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Non-osteotomy Treatment Of Class III Skeletal Malocclusion
Nathan Eberle, DDS,MD.
Cleveland Clinic Florida, Weston, FL, USA.

PURPOSE: Class III dentofacial deformities are growth-related deformities characterized by deficiency of the maxilla and/or a prognathic mandible. Three approaches to the correction are growth modification, orthodontic camouflage, and surgery. Traditional Orthodontic treatment for maxillary deficiency is protraction of the maxilla with reverse pull headgear or facemasks. Posterior rotation of the mandible and an unaesthetic increased vertical dimension of the face can result. Camouflage is an option depending on the patient’s aesthetic desires, but will not correct the facial deformity. Surgical treatment involves Le Fort I advancement alone or in combination with BSSO set-back. A newer approach involves manipulating the immature facial skeleton by way of bone anchored maxillary protraction. This method uses growth modification with the assistance of a minor surgical procedure attempting to avoid a future major surgical procedure. We evaluated this method using miniplates in patients with class III skeletal relationships:
METHODS: A retrospective chart review to identify patients who had been treated with placement of bollard plates for class III skeletal malocclusion. Data was collected from lateral cephalograms and exams.
RESULTS: See table
CONCLUSION: Our results demonstrate this method was effective at normalizing the maxillomandibular relationship in these patients without deleteriously affecting facial aesthetics. Bone anchored maxillary protraction with miniplates appears to offer an alternative to both reverse pull headgear & possibly future orthognathic surgery for the treatment of class III dentofacial deformities.

Results
Avgerage age at start of TxAvgerage Tx timeAverage ANB
Start/End
Average WITS
Start/End
Class I molar relationship at end of treatmentImproved Facial convexity/profileMinor ComplicationsAverage F/U
Total Patients=1312.3yrs16 months-0.2/+2.3-9.4/-4.112/1313/134/1318.9 months
Female=912.2yrs15.5 months+0.1/+2.3-8.9/-2.69/99/91/920 months
Male=412.3yrs17 months-1.3/+1.8-11/-8.83/44/43/414.5 months


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