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Soft tissue paradigm based Treatment planning in skeletal class III.

YoungCheol Kim1, Seung Il Song2, Sung Hyo Lee1

  • 1Department of Orthodontics, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, South Korea.

Clinical Oral Investigations
|November 26, 2024
PubMed
Summary

Orthodontic treatment for skeletal Class III malocclusion shows that while surgery yields significant skeletal changes, both non-extraction and extraction camouflage treatments offer distinct soft tissue improvements, guiding treatment selection.

Keywords:
Angle Class III malocclusionCKHAExtraction vs non-extractionJaw abnormalityOrthognathic surgerySoft tissue paradigm

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Area of Science:

  • Orthodontics and Dentofacial Orthopedics
  • Cephalometric Analysis
  • Skeletal Malocclusion Treatment

Background:

  • Skeletal Class III malocclusion (ANB < 0°) presents challenges in achieving optimal facial aesthetics.
  • Treatment decisions involve balancing hard tissue correction with soft tissue outcomes.
  • Evaluating soft tissue changes, such as the nasolabial angle (CKHA), is crucial for treatment success.

Purpose of the Study:

  • To compare the soft tissue improvement effects of non-extraction, extraction camouflage, and orthognathic surgery in skeletal Class III malocclusion.
  • To propose guidelines for treatment selection based on soft tissue response.
  • To correlate hard tissue changes (ANB) with soft tissue changes (CKHA).

Main Methods:

  • Retrospective cephalometric analysis of 66 patients with skeletal Class III malocclusion.
  • Patients were divided into three groups: non-extraction (G1), extraction (G2), and orthognathic surgery (G3).
  • Lateral cephalometric radiographs before and after treatment were analyzed to compare changes in ANB and CKHA.

Main Results:

  • Significant differences in ANB were found between non-extraction (G1) and extraction/surgery (G2/G3) groups.
  • No significant differences in CKHA were observed across the three treatment groups post-treatment.
  • In the extraction group (G2), CKHA approached normal values (-1.8°), indicating potential soft tissue normalization with minimal skeletal change.

Conclusions:

  • Orthognathic surgery provides the most substantial skeletal correction.
  • Both non-extraction and extraction camouflage treatments offer significant advantages in soft tissue outcomes.
  • Extraction camouflage (G2) demonstrated posterior lower lip movement and soft tissue B point shift, contributing to improved aesthetics.