of craniofacial growth in the untreated Class III female with anterior crossbite. Am J Orthod Dentofacial Orthop 1997;112:425-34.

3. Guyer EC, Ellis EE 3rd, McNamara JA Jr, Behrents RG. Components of class III malocclusion in juveniles and adolescents. Angle Orthod 1986;56:7-30.

4. Kuc-Michalska M, Baccetti T. Duration of the pubertal peak in skeletal Class I and Class III subjects. Angle Orthod 2010;80:54-7.

5. Baccetti T, Reyes BC, McNamara JA Jr. Craniofacial changes in Class III malocclusion as related to skeletal and dental maturation. Am J Orthod Dentofacial Orthop 2007;132:171.e1-171.e12.

6. Reyes BC, Baccetti T, McNamara JA Jr. An estimate of craniofacial growth in Class III malocclusion. Angle Orthod 2006;76:577-84.

7. Woods MG. Class III treatment opportunities. Ann R Australas Coll Dent Surg 2002;16:71-3.

8. Sperry TP, Speidel TM, Isaacson RJ, Worms FW. Differential treatment planning for mandibular prognathism. Am J Orthod 1977;71:531-41.

9. Proffit WR, Fields HW, Sarver DM. Contemporary orthodontics. 4th edn. St. Louis, Mo.: Mosby Elsevier, 2007; xii, 751.

10. Troy BA, Shanker S, Fields HW, Vig K, Johnston W. Comparison of incisor inclination in patients with Class III malocclusion treated with orthognathic surgery or orthodontic camouflage. Am J Orthod Dentofacial Orthop 2009;135:146.e1-9.

11. Bell WH, Creekmore TD. Surgical-orthodontic correction of mandibular prognathism. Am J Orthod 1973;63:256-70.

12. Johnston C, Burden D, Kennedy D, Harradine N, Stevenson M. Class III surgical-orthodontic treatment: a cephalometric study. Am J Orthod Dentofacial Orthop 2006;130:300-9.

13. Stellzig-Eisenhauer A, Lux CJ, Schuster G. Treatment decision in adult patients with Class III malocclusion: orthodontic therapy or orthognathic surgery? Am J Orthod Dentofacial Orthop 2002;122:27-37; discussion 37-8.

14. Kerr WJ. Miller S, Dawber JE. Class III malocclusion: surgery or orthodontics? Br J Orthod 1992;19:21-4.

15. Valko RM, Sather AH, Turlington EG. Indications for selecting surgical or orthodontic correction of mandibular protrusion. J Oral Surg 1968;26:230-8.

16. Rabie AB, Wong RW, Min GU. Treatment in borderline Class III malocclusion: orthodontic camouflage (extraction) versus orthognathic surgery. Open Dent J 2008;2:38-48.

17. Schoenwetter R. Nonsurgical class III orthodontic treatment. Angle Orthod 1977;47:147-55.

18. Lin J, Gu Y. Preliminary investigation of nonsurgical treatment of severe skeletal Class III malocclusion in the permanent dentition. Angle Orthod 2003;73:401-10.

19. Sperry TP, Speidel TM, Isaacson RJ, Worms FW. The role of dental compensations in the orthodontic treatment of mandibular prognathism. Angle Orthod 1977;47:293-9.

20. Kerr WJ, Ten Have TR. Changes in soft tissue profile during the treatment of Class III malocclusion. Br J Orthod 1987;14:243-9.

21. Vasir NS, Thompson RT, Davies TM. Dental and skeletal changes following sagittal split osteotomy for correction of mandibular prognathism. Eur J Orthod 1991;13:134-42.

22. Marşan G, Cura N, Emekli U. Soft and hard tissue changes after bimaxillary surgery in Turkish female Class III patients. J Craniomaxillofac Surg 2009;37:8-17.

23. Capelozza FL, Martins A, Mazzotini R, da Silva Filho OG. Effects of dental decompensation on the surgical treatment of mandibular prognathism. Int J Adult Orthodon Orthognath Surg 1996;11:165-80.

24. Franchi L, Baccetti T, McNamara JA Jr. Mandibular growth as related to cervical vertebral maturation and body height. Am J Orthod Dentofacial Orthop 2000;118:335-40.

25. Roth RH. Functional occlusion for the orthodontist: Part III. J Clin Orthod 1981;15:174-9, 182-98.

26. Andrews LF. The six keys to normal occlusion. Am J Orthod 1972;62:296-309.

27. Ong HB, Woods MG. An occlusal and cephalometric analysis of maxillary first and second premolar extraction effects. Angle Orthod 2001;71:90-102.

28. Woods MG. Overbite correction and sagittal changes: late mixeddentition treatment effects. Aust Orthod J 2001;17:69-80.

29. Wholley CJ, Woods MG. Tooth and lip responses to three commonly prescribed premolar extraction sequences: a review of recent research findings. Aust Orthod J 2004;20:115-21.

30. Tadic N, Woods MG. Incisal and soft tissue effects of maxillary premolar extraction in Class II treatment. Angle Orthod 2007;77:808-16.

31. Woods MG. Sagittal mandibular changes with overbite correction in subjects with different mandibular growth directions: late mixeddentition treatment effects. Am J Orthod Dentofacial Orthop 2008;133:388-94.

32. Sherman SL, Woods MG, Nanda RS, Currier GF. The longitudinal effects of growth on the Wits appraisal. Am J Orthod Dentofacial Orthop 1988;93:429-36.

33. Nanda RS, Meng H, Kapila S, Goorhuis J. Growth changes in the soft tissue facial profile. Angle Orthod 1990;60:177-90.

34. Enlow DH, Kuroda T, Lewis AB. The morphological and morphogenetic basis for craniofacial form and pattern. Angle Orthod 1971;41:161-88.

35. Scott JH. The cranial base. Am J Phys Anthropol 1958;16:319-48.

36. Björk A, Skieller V. Normal and abnormal growth of the mandible: a synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod 1983;5:1-46.

37. Lin PT, Woods MG. Lip curve changes in males with premolar extraction or non-extraction treatment. Aust Orthod J 2004;20:71-86.

38. Moseling KP, Woods MG. Lip curve changes in females with premolar extraction or non-extraction treatment. Angle Orthod 2004;74:51-62.

39. Lew KK. Soft tissue profile changes following orthodontic treatment of Chinese adults with Class III malocclusion. Int J Adult Orthodon Orthognath Surg 1990;5:59-65.

40. Ellis E 3rd, McNamara JA Jr. Components of adult Class III malocclusion. J Oral Maxillofac Surg 1984;42:295-305.

41. Woods MG, Swift JQ, Markowitz NR. Clinical implications of advances in orthognathic surgery. J Clin Orthod 1989;23:420-9.

42. Woods MG, Wiesenfeld DW. A practical approach to presurgical orthodontic preparation. J Clin Orthod 1998;32:350-8.

43. Troy BA, Shanker S, Fields HW, Vig K, Johnston W. Editor’s Summary, Q & A, Reviewer’s critique: Comparison of incisor inclination in patients with Class III malocclusion treated with orthognathic surgery or orthodontic camouflage. Am J Orthod Dentofacial Orthop 2009;135:146-7.

EXTRA FILES

COMMENTS