Presurgical Orthodontics in Class III Patients: Extraction versus Non-Extraction

Reza Tabrizi, Hosein Behnia, Zeinab Behroozi, Zahra Javanmardi



Introduction: Matching dental discrepancy (DD) with skeletal discrepancy (SD) in pre-surgical orthodontic preparation is crucial for obtaining a desirable surgical outcomes. The aim of the present study was to compare DD to SD in class III patients with and without extraction of the maxillary second premolars. Materials and Methods: This retrospective cohort study assessed subjects in two groups: the 1st group included individuals who were afflicted by class III skeletal and underwent non-extraction orthodontic treatment prior to the surgery; the 2nd group, included: patients who suffered from class III skeletal malocclusion and underwent tooth-extraction orthodontic treatment prior to the surgery. The Wits analysis was applied to establish the apical base relationship between the maxillary and the mandibular arches as measured along the Jacobson occlusal plane. Two angles were applied to determine the upper and lower incisors position to the skeletal base: IMPA (the lower incisor teeth to the mandibular plane) and the upper 1 to SN. The horizontal distance between the upper and lower incisors+2 mm was considered as the dental discrepancy. Results: Forty-six individuals were studied in the 1st group and 31 patients included in the 2nd group. The mean for DD was 7.39±3.40 mm in the 1st group and 9.65±2.57 mm in the 2nd group. The mean was 11.59±4.9 mm in group 1 and 8.48±2.35 mm in group 2. Pearson’s correlation did not show any significant correlation between dental discrepancy and the skeletal discrepancy in the 1st group (P˃0.05). A positive correlation was obtained between dental discrepancy and the skeletal discrepancy in the 2nd group (P˂0.001). Conclusion: It was magnificently attained that extraction of the second premolars of the maxilla could be a better match for DD and SD in the pre-surgical preparation in class III patients with an excessive SD.


Orthodontic treatment ;Class III skeletal; Skeletal discrepancy; Osteotomy

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Frapier L, Garcia C, Pic E, Morant F, Belguendouz S, Gauthier A, Raynal P.Successful orthodontic-surgical treatment: Aiming for esthetics and function. Analysis of some clinical cases.IntOrthod. 2013 30. pii: S1761-7227(13)00092-2.

Johnston C, Burden D, Kennedy D, Harradine N, Stevenson M.Class III surgical-orthodontic treatment: a cephalometric study.Am J OrthodDentofacialOrthop. 2006 ;130(3):300-9.

Stellzig-Eisenhauer A, Lux CJ, Schuster G.Treatment decision in adult patients with Class III malocclusion: orthodontic therapy or orthognathic surgery?Am J OrthodDentofacialOrthop. 2002 ;122(1):27-37.

Kim DK, Baek SH.Change in maxillary incisor inclination during surgical-orthodontic treatment of skeletal Class III malocclusion: comparison of extraction and nonextraction of the maxillary first premolars.Am J OrthodDentofacialOrthop. 2013 ;143(3):324-35.

Xu B, Qin K.[The effect of extraction and non-extraction decompensation to bimaxillaryorthognathic surgery in skeletal class III malocclusion].Hua Xi Kou Qiang Yi XueZaZhi. 2012 ;30(2):143-7.

Proffit WR, White RP, Sarver DM. Combining surgeryand orthognathics: Who does what, when? In: Proffit WR,White RP, and Sarver DM, eds. Contemporary Treatmentof Dentofacial Deformity. 1st ed. St. Louis, Missouri:Mosby, 2003:245-67.

Yu CC, Chen PH, Liou EJ, Huang CS, Chen YR.A Surgery-first approach in surgical-orthodontic treatment of mandibular prognathism--a case report.Chang Gung Med J. 2010 ;33(6):699-705.

Troy BA, Shanker S, Fields HW, Vig K, Johnston W.Comparison of incisor inclination in patients with Class III malocclusion treated with orthognathic surgery or orthodontic camouflage.Am J OrthodDentofacialOrthop. 2009 ;135(2):146.e1-9.

Aymach Z, Sugawara J, Goto S, Nagasaka H, Nanda R.Nonextraction "surgery first" treatment of a skeletal Class III patient with severe maxillary crowding.J ClinOrthod. 2013 ;47(5):297-304; quiz 327-8.

Gonzalez B.Non-extraction treatment of a Class III skeletal case.Int J Orthod Milwaukee. 2009 Summer;20(2):15-21.

Kerr WJS, Miller S, Dawber JE. Class III malocclusion: surgeryor orthodontics? Br J Orthod 1992;19:21-4.

Battagel JM. The aetiological factors in Class III malocclusion.Eur J Orthod 1993;15:347-70.

Stellzig-Eisenhauer A, Lux CJ, Schuster G.Treatment decision in adult patients with Class III malocclusion: orthodontic therapy or orthognathic surgery?Am J OrthodDentofacialOrthop. 2002 ;122(1):27-37.

Daniels C, Richmond S.The development of the index of complexity, outcome and need (ICON).J Orthod. 2000 ;27(2):149-62.

Joh B, Bayome M, Park JH, Park JU, Kim Y, Kook YA.Evaluation of minimal versus conventional presurgical orthodontics in skeletal class III patients treated with two-jaw surgery.J Oral Maxillofac Surg. 2013 ;71(10):1733-41

Aydil B, Özer N, Marşan G.imaxillary surgery in Class III malocclusion: soft and hard tissue changes.JCraniomaxillofac Surg. 2013 ;41(3):254-7.

Rustemeyer J, Martin A.Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry.Oral Maxillofac Surg. 2013 ;17(1):33-41.

Marşan G, Cura N, Emekli U. Soft and hard tissue changes after bimaxillary surgery in Turkish female class III patients. J Craniomaxillofac Surg. 2009;37:8–17.



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