【Chris Chang Ortho】419. Class III Malocclusion with Anterior Crossbite

Abstract

A 24 year-old male sought consultation for his protrusive chin and crowded teeth. The diagnosis was a bilateral skeletal and dental class III relationship, anterior crowding complicated by an anterior crossbite. The Discrepancy Index was 42 points, indicating a difficult Class III malocclusion. Orthognathic surgery was proposed and declined by the patient. The 3-Ring diagnosis showed that treatment without orthognathic surgery was a viable approach. A non-surgical treatment plan was selected to correct this challenging Class III malocclusion by extracting all 1st premolars to relieve crowding, correcting anterior crossbite with bite turbos and closing extraction spaces with power chains and intermaxillary elastics. After 31 months of treatment his profile was significantly improved. The anterior crowding was relieved and the anterior cross bite was corrected. Bilateral Class I occlusions was achieved. The post treatment evaluation CRE score was 30 points and the Pink & White Esthestics score was 4 points.

摘要
一名24歲的男性前來求診，主訴為下巴太凸，牙齒亂。經過臨床檢查與分析，診斷為雙側骨性三級咬合、安格氏三級咬合、前牙擁擠與錯咬。在Discrepancy Index的得分為42分，屬於相當困難的三級咬合不正。由於患者前牙錯咬的差距達5 mm且合併骨性三級咬合，一般可以以手術有效改善。但是病人希望使用不手術的方式治療。根據3-Ring Diagnosis的分析結果，不手術是可行的方案。因此我們決定採用不手術的方式進行治療。首先拔除四顆第一小臼齒來緩解擁擠的齒弓，接著使用前牙Bite-turbo加上Class III elastics來改正前牙錯咬，最後再關閉上下拔牙空間。經過31個月的治療後，病人的側臉輪廓獲得大幅的改善，原本前凸的下巴回到了正常的位置，口內原本擁擠且錯咬的牙齒也排整齊，雙側安格氏咬合都達到穩定的一級咬合，最後在CRE得分為30分，Pink & White Esthestics的得分為4。

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