Skeletal Class III Malocclusion with Lateral Open Bite and Facial Asymmetry Treated with Asymmetric Lower Molar Extraction and Lingual Appliance: A Case Report

Abstract

A skeletal Class III malocclusion with open bite tendency is considered very difficult to treat orthodontically without surgery. This case report describes the lingual orthodontic treatment of an adult skeletal Class III patient with mandibular deviation to the left side, lateral open bite, unilateral posterior crossbite, zero overbite and negative overjet. The lower incisors were already retroclined to compensate with the skeletal discrepancy. The patient was treated by asymmetric molar extraction in the mandibular arch to retract the lower incisors and correct the dental midline, with the help of intermaxillary elastics. Lingual appliance was used with over-torqued lower anterior teeth's brackets to control the torque of mandibular incisors. After a 30-month treatment, satisfactory smile and facial esthetics and good occlusion was achieved. A 12-month follow-up confirmed that the outcome was stable. Asymmetric molar extraction could be a viable option to retract mandibular incisors in Class III malocclusion with lower dental midline deviation.

Keywords: lateral open bite; lingual orthodontics; mandibular lateral deviation; molar extraction; skeletal class III malocclusion.

Figure 1

Pretreatment photographs.

Figure 2

Pretreatment models.

Figure 3

Pretreatment radiographs and tracing.

Figure 4

Space closure with labial and lingual elastic chains in the lower arch.

Figure 5

15-month treatment follow-up photographs.

Figure 6

Applying intermaxillary elastics to correct transverse and sagittal discrepancies.

Figure 7

26-month treatment follow-up photographs.

Figure 8

Posttreatment photographs.

Figure 9

Posttreatment models.

Figure 10

Post treatment radiographs and tracing.

Figure 11

Overall and regional cephalometric superimpositions: blue, pretreatment; red, posttreatment.

Figure 12

One-year retention photographs.