Class III Malocclusion — ORE Part 1 MCQ

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HardOrthodonticsClass III MalocclusionORE Part 1

A 13-year-old girl has a skeletal Class III malocclusion with anterior crossbite. Cephalometric assessment shows maxillary retrusion rather than isolated mandibular excess. She is pre-pubertal and has substantial remaining growth. What is the most appropriate management?

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Correct answer: D — Provide maxillary protraction facemask therapy

The correct answer is D. In a growing patient with skeletal Class III due to maxillary retrusion, a protraction facemask is the appropriate interceptive growth-modification approach. The key discriminators are demonstrated maxillary deficiency and remaining pre-pubertal growth; fixed appliances alone cannot correct the skeletal discrepancy. A UK multicentre randomised trial found that early facemask treatment reduced later assessed need for orthognathic surgery compared with observation. A functional appliance is not an established means of predictably restraining mandibular growth and is not the treatment of choice for maxillary retrusion. Observation may be appropriate for a predominantly mandibular Class III pattern, but is less appropriate here. Premolar extraction is a camouflage strategy, not first-line interceptive management of this skeletal discrepancy.

Reference: Mandall N, et al. Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial. Journal of Orthodontics, 2016. https://pubmed.ncbi.nlm.nih.gov/27564126/