CASE REPORT Fig. 26 Fig. 29 Fig. 27 Fig. 30 Fig. 28 In growing patients, timely targeted extractions can “put the brakes” on excessive mandibular alveolar development. Anyone with experi-ence has had the nightmare of treat-ing a Class III grow-ing patient during the pubertal growth spurt, where growth exceeds our ability to advance the upper teeth to keep pace with the rapidly growing lower arch. This is particularly a prob-lem when there is anterior crossbite or open bite present.(Figs. 26-28) As mentioned earlier, many Class III cases present with TMD consid-erations. Surgery often is prescribed but this treatment alternative may not be best to resolve TMJ issues. A bi-sagittal split osteotomy (BSSO) might set back the anterior mandible but does nothing to improve condyles that are posteri-orly displaced into the fossae. Simi-larly, a maxillary advancement procedure (Le Forte) might correct an anterior crossbite but have no regard for the TMJs. Sensitivity to TMJ issues in Class III cases is often best treated with a combination of lower extractions, Class II elastics, and lower intra-arch mechanics to 38 Fall 2021 JAOS
Journal of the American Orthodontic Society Fall 2021: Page 38
