Interception of Skeletal Class 3 Malocclusion …… U. B. Rajasekaran, et al.

Interception of Skeletal Class 3 Malocclusion

with Frankle 3 Appliance in Late Mixed Dentition
A Case Report
U. B. Rajasekaran,* Khalled Abdulla,**

Abstract:
Class III malocclusion can be classified as dentoalveolar, skeletal or functional, which will determine
the prognosis. The aim of this article was to describe and discuss a clinical case with skeletal Class III
malocclusion treated with frankle 3 appliance and fixed mechanotherapy and followed up for two
years.

Introduction:
Skeletal class III malocclusion is a growth Following the confirmation of a Class III
related problem either could be due to malocclusion through the cephalometric
retrognathic maxilla or prognathic mandible or analysis, clinical differential diagnosis was
a combination of both.1 The optimal treatment accomplished by verifying the occlusion
time for skeletal class III due to retrognathic pattern at either the intercuspal position (IP) or
maxilla and normal mandible is early mixed at the centric relation (CR). The patient
dentition as anterior crossbite due to showed no functional shifting of the mandible.
retrognathic maxilla will further restrict the This clinical and cephalometric findings
maxillary growth.2,3 There are various confirmed a skeletal Class III malocclusion
appliances in peadodontic and orthodontic due to the maxillary retrognathism.
literature described for treating skeletal class
III malocclusion.3-6 In our case we opted for The patient was at a late mixed dentition stage,
frankle 3 in place of all other appliances with almost 40 percent of growth left as
because patient demanded a removable confirmed from hand and wrist radiographs, so
intraoral appliance. the main goal of the treatment was to correct
the anterior crossbite, and allowing the maxilla
Case Report: to be in a forward position in relation to the
A 11 years and 10 months old male patient in mandible, thus affording a normal
the mixed dentition stage (second transitional development.
period) was referred for treatment with a chief
complaint of an anterior crossbite. During the The proposed treatment protocol comprised the
clinical interview, the presence of this interception of maxillary retrognathism with
malocclusion in other family members was frankle 3 and settling the occlusion with fixed
reported. Facial evaluation showed lack of mechanotherapy and observe the patient for
development of the middle third. Intraoral the relapse of the class III tendency.
examination revealed a with a mesial molar The patient was on frankle 3 (figure
relationship, and a crossbite of the four 2)treatment for 8 months wearing the
permanent incisors. Pre treatment photographs appliance part time (only in the evenings) for
and radiographs are shown in figure 1. first 2 months and full time wear for 6
A panoramic radiograph revealed the presence months,the anterior cross bite got corrected
of all permanent teeth either erupted or in and immediately after the crossbite correction
several developing stages. Careful evaluation the fixed mechanotheraphy with straight wire
of lateral cephalograms confirmed a Class III was started and debonded after 6 months after
malocclusion, with an obtuse nasolabial angle, settling the occlusion. The patient was
and a horizontal growth pattern. followed for 2 years period after debonding.
Post treatment photographs figure 3.

*) Lecturer in Orthodontics, Sebha University, Sebha – Libya.

**) Head Department of Orthodontics, Department of Orthodontics, Sebha University, Sebha – Libya.

75 Sebha Medical Journal, Vol. 10(2), 2012.

 Interception of Skeletal Class 3 Malocclusion …… U. B. Rajasekaran, et al.

Discussion: thereby, providing an environment which

In this case, Class III was intercepted with maximizes skeletal growth. Four main types of
frankle III, and a fixed appliance was installed functional regulators have been described by
only to correct small rotations, the anterior Frankel. They are the FR I, II, III and IV. One
diastema, and to improve axial teeth of these appliances, the FR-III is used in the
relationships. After the cephalometric analysis treatment of skeletal Class III malocclusion.
(Table 1), it was verified that the SNA angle This appliance is used during early mixed
was increased, while the SNB angle and dentition stage to correct skeletal Class III
mandibular plane angle were unaltered during malocclusion, characterized by maxillary
the interceptive phase. This suggests that the skeletal retrusion and no mandibular
treatment using frankle III therapy was very prognathism. The correct fabrication of FR-III
effective. The measurements representing the is required. In order to do it, one must pay
vertical position of the mandible, FMA, and attention to the following points: mixing the
[Link] were stable. The linear and angular alginate impression material in a thick
measurements of the upper and lower incisors consistency, optimum vestibular depth, oblique
where maintained at pretreatment levels. The mounting of casts in the vertiiculator,
anterior crossbite corrected possibly due to the minimum incisal vertical height of
positive growth effect of the retrognathic construction bite, sufficient working model
maxilla. trimming, rectangular wax relief of the
Fixed orthodontic treatment was initiated occlusal margin area in the working cast and a
immediately after the use of frankle 3 therapy. palatal bow of 1.2 mm heavy wire. 8,9
Table 1 shows the cephalometric values at the According to previous studies10-12 they
initial, and 2-year post-corrective follow-up. It suggested the frankle 3 corrects the maxillary
was observed that the ANB angle improved retrognathism by relative downward rotation of
and maintained till 2 year follow up due to the the mandible and by proclination of the upper
stability of both SNA and SNB angles, as well and retroclination of lower incisors but in our
as those for FMA and [Link]. The given case the none of these changes can be
measurements were related to incisor demonstrated and the anterior crossbite is
inclinations remained stable at the 2-year corrected due to the growth of the maxillary
follow-up, contributing for the maintenance of skeletal base. This variation in findings can be
the positive overjet. attributed variations in frabrication of frankle 3
The cephalometric analysis of the case under appliance and proper selection of cases.
study was demonstrated an increase of the Conclusion:
ANB angle, and mandibular plane stability. This study demonstrated the achievement of
The ANB was altered to a favorable value in optimal results, and the stability of the
the relationship of the jaws due to the correction of a functional Class III
treatment. The functional Regulator was malocclusion treated with a frankle 3 and
developed by Rolf Frankel of Zwickau, followed by corrective orthodontics. In spite of
Germany in 1966.7 The Frankel appliance is the good outcomes achieved in this case,
used to effect changes in sagittal, transverse, further long-term clinical investigations are
and vertical jaw relationships and remove the necessary to assure the stability of Class III
abnormal muscle forces in the labial and treatment.
buccal areas that restrict skeletal growth,
TABLE 1:
ANGLES PRE TREATMENT POST TREATMENT
1 SNA 74 79
2 SNB 80 81
3 ANB -6 -2
4 Go Gn to SN 32 32
5 Occl. Pl to SN 14 14
6 U1 to N-A(mm) 10 7
7 U1 to N-A (Angle) 30 30
8 L1 to N-B (mm) 4mm 4
9 L1 to N-b (Angle) 22 22
10 Int. Inc. Angle 128 129

76 Sebha Medical Journal, Vol. 10(2), 2012.

 Interception of Skeletal Class 3 Malocclusion …… U. B. Rajasekaran, et al.

Fig. 1a frontal. Fig. 1b left profile. Fig. 1c right profile.

Fig. 1d right intra oral. Fig. 1e left intra profile.

Fig. 1f opg.

Fig. 1g lateral cephalogram.

Fig. 1h hand and wrist radiograph.

Fig. 1. Pretreatment photos.

77 Sebha Medical Journal, Vol. 10(2), 2012.

 Interception of Skeletal Class 3 Malocclusion …… U. B. Rajasekaran, et al.

fig. 2a. front view. fig. 2b. top view.

Fig. 2. Frankle 3 appliance.

3c

3a

3d

3b
fig. 3a and 3b. end of frankle 3c
treatment frontal and profile.
fig. 3c, 3d, 3e post frankle intraoral.

78 Sebha Medical Journal, Vol. 10(2), 2012.

 Interception of Skeletal Class 3 Malocclusion …… U. B. Rajasekaran, et al.

fig. 3f. straight wire appliances for settling fig. 3g. end of occlusal settlement.
the occlusion.

3h 3i
fig. 3h and 3i. follow up frontal and profile,

fig. 3j. follow up lateral cephalogram.

Fig. 3. Post treatment photos.

79 Sebha Medical Journal, Vol. 10(2), 2012.

 Interception of Skeletal Class 3 Malocclusion …… U. B. Rajasekaran, et al.

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