| The developing skeletal Class III malocclusion is one of the most challenging problems confronting the practicing orthodontist. Early orthopedic intervention can be effective in normalizing skeletal Class III malocclusions if patients are treated in a timely manner. However, there are a significant group of patients who either do not have the opportunity to receive early treatment or are corrected during childhood and relapse during the adolescent growth spurt. In addition, there are a large number of skeletal Class III patients that either decline or cannot afford surgical treatment. The only alternative is orthodontic camouflage through comprehensive treatment with fixed appliances.;The purpose of this study was to determine the success of camouflage treatment by evaluating the type of tooth movements that are used by orthodontists to camouflage skeletal Class III malocclusions, the extent of tooth movement that can occur without jeopardizing the periodontium, the soft tissue effects of camouflage treatment, and the range of skeletal malocclusion that can be camouflaged by orthodontic tooth movement. Records from 34 Caucasian patients between the ages of 9 and 18 who have completed comprehensive orthodontic treatment were used and matched by age, sex, and craniofacial morphology to a group of control samples taken from the Bolton-Brush Study in Cleveland, Ohio. Cephalometric and soft tissue changes that occurred during camouflage treatment were evaluated on the lateral cephalometric radiographs using a combination of landmarks obtained from various traditional cephalometric analyses. Superimpositions were made on the Sella-nasion line and the anterior cranial base structures. In addition, analysis of the periodontium was performed using lateral head films and study casts to evaluate the changes that occurred as a result of the camouflage treatment compared to the untreated dentitions. Data were analyzed using matched t-tests and repeated measures analysis.;Due to the mechanics of Class III camouflage treatment the following occurred: (1) The molars extruded tipping the mandibular plane down and back, which made the Wits value more positive. (2) This, in turn, increased the LFH, improving the skeletal relationship and the facial profile. (3) The maxillary incisors proclined and the molar relationship improved by rotating the occlusal plane counterclockwise.;Growth alone resulted in the following changes: (1) The maxillary incisors proclined twice as much as the treated group while the lower incisors displayed more retroclination than the treated sample trying to compensate for the skeletal discrepancy. (2) The mandibular plane angle decreased, which decreased the WITS giving it a more negative value. (3) The occlusal plane angle rotated clockwise worsening the molar relationship and the soft tissue profile became more concave appearance.;Overall, there were significant skeletal and dental changes in both the control and treatment groups; however, the two groups were slightly different. The maxillary and mandibular bases displayed movement in the downward and forward direction in both the control and treated samples. There was a wide range of variability between the amount of individual changes that took place.;The periodontal tissues showed slight loss of attachment in both the treated and control samples. The greatest amount of tissue loss in the treated group was 0.67mm and the greatest loss in the control group was 0.47mm. Therefore, it is safe to conclude that camouflage treatment can be successfully performed without deliterious effects on the periodontium. Also a large range of lower incisor movement is possible without causing significant loss of attachment.;As clinicians, we can utilize the information obtained from this study to choose a suitable treatment plan for camouflaging Class III skeletal malocclusions and also identify whether our skeletal Class III patient can be successfully camouflaged without compromising the periodontium. |
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