Correction of Class III Malocclusion with Klammt's Elastic Open Activator: A Case Report­­­

Authors

DOI:

https://doi.org/10.47990/ez7w0995

Keywords:

Dentition Mixed , Malocclusion , Preventive Orthodontics, Pediatric Dentistry

Abstract

Introduction: Class III malocclusion has a multifactorial etiology, resulting from interactions among innate, genetic, and environmental factors. It is generally characterized by a concave facial profile, anterior crossbite, increased effective mandibular length, and, in combined cases, midface deficiency due to maxillary retrusion. Objective: This case report aims to review the biological basis and characteristics of Class III malocclusion in the mixed dentition, as well as its early functional orthopedic management. Case Report:An 8-year-old girl with anterior crossbite and skeletal Class III malocclusion was treated with the Klammt Class III elastic open activator, resulting in correction of the anterior crossbite and a favorable change in her facial profile. Conclusion: The Klammt Class III elastic open activator produces favorable outcomes in anterior crossbite correction, enhances facial profile and posture, and redirects maxillary and mandibular growth during the mixed dentition stage.

References

Zere, E., Chaudhari, P. K., Sharan, J., Dhingra, K., & Tiwari, N. (2018). Developing Class III malocclusions: challenges and solutions. Clinical, Cosmetic and Investigational Dentistry, 10, 99–116. DOI: 10.2147/CCIDE.S134303

Correlations between Malocclusion and Postural Anomalies in Children with Mixed Dentition. Sambataro S, Bocchieri S, Cervino G, La Bruna R, Cicciù A, Innorta M, Torrisi B, Cicciù M. J Funct Morphol Kinesiol. 2019 Jul 19;4(3):45. https://doi.org/10.3390/jfmk4030045

Association between oral habits, mouth breathing and malocclusion. Grippaudo C, Paolantonio EG, Antonini G, Saulle R, La Torre G, Deli R. Acta Otorhinolaryngol Ital. 2016 Oct;36(5):386-394. doi: 10.14639/0392-100X-770

Zhao W, Chen Y, Kyung HM, Xu JS. Effectiveness of Tongue Crib Combination Treating Severe Skeletal Angle Class III Malocclusion in Mixed Dentition. Int J Clin Pediatr Dent. 2020 Nov-Dec;13(6):668-676. doi: 10.5005/jp-journals-10005-1855.

Angle E H. Malocclusion of the teeth, 7th edition. SS White, Philadelphia.1907.

Leslie Imara de Armas Gallegos, Nurys Mercedes Batista González, Elaine Fernández Pérez Tratamiento ortopédico funcional para el Síndrome de Clase III en edades tempranas Revista Latinoamericana de Ortodoncia y Odontopediatría Año 2018.

Liu, H., Wu, C., Lin, J., Shao, J., Chen, Q., & Luo, E. (2017). Genetic etiology in nonsyndromic mandibular prognathism. The Journal of Craniofacial Surgery, 28(1), 161–169. DOI: 10.1097/SCS.0000000000003287

Sandoval C, Díaz A, Manríquez G. Relationship between craniocervical posture and skeletal class: A statistical multivariate approach for studying Class II and Class III malocclusions. Cranio [Internet]. 2021;39(2):133–40. DOI: 10.1080/08869634.2019.1603795

Kerbrat A, Schouman T, Decressain D, Rouch P, Attali V. Interaction between posture and maxillomandibular deformity: a systematic review. Int J Oral Maxillofac Surg [Internet]. 2022;51(1):104–12. https://doi.org/10.1016/j.ijom.2021.05.003

Jayaratne YSN, Zwahlen RA. The oropharyngeal airway in young adults with skeletal class II and class III deformities: A 3-D morphometric analysis.

PLoS One.2016;11(2):e0148086. DOI: 10.1371/journal.pone.0148086

Abdolreza Jamilian, Rosangela Cannavale, Maria Grazia Piancino, Sara Eslami & Letizia Perillo (2016): Calidad metodológica y resultado de las revisiones sistemáticas que informan sobre el tratamiento ortopédico para la maloclusión de clase III: Resumen de las revisiones sistemáticas, Journal of Orthodontics. http://dx.doi.org/10.20453/reh.v27i3.3202

Oltramari-Navarro, P. V. P., de Almeida, R. R., Conti, A. C. de C. F., Navarro, R. de L., de Almeida, M. R., & Fernandes, L. S. F. P. (2013). Early treatment protocol for skeletal Class III malocclusion. Brazilian Dental Journal, 24(2), 167–173. https://doi.org/10.1590/0103-6440201301588

Amat, P., & Delaire, J. (2013). Traitement précoce des malocclusions de classe III : les convictions. L’ Orthodontie francaise, 84(1), 53–70. https://doi.org/10.1051/orthodfr/2013038

Merwin, D., Ngan, P., Hagg, U., Yiu, C., & Wei, S. H. (1997). Timing for effective application of anteriorly directed orthopedic force to the maxilla. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 112(3), 292–299. https://doi.org/10.1016/S0889-5406(97)70259-2

Vadiakas G, Viazis AD. Anterior crossbite correction in the early deciduous dentition. Am J Orthod Dentofacial Orthop [Internet]. 1992;102(2):160–2. https://doi.org/10.1016/0889-5406(92)70029-A

Delaire J. Le développement “adaptatif” de la base du crâne. Justification du traitement précoce des dysmorphoses de classe III. Rev Orthop Dento Faciale 2003; 37:243–265. https://doi.org/10.1051/odf/2003019

García Garma, G., & Durán von Arx, J. (2012). Relación entre el sistema estomatognático y el cuello. Ortodoncia española, 52(2), 51–67. https://doi.org/10.1016/S0210-1637(12)70008-9

Suami González Rodríguez MSC. Maiyelin Llanes Rodríguez MSc. Nurys Mercedes Batista González MSc. Lucía Pedroso Ramos Dr. Maikel Pérez Valerino. Ene –Feb 2019. Relación entre oclusión dentaria y postura cráneocervical en niños con maloclusiones clase II y III. Relationship between dental occlusion and craniocervical posture in children with class II and III malocclusions. Rev Med Electrónica Vol 41 No 1. https://doi.org/10.1016/S0210-1637(12)70008-9

Ortodoncia. Diagnóstico y planificación clínica. 1era ed. Brasil: Artes médicas Ltda; 2002.

Yoshida S, Tohara H, Nakagawa K, Hara K, Yamaguchi K, Nakane A, et al. Relationship between jaw-opening force and neck circumference in healthy older individuals. Geriatrics and Gerontology International. 2019;19(4):330-4. https://doi.org/10.1111/ggi.13620

Proffit WR, Fields HW, Sarver DM. Ortodoncia contemporánea. 5ª ed. Madrid: Elsevier; 2013.

Gregoret J. Análisis lateral de Ricketts. En: Ortodoncia y cirugía ortognática. Diagnóstico y planificación de tratamiento. Barcelona: Publicaciones Médicas; 1997.

Torres LM, González CSC, Bioti TAM, et al. Tratamiento con Activador Abierto Elástico de Klammt en pacientes con Síndrome de Clase III. Rev Ciencias Médicas. 2020; 24(1):1-10.

Dolce, C., Mansour, D. A., McGorray, S. P., & Wheeler, T. T. (2012). Intrarater agreement about the etiology of Class II malocclusion and treatment approach. American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics, 141(1), 17–23.

https://doi.org/10.1016/j.ajodo.2011.07.015

Wolfe, S. M., Araujo, E., Behrents, R. G., & Buschang, P. H. (2011). Craniofacial growth of Class III subjects six to sixteen years of age. The Angle orthodontist, 81(2), 211–216. https://doi.org/10.2319/051010-252.1

Masucci, C., Franchi, L., Defraia, E., Mucedero, M., Cozza, P., & Baccetti, T. (2011). Stability of rapid maxillary expansion and facemask therapy: a long-term controlled study. American journal of orthodontics and dentofacial orthopedics.

https://doi.org/10.1016/j.ajodo.2010.09.031

Elkalza AR, Yacout YM. Effect of SEC III protocol on upper airway dimensions in growing class III patients: a retrospective study. BMC Oral Health. 2023 Nov 8;23(1):841. doi: 10.1186/s12903-023-03613-8. PMID: 37940933; PMCID: PMC10631026.Pérez-Rodríguez LM, Diéguez-Pérez M, Millón-Cruz A, Arcos-Palomino I. Airways cephalometric norms from a sample of Caucasian Children. J Clin Exp Dent. 2021;13(9):e941-7.

Al-Kurwi AS, Bos A, Kuitert RB. Overjet reduction in relation to wear time with the van Beek activator combined with a microsensor. Am J Orthod Dentofacial Orthop. 2017 Feb;151(2):277-283.

https://doi.org/10.1016/j.ajodo.2016.06.046

Moon YM, Ahn SJ, Chang YI. Cephalometric predictors of long-term stability in the early treatment of Class III malocclusion. Angle Orthod. 2005 Sep;75(5):747-53. DOI: 10.1043/0003-3219(2005)75[747:CPOLSI]2.0.CO;2

Liu C, Du S, Wang Z, Guo S, Cui M, Zhai Q, Zhang M, Fang B. Impact of orthodontic-induced facial morphology changes on aesthetic evaluation: a retrospective study. BMC Oral Health. 2024 Jan 5;24(1):24. doi: 10.1186/s12903-023-03776-4. PMID: 38183059; PMCID: PMC10768126.

Kan H, Sözen T, Öğretmenoğlu O, Ciğer S. Evaluation of the Effects of Orthopedic Treatment on the Dentofacial Structure and Upper Airway of Subjects with Skeletal Class III Malocclusion. Turk J Orthod. 2024 Sep 30;37(3):153-161. doi: 10.4274/TurkJOrthod.2023.2023.3. PMID: 39344809; PMCID: PMC11589176.

Published

2025-12-11

Issue

Section

Case report

How to Cite

Correction of Class III Malocclusion with Klammt’s Elastic Open Activator: A Case Report­­­. (2025). Latin American Pediatric Dentistry Journal, 15. https://doi.org/10.47990/ez7w0995