Class III malocclusions aren’t just “reverse overjet cases.” They involve a combination of:
- Skeletal discrepancies (maxillary deficiency, mandibular prognathism, or both)
- Dental compensations (retroclined lower incisors, proclined upper incisors)
- Growth patterns (vertical growers complicate everything)
- Functional shifts (apparent vs true Class III)
The difficulty?
Growth often exacerbates the problem—especially mandibular growth. So the treatment plan you choose at 12 years of age can dramatically influence whether that patient avoids or needs orthognathic surgery at 18.
1. Non-Extraction Approach
👉 When to choose:
- Mild–moderate Class III
- Little or no mandibular crowding
- Early permanent dentition
- Forward functional shift present
- Patient accepts extraoral appliances
2. Extraction Approach
👉 When to choose:
- Marked lower arch crowding
- Dental compensation is needed to correct overjet
- Patient is in the late mixed/early permanent dentition
- Non-compliance expected for extraoral appliances
| Parameter | Non-Extraction + Headgear | Extraction + Fixed Appliances |
|---|---|---|
| Upper Incisors | Proclined | Usually stable / mild retroclination |
| Lower Incisors | Spontaneous retroclination | Controlled orthodontic retroclination |
| Mandible | Downward–backward rotation | Tends to grow forward |
| ANB Change | Improves | Minimal improvement |
| Profile | More convex, softer appearance | Mostly dental correction |
| Best For | Mild skeletal Class III | Crowding cases |
| Treatment Time | Shorter | Longer |
| Long-term Stability | Depends on growth control | Depends on dental compensation |
👩⚕️👨⚕️ What Exam Answers Must Include
If an examiner asks:
“How would you decide between extraction and non-extraction in Class III?”
Your ideal answer should include:
- Crowding analysis (most important)
- Growth pattern & age
- Severity of skeletal discrepancy
- Incisor inclination (U1-SN, L1-MP)
- Soft tissue profile
- Compliance for extraoral appliances
- Future orthognathic surgery considerations
🧩 Clinical Case Tip for PG Examination
- A skeletal Class III child with minimal lower crowding, reverse overjet, and acceptable profile → Non-extraction + headgear
- A Class III adolescent with >5 mm crowding, upright upper incisors, and camouflaging need → Extraction-based camouflage
Remember
Class III = growth-driven problem.
Your treatment choice must consider future mandibular growth and potential need for surgery.
Dentowesome 