Question

I have some questions for timing for class III cases and use of headgear- I would love some input. I have two cases and I just want to hear should we start now- first one, i told parents to wait 3 months to help teeth come in a little more

Answer

In cases where a young patient presents with class 3 malocclusion, the timing for treatment depends on a few factors. Ideally, treatment starts after the lateral incisors have erupted, but if trauma to the bite is evident, I would start sooner. Class 3 elastics can be highly effective, especially in growing patients. If the patient is biting edge-to-edge and has a functional shift, this case becomes easier to manage with class 3 elastics from the lower primary canines to the sixes.

Given their age, those canines will remain in place for a while, so we can bond buttons to them and use elastics. While there may be more time required if the lateral incisors erupt in poor positions, the chipping and wear on the teeth suggest starting sooner is preferable. The goal is to achieve proper overjet early on, continuing class 3 elastics at night.

Proper arch development is also essential, and whether that requires an Invisalign Palatal Expander or Hyrex Expander depends on the occlusal situation, which isn't fully clear without photos. Arch expansion could potentially be managed with aligners or may need additional intervention. Monitoring the eruption of adult canines via x-rays is crucial. Overall, using aligners with significant class 3 elastics yields successful outcomes in cases like this.