GAP Australasian Dentist Mar Apr 2020

Category Austràlàsiàn Dentist 65 and distal movement /uprighting of the lower incisor segment. àhe treatment approach to Class malocclusions can be different between growing and non-growing patients. Treatment of a developing Class III: àeveral authors have recommended early treatment of developing Class malocclusions to obtain growth modification. àhe validity of two-phase treatment is supported by studies that show greater orthopaedic effects when treatment is started in younger patients. Expansion and partial fixed appliance: àhe use of a palatal expander and maxillary protraction facemask is highly recommended. àhe maxillary expander can be banded in hypo-divergent cases or bonded in Hyperdivergent cases. Face mask treatment: àhis can commence as soon as the upper permanent incisors start to erupt, and our aim is to obtain significant positive overjet, and follow up until the pubertal growth is completd – and hopefully the new position of the maxille can house the mandible and restricts its growth in future. However, in some casey the mandible can grow excessively, and the reverse overjet returns, and those cases may require surgery or a camouflage extraction treatment. àhen downside to early treatment using Facemask therapy, which usually is followed by a course of fixed appliance treatment – is the long treatment time. on the airway or not. A combination of mandibular reduction, maxillary advancement, and genioplasty is very common – but from a surgical point of view, minimising the amount of surgery is always preferable if possible. Conclusion àhe treating practitioner will list all potential treatment options to the patient and together decide on the appropriate treatment plan according to the patient’s needs and their desired outcome of the treatment. u àlàn al Figure 5: Extraction of a lower incisor (before and after) Figure 9: Patient requiring orthognathic surgery (before and after) Figure 11: Classification of developing class 3 Figure 10: Diagnostic decision flow chart Figure 8: Patient with Facemask therapy Figure 7a: Banded RPE for Facemask b Bonded RPE for Facemask Figure 6: Extraction of premolar teeth (before and after) Previously, àemovable Functional appliances, such as the Frankel appliance was popular for early orthopaedic treatment of growing Class cases. However, its limitations were the extended treatment times, the bulkiness of the appliance and that it required excellent patient cooperation (which was rarely achieved). Surgical Treatmenx of Class III malocclusions àurgical treatment of a Class malocclusion is indicated where a profile change is required, as well as with those patients who exhibit a true skeletal Class 3 malocclusion or a Pseudo Class 3 malocclusion with excising significant dental compensations. Definitive surgery may also be accompanied by a genioplasty procedure to improve the chin appearance. àt’s debatable whether mandibular reduction surgery has a negative impact