Elements of Diagnosis & Treatment in Class III Cases

One of the great myths in dentistry and orthodontics is that treatment of Class III malocclusion is more difficult than treatment of Class II cases. Yet when we look at the unique biophysics of a mouth, there is ample evidence that Class III cases have advantages that make them easier to treat than Class II cases. Some of these include:

  1. Upper posterior teeth are quite amicable to coming forward.
  2. Lower posterior teeth are the stingiest about coming forward.
  3. Upper anterior teeth require delicate precision, knowledge and skill to retract without de-torquing and extrusion due to the palatal cortical plate barrier.
  4. Lower anterior teeth love to collapse and retract distally.

All of these are reasons that favor Class III cases being easier to treat than Class II cases. And there are others including the introduction of vertical forces (i.e. inter-arch elastics) that make Class II worse yet helps to correct Class III and contribute to the camouflage effect of Class III correction. (Figs. 1 & 2)

Certainly, there are difficult Class III cases. Some even requiring orthognathic surgery. But this treatment option is presumed necessary far too often than is necessary to achieve the objectives of beautiful aesthetics, function and oral health. The intent of this article is to discuss the details of Class III orthodontic treatment to make it more accessible to both patients and treating dentists.

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