Nonsurgical treatment of a hyperdivergent skeletal Class III patient with mini-screw-assisted mandibular dentition distalization and flattening of the occlusal plane.

Treatment of hyperdivergent skeletal Class III malocclusion is challenging for orthodontists, and orthognathic-orthodontic treatment is usually required. This report presents the successful nonsurgical treatment of a 20-year-old man who had a skeletal Class III malocclusion with anterior open bite, anterior and posterior crossbite, hyperdivergent growth pattern, steep occlusal plane, early loss of three first molars, and an uncommon convex profile with a retruded chin. An orthodontic camouflage treatment plan was chosen based on the etiology and the patient's complaints. Tooth #37 was extracted. Miniscrews were used for uprighting and intruding of the lower molars, distalization of the lower dentition, and flattening of the occlusal plane. After 34 months of active treatment, Class I relationships, proper anterior overjet and overbite, flat occlusal plane, and an esthetic facial profile were achieved. The results demonstrated that the biomechanics involved in the nonsurgical treatment assisted with miniscrews to distalize the mandibular dentition and flatten the occlusal plane while keeping the mandibular plane stable was effective for treating this hyperdivergent skeletal Class III patient with a convex profile and anterior open bite.

Dental and skeletal effects after total arch distalization using modified C-palatal plate on hypo- and hyperdivergent Class II malocclusions in adolescents.

OBJECTIVES: To compare the dental and skeletal treatment effects after total arch distalization using modified C-palatal plates (MCPPs) on adolescent patients with hypo- and hyperdivergent Class II malocclusion. MATERIALS AND METHODS: The study group included 40 patients with Class II malocclusion (18 boys and 22 girls, mean age = 12.2 ± 1.4 years) treated with MCPPs. Fixed orthodontic treatment started with the distalizing process in both groups. Participants were divided into hypo- or hyperdivergent groups based on their pretreatment Frankfort mandibular plane angle (FMA) ≤22° or ≥28°, respectively. Pre- and posttreatment lateral cephalograms were digitized, and 23 variables were measured and compared for both groups using paired and independent t-tests. RESULTS: The hyper- and hypodivergent groups showed 2.7 mm and 4.3 mm of first molar crown distalizing movement, respectively (P < .001). The hypodivergent group had a slight 2.2° crown distal tipping of first molars compared with 0.3° in the hyperdivergent group. After distalization, the FMA increased 3.1° and 0.3°, in the hypodivergent and hyperdivergent groups, respectively (P < .001). SNA decreased in the hypodivergent group, while other skeletal variables presented no statistically significant differences in the changes between the groups. CONCLUSIONS: The hypodivergent group showed more distal and tipping movement of the maxillary first molar and increased FMA than the hyperdivergent group. Therefore, clinicians must consider vertical facial types when distalizing molars using MCPPs in Class II nonextraction treatment.

Dental and skeletal effects after total arch distalization using modified C-palatal plate on hypo- and hyperdivergent Class II malocclusions in adolescents.

OBJECTIVES: To compare the dental and skeletal treatment effects after total arch distalization using modified C-palatal plates (MCPPs) on adolescent patients with hypo- and hyperdivergent Class II malocclusion. MATERIALS AND METHODS: The study group included 40 patients with Class II malocclusion (18 boys and 22 girls, mean age = 12.2 ± 1.4 years) treated with MCPPs. Fixed orthodontic treatment started with the distalizing process in both groups. Participants were divided into hypo- or hyperdivergent groups based on their pretreatment Frankfort mandibular plane angle (FMA) ≤22° or ≥28°, respectively. Pre- and posttreatment lateral cephalograms were digitized, and 23 variables were measured and compared for both groups using paired and independent t-tests. RESULTS: The hyper- and hypodivergent groups showed 2.7 mm and 4.3 mm of first molar crown distalizing movement, respectively (P < .001). The hypodivergent group had a slight 2.2° crown distal tipping of first molars compared with 0.3° in the hyperdivergent group. After distalization, the FMA increased 3.1° and 0.3°, in the hypodivergent and hyperdivergent groups, respectively (P < .001). SNA decreased in the hypodivergent group, while other skeletal variables presented no statistically significant differences in the changes between the groups. CONCLUSIONS: The hypodivergent group showed more distal and tipping movement of the maxillary first molar and increased FMA than the hyperdivergent group. Therefore, clinicians must consider vertical facial types when distalizing molars using MCPPs in Class II nonextraction treatment.

Management of Developing Skeletal Class III Malocclusion in a Prepubertal Girl with Prognathic Mandible in Late Mixed Dentition.

Treatment of skeletal Class III patients at younger age is highly unpredictable. The patient may respond well to the treatment or may show excessive mandibular growth during growth spurt which may require orthognathic surgery later on. If not treated at earlier stages of life, the condition may worsen with time. This case report will present the comprehensive orthodontic management of a 9-year-old prepubertal girl in late mixed dentition with prognathic mandible. Chin cup therapy was started and continued for 3 years. After chin cup therapy, maxillary and mandibular dentition were bonded with standard edgewise appliance. After leveling and alignment, Class III elastics were started. Fixed orthodontic treatment was completed in 3 years. At the end, good Class I molar and canine relationship with normal overjet and overbite were achieved. The total treatment time of orthopedic and orthodontic correction was 6 years, 2 months. The patient revealed the same Class I molar and canine relationship after 6 years of treatment. Redirection of mandibular growth pattern from hyperdivergent to normodivergent advocates the use of chin cup as a viable treatment regimen for the management of prognathic mandible in prepubertal patients.