Camouflaged Orthodontic Treatment Of Adult Skeletal Class Ⅲ Patients

Objective: In this paper, no growth and development ability of adult patients withskeletal class Ⅲ malocclusions treated with camouflaged orthodontic therapy, cephalometric measurements and soft tissue profiles before and after treatment werecompared, to discuss the effects of camouflaged orthodontic treatment of adultpatients with skeletal class Ⅲ malocclusions and the improvements of variousmeasurements.Methods: An adult patient with skeletal class Ⅲ malocclusion started orthodontictreatment in Shenyang Stomatological Hospital in November2010was chosen, one21-year-old male. Angle Class Ⅲ, Mao II1, skeletal Class Ⅲ. He was characterized bya deficiency of the maxilla and proghathism of the mandible. The relationships ofboth molars and canines were completely mesial. The maxillary dental arch had1mmmild crowding, the inferior dental arch had no crowded.Anterior tooth had reverseoverjet I°and reverse overbite I°. The maxillary median line was normal, the inferiormedian line right-axis deviated about3mm. According to the patient’s cephalometricvalues and model measurement analyses, combined with adult patient with nodevelopment potential,suggested him orthognathic surgery,the patient refused surgicaltreatment,finally the patient accepted camouflaged orthodontic treatment. Self-lockingmetal braces were chosen to relieve mild crowded on maxillary dental arch,aligndentition,level arch and decrease lower incisor inclination angle.We used class Ⅲelastics and median line elastics to modulate occlusion,align upper and lowermidline.Pre-therapy and post-treatment cephalometric measurements were comparedto observe relative position change of maxillary and mandible,inclination changes ofupper and lower incisors and changes of soft tissue appearance in the1/3lower face.Results: Orthodontic course lasted34months.After treatment,upper and lower archeswere aligned,the relationship of bilateral molars were mild mesial,both sides ofcanines relationship were centric relation,upper and lower median line werealigned.The range of opening and the style of opening of temporomandibular jointswere normal posttreatment,without joint clicking or noises.Masticatory muscles hadno tenderness.The patient was satisfied with the effect of treatment,the improvementof soft tissue appearance in the1/3lower face,the decrease of lower lip protrusion andthe increase of labiomental groove.Pre-therapy and post-treatment measurementswere compared:(1)SNB angle decreased、 ANB increased、Wits value increased. Mandible relative to skull base retruded. Skeletal class Ⅲ relationship hadimproved;(2)U1-NA、U1-SN angle increased，L1-NB、L1-MP angle decreased.Theinclination of upper and lower incisors increased,it was compensatory presentation forcovering up skeletal deformity;(3)MP-FH、 MP-SN angle slightly increased，mandibular plane angle slightly increased. Due to the patient had no growing ability，class Ⅲ elastics extruded the upper molars，the resultant was a clockwise rotation ofthe mandible.(4)G-Sn/Sn-Mes、Sn-St/St-Mes ratio decreased，ANS-Me/N-Me ratioincreased,this suggested the lower anterior facial height increase,mandible had mildlyclockwise rotation;Li-Hline、Li-Eline and Li-LsPos distance decreased, suggested Lipoint get closer to esthetic plant; Sn-Hline decreased、 CmSnLs and LsSn-SNincreased, suggested Ls point get closer to esthetic plant; SNPog、NAPog、S-Ns-Si、GSnPos、FH-NsPos and Holdaway angle decreased，Si-Hline increased, suggested thechin retrusion and Si point retrusion.The improvements of soft and hard tissue bothmaxilla and mandibular corrected the skeletal and dental discrepancies,improvedfacial esthetics and harmonized the profile.Conclusion: A nongrowing adult patient with skeletal class Ⅲ malocclusion wastreated by orthodontic camouflage treatment. After the treatment,tooth were straightand evenly aligned,completely mesial relationships of molars and canines werecorrected,anterior tooth established normal overbite and overjet. Upper and lowermedian line were in alignment.Lower lip protrusion was reductive,the chin wasretrusive. Facial profile in the1/3lower face was modified.For orthodonticcamouflage treatment on an adult patient,the labial inclination of the upper incisorsand the lingual inclination of the lower incisors increased.Class Ⅲ elastics lead to aclockwise rotation of the mandible,which slightly increases the lower anterior facialheight.