Treatment of Class III problems begins with differential diagnosis of anterior crossbites

Etiology of Class III malocclusion can be genetic or environmental. Proclination of mandibular incisors and retroclination of maxillary incisors can cause posturing of the mandible in an anterior position due to incisal interference, a condition called pseudo Class III malocclusion that can be misleading in evaluating a patient with skeletal Class III malocclusion. Unfortunately, cephalometric evaluation may not be the most reliable tool in differentiating whether the maxilla or the mandible contributes to the skeletal disharmony. The most consistent findings seem to be the dental characteristics of Angle's Class III molars and canines, retroclined mandibular incisors, and the presence of an edge-to-edge or an anterior crossbite occlusion. This paper presents a diagnostic scheme to differentiate between dental and skeletal crossbites. Early treatment of Class III malocclusion can help to minimize the adaptations and limitations that are often seen in severe malocclusion of the late adolescence. However, treatment of skeletal crossbites remains a continuous challenge to the profession. Due to the diversity and variability in facial growth, accurate individualized growth prediction is not possible at the moment. Treatment directed at the mandible seems to invite relapse during the pubertal growth period. Treatment directed at the maxilla shows promising results and is awaiting long-term clinical results following early orthopedic interventions. Several intraoral appliances have proved to be successful in eliminating dental crossbites.