CASE REPORT By William E. Wyatt, Sr., DDS efore initiating treatment of a Class III patient, there are relevant facts which every practitioner should take into consideration. Class III malocclusion is most often genetic. In fifty-seven years of practice I cannot remember ever having seen a Class III patient without finding some evidence of this malocclusion in other blood kin. Class III patients do not all start out with this malocclusion and continue that growth pattern throughout development. Always look at blood relatives to aid in predicting how your patient may eventually develop. Do not be eager to treat a Class I malocclusion in a child when one, or both parents have a prominent chin -which denotes a Class III malocclusion. 18 March/April 2013 JAOS B “In adults, most Class III malocclusion is occasioned by a protrusive mandible; a lesser number by an insufficiently developed maxilla. In most cases there is a combination of these problems.” Young men frequently have a latent growth spurt between 18 to 21 years of age. I have had cases successfully treated to a Class I at 14 to 16 years, yet grow out to an end-to-end (or worse!) relationship at 18 to 21 years of age. Always warn the patient, and parents, of the possibil-ity of latent forward growth of the mandible in young men. Young Class III patients (aged 4 to 14) can be treated successfully with palatal separators and reverse headgear. These work best on very young patients (aged 4 to 7 years), but will still work on some patients up to the age of 14. Again, studying the parents for genetics are paramount, even with this proven form of treatment. In young Class III patients a fixed palatal expander is used to loosen sutures in the maxilla. This procedure should take three to five weeks. When this is accomplished, tie off the palatal separator, and at the same time use a face mask which is attached, by elastics, to hooks on the anterior portion of
Journal of the American Orthodontic Society March-April 2013: Page 18
