2. Class
III
Historically –
mandibular
overdevelopment
Combination
Recently
Maxillary
Retrusion (60%)
Ant./Post.
Crossbite
Ellis E, McNamara JA. Components of adult Class III malocclusion. J Oral Maxillofac Surg 1984.
Guyer EC, Ellis EE, McNamara JA, Behrents RG. Components of Class III malocclusions in juveniles and adolescents.
Angle Orthod 1986.
ETIOLOGY OF
CLASS III
MALOCCLUSION

3. 3.5% US
14%
Chinese
and
Japanese
INCIDENCE
3.4%
Indian
Ast DB, Carlos JP, Cons NC. The prevalence and characteristics of malocclusion among senior highschool students in
upstate New York. Am J Orthod 1965.
Irie M, Nakamura S. Orthopedic approach to severe skeletal Class III malocclusion. Am J Orthod 1975.
Kharbanda OP, Siddhu SS, Sundarum KR, Shukla DK. Prevalence of malocclusion and its trait in Delhi children. J Indian
Orthod. Soc 1995.
INCIDENCE

4. Orthodontic
Camouflage
Orthognathic
surgery
Distraction
osteogenesis
Growth
Modification
Tindlund RS. Orthopaedic protraction of the midface in the deciduous dentition. J Craniomaxillofac Surg 1989.
TREATMENT
OPTIONS

5. Current Tx
protocol for
orthopedic
Maxillary
Protraction is by
means of elastic
Facemask
Chin Cup
Expansion
Turley, P.K.: Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction
headgear, J. Clin. Orthod. 1988.
Hideo, M.: Early application of chincup therapy to skeletal Class III malocclusion, Am. J. Orthod. 2002.
Sakamoto M, Sugawara J, Umemori M, et al. Craniofacial growth of mandibular prognathism during pubertal
growth period in Japanese boys – Longitudinal study rom 10 to 15 years of age. J Jpn Orthod Soc 1996

6. Physical
appearance
of the extra-
oral
appliance
Skin irritation
from the
anchorage
pad
POOR
COMPLIANCE
of child to wear
it, major problem
associated with
facemask therapy
Sung, S.J. and Baik, H.S.: Assessment of skeletal and dental changes by maxillary protraction, Am. J. Orthod. 1998.
PROBLEMS IN CONVENTIONAL THERAPY

7. NEED OF NEW APPLIANCE
Hence there was a need of another appliance to enhance
the patient compliance with much better biomechanics
Present paper discussed the construction and clinical
procedure of an intraoral fixed appliance for the
treatment of Class III malocclusion in young patients
without relying on patient co-operation

8. Fixed Maxillary Appliance with soldered buccal arm on
first molar band for Class Traction
Fixed Mandibular Appliance with welded buccal tube
on first molar band to headgear facebow
A 0.045 inch headgear face bow with the outer bows
bent out for Class III elastic attachment with a soldered
stop at terminal end on inner bow
Components of
Modified Fixed Nanobite Tandem Appliance (MFNTA)

9. FIXED MAXILLARY APPLIANCE
Sean Shih-Yao Liu, Hee-Moon Kyung and Peter H. Buschang.
Continuous forces are more effective than intermittent forces in
expanding sutures. Eur J Orthod 2010.

10. FIXED MANDIBULAR APPLIANCE
 Veerendra Prasad, Vijay P. Sharma, Pradeep
Tandon, Gyan P. Singh. A new fixed biteplane. J
of Clinical Orthod 2008.

11. Modified Fixed Nanobite Tandem
Appliance (MFNTA)

12. Mechanism of action of MFNTA
Schematic representation of a line of
force through the center of resistance
(CR) of maxilla, which will result in a
translatory movement of maxilla. In
the long vertical dimension of Class III
patients, it is advisable to adjust the
line of force ≤20° to the occlusal
plane (OP) to prevent downward
rotation of mandible.

13. Mechanism of action of MFNTA
Schematic representation of a line of
force for Class III with flat mandibular
plane; it is advisable to adjust the line
of force ≥25° to the occlusal plane
(OP) which will result in downward
and forward movement (clockwise) of
midface and dentition resulting in
downward and backward rotation of
mandible.

14. A CLINICAL REPORT OF PEDIATRIC PATIENT WITH CLASS III MALOCCLUSION TREATED
BY MFNTA
Pretreatment patient photographs
 She and her
parents were
psychologically
depressed with
her facial
appearance and
reverse bite

15. Patient photographs with appliance

16. Post treatment Patient photographs
Posttreatment
facial photographs
of the patient
showed marked
improvement in
facial esthetics and
correction of reverse
bite

17. Pre and post treatment study model

18. GTRV= 0.60
(If GTRV is between .33 to .88 then Class III
malocclusion can be treated nonsurgical)
Early Timely Treatment of Class III Malocclusion: Semin Orthod 11:140–145 © 2005 Elsevier Inc.

19. CONCLUSION
Pre and post
treatment record
revealed-
significant skeletal
improvement,
and marked
improvement in
facial balance

20. Address for
correspondence
Dr. Prabhat K C,
Assistant Professor,
Department of Orthodontics,
Dr. Z A Dental College,
Aligarh Muslim University,
Aligarh, India -202001.
Email ID-
dr.prabhatkc@gmail.com
Modified Fixed
Nanobite Tandem
Appliance (MFNTA)