Class III

Historically –mandibular

overdevelopment

Combination

Recently Maxillary

Retrusion (60%)

Ant./Post. Crossbite

Ellis E, McNamara JA. Components of adult Class III malocclusion. J Oral Maxillofac Surg 1984.Guyer EC, Ellis EE, McNamara JA, Behrents RG. Components of Class III malocclusions in juveniles and adolescents.

Angle Orthod 1986.

ETIOLOGY OF CLASS III

MALOCCLUSION

3.5% US

14% Chinese

and Japanese

INCIDENCE

3.4% Indian

Ast DB, Carlos JP, Cons NC. The prevalence and characteristics of malocclusion among senior highschool students inupstate New York. Am J Orthod 1965.

Irie M, Nakamura S. Orthopedic approach to severe skeletal Class III malocclusion. Am J Orthod 1975.Kharbanda OP, Siddhu SS, Sundarum KR, Shukla DK. Prevalence of malocclusion and its trait in Delhi children. J Indian

Orthod. Soc 1995.

INCIDENCE

Orthodontic Camouflage

Orthognathic surgery

Distraction osteogenesis

Growth Modification

Tindlund RS. Orthopaedic protraction of the midface in the deciduous dentition. J Craniomaxillofac Surg 1989.

TREATMENT OPTIONS

Current Txprotocol for orthopedic Maxillary

Protraction is by means of elastic

Facemask

Chin Cup

Expansion

Turley, P.K.: Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction

headgear, J. Clin. Orthod. 1988.

Hideo, M.: Early application of chincup therapy to skeletal Class III malocclusion, Am. J. Orthod. 2002.

Sakamoto M, Sugawara J, Umemori M, et al. Craniofacial growth of mandibular prognathism during pubertalgrowth period in Japanese boys – Longitudinal study rom 10 to 15 years of age. J Jpn Orthod Soc 1996

Physical appearance of the extra-

oral appliance

Skin irritation from the

anchorage pad

POOR COMPLIANCE

of child to wear it, major problem associated with

facemask therapy

Sung, S.J. and Baik, H.S.: Assessment of skeletal and dental changes by maxillary protraction, Am. J. Orthod. 1998.

PROBLEMS IN CONVENTIONAL THERAPY

NEED OF NEW APPLIANCE

Hence there was a need of another appliance to enhancethe patient compliance with much better biomechanics

Present paper discussed the construction and clinicalprocedure of an intraoral fixed appliance for thetreatment of Class III malocclusion in young patientswithout relying on patient co-operation

Fixed Maxillary Appliance with soldered buccal arm on first molar band for Class Traction

Fixed Mandibular Appliance with welded buccal tube on first molar band to headgear facebow

A 0.045 inch headgear face bow with the outer bows bent out for Class III elastic attachment with a soldered stop at terminal end on inner bow

Components of Modified Fixed Nanobite Tandem Appliance (MFNTA)

FIXED MAXILLARY APPLIANCE

Sean Shih-Yao Liu, Hee-Moon Kyung and Peter H. Buschang.

Continuous forces are more effective than intermittent forces in

expanding sutures. Eur J Orthod 2010.

FIXED MANDIBULAR APPLIANCE

Veerendra Prasad, Vijay P. Sharma, PradeepTandon, Gyan P. Singh. A new fixed biteplane. J of Clinical Orthod 2008.

Modified Fixed Nanobite Tandem

Appliance (MFNTA)

Mechanism of action of MFNTA

Schematic representation of a line offorce through the center of resistance(CR) of maxilla, which will result in atranslatory movement of maxilla. Inthe long vertical dimension of Class IIIpatients, it is advisable to adjust theline of force ≤20° to the occlusalplane (OP) to prevent downwardrotation of mandible.

Mechanism of action of MFNTA

Schematic representation of a line offorce for Class III with flat mandibularplane; it is advisable to adjust the lineof force ≥25° to the occlusal plane(OP) which will result in downwardand forward movement (clockwise) ofmidface and dentition resulting indownward and backward rotation ofmandible.

A CLINICAL REPORT OF PEDIATRIC PATIENT WITH CLASS III MALOCCLUSION TREATED BY MFNTA

Pretreatment patient photographs

She and herparents werepsychologicallydepressed withher facialappearance andreverse bite

Patient photographs with appliance

Post treatment Patient photographs

Posttreatmentfacial photographsof the patientshowed markedimprovement infacial esthetics andcorrection of reversebite

Pre and post treatment study model

GTRV= 0.60(If GTRV is between .33 to .88 then Class III malocclusion can be treated nonsurgical)

Early Timely Treatment of Class III Malocclusion: Semin Orthod 11:140–145 © 2005 Elsevier Inc.

CONCLUSION

Pre and post treatment record revealed-

significant skeletal improvement,

and marked improvement in facial balance

Address for correspondence

Dr. Prabhat K C,

Assistant Professor, Department of Orthodontics,

Dr. Z A Dental College, Aligarh Muslim University,

Aligarh, India -202001.Email ID-

dr.prabhatkc@gmail.com Modified Fixed

Nanobite Tandem Appliance (MFNTA)