TX Planning Session – An Adult Class III, and Why Staging Made The Case
Some cases look straightforward until you bond them up and start closing space. This one, an early 40’s female with a compensated Class III, an anterior crossbite on the upper laterals, crowding, and a dolichofacial pattern, is exactly that trap. Go in the conventional way, and the lower anteriors come forward; you lose your anchorage, and by the end you’re short of space and fighting the case.
In this session Geoff talks through how he approached it: offering the ideal plan first (orthodontic surgery, which the patient declined), the extraction debate the room had, four premolars versus one or two lower incisors, and the staging call that carried the result. No lower brackets to start, an open coil spring and power chain to retract the lower teeth, make the space, then align. The case ran longer than it should have, and with hindsight a single lower incisor extraction would have made that lower arch far simpler.
What Geoff covers:
- Reading the profile, compensated Class III, dolichofacial, and where the midlines actually sit
- Why “just bond it and close” backfires on this pattern
- The extraction debate: four premolars vs lower incisors, and the buccal relationship trade-off
- Staging without lower brackets: open coil spring and power chain mechanics
- Managing the severely rotated lower lateral
- Why you offer the ideal (surgical) plan even when the patient says no
- His hindsight: what he’d do differently next time
Grab half an hour and watch it through. As always, I would be very interested to know how you would plan this patient if they presented to your practice, and I look forward to hearing your thoughts. This one rewards thinking outside the box; I’m curious whether you’d land somewhere different from us.
