Class III correction using an inter-arch spring-loaded module
Robert Vanlaecken, Michael O Williams, Thomas Razmus, Erdogan Gunel, Chris Martin and Peter Ngan
Background: A retrospective study was conducted to determine the cephalometric changes in a group of Class III patients treated with the inter-arch spring-loaded module (CS2000®, Dynaflex, St. Ann, MO, USA). Methods: Thirty Caucasian patients (15 males, 15 females) with an average pre-treatment age of 9.6 years were treated consecutively with this appliance and compared with a control group of subjects from the Bolton-Brush Study who were matched in age, gender, and craniofacial morphology to the treatment group. Lateral cephalograms were taken before treatment and after removal of the CS2000® appliance. The treatment effects of the CS2000® appliance were calculated by subtracting the changes due to growth (control group) from the treatment changes. Results: All patients were improved to a Class I dental arch relationship with a positive overjet. Significant sagittal, vertical, and angular changes were found between the pre- and post-treatment radiographs. With an average treatment time of 1.3 years, the maxillary base moved forward by 0.8 mm, while the mandibular base moved backward by 2.8 mm together with improvements in the ANB and Wits measurements. The maxillary incisor moved forward by 1.3 mm and the mandibular incisor moved forward by 1.0 mm. The maxillary molar moved forward by 1.0 mm while the mandibular molar moved backward by 0.6 mm. The average overjet correction was 3.9 mm and 92% of the correction was due to skeletal contribution and 8% was due to dental contribution. The average molar correction was 5.2 mm and 69% of the correction was due to skeletal contribution and 31% was due to dental contribution. Conclusions: Mild to moderate Class III malocclusion can be corrected using the inter-arch spring-loaded appliance with minimal patient compliance. The overjet correction was contributed by forward movement of the maxilla, backward and downward movement of the mandible, and proclination of the maxillary incisors. The molar relationship was corrected by mesialization of the maxillary molars, distalization of the mandibular molars together with a rotation of the occlusal plane.