Original Articles
A comparison of shear bond strength of immediate and delayed bonding of brackets to FRC bars using various orthodontic adhesives
Farzin Heravi, Saied Mostafa Moazzami, Navid Kerayechian and Elham Nik
The effects of the Pendulum distalising appliance and cervical headgear on the dentofacial structures
Ebubekir Toy and Ayhan Enacar
Comparison of dietary intake between fixed orthodontic patients and control subjects
Alireza Sarraf Shirazi, Majid Ghayour Mobarhan, Elham Nik, Navid Kerayechian and Gordon A. Ferns
Evaluation of primary surgical outcomes in New Zealand patients with unilateral clefts of the lip and palate
Hannah C. Jack, Joseph S. Antoun and Peter V. Fowler
The effects of various surface treatments on the shear bond strengths of stainless steel brackets to artificially-aged composite restorations
Ladan Eslamian, Ali Borzabadi-Farahani, Nasim Mousavi and Amir Ghasemi
A systematic review of the association between appliance-induced labial movement of mandibular incisors and gingival recession
Tehnia Aziz and Carlos Flores-Mir
Skeletal, dental and soft tissue changes in Class III patients treated with fixed appliances and lower premolar extractions
Elham S.J. Abu Alhaija and Susan N. Al-Khateeb
Presence of cariogenic streptococci on various bracket materials detected by polymerase chain reaction
Smitha Pramod, Vignesh Kailasam, Sridevi Padmanabhan and Arun B. Chitharanjan
Effectiveness and acceptability of Essix and Begg retainers: a prospective study
Arun G. Kumar and Anchal Bansal
Case Reports
Orthodontic management of ectopic maxillary first permanent molars: a case report
Jadbinder Seehra, Lindsay Winchester, Andrew T. DiBiase and Martyn T. Cobourne
Alignment of an ectopic canine with mini-implant anchorage: a case report
Priyanka Sethi Kumar, K. Nagaraj, Ruchi Saxena and Juhi Yadav
Treatment of a Class III patient: a case report
Rahman Showkatbakhsh and Abdolreza Jamilian
Abstracts
A comparison of shear bond strength of immediate
and delayed bonding of brackets to FRC bars
using various orthodontic adhesives
Farzin Heravi,* Saied Mostafa Moazzami,† Navid Kerayechian* and Elham Nik+
Department of Orthodontics and Dental Research Center,* Department of Operative Dentistry and Dental Research Center,† Mashhad University
of Medical Sciences, Iran and Department of Pediatric Dentistry, School of Dentistry, Ahvaz University of Medical Sciences,+ Ahvaz, Iran
Background: Fibre reinforced composite bars (FRC) have applications as bonded retainers, space maintainers and anchorage/
movement units. However, the bond strength of attachments to FRC anchorage bars is unknown.
Aims: To compare the shear bond strengths of brackets bonded immediately to FRCs with different orthodontic adhesive systems
and bonded with the same adhesives after a 48-hour delay, abraded with a diamond bur and etched with phosphoric acid.
Method: One hundred and five recently extracted upper premolars were randomly assigned to seven groups (N = 15 teeth per
group). FRCs were bonded to the buccal surfaces of the teeth and stainless steel orthodontic brackets were bonded to the FRCs
with the following adhesive systems: Group 0 (Tetric Flow); Groups 1, 2 and 3 (Immediate bonding with chemically cured,
no-mix and light cured composites, respectively, the bars covered with Tetric Flow); Groups 4, 5 and 6 (Bonding to FRCs
delayed 48 hours, then bonded with chemically cured, no-mix and light cured composites, respectively, the bars covered with
Tetric Flow). The FRC bars in Groups 4, 5 and 6 were abraded with a coarse-grit diamond bur before bonding the
attachments to the bars. The shear bond strengths (SBS) were measured with a universal testing machine, and the adhesive
remaining on the teeth after debonding was scored with the Adhesive Remnant Index (ARI). Data were analysed using analysis
of variance (ANOVA), Duncan’s post-hoc and Fisher’s Exact test.
Results: There were no statistically significant SBS differences between Groups 0 (Mean SBS: 9.56 MPa), 1 (Mean SBS: 9.74
MPa), 2 (Mean SBS: 10.72 MPa) or 3 (Mean SBS: 9.54 MPa). Groups 4, 5 and 6 (Bonding delayed by 48 hours) had
SBSs of 11.79 MPa, 11.63 MPa and 13.11 MPa, respectively, and were significantly higher than the SBSs in Groups 1, 2
and 3 (Immediate bonding). There were no significant differences in ARI scores among the groups.
Conclusions: The mean SBSs in all groups fell within the clinically acceptable range (> 7 MPa). The combination of a 48-hour
delay between placement of an FRC bar and bonding an attachment, abrading the FRC with a diamond bur and etching with
phosphoric acid resulted in higher bond strengths.
(Aust Orthod J 2011; 4–9)
Received for publication: December 2009
Accepted: May 2010
Farzin Heravi: heravif@mums.ac.ir
Saied Mostafa Moazzami: MoazzamiM@mums.ac.ir
Navid Kerayechian: Kerayechiann861@mums.ac.ir
Elham Nik: nike861@mums.ac.i
The effects of the Pendulum distalising appliance
and cervical headgear on the dentofacial structures
Ebubekir Toy* and Ayhan Enacar†
Department of Orthodontics, I˙nönü University, Malatya* and the Department of Orthodontics, Hacettepe University, Ankara,† Turkey
Background: Headgears are effective in distalising maxillary molars, but success depends on patient compliance and
tolerance. Intra-oral distalising appliances are simple to construct and use and may be a better alternative for patients who are
non-compliant or cannot tolerate headgear.
Aims: To compare the Pendulum (PEN) appliance and cervical headgear (CHG) on distal movement of maxillary first molars in
patients requiring maxillary molar distalisation.
Methods: Thirty patients were randomly divided into two groups. Both groups had comparable occlusal and cephalometric
characteristics before treatment. Fifteen patients (9 girls, 6 boys) with a mean age of 11.45 ± 1.54 years (Range:
8.58–13.50 years) were treated with Pendulum appliances and 15 patients (10 girls, 5 boys) with a mean age of 11.72 ±
1.24 years (Range: 9.58–13.33 years) were treated with a Ricketts-type CHG. A pilot study of four patients estimated that the
time required to distalise the maxillary molars with the Pendulum appliance was five months. Therefore, the end of treatment
records for the CHG group were taken after 4.96 ± 0.35 months. Lateral and postero-anterior cephalometric radiographs
were taken of both groups at the start (T1) and end of distalisation/treatment (T2). Changes in cephalometric measurements in
the two groups were compared with Wilcoxon and Mann-Whitney U tests.
Results: Measurements indicated that U6-ANS distance, overjet and U1-APo distance increased, U6-PP angle and U6-PTV
distance reduced, and the molar relationship improved more in the PEN group compared with the CHG group. Statistically,
significant right molar – left molar differences were found between the two groups. Distalisation produced significant side
effects, resulting in distal tipping of the first molars and an increase in overjet, whereas the CHG reduced the overjet.
Conclusion: The Pendulum appliance was more effective than the CHG in distalising the maxillary first molars.
(Aust Orthod J 2011; 10–16)
Received for publication: October 2009
Accepted: July 2010
† Deceased
Ebubekir Toy: ebubekirtoy@hotmail.com
Comparison of dietary intake between fixed
orthodontic patients and control subjects
Alireza Sarraf Shirazi,* Majid Ghayour Mobarhan,† Elham Nik,+ Navid Kerayechian±
and Gordon A. Ferns¶
Department of Pediatric Dentistry and the Dental Research Center;* Cardiovascular Research Center and Biochemistry and Nutrition Research
Center,† Mashhad University of Medical Sciences, Mashhad, Iran; Department of Pediatric Dentistry, Ahvaz University of Medical Sciences,
Ahvaz, Iran;+ Department of Orthodontics, Mashhad University of Medical Sciences, Mashhad, Iran± and the Institute for Science and
Technology in Medicine, University of Keele, United Kingdom¶
Background: Adolescence is a period of rapid physiological and psychological development which is associated with an
increased demand in nutritional requirements. Orthodontic therapy is also commonly initiated during this phase of life and
nutritional intake may also change during treatment.
Aims: To compare the nutrient intakes of adolescents wearing fixed orthodontic appliances and a control group matched for
age and gender.
Method: A total of 180 patients aged between 15 and 17 years participated in this study (90 in the study group and 90
controls). Demographic data were collected by questionnaire and dietary intake was assessed using a 24-hour memory recall
and was analysed using Dietplan6 software (Forestfield Software Ltd, UK). Comparisons between groups were assessed by the
Independent sample t-test and the SPSS was used for statistical analysis.
Results: Orthodontic patients consumed a similar number of total calories, protein and carbohydrate (p > 0.05); however, they
had a greater intake of total fat, saturated fat, monosaturated fat, polysaturated fat, linolenic fat, linoleic fat and cholesterol and
significantly lower intake of fibre, chromium and beta-carotene (p < 0.05) compared with the Control group. The intake of
other macro- and micro-nutrients did not differ significantly between groups.
Conclusions: Adolescents receiving orthodontic treatment have an altered dietary intake that can be harmful to their health.
As adolescents are at a critical stage of development and dietary intake is of particular importance, it is recommended that
targeted nutritional guidance is provided to patients during orthodontic treatment.
(Aust Orthod J 2011; 17–22)
Received for publication: August 2010
Accepted: December 2010
Alireza Sarraf Shirazi: SarrafA@mums.ac.ir
Evaluation of primary surgical outcomes in New
Zealand patients with unilateral clefts of the lip
and palate
Hannah C. Jack,* Joseph S. Antoun* and Peter V. Fowler†
Orthodontic Department, School of Dentistry, University of Otago, Dunedin* and the Oral Health Centre, Christchurch Hospital,
Christchurch,† New Zealand
Objective: To evaluate and compare the primary surgical outcomes of complete unilateral cleft lip and palate (UCLP) patients in
two New Zealand cleft care centres.
Methods: This is a retrospective study of two providers of cleft care in New Zealand: Centre A in the North Island and Centre
B in the South Island of New Zealand. Pre-orthodontic study models were evaluated from 28 UCLP patients from Centre A with
primary surgical repairs performed between 1987–1999 and 31 UCLP patients from Centre B with primary surgical repairs
performed between 1984–2000. Dental arch relationships were measured using the Goslon Yardstick. A Goslon score of 1 is
considered to be an excellent outcome, whereas a score of 5 is a very poor treatment outcome.
Results: Intra- (Kappa: 0.84 – 0.93) and inter-examiner (Kappa: 0.63 – 0.69) reliabilities revealed good to very good agreement
between examiners using the Goslon Yardstick. The mean Goslon score for Centre A was 3.5, with no cases in Group 1,
five cases in Group 2 (17.9 per cent), nine cases in Group 3 (32.1 per cent), 11 cases in Group 4 (39.3 per cent) and three
cases in Group 5 (10.7 per cent). The mean score for Centre B was 3.1, with one case in Group 1 (3.2 per cent), nine cases
in Group 2 (29.0 per cent), eight cases in Group 3 (25.8 per cent), 11 cases in Group 4 (35.5 per cent) and two cases in
Group 5 (6.5 per cent). There were no statistically significant differences between the two centres (p > 0.05).
Conclusions: The outcome scores from the two cleft centres, based on historic records, were disappointing and higher than
expected. It is recommended that a review of primary surgical protocols be implemented to ensure outcomes comparable with
international standards. The results provide useful benchmarks for future comparisons of treatment.
(Aust Orthod J 2011; 23–27)
Received for publication: June 2010
Accepted: December 2010
Hannah C. Jack: hcajack@gmail.com
The effects of various surface treatments on the
shear bond strengths of stainless steel brackets to
artificially-aged composite restorations
Ladan Eslamian,* Ali Borzabadi-Farahani,† Nasi Mousavi+ and Amir Ghasemi$
Department of Orthodontics and Dental Research Center, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran;*
Craniofacial Orthodontics, Division of Dentistry and Orthodontics, Children’s Hospital Los Angeles, Center for Craniofacial Molecular Biology,
University of Southern California, Los Angeles, CA, USA;† Private Practice, Tehran, Iran+ and Department of Operative Dentistry and Dental
Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran$
Objective: To compare the shear bond strengths (SBS) of stainless steel brackets bonded to artificially-aged composite
restorations after different surface treatments.
Methods: Forty-five premolar teeth were restored with a nano-hybrid composite (Tetric EvoCeram), stored in deionised water for
one week and randomly divided into three equal groups: Group I, the restorations were exposed to 5 per cent hydrofluoric
acid for 60 seconds; Group II, the restorations were abraded with a micro-etcher (50 μm alumina particles); Group III, the
restorations were roughened with a coarse diamond bur. Similar premolar brackets were bonded to each restoration using the
same resin adhesive and the specimens were then cycled in deionised water between 5 °C and 55 °C (500 cycles). The
shear bond strengths were determined with a universal testing machine at a crosshead speed of 1 mm/min. The teeth and
brackets were examined under a stereomicroscope and the adhesive remnants on the teeth scored with the adhesive remnant
index (ARI).
Results: Specimens treated with the diamond bur had a significantly higher SBS (Mean: 18.45 ± 3.82 MPa) than the
group treated with hydrofluoric acid (Mean: 12.85 ± 5.20 MPa). The mean SBS difference between the air-abrasion
(Mean: 15.36 ± 4.92 MPa) and hydrofluoric acid groups was not significant. High ARI scores occurred following abrasion
with a diamond bur (100 per cent) and micro-etcher (80 per cent). In approximately two thirds of the teeth no adhesive was
left on the restoration after surface treatment with hydofluoric acid.
Conclusion: Surface treatment with a diamond bur resulted in a high bond strength between stainless steel brackets and
artificially-aged composite restorations and was considered to be a safe and effective method of surface treatment. Most of the
adhesive remained on the tooth following surface treatment with either the micro-etcher or the diamond bur.
(Aust Orthod J 2011; 28–32)
Received for publication: July 2010
Accepted: December 2010
A systematic review of the association between
appliance-induced labial movement of mandibular
incisors and gingival recession
Tehnia Aziz* and Carlos Flores-Mir†
Private practice* and the Division of Orthodontics, Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta,†
Edmonton, Canada
Objective: To determine if an association exists between appliance-induced labial movement of mandibular incisors and
gingival recession.
Methods: Electronic databases were searched for studies with the terms: ‘incisor’, ‘incisor proclination’, ‘tooth movement’,
‘orthodontic tooth movement’, ‘gingival recession’ and ‘orthodontic appliance’. The original articles and abstracts that met the
initial inclusion criteria were retrieved, and their references hand searched for possible articles missed by the database
searches. Inclusion criteria included human studies that suggested a link between labial movement of lower incisors produced
by orthodontic treatment and gingival recession. Exclusion criteria included significant intrusion or extrusion of the mandibular
incisors, periodontal disease, subjects taking medication that affects gingival health and subjects with systematic diseases.
Results: Seven articles fulfilled the selection criteria. Gingival recession after labial movement of lower incisors was assessed on
dental casts, intra-oral slides, lateral cephalograms and gingival examination. The articles were analysed to determine the
impact of their treatment methodology on the outcomes.
Conclusions: No association between appliance-induced labial movement of mandibular incisors and gingival recession was
found. Factors that may lead to gingival recession after orthodontic tipping and/or translation movement were identified as a
reduced thickness of the free gingival margin, a narrow mandibular symphysis, inadequate plaque control and aggressive tooth
brushing.
(Aust Orthod J 2011; 33–39)
Submitted for publication: September 2010
Accepted: November 2010
Tehnia Aziz: tehniaaziz@yahoo.com
Skeletal, dental and soft tissue changes in Class III
patients treated with fixed appliances and lower
premolar extractions
Elham S.J. Abu Alhaija and Susan N. Al-Khateeb
Preventive Dentistry Department, Faculty of Dentistry, Jordan University of Science and Technology, Irbid, Jordan
Background: Mild Class III malocclusions can be treated by upper incisor proclination and lower incisor retroclination following
extraction of the lower first premolars.
Aims: To compare the skeletal, dental and soft tissue changes in Class III patients treated with fixed appliances, Class III traction
and lower first premolar extractions with the changes in a group of untreated Class III patients.
Methods: The Treatment group consisted of 30 Class III patients (Mean age 13.69 ± 1.48 years) who were treated by upper
and lower fixed appliances, Class III intermaxillary traction and lower first premolar extractions for 2.88 ± 1.12 years. The
Control group consisted of 20 untreated Class III patients (Mean age 13.51 ± 0.95) matched for age and gender. The T1 to
T2 changes in the treated and untreated groups were compared using a paired t-test while differences between the two groups
were compared with an independent t-test.
Results: During treatment, the upper incisors were proclined about 1 degree and the lower incisors were retroclined 8 degrees.
Small, but statistically significant changes in SNB, Wits and the overlying soft tissues accompanied the changes in incisor
inclination. At the end of treatment a positive overbite and overjet were achieved. The increase in lower facial height in the
Treatment group was comparable with the change in the Control group.
Conclusions: A range of mild to moderate Class III malocclusions can be treated by dentoalveolar compensation.
(Aust Orthod J 2010; 40–45)
Received for publication: December 2009
Accepted: March 2011
Elham S. J. Abu Alhaija: elham@just.edu.jo
Presence of cariogenic streptococci on various
bracket materials detected by polymerase
chain reaction
Smitha Pramod, Vignesh Kailasam, Sridevi Padmanabhan and Arun B. Chitharanjan
Department of Orthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Chennai, India
Objective: To determine the in vivo presence of Streptococcus mutans and Streptococcus sobrinus on different bracket materials
and to correlate the prevalence with the Visible Plaque Index (VPI) and the Gingival Bleeding Index (GBI).
Methods: Orthodontic brackets made of different materials (stainless steel, gold, ceramic, plastic) were bonded to the
upper and lower second premolars in 40 subjects receiving fixed orthodontic appliances. After 30 days, the brackets were
debonded and the presence of S. mutans and S. sobrinus on the brackets was determined using the polymerase chain reaction
(PCR) technique. The VPI and GBI were recorded and the relationship between the prevalence of the streptococci and the level
of oral hygiene was calculated.
Results: There were fewer S. mutans and S. Sobrinus over the surface of gold and stainless steel brackets compared with the
plastic and ceramic brackets. A statistically significant difference was observed in S. mutans and S. sobrinus prevalence
between the metal brackets and the aesthetic brackets. However, there were no statistically significant differences in S. mutans
and S. Sobrinus prevalence when the gold and stainless steel brackets were compared. Comparison between the plastic and
ceramic brackets revealed a similar finding. Furthermore, a significant correlation was found between the in vivo prevalence of
S. mutans and S.sobrinus and the oral hygiene indices (p < 0.05), suggesting that the oral hygiene indices could be a good
indicator of S. mutans and S. sobrinus prevalence.
Conclusions: Since microbial adhesion is greater on aesthetic brackets, good oral hygiene during treatment should be
emphasised.
(Aust Orthod J 2011; 46–51)
Received for publication: December 2009
Accepted: May 2010
Smitha Pramod: drsmithapramod@gmail.com
Effectiveness and acceptability of Essix and Begg
retainers: a prospective study
Arun G. Kumar and Anchal Bansal
Department of Orthodontics and Dentofacial Orthopedics, College of Dental Science, Davangere, Karnataka, India
Background: Retainers vary in their effectiveness in maintaining teeth in their treated positions and in their acceptability by
patients.
Aims: To compare the effectiveness and acceptability of Essix and Begg retainers.
Methods: Two hundred and twenty-four patients were randomly assigned to receive either upper and lower Essix or upper and
lower Begg retainers. Subject acceptability was evaluated with seven questions related to chewing and biting, fit, speech,
appearance, oral hygiene, comfort and maintenance recorded on a 10-point visual analogue scale. The effectiveness of the
retainers to maintain alignment was assessed on study models taken on the day after debonding (T1), after three months retention
(T2) and six months retention (T3) with the Peer Assessment Rating (PAR) and Irregularity Index (II). In addition to the upper
and lower retainers, all subjects had bonded lower lingual retainers placed at the end of active treatment.
Results: There were small, but statistically significant, deteriorations in the PAR scores in both groups at T2 and T3. The T2-T1
and T3-T1 differences between the groups were statistically significant (Begg > Essix), but the differences did not exceed 2
points. For the Irregularity Index, the T3-T1 difference was statistically significant (Begg > Essix), but clinically insignificant as the
difference was only 0.25 points. Subjects preferred the Begg retainer for chewing and biting (p = 0.000), and liked the
appearance (p = 0.000) and comfort (p = 0.05) of the Essix retainers. The subjects in both groups reported both retainers had
an acceptable fit.
Conclusions: More subjects wearing Essix retainers considered their retainers were comfortable and had an acceptable appearance
than subjects wearing Begg retainers, and more subjects with Begg retainers considered that their retainers were acceptable
for biting and chewing than the subjects wearing Essix retainers. Both retainers allowed some relapse of teeth post-treatment,
but the 6-month differences were small and may not be clinically significant.
(Aust Orthod J 2011; 52–56)
Received for publication: February 2010
Accepted: May 2010
Arun G. Kumar: orthoarun@yahoo.co.in
Orthodontic management of ectopic maxillary
first permanent molars: a case report
Jadbinder Seehra,* Lindsay Winchester,† Andrew T. DiBiase+ and Martyn T. Cobourne±
Guy’s and St Thomas NHS Foundation Trust, Department of Orthodontics and Pediatrics, London and Queen Victoria Hospital NHS
Foundation Trust, East Grinstead, West Sussex;* Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex;† East Kent
Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, Kent;+ King’s College London Dental Institute,
Department of Orthodontics and Craniofacial Development, King’s College London Dental Institute, London,± United Kingdom
Background: Ectopic position of a maxillary first permanent molar results in a local malocclusion within the mixed dentition and
occurs when the tooth erupts more mesially to its normal path of eruption. The prevalence of ectopic maxillary first
permanent molars has been reported at approximately 4 per cent. Possible treatment options include the extraction of the
primary second molar and the placement of a space maintainer, extraction of the primary second molar and later regaining
lost space during comprehensive treatment of the malocclusion or implementing interceptive treatment to disimpact the maxillary
first permanent molar and preserving arch length.
Aim: To describe the aetiology, classification and management of ectopic maxillary first permanent molars and to present two
cases of intervention using simple orthodontic appliances.
Methods: A sectional fixed appliance and orthodontic separators were used to correct the ectopic maxillary first permanent
molars.
Results: Successful disimpaction resulted in normal vertical eruption and arch length preservation.
Conclusions: Management of ectopic maxillary first molars can be successfully achieved in the mixed dentition.
(Aust Orthod J 2011; 57–62)
Received for publication: October 2010
Accepted: April 2011
Jadbinder Seehra: jad_Seehra@hotmail.com
Alignment of an ectopic canine with mini-implant
anchorage: a case report
Priyanka Sethi Kumar,* K. Nagaraj,† Ruchi Saxena+ and Juhi Yadav*
Department of Orthodontics and Dentofacial Orthopedics, Santosh Dental College and Hospital, Ghaziabad;* Department of Orthodontics and
Dentofacial Orthopedics, Institute of Dental Sciences, (Karnataka Lingayat Education) University, Belgaum;† Department of Orthodontics and
Dentofacial Orthopedics, Vydehi Institute of Dental Sciences and Research Centre, Bangalore,+ India
Aims: To describe the treatment of an ectopic maxillary left canine and Class II molar relationship in a 12 year-old girl.
Methods: A pendulum appliance was used in a first phase of treatment to distalise the maxillary molars to a Class I molar relationship.
In the second phase of treatment, a mini-implant, inserted between the roots of the left maxillary central and lateral
incisors, provided anchorage to move an ectopic maxillary left canine into position.
Results: The implant remained stable throughout treatment and a maxillary canine – first premolar transposition was corrected.
Good overjet and overbite were achieved and have been maintained one year after completion of active treatment.
(Aust Orthod J 2011: 63–68)
Received for publication: April 2010
Accepted: December 2010
Priyanka Sethi Kumar: priyankakumar@rediffmail.com
Treatment of a Class III patient: a case report
Rahman Showkatbakhsh* and Abdolreza Jamilian†
Department of Orthodontics, Shahid Beheshti University of Medical Sciences* and Dental Branch, Islamic Azad University,† Tehran, Iran
Background: The skeletal Class III malocclusion may be characterised by mandibular prognathism, maxillary deficiency or both.
Aim: To describe the early treatment of a skeletal Class III patient.
Methods: This case report presents a 10 year-old boy with a Class III malocclusion comprising a combination of maxillary
deficiency and mandibular prognathism. Two treatment plans were considered. The first was to correct maxillary deficiency at
an early age, while the second aimed to postpone treatment until after skeletal growth completion and then offer bimaxillary
surgery. The case was treated early and a tongue appliance was used for maxillary protraction.
Results: The post-treatment SNA angle showed a 5 degree increase and a positive overbite and overjet were achieved after
23 months of active treatment. However, mandibular prognathism was still evident.
Conclusion: Both treatment options have advantages and disadvantages which require informed clinical consideration.
(Aust Orthod J 2011; 69–73)
Received for publication: July 2010
Accepted: April 2011
Rahman Showkatbakhsh: Showkatbakhsh@hotmail.com