DIFFERENTIAL DIAGNOSIS (HIGH‑YIELD)
| Feature | Pseudo‑Class III | True Class III |
|---|---|---|
| Skeletal base | Class I / mild III | Skeletal III |
| Functional shift | Present | Absent |
| Profile at rest | Straight | Concave |
| Upper incisors | Retroclined | Proclined |
| Lower incisors | Normal | Retroclined |
ETIOLOGY (REMEMBER: D‑F‑S)
Dental – ectopic maxillary incisors, premature loss of deciduous molars
Functional – tongue posture, neuromuscular reflex, airway issues
Skeletal – minor transverse maxillary deficiency
WHEN TO TREAT?
- Ideal age: 6–9 years (mixed dentition)
- Early intervention often requested due to aesthetic concerns
- Some clinicians delay due to: • Behavioural issues in young children
• Risk of relapse during transitional dentition
TIMING CONTROVERSY (EXAM FAVORITE)
- Deciduous anterior crossbite may occasionally self‑correct
- Many prefer to wait till permanent maxillary incisors erupt
- White’s recommendation: intervene in mixed dentition after maxillary & mandibular incisors erupt
WHY TREAT EARLY? (MIXED DENTITION BENEFITS)
✔ Prevents unfavourable skeletal growth adaptations
✔ Reduces risk of functional posterior crossbite
✔ Prevents parafunctional habits (bruxism)
✔ Creates space for canine eruption (by correcting retroclined maxillary incisors)
✔ Prevents periodontal trauma to mandibular incisors
TREATMENT OPTIONS (CASE‑BASED)
Fixed (Minimal Compliance)
• Modified Quad Helix ± anterior arms
• Posterior bite planes / blocks
Functional (Compliance Dependent)
• Balters’ Bionator III
– Construction bite in CR
– Vertical opening: 3–4 mm
– Wear: ~14–16 hrs/day
Dentowesome 