ORTHODONTICS: Severe Skeletal Class III Correction with Class III Elastics and Bite Turbos

This 25 years old patient came for treatment to correct his prominent chin. Intraoral examination revealed: three missing teeth, anterior and posterior crossbite, Class III molar relationship, and discrepancy between CO and CR position. The profile was good at CR position. A smaller SNA and a larger SNB resulted in severe skeletal Class III. 

The Discrepancy Index was scored at 42 points, indicating a difficult Class III malocclusion. The patient rejected the treatment plan to open up the edentulous space in the maxilla, substitute the missing teeth with two implants and use two buccal shelf mini screws to retract the mandibular dentition due to costs. An alternative treatment plan was devised to extract the lower first premolars, and use bite turbos and Class III elastics to correct anterior crossbite. Further retraction of the mandibular dentition by two buccal shelf miniscrews was planned if necessary. 

After 30 months of treatment his profile was significantly improved. The 3 key factors to the successful camouflage Class III treatment are, first, a positive prognosis indicated by Lin’s 3-Ring diagnosis; second, carefully monitored torque control of lower incisors to ensure bodily tooth movement; third, closing large space with simultaneous lingual and buccal forces to prevent binding of the archwire due to a molar mesial-in rotation.