Part 3 of 3 | Optimizing Aesthetics and Lower Incisor Periodontal Health: A Comprehensive Summary of the Diagnosis and Treatment of Class III Cases

“If everyone thinks the same, nobody is thinking…” —Benjamin Franklin

In this third and final part of this article, we continue to discuss the key issues and questions to consider with the diagnosis and treatment of Class III cases. Far too often, Class III cases are immediately dismissed as only being treatable with orthognathic surgery. Or, in other cases, simply establishing positive overjet in the correction of anterior crossbite is considered “good enough” despite the upper incisors ending up ridiculously proclined and far from optimally aesthetic. Traditionally, Class III treatment modalities of reverse headgear (RHG) and/or Class III elastics result in an occlusal plane that is too low posteriorly resulting in a reverse smile line and excessive posterior gingival display.

Part 1 of this article focused on how understanding growth and development creates opportunities for better Class III treatment outcomes. Part 2 of this article focused on how lower extractions should be utilized with much higher frequency to improve facial aesthetics, anterior crossbite correction, posterior crossbite correction, and to improve Temporomandibular Joint (TMJ) health.

Further, there was discussion of which lower teeth should be extracted. (See JAOS’s digital archive to those previous articles: Current issue: www.orthodontics.com/journal/journal)

In Part 3 of this article, we discuss sensitivity of upper incisor inclination. We also highlight management of the periodontal health of retroclined lower incisors that are quite typical in significant skeletal and dental Class III patients. Finally, we introduce a remarkably safe, effective and practical procedure that permits aggressive retraction of already retroclined lower incisors called a lower lingual corticotomy. Having an open mind can convert what appears to be a very difficult situation into a relatively easy and manageable case to treat. (Fig.1)