Transcript Class lll treatment, Surgical or camouflage ?

Class ΙΙΙ malocclusion treatment,
Surgery or camouflage ?
Dr Firas Elayyan
Searching
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Pubmed and google scholar
Key word :Class ΙΙΙ malocclusion
treatment
Search orthodontic journals
available on the internet
Most of results are single study
cases and retrospective studies
No RCT’s
Class ΙΙΙ malocclusion treatment, Surgery or camouflage?
1-The dilemma of class ΙΙΙ treatment
Authors
Campell P.M
year
1983
Type of study
Clinical study
Sample
14
2-Treatment decision in adult patients with class ΙΙΙ
malocclusion : Orthodontic therapy or orthognathic
surgery?
3-Class ΙΙΙ malocclusion: Surgery or Orthodontics?
StellzigEisenhauer et
al.
Kerr et al.
2002
Retrospective
study
175
1992
Clinical study
40
4-Cephalometric predictors of Long-term stability in the
Early Treatment of class ΙΙΙ Malocclusion
Young-Min
Moon et al.
2005
Retrospective
study
45
5- Morphological parameters as predictors of successful Zentner et al.
correction of class ΙΙΙ malocclusion.
2001
Retrospective
study
80
6-Predictors of relapse in orthodontically-treated class
ΙΙΙ malocclusion
1994
Retrospective
study
64
7-Cephalometric variables predicting the long-term
success or failure of combined RME and facial mask
therapy
Battagel J.M.
Baccetti et al.
2004 Retrospective
study
42
8-Long-term effects of class ΙΙΙ treatment with RME and Westwood et
facemask therapy followed by fixed appliance
al.
2003 Retrospective
study
9-A retrospective comparison of functional appliance
treatment of class ΙΙΙ in the decidous and mixed
dentition
1998
Retrospective
study
34 and
22 as
control
group
20
1997
Clinical study (
Review)
Baccetti and
Tollaro
10- Facial growth of Skeletal class ΙΙΙ Malocclusion and Sugawara and
the Effects, Limitations, and Long-Term Dentofacial
Mitani
Adaptations to Chincap therapy
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1-The dilemma of class ΙΙΙ treatment
Early or late?
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Campell P.M.
AO (1983); 53(3):175-191
Clinical study
Case reports of 14 patients
Result:
The conclusion is that the important benefits of early
treatment should not be denied because of concerns
that a few may still require further treatment later.
2-Treatment decision in adult patients with class ΙΙΙ
malocclusion : Orthodontic therapy or orthognathic surgery?
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Stellzig-Eisenhauer et al
AJODO (2002);122: 27-38
Retrospective study
175 cephalograms
2-Treatment decision in adult patients with class ΙΙΙ
malocclusion : Orthodontic therapy or orthognathic
surgery? Stellzig-Eisenhauer et al (2002)
-Result :The resulting equation was:
Individual score =
-1.805 + 0.209. Wits+0.044. S-+ 5.689.M/M ratio-0.056.Go(lower)
The critical score is -0.023
 >-0.023 : Orthodontic treatment
 <-0.023 : Orthognathic SX
3-Class lll malocclusion:
Surgery or orthodontics?
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Kerr WJ et al
BJO (1992) 19; 21-24
Clinical study
Case reports of 40 patients
Result :
The most significant differences between the groups
were in angle ANB, M/M ratio, lower incisor
inclination and Holdaway angle. Threshold values for
angle ANB and lower incisor angulation below which
surgery was almost always carried out were-4 and
83 degrees, respectively.
4-Cephalometric predictors of Long-term stability in the
Early Treatment of class lll Malocclusion
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Young-Min Moon et al.
AO ( 2005);75:747-753
Retrospective study ( 5.7 years)
Sample size : 45
Study Design : records of chin cap-FA follow up of 5.7
years
Results:
Generally, the subjects with a smaller gonial angle and a
more hypodivergent skeletal pattern had good prognosis
after the early treatment of Class III malocclusion.
5-Morphological parameters as predictors of successful
correction of class lll malocclusion
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Zentner A. et al
EJO (2001) 23(4): 383-392
Retrospective study
80 cephalograms
Result :
With the exception of the percentage midfacial
length/mandibular length ratio, the net sum of
maxillary and mandibular length differences, the
mandibular ramus height/mandibular body length
ratio and the gonion angle, most cephalometric
parameters of pre-treatment craniofacial morphology
assessed were poor predictors of successful
correction of Class III malocclusions.
6-Predictors of relapse in orthodontically-trated
class lll malocclusion
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Battagel J.M.
BJO( 1994) 21(1):1-13
Retrospective study
64 patient records (31 non-extracion,33
extraction)
Result :The capacity for predicting the observed outcome
of therapy was assessed in three ways: correlation
coefficients, the number of cephalometric measurements
exceeding two standard deviations from a control group
mean, and discriminant analysis. Only the latter proved an
effective indicator of relapse, with a separate discriminant
model being necessary for each sub-group.
7-Cephalometric variables predicting the long-term success or failure of
combined rapid maxillary expansion and facial mask therapy
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Baccetti et al.
AJODO (2003); 126:16-22
Retrospective study
42 patints
Result
Orthopedic treatment of Class III malocclusion might be
unfavorable over the long term when a patient's
pretreatment cephalometric records exhibit a long
mandibular ramus (ie, increased posterior facial height),
an acute cranial base angle, and a steep mandibular plane
angle.
8-Long-term effects of class ΙΙΙ treatment with RME
and facemask therapy followed by fixed appliance
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Westwood et al.
AJODO (2003); 123:306-320
Long Retrospective study
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34 patients and 22 as control group.
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Result:
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RME/FM therapy was shown to be effective
treatment of correcting class ΙΙΙ malocclusion in the
long term. The favourable skeletal effects induced
before the pubertal growth spurt led to
establishment of positive overbite and overjet
relation. The occlusal relation generally withstood
subsequent class craniofacial growth throughout
attainment of skeletal maturity.
9-A retrospective comparison of functional appliance
treatment of class lll in the decidous and mixed dentition
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Baccetti T and Tollaro
EJO(1998); 20(3):309-17
Retrospective study
20 child (Mean age: 5.1 years)
Result
The optimum timing to improve skeletal relationships in
Class III malocclusions by means of a functional appliance
appears to be in the deciduous dentition.
10-Facial growth of Skeletal class lll Malocclusion and the
Effects, Limitations, and Long-Term Dentofacial Adaptations to
Chincap therapy
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Sugawara and Mitani
Seminars in Orthodontics (1997);3:244-254
Clinical study ( Review)
Result
the skeletal profile is greatly improved during the initial
stages of chincap therapy. However, such changes are
rarely maintained during pubertal growth period.
Treatment with chincap appliances seldom alters the
inherited prognathic characteristics of skeletal Class III
profiles after completion of growth.
Class ΙΙΙ malocclusion treatment, Surgery or camouflage?
1-The dilemma of class ΙΙΙ treatment
Authors
Campell P.M
year
1983
Type of study
Clinical study
Sample
14
2-Treatment decision in adult patients with class ΙΙΙ
malocclusion : Orthodontic therapy or orthognathic
surgery?
3-Class ΙΙΙ malocclusion: Surgery or Orthodontics?
StellzigEisenhauer et
al.
Kerr et al.
2002
Retrospective
study
175
1992
Clinical study
40
4-Cephalometric predictors of Long-term stability in the
Early Treatment of class ΙΙΙ Malocclusion
Young-Min
Moon et al.
2005
Retrospective
study
45
5- Morphological parameters as predictors of successful
correction of class ΙΙΙ malocclusion .
Zentner et al.
2001
Retrospective
study
80
1994
Retrospective
study
64
6-Predictors of relapse in orthodontically-treated class
ΙΙΙ malocclusion
Battagel J.M.
7-Cephalometric variables predicting the long-term
Baccetti et al.
success or failure of combined rapid maxillary expansion
and facial mask therapy
2004 Retrospective
study
42
8-Long-term effects of class ΙΙΙ treatment with RME and Westwood et
facemask therapy followed by fixed appliance
al.
2003 Retrospective
study
9-A retrospective comparison of functional appliance
treatment of class ΙΙΙ in the decidous and mixed
dentition
1998
Retrospective
study
34 and
22 as
control
group
20
1997
Clinical study (
Review)
Baccetti and
Tollaro
10- Facial growth of Skeletal class ΙΙΙ Malocclusion and Sugawara and
the Effects, Limitations, and Long-Term Dentofacial
Mitani
Adaptations to Chincap therapy
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