See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/317380038

Research and Reviews: Journal of Dentistry Class III Malocclusion and its
Management: An Overview

Article · January 2016

CITATIONS READS

0 306

3 authors, including:

Rohit Kulshreshta
Terna Dental College and Hospital
45 PUBLICATIONS   21 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Assessment of Extent of awareness regarding periodontal disease in patients of diabetes mellitus View project

Condyle Fossa Relation View project

All content following this page was uploaded by Rohit Kulshreshta on 07 June 2017.

The user has requested enhancement of the downloaded file.

 Research and Reviews: Journal of Dentistry
ISSN: 2230-8008(online), ISSN: 2348-9561(print)
Volume 7, Issue 2
www.stmjournals.com

Class III Malocclusion and its Management: An Overview

Vinay Umale, Rohit Kulshrestha*, Ragni Tandon
Department of Orthodontics and Dentofacial Orthopedics, Saraswati Dental College, Lucknow, India

Abstract
Angle’s Class III malocclusion is one of the most complex malocclusions which have several
etiological factors. The etiology may be present at different levels of development like dental,
skeletal and combination of both. The treatment modality depends upon the age and the
severity of the malocclusion. In this article, we summarize the etiology, types, prevalence,
characteristic features, diagnosis, different treatment methods for the Angle’s Class III
malocclusion.

Keywords: Class III malocclusion, clinical features, treatment methods

*Author for Correspondence: kulrohit@gmail.com

INTRODUCTION adult class III patient implies a series of

Orthodontics is considered to be the oldest
branch of dentistry. Angle was the first to
classify malocclusion and publish it in the year
1899 [1]. According to Angle, Class III
malocclusion occurs when lower teeth
occludes mesial to their normal relationship.
Class III malocclusion is characterized by
either retrognathic maxilla or prognathic
mandible or combination of both (Figure 1).
Class III malocclusion is divided into, pseudo-
Class III with normal development of
mandible and underdeveloped maxilla and
skeletal Class III with large mandible
according to Tweed [2].
transitional stages about which doubts can
arise as to developmental pattern and the
clinician is forced to attempt to predict future
growth. A prediction that is crucial for
treatment approach [4]. The uniquely
individual timing, direction, rate, and
increments of growth while treatment is
actually taking responses have to be
considered to get the best results [5].
Prevalence of Class III Malocclusion
Prevalence of malocclusion varies greatly in
different parts of the world, in different ethnic
groups and in different races [6]. Prevalence of
malocclusion is estimated higher in developed
countries as compared to developing and
under developed countries [7]. In Indian
children it has been reported as low as 19.6%
in Madras and as high as 90% in Delhi, it was
2.9% in 10 to 11 years age group and 3.9% in
12 to 13 years age group [8].

Etiology of Class III Malocclusion

There are various etiological factor for the
class III malocclusion, that shown in (Table 1).

Components of Class III Malocclusion

Fig. 1: Class III Malocclusion.
Moyers [3] in his classification of Class III
malocclusion has divided it into cause
muscular, skeletal or dental. Development
from the retrognathism seen in new born child
to the relative mandibular prognathism of the
Class III malocclusion may have combinations
of skeletal and dental dsyplasias. The etiology
of the malocclusion should be diagnosed first.
Ellis and McNamara [10] had calculated 243
possible combinations of Class III
malocclusion. The result showed that Class III
malocclusion was related with sagittal and

RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved Page 24
Angle’s Class III Malocclusion Umale et al.

vertical problems. A cephalometric study was
done to identify the types of skeletal Class III
malocclusions in adolescent children [11]. It
was seen that approximately 57% of the
children with a normal or prognathic mandible
showed a deficient maxilla (Figure 2). In
Chinese patients, Wu, Peng, and Lin [12]
found the percentage of skeletal Class III
malocclusion with a deficient maxilla to be
75%.

Table 1: Etiology of Angle’s Class III Malocclusion.

Moyer’s Classification [3]
1. Heredity 5. Habits
a. Neuromuscular system a. Thumb sucking and finger sucking
b. Bone b. Tongue thrusting
c. Teeth c. Lip sucking and lip biting
d. Soft parts d. Posture
e. Nail biting
2. Developmental defects of unknown origin f. Other habits

3. Trauma 6. Diseases
a. Prenatal trauma and birth injuries a. Systemic diseases
b. Postnatal trauma b. Endocrine diseases
c. Local diseases
4. Physical agents d. Nasopharyngeal diseases and disturbed respiratory function
a. Premature extraction of primary teeth e. Gingival and periodontal disease
b. Nature of food f. Tumors
g. Caries

7. Nutrition

Graber’s Classifications [9]

General Factors Local Factors

1) Heredity 1) Anomalies of number

a) Supernumerary teeth
2) Congenital b) Missing teeth (congenital absence or loss due to accidents,
caries, etc.)
3) Environment
a) Prenatal (trauma, maternal diet, German 2) Anomalies of tooth size
measles etc)
b) Postnatal (birth injury, cerebal palsy, TMJ 3) Anomalies of tooth shape
injury )
4) Abnormal labial frenum : mucosal barrier
4) Predisposing metabolic climate and diseases
a) Exocrine imbalance 5) Premature loss of deciduous teeth
b) Metabolic disturbances
c) Infectious diseases 6) Prolonged retention of deciduous teeth

5) Dietary problems (nutritional deficiency) 7) Delayed eruption of permanent teeth

6) Abnormal pressure habits and functional 8) Abnormal eruptive pathway

aberrations
a) Abnormal sucking 9) Ankylosis
b) Thumb and finger sucking
c) Tongue thrust and tongue sucking 10) Dental caries
d) Lip and nail biting
e) Abnormal swallowing habits (Improper 11) Improper dental restoration
deglutition)
f) Speech defects
g) Respiratory abnormalities (mouth breathing)
h) Tonsils and adenoids
i) Psychogenic tics and Bruxism

7) Posture

8) Trauma and accidents

RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved Page 25
Research and Reviews: Journal of Dentistry
Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561 (print)

Fig. 2: Cephalometric Appearance of Class III Malocclusion.

Table 2: Symptoms of Class III Malocclusion.

1. Eruption of the maxillary central incisors in a lingual relationship and the mandibular incisors in a forward position with
no overjet.
2. Development of an incisal crossbite during the eruption of the lateral incisors into a normal relationship.
3. Full incisor cross bites some weeks later.
4. Flattening of the tongue as it drops away from the palatal contact and postures forward, pressing against the lower
incisors
5. Habitual protraction of the mandible by the child into the protruded functional and morphologic relationship.

Fig. 3: Features of Class III Malocclusion.

RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved Page 26
Angle’s Class III Malocclusion
Features of Class III Malocclusion
(Figure 3)
Early signs of true progressive mandibular
prognathism occasionally can occur in
infancy. In the first months of life a sequential
development of the class III condition may be
observed [9] that is shown in Table 2.
Clinical Examination
The forehead and nose in relation to the lower
jaw and the dentition, which includes the
shape, size and number of teeth also play a
significant role for esthetics and treatment
planning. Naso-labial angle is important for a
good esthetic result. If the angle is acute, the
pre-maxilla segment can be retracted. If the
angle is obtuse, it can be protracted to improve
facial esthetics. The soft tissue of the chin can
compensate for or accentuate a skeletal class
III relationship depending on its thickness.
Gingival retraction or dehiscence can often be
seen in early class III malocclusion. This
damage is irreversible and is an indication for
early treatment.
Cephalometric Assessment of Class III
Malocclusion
Several studies have expanded on these
findings in an attempt to compare Class III
malocclusion with Class I controls relative to
the morphology of the maxilla, the mandible,
and the cranial base [13]. These differences are
shown in Table 3.
Differential Diagnosis of Class III
Malocclusion
In Class III malocclusions, patients present
with Class III symptoms such as anterior cross
bite, reduced overjet, or lower incisors
lingually inclined. Anterior cross bite is caused
due to incorrect inclination of the maxillary
and mandibular incisors, occlusal
interferences, or skeletal discrepancies of both
jaws [13].
Table 3: Cephalometric Features of Class III Malocclusion.
1. The SNA angle is significantly lower in the Class III samples, indicating a greater degree of maxillary retrusion.
2. Mandibular protrusion is greater in the Class III samples.
3. The mean ANB angle in the Class III samples is negative.
4. The gonial angle is more obtuse in the Class III samples.
5. The mandibular plane angle is steeper than normal in the Class III samples.
6. Lower anterior face height is significantly greater in the Class III samples.
7. The sella angle and articular angle were smaller in class III samples.
8. Anterior position of the mandible is seen.
RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved
Umale et al.
Class III Malocclusion Caused by a
Dentoalveolar Dysplasia
In the dentoalveolar Class III malocclusion,
there is no anterio-posterior skeletal
discrepancy. The ANB angle is within normal
limits. Lingual inclination of the maxillary
incisors and labial inclination of the
mandibular incisors is the main problem.
Skeletal Class III Malocclusion with
Maxillary Retrusion, Mandibular
Protrusion, or Both
The ANB angle is negative in the patients with
skeletal Class III malocclusion with a less than
normal SNA angle or greater than normal SNB
angle. ANB angle is affected by individual
variations in cranial base flexure and sagittal
displacement of nasion [14].
Different cephalometric values can be used to
evaluate the anteroposterior relationship of the
maxilla and mandible. Patients with a long
mandibular base have a large gonial angle. The
incisal inclination in this type of malocclusion
is the opposite of that seen in the dentoalveolar
Class III malocclusion.
Pseudo Class III Malocclusion
Kwong and Lin [15] conducted a
cephalometric study comparing the
characteristics of patients with Class I, pseudo
Class III, and skeletal Class III malocclusion
and most of the measurements suggested that
pseudo Class III malocclusion is an
intermediate form between Class I and skeletal
Class III malocclusion (Figure 4).
The gonial angle is the only exception, which
is more obtuse in the skeletal Class III
malocclusion than pseudo Class III. Due to
this the gonial angle measurement is important
in diagnosis between pseudo and skeletal
Class III malocclusions.
Page 27
Research and Reviews: Journal of Dentistry
Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561 (print)
Fig. 4: Pseudo Class III Malocclusion.
Growth Prediction of Class III
Malocclusion
Dietrich [16] reported Class III skeletal
malocclusions worsened with age. Patients
with a negative ANB angle were examined in
three stages primary, mixed and permanent
dentition. The mandibular protrusion increased
from 23% to 30% to 34% as the dentition
progressed from primary through permanent
dentition. Maxillary anteroposterior deficiency
problems went from 26% to 44% to 37%.
These results indicate that the abnormal
skeletal characteristics can become more
pronounced with time. Several investigators
[17–19] attempted to predict the growth of
Class III malocclusion. Their aim was to
determine if growth prediction can be used to
differentiate children with Class III tendency
and identify a specific skeletal morphologic
pattern in patients with Class III
malocclusions. Certain cephalometric
measurements such as cranial flexure, porion
location, and ramus position have been used to
predict normal or abnormal growth [20].
Treatment of Class III Malocclusion
There are various methods for the treatment of
Class III malocclusion depending upon the
severity and age of the patient. The objective
of early Class III treatment is to create an
environment in which a more favorable
dentofacial development can occur [21]. The
Table 4: Early Interceptive Treatment Goals.
1. Preventing progressive, irreversible, soft tissue, or bony changes;
2. Improving skeletal discrepancies and providing a more favorable environment for future Growth.
3. Improving occlusal function;
4. Simplifying phase II comprehensive treatment and minimizing the need for orthognathic Surgery.
5. Providing more pleasing facial esthetics, thus improving the psychosocial development of a child.
RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved
goals of early interceptive treatment may
include (Table 4).
Treatment of Pseudo Class III Malocclusion
Patients with pseudo Class III malocclusion
present with anterior cross bites caused by
premature tooth contact or faulty occlusion
and the TMJ. Removal of the centric relation
and centric occlusion discrepancy will avoid
wear and traumatic occlusal forces to the teeth.
It also avoids potentially adverse growth
influences in both the jaws, improves
maxillary lip posture, facial appearance and
avoids abnormal posterior occlusion. Reverse
stainless steel crowns were used to correct a
single tooth in anterior crossbite [22], in which
an oversized permanent lateral incisor
preformed crown formed and fit snugly over
the maxillary primary tooth. The crown is
cemented in reverse (i.e., facial to lingual)
with polycarboxylate cement.
One drawback of this method is the non-
esthetic appearance of the crown. With the
advent of bonded resin composite, the stainless
steel crown can be replaced by bonded
composite resin slopes for anterior tooth
crossbite correction [23]. Another method for
single tooth crossbite correction is tongue
blade and removable appliances with auxiliary
springs. These methods are unpredictable and
its effect is dependent on the frequency of
patients use and the patient's tolerance of
discomfort.
Treatment of Skeletal Class III
Malocclusion
Functional Appliance Therapy
The Frankel III (FR III) regulator [24] is a
functional appliance designed to counteract the
muscle forces acting on the maxilla (Figure 5).
According to Frankel [24], the vestibular
shields in the sulcus are placed away from the
buccal plates of the maxilla to stretch the
periosteum so bone apposition can take place.
Page 28
Angle’s Class III Malocclusion Umale et al.

Treatment with an FR III and other types of redirection and posterior positioning of the
functional appliances is more successful in mandible.
patients with a Class III malocclusion
presenting with a functional shift on closure.
The mandible gets repositioned downward and
backward, decreasing the prognathism of the
mandible and increasing the lower facial
height. The best response to FR III treatment
was noted in patients with Class III
malocclusions with an increased overbite of 4
to 5 mm in the early mixed dentition. The FR
III appliance can also be used as a retentive
device following maxillary protraction
treatment.

Fig. 6: Chin Cup.

Force Magnitude and Direction

Fig. 5: Frankel (FR) III.
Chin Cup Therapy
Skeletal Class III malocclusion with a normal
maxilla and a slightly forward mandible can be
treated with chin cup therapy (Figure 6). The
objective of early treatment with the use of a
chin cup is to provide growth inhibition or
It is of two types: the occipital-pull chin cup
that is used for patients with mandibular
protrusion and the vertical-pull chin cup that is
used in patients presenting with a steep
mandibular plane angle and excessive anterior
facial height [25–28]. Studies recommend an
orthopedic force of 350 to 550 g per side.
Patients are instructed to wear the appliance 14
hours/day. The orthopedic force is usually
directed either through the condyle or below
the condyle.

Protraction Face Mask Therapy (Figure 7)

Fig. 7: Protraction Face Mask.

RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved Page 29
Research and Reviews: Journal of Dentistry
Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561 (print)
Protraction face mask has been used in the
treatment of patients with Class III
malocclusion and a deficient maxilla.
Oppenheim (1944) [29] believed that one
could not control the growth or anterior
displacement of the mandible and suggested
moving the maxilla forward in an attempt to
counterbalance mandibular protrusion. In the
1960s Delaire and others [30] revived the
interest in using a face mask for maxillary
protraction. Petit [31] later modified Delaire's
basic concept by increasing the amount of
force generated by the appliance, thus
decreasing the overall treatment time.
In 1987 McNamara [32] introduced the use of
a bonded expansion appliance with acrylic
occlusal coverage for maxillary protraction.
Turley [33] improved patient cooperation in
wearing the appliance by fabricating
customized face masks. Till date, short-term
results show promising skeletal, dental, and
profile improvements with treatment. The
long-term benefits of early face mask
treatment need further substantiation, awaiting
results from prospective clinical trials. The
protraction face mask is made of two pads one
on the forehead and the other on chin region.
The pads are connected by a midline wire and
are adjustable through the loosening and
tightening of a set screw.
In protraction face mask an anterior wire with
hooks is also connected to the midline wire to
accommodate a downward and forward pull
on the maxilla with elastics. To minimize the
opening of the bite as the maxilla is
repositioned the protraction elastics are
attached near the maxillary canines with a
downward and forward pull of 30 degrees to
the occlusal plane. Maxillary protraction
requires 300 to 600 g of force per side,
depending on the age of the patient. The
tension of the elastics is measured by using a
tension stress gauge. Patients are instructed to
wear the face mask for 12 hours a day.
Rapid Palatal Expansion (RPE) (Figure 8)
The objective of maxillary expansion is to
widen the maxilla, expand the dental arch and
also open the sutures. With rapid expansion,
at a rate of 0.5 to 1 mm/day, a centimeter or
more of expansion is obtained in 2 to 3 weeks,
RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved
with most of the movement being separation
of the two halves of the maxilla.
Fig. 8: Rapid Palatal Expansion using Hyrax
Appliance.
A space appears between the central incisors.
The expansion device must be stabilized so
that it cannot screw itself back shut, and is left
in place for 3 to 4 months. By then, new bone
has filled in the space at the suture, and the
skeletal expansion is stable. The midline
diastema decreases and disappears with time.
If a jackscrew device attached to the teeth is
activated at the rate of one-quarter turn of the
screw (0.25 mm)/day, the ratio of dental to
skeletal expansion is about 1:1, tissue damage
and hemorrhage at the suture are minimized,
and a large midline diastema never appears.
Ten mm of expansion over a 10-week period,
at the rate of 1 mm per week is required. This
would lead to 5 mm of skeletal and dental
expansion respectively. Completion of active
expansion is followed by bone filling in the
suture spaces. The overall result of rapid vs.
slow expansion is similar, but with slower
expansion a more physiologic response is
obtained [34].
Implant-Supported Expansion (Figure 9)
Now-a-days, bone screws can be placed in the
maxilla to serve as temporary skeletal
attachments. Forces can be applied directly to
the maxilla instead of using the teeth as
anchorage to transfer force to the bone. This
provides a way to expand the maxilla even if
no teeth are present. This would avoid
unwanted tooth movement and should produce
almost total skeletal change in patients with
lingual crossbite. When a jackscrew is
attached to skeletal anchors, minimal suture
Page 30
Angle’s Class III Malocclusion
separation is seen, so slow rather than rapid
expansion is expected. A retainer is needed
even after bone fill-in is done with RPE or
slow expansion. The expansion appliance
should remain in place for 3 to 4 months, and
then should replace with a removable or fixed
retainer [34].
Fig. 9: Implant Supported Expansion.
Post-treatment Stability
It was found that, in general, the anterior
position of the maxilla was maintained after
treatment. It is interesting to note that during
this growth period the maxilla and mandible
reverted back to the original growth pattern
and, in some cases; Class III correction was
lost because of excess mandibular growth.
Treatment Approach in Adolescence and
Non-growing Patients with Class III
Malocclusion
Treatment to Camouflage the Class III
Skeletal Discrepancy
Skeletal discrepancies that cannot be corrected
during mixed dentition by growth modification
require surgical intervention. Patients treated
during childhood may have relapse when they
grow older due to additional growth.
Treatment of Class III malocclusion in
Fig. 10: Surgical Treatment of Class III.
RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved
Umale et al.
adolescence is indicated in many instances to
alleviate the potential psychosocial problems
and perhaps reduce the need for surgery.
Malocclusions with a mild mandibular
prognathism and a moderate overbite can be
corrected by dentoalveolar movements. Class
III elastics with or without extraction of teeth
have been used to camouflage the skeletal
discrepancy, resulting in an acceptable facial
profile [35, 36]
Combined Orthodontics and Orthognathic
Surgery
Patients with excess anterio-posterior, vertical
growth and bimaxillary retrusion or
prognathism combined with a divergent facial
pattern have only few nonsurgical treatment
options. These patients are outside the
"envelope of discrepancy" which was given by
Proffit and Ackerman [37]. Early surgery is a
possible alternative solution, but surgical
intervention in the maxilla in a young child
may hamper growth potential that is probably
already less [38]. Patients with true mandibular
prognathism may continue to grow for several
years beyond puberty.
Therefore, continued mandibular growth must
be assumed until two lateral cephalograms
taken at least 1 year apart demonstrate no
significant growth occurring over that period.
The current surgical methods for correcting
skeletal Class III problems include ramus
osteotomy to set back a prognathic mandible,
mandibular inferior border osteotomy to
reduce chin height or prominence and a Le
Fort I osteotomy to advance a deficient
maxilla, often segmented to allow for
transverse expansion if indicated.
Page 31
Research and Reviews: Journal of Dentistry
Volume 7, Issue 2
ISSN: 2230-8008(online), ISSN: 2348-9561 (print)
REFERENCES
1. Angle EH. Classification of malocclusion.
Dent Cosmos. 1899; 41: 248p. 17.
2. Tweed CH. Clinical orthodontics. St
Louis, Mosby. 1966; 2. 18.
3. Moyers R. Handbook of orthodontics. Edn
3, Chicago, 1997, Year-Book Medical.
4. Ainsworth NJ. The incidence of dental
disease in the children. In Medical 19.
Research Council: Reports of the
committee for the investigation of dental
disease. Special Report Series, No 7,1925.
5. Bjork A. The face in profile: an 20.
anthropological x-ray investigation of
Swedish children andconscripts, Lund:
Berlingska Boktrycheriet. 1947; 40: 58p. 21.
6. Altemus LA: Frequency of the incidence
of malocclusion in American Negro
children aged12-16, Angle Orthod. 1959;
29: 189–200p.
7. Harris JE, Kowalski CJ, Watnick SS. 22.
Genetic factors in the shape of the
craniofacial complex. Angle Orthod. 1973;
43: 109–111p. 23.
8. Kharbanda OP. Orthodontics: Diagnosis
and management of Malocclusion and
DentofacialDeformaties. 2nd Edn. Elsevier
Publisher. 547–573p. 24.
9. Graber TM. Orthodontics current
principles and techniques. 5th Edn.
10. Ellis E, McNamara JA. Components of 25.
adult Class III malocclusion, J Oral
MaxillofacialSurg. 1984; 42: 295–305p.
11. Guyer EC et al. Components of Class III
malocclusions in juveniles and 26.
adolescents. AngleOrthod. 1986; 56: 7–
30p.
12. Wu TF, Peng CJ, Lin JJ. Components of 27.
Class III malocclusion in Chinese young
adults, ClinDent (Chinese). 1986; 6: 233–
241p.
13. Bishara: Text Book of Orthodontics.
Elsevier. 2001 by Saunders. 28.
14. Latham RA. The sella point and postnatal
growth of the human cranial base. Am J
Orthod.1972; 61: 156–162p. 29.
15. Kwong WL, Lin JJ. Comparison between
pseudo and true Class III malocclusion by
Veterans'General Hospital cephalometric
analysis. Clin Dent.1987; 7(2): 69–78p.
16. Dietrich UC. Morphological variability of
skeletal Class III relationships as revealed
RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved
bycephalometric analysis. Rep Cong Eur
Orthod Soc. 1970; 131–143p.
Enlow DH. Handbook official growth.
Edn 2, Philadelphia, 1982, WB Saunders.
Aki T et al. Assessment of symphysis
morphology as a predictor of the direction
of mandibular growth, Am J Orthod
Dentofacial Orthop. 1994; 106(60): 69p.
Schulof RJ, Nakamura S, Williamson WV.
Prediction of abnormal growth in Class
IIIMalocclusions. Am J Orthod. 1977; 71:
421–430p.
Joondeph DR. Early orthodontic
treatment. Am J Orthod. 1993; 104: 199–
200p.
Croll TP, Riesenberger RE. Anterior
crossbite correction in the primary
dentition using fixed inclined planes 1.
Technique and examples. Quintessence
Int. 1987; 18: 847–853p.
Croll TP: Correction of anterior tooth
crossbite with bonded resin composite
slopes,Quintessence Int. 1996; 27: 7–10p.
Frankel R: Maxillary retrusion in Class II
and treatment with the functional corrector
III,Trans Eur Orthod Soc. 1970; 46: 249–
259p.
Uner O, Yuksel S, Ucuncu N. Long-term
evaluation after chin cup treatment. Eur J
Orthod.1995; 17: 135–141p.
Sugawara J et al. Long-term effects of
chin cup therapy on skeletal profile in
mandibularPrognathism. Am J Orthod
Dentofacial Orthop. 1990; 98: 127–133p.
Deguchi T, Kitsugi A. Stability of changes
associated with chin cup treatment.
AngleOrthod. 1996; 66: 139–146p.
Ishii H et al. Treatment effect of combined
maxillary protraction and chin cap
appliance in severe skeletal Class III cases.
Am J Orthod Dentofacial Orthop. 1987;
92: 304–312p.
Oppenheim A. A possibility for
physiologic orthodontic movement. Am J
Orthod Oral Surg.1944; 30: 277–328p.
Delaire VJ, Verdon P, Floor J. Ziele and
ergebnisse extraoraler Zuge in postero-
anterior Richtung in anwendung einer
orthopadischen Maske bei der Behandlung
von Fallen derKlasse III. Fortschr Kiefer
Orthop. 1976; 37: 246–262p.
Page 32
 Angle’s Class III Malocclusion
30. Petit H. Adaptations following accelerated
facial mask therapy in clinical alteration of
the growing face. In McNamara JA Jr,
Ribbens KA, Howe RP (Eds): Monograph
14, Craniofacial Growth Series. Center for
Human Growth and Development, Ann
Arbor, Mich, 1983, Universityof
Michigan.
31. McNamara JA Jr. An orthopedic approach
to the treatment of Class III malocclusion
ingrowing children. J Clin Orthod. 1987;
21: 598–608p.
32. Turley P. Orthopedic correction of Class
III malocclusion with palatal expansion
and customprotraction headgear. J Clin
Orthod.1988; 22: 314–325p.
33. Proffit W. Fields H. Contemporary
Orthodontics, 3rd Edn. St. Louis. Mosby
2000.
34. Graber LW. Psycho-social implications of
dentofacial appearance, Unpublished
Thesis, Ann Arbor, Mich, 1880,
University of Michigan.
35. Proffit WR, White RP. Surgical
orthodontic treatment, St Louis Mosby.
1991; 19–22p.
RRJoD (2016) 24-33 © STM Journals 2016. All Rights Reserved
View publication stats
Umale et al.
36. Graber TM, Vanarsdall RL. Current
orthodontic concepts and techniques, 3rd
Edn,St.Louis, Mosby, 2000.
37. McNamara JA Jr, Carlson DS, Ribbens
KA (Eds). The effect of surgical
intervention on craniofacial growth,
Monograph 12, Craniofacial Growth
Series, Center for Human Growthand
Development, Ann Arbor, Mich, 1982,
University of Michigan. 414 Section IV.
Treatment and Treatment Considerations
38. Sinclair PM, Proffit WR. Class III
problems: mandibular excess /maxillary
deficiency. In Proffit WR, White RP.
Surgical Orthodontic Treatment. St Louis,
Mosby.
Cite this Article
Vinay Umale, Rohit Kulshrestha, Ragni
Tandon. Class III Malocclusion and its
Management: An Overview. Research
and Reviews: Journal of Dentistry.
2016; 7(2): 24–33p.
Page 33