Malocclusion class iii

Definition :
According to British Standards class iii incisor relationship includes those malocclusions ::*where the lower incisor edge occludes anterior to the cingulum plateau of upper incisors . , *the overjet is reduced or reversed

Ashraf 16 yrs old presented with incisor 3 relationship based on class 1 skeletal relationship with anterior crossbite and ectopic canines in the upper arch.

His oj=1 mm

Incidence
-It affects 3% Caucasians - 2- 5 % Jordanian people The incidence of this malocclusion ranges between 4%and 13% among the Japanese and 4% and 14% among the Chinese

 Skeletal Pattern eitiology Features: A-P vertical Transverse

Aetiology :Skeletal Pattern

The most important Factor in producing Class iii malocclusion : skeletal class iii A-P: the more adverse the skeletal pattern the more severe the class iii

Skeletal iii could result from 1.early closure of the nasomaxillary complex sutures .

3.collapsed maxilla for cleft lip and palate patients.

2.hereditary ,small size maxilla and big size mandible.

the prognathic mandible of Austrian royal family

*Now the class iii skeletal which is associated with iii malocclusion could result from:
Maxilla : Retrognathic +- growth deficiency MICROGNATHIA), Mandible : Prognathic <anterior place in glenoid fossae +- Large Macrognathia Combination * Mandible *Note: More commonly it is a combination of factors <Mandible / Maxilla and cranial base >

Skeletal Pattern Features A-P:

Usually there is Class iii skeletal pattern It is possible to have class i skeletal

Ashraf 16 yrs old presented with incisor 3 relationship based on class 1 skeletal relationship with anterior crossbite and ectopic canines in the upper arch.

Diagnosis of class III malocclusion

PROFILE ASSESSMENT

Evaluate the chin position

Evaluate midface

concave profile, flattening of the infraorbital rim the chin is protruded Convexity in midface

Now how to determine you A-P skeletal pattern with the aid of Cephalometics : it is by determining the values of: 1-SNA: 81 +-2 (maxilla cranial base ) 2- SNB:78 +-2 (mandible position ) 3-ANB: <2 Class iii skeletal often negative

Skeletal Pattern Features

Vertical :
We have wide range of the lower facial height it could be : Avg , increased or decreased ,, So the overbite maybe normal in amount , deep ,reduced,, or we could have open bite

*Decreased LFH:
Ant /vertical /Acc growth low mmpa <27 C: behind the occiput with prominent chin *AlFH < 0.55

*increased LFH:
Posterior growth /horizontal /cc/ high mmpa :>27 Infront of occiput Reduced OB or open bite AlFH > 0.55

 Soft tissue

 SOFT TISSUE:
The soft tissue surrounding play a very minor effect in the etiology of class III malocclusion Competent lips This will induse retroclination of the lower incisors and prolination of the upper incisors

Incompetent lips

 these cases often have a skeletal anterior open bite with an adaptive variation of swallowing behaviour e.g : tongue to lower lip seal which may procline the lower incisors.

Dentoalveolar Aetiology And Occlusal features

Dentoalveolar Aetiology
A-proclination of lower anterior teeth B-retroclination of upper anterior teeth. C-(or both) mild CL III : O.J.=(1,0,-1,-2 mm)

Ashraf
Dental class iii Oj 1mm

OCCLUSAL FEATURE:
Incisor iii Overjet : reduced , edge-edge, or reversed Molar relationship iii , i ,ii

 Crowding is more common and more severe in

the upper arch often resulting from the fact that : The upper arch is short and narrow compared with a longer and wider lower arch.

Spacing : lower arch

Overbite
The overbite may be increased ,average ,or reduced. Where the vertical facial proportions are increased ,there is often an anterior open bite

Skeletal open bite :

symmmetrical , severe increased lower facial ht

,beyond canine

Cross bites
Cross bites of the labial and/or buccal segments are common,. Cross bite may be associated with a mandibular displacement particularly where a unilateral buccal segment crossbite exists. In the case of anterior cross bite, the possibility of displacement should be assessed

Diagnosis of class III malocclusion

DENTAL ASSESSMENT (overjet)

Negative overjet

Positive overjet or end end incisal relationship

FUNCTIONAL ASSESSMENT

No CR- CO shift

CR- CO shift

True class III malocclusion

Pseudo class III malocclusion

Compensated class III malocclusion

PSEUDO CLASS III MALOCCLUSION:

FUNCTIONAL ANALYSIS: The path of closure is from the postural rest position to occlusion must be carefully studied. The mandible may slide anteriorly into a forced protrusion because of premature contact and tooth guidance when the jaw closes into full occlusion.

PSEUDO CLASS III MALOCCLUSION:

CLASS III MALOCCLUSION WITH A PSEUDO FORCED BITE OR ANTERIORDISPLACEMENT 1. This condition is partially compensated by the labial tipping of the upper incisors and the lingual inclination of the lower incisors pt is often with skeletal classi or mild iii 2. This tooth mal position results in additional anterior guidance of the mandible on the path from postural rest to the habitual occlusion as the lingual aspect of thelower incisors rides on the maxillary incisor margins after initial contact