International Journal of Medical Dentistry 169 Abstract Introduction: Dento-maxillary abnormalities inclu- ded in Angle class III are dismorphic entities with multi- factorial aetiology and different clinical manifestations 1-5 . They can develop from simple forms (reverse interlock- ing) to major modifications in the facial harmony (man- dibular protrusion with macrognathism) 6-9 . Aim of the study: to assess the frequency of Angle Class III malocclusion in a group of children, with em- phasis on early therapeutic methods that can prevent the evolution of severe anatomical forms 9-12 . Materials and method: The study group comprised 355 children (200 females, 155 males), aged 4-6 years, with dento-maxillary abnormalities. Investigations were con- ducted over a period of 3 years (2007-2010) by analyzing patients’ records from the Department of Orthodontics, Tg. Mure[. The children were examined both clinically and radiologically. On clinical examination, the facial form was evalu- ated from the frontal and side view, while medical his- tory established the involvement of genetic factors in pa- tients with Class III abnormalities. Paraclinical examinations included study design (perimeter and sag- ittal arrow), lateral cephalometric examination (to assess bone deviations) and panoramic radiography (to assess Björk’s structural signs of mandibular growth rotation). The retropulsion test made possible the differential diag- nosis between different clinical forms 2,5,13-15 . Results and discussion: The study first evaluated the gravity of malocclusion Class III out of the total dento- maxillary abnormalities, the 2.81% percent obtained, ranking between 2.82% and 3.5%,corresponding to the values published by Schapira in literature (Fig.1) 2.81% 97.19% Class III Malocclusions Other abnormalities Fig. 1. Distribution of Class III malocclusion The clinical forms had the following distribu- tion: 10% reverse interlocking, 20% mandibular EARLY ORTHODONTIC THERAPY IN ANGLE CLASS III MALOCCLUSIONS Hompoth Zsuzsa 1 , Klara Brânzaniuc 2 , Mariana P\curar 3 1 PhD Student, University of Medicine and Pharmacy, Targu Mures 2 University of Medicine and Pharmacy, Targu Mures, Dept. Anatomy 3 University of Medicine and Pharmacy, Targu Mures, Dept. Pedodontics and Orthodontics Corresponding author : [email protected]prognathism, 30% false prognathism, 40% true prognathism, as illustrated in Fig. 2. The number of reported clinical cases regard- ing the clinical forms is represented in the fol- lowing chart: 10% 40% 20% 30% Reverse interlocking True prognathism True prognathism with open occlusion False prognathism Fig. 2. Clinical Forms of Class III Malocclusions A higher frequency of abnormalities was ob- served in young males, specifically 6 cases were recorded in boys and 4 cases in girls. (Fig.3) 0 1 2 3 4 5 6 Young Males Young Females Fig. 3. Gender-based distribution of abnormalities Taking into consideration each patient’s den- tition and gender, the clinical cases occur as: 1 case of temporary dentition, 4 cases of mixed dentition (4 males), 4 cases of young permanent dentition (3 females and 1 male), 1 case of adult permanent dentition. Data are presented both in a table and as a graph. (Fig. 4) Orthodontics
ded in Angle class III are dismorphic entities with multi-factorial aetiology and different clinical manifestations1-5.They can develop from simple forms (reverse interlock-ing) to major modifications in the facial harmony (man-dibular protrusion with macrognathism)6-9.
Aim of the study: to assess the frequency of AngleClass III malocclusion in a group of children, with em-phasis on early therapeutic methods that can prevent theevolution of severe anatomical forms9-12.
Materials and method: The study group comprised355 children (200 females, 155 males), aged 4-6 years, withdento-maxillary abnormalities. Investigations were con-ducted over a period of 3 years (2007-2010) by analyzingpatients’ records from the Department of Orthodontics,Tg. Mure[. The children were examined both clinicallyand radiologically.
On clinical examination, the facial form was evalu-ated from the frontal and side view, while medical his-tory established the involvement of genetic factors in pa-tients with Class III abnormalities. Paraclinicalexaminations included study design (perimeter and sag-ittal arrow), lateral cephalometric examination (to assessbone deviations) and panoramic radiography (to assessBjörk’s structural signs of mandibular growth rotation).The retropulsion test made possible the differential diag-nosis between different clinical forms2,5,13-15.
Results and discussion: The study first evaluated thegravity of malocclusion Class III out of the total dento-maxillary abnormalities, the 2.81% percent obtained,ranking between 2.82% and 3.5%,corresponding to thevalues published by Schapira in literature (Fig.1)
2.81%
97.19%
Class III Malocclusions
Other abnormalities
Fig. 1. Distribution of Class III malocclusion
The clinical forms had the following distribu-tion: 10% reverse interlocking, 20% mandibular
EARLY ORTHODONTIC THERAPY IN ANGLE CLASS IIIMALOCCLUSIONS
1 PhD Student, University of Medicine and Pharmacy, Targu Mures2 University of Medicine and Pharmacy, Targu Mures, Dept. Anatomy3 University of Medicine and Pharmacy, Targu Mures, Dept. Pedodontics and OrthodonticsCorresponding author : [email protected]
prognathism, 30% false prognathism, 40% trueprognathism, as illustrated in Fig. 2.
The number of reported clinical cases regard-ing the clinical forms is represented in the fol-lowing chart:
10%
40%20%
30%
Reverse interlocking
True prognathism
True prognathism with open occlusion
False prognathism
Fig. 2. Clinical Forms of Class III Malocclusions
A higher frequency of abnormalities was ob-served in young males, specifically 6 cases wererecorded in boys and 4 cases in girls. (Fig.3)
0
1
2
3
4
5
6
Young MalesYoung Females
Fig. 3. Gender-based distribution of abnormalities
Taking into consideration each patient’s den-tition and gender, the clinical cases occur as: 1case of temporary dentition, 4 cases of mixeddentition (4 males), 4 cases of young permanentdentition (3 females and 1 male), 1 case of adultpermanent dentition. Data are presented both ina table and as a graph. (Fig. 4)
Orthodontics
170 volume 1 • issue 2 April / June 2011 •
0 1 2 3 4 5
Temporary dentition
Mixed dentition
Young permanent dentition
Adult permanent dentition
Females
Males
Fig. 4. Distribution according to the type of dentition
Analysis of the above chart shows that mostof the patients were in the mixed and young per-manent dentition period. The mixed dentitionperiod is a proper period for the correction ofthese abnormalities while, during the young per-manent dentition period, the possible correctionof these abnormalities also depends on the se-verity of the morphological changes. The studyincluded only 1 case in the temporal dentitionperiod, known as ideal for a permanent correc-tion of this abnormality without relapses8-10.
Our results are similar to data published inthe literature on the prevalence of the abnormal-ity, namely between 1-3% in white people and 4-5% in Mongoloid people. Although they occuronly rarely, these anomalies have serious clini-cal manifestations by their impact on the evolu-tion of the dento-maxillary functions, so thattherapeutic intervention during temporary den-tition is required9,10,16,17.
Fig. 5. Facial aspect (front and side view)
Illustrative for the early orthodontic therapyis the case of N.P, a 6 year-old patient with longfacies concave profile and progenia (Fig. 5), who
came to us for orthodontic treatment, because ofphysiognomic and functional reasons (lockedbite due inverted occlusion).
For the applied functional therapy, Frankel’sfunction regulator was used as orthodontic ap-pliance.
Fig. 6. Endo-oral aspect (front and profile view)
Two years after starting the treatment withtype III Frankel’s functional device (Fig. 7), theaccomplishment of retrognathia and improve-ment of the facial aspect may be observed.
Fig. 7. Frankel’s intra-oral appliance
pp 169-171
Hompoth Zsuzsa, Klara Brânzaniuc, Mariana P\curar
International Journal of Medical Dentistry 171
Fig. 8. Facial and teleradiographic aspect 2 years afterthe treatment
CONCLUSIONS
1. The incidence of Angle class IIImalocclusion in our study is 2.81%
2. Gender-based distribution indicates ahigher occurrence in young males than in youngfemales, but the degree of addressability ishigher among young females.
3. Angle class III malocclusion is an ortho-dontic emergency and should be diagnosed andtreated since early temporary dentition.
4. The earlier the orthodontic treatment is per-formed, the more efficient it is. The explanationis twofold: on one hand, the abnormality is in-tercepted at a less prominent stage, on the otherhand, bone plasticity (which decreases with age)allows an increased efficiency of the orthodonticappliances.
References1. Kanno Zuisei — Early correction of a developing skel-
etal Class III malocclusion. The Angle Orthodon-tist 2007; 3: 549-556.
2. McNamara James A., Baccetti Tiziano — Gender dif-ferences in Class III malocclusion. The Angle Or-thodontist 2005; 4: 510-520.
3. Battagel J. M. – The aetiological factors in Class IIImalocclusion. European Journal of Orthodontics1993; 15: 347-370.
5. Elham S. J., Abu Alhajia, Richardson A. – Growthprediction in Class III patients using cluster anddiscriminant function analysis. European Journalof Orthodontics 2003, 25:599-608.
6. Dènes Jüzsef, Hidasi Gyula – Gyermekfogászat,fogszabályozás. Editura Semmelweis Budapest1998, 18: 300-307
7. Johnston Chris, Hunt Orlaghi – The influence of man-dibular prominence on facial attractiveness. Eu-ropean Journal of Ortodontics 2005; 27: 129-133.
9. Cozza P., Marino A. – An orthopaedic approach totreatment of Class III malocclusions in the earlymixed dentition. European Journal of Orthodon-tics 2004., 26: 191-199.
10. Hagg Urban, Tse Agnes – Long-term follow-up ofearly treatment with reverse headgear. EuropeanJournal of Ortodontics 2003; 25: 95-102.
11. Fujita T., Ayca Arman – Evaluation of maxillaryprotraction and fixed appliance therapy in ClassIII patients. European Journal of Ortodontics2006; 28: 383-392.
12. Tse Agnes, Bendeus Margareta – A follow-up studyof early treatment of pseudo Class IIImalocclusion. The Angle Orthodontist
13. Motoyoshi Mitsuru, Shirai Sawa – Permissible limitfor mandibular expansion. European Journal ofOrtodontics 2005; 27: 115-120.
14. Neslihan Tuba, Tortop Sema – A comparison ofchincap and maxillary protraction appliances inthe treatment of skeletal Class III malocclusions.European Journal of Ortodontics 2000; 22: 43-51.
15. Grant T., Mossey P. – Size and shape measurmentin contemporary cephalometrics. European Jour-nal of Ortodontics 2003; 25: 231-242.
16. Perkiomani Marja R., Kyrkanidies S. – The relation-ship of distinct craniofacial features betweenDown syndrome female and their parents. Euro-pean Journal of Ortodontics 2005; 27: 48-52.
17. Rey Diego, Baccetti Tiziano – Mandibular cervicalheadgear vs rapid maxillary expander facemaskfor orthopedic treatment of Class III malocclu-sion. The Angle Orthodontist 2007; 4: 619-624.
EARLY ORTHODONTIC THERAPY IN ANGLE CLASS III MALOCCLUSIONS
