Early treatment of dento-skeletal class III malocclusion: rationale and long- term stability

Background: Dento-skeletal Class III malocclusions are characterized by maxillary deficiency, mandibular prognathism, or a combination of both. Their prevalence varies among populations, and their multifactorial etiology involves both genetic and environmental factors. Early treatment is essential to optimize maxillary growth, modify mandibular growth direction, improve quality of life, and reduce the psychosocial impact on affected children. Objective: This paper presents the rationale, clinical management, and long-term stability of splints, Class III elastics, and chincup (SEC III) and Modified SEC III protocols in the early treatment of Class III malocclusions. Methods: The SEC III protocol combines two occlusal splints, Class III elastics, and a chin cup to achieve sagittal correction while controlling vertical dimensions and preventing clockwise mandibular rotation. The Modified SEC III protocol, designed for hyperdivergent patients, additionally incorporates anterior elastics to enhance vertical control and, when needed, an expansion screw in the upper splint to correct posterior crossbite. Results: Both protocols have demonstrated effective dento-skeletal sagittal correction and significant improvements in facial aesthetics and quality of life. Long-term follow-up confirmed high stability rates for the SEC III protocol at the end of growth, with only minor relapse, mainly in hyperdivergent patients. The Modified SEC III protocol ensures better vertical control, thereby reducing the risk of relapse in hyperdivergent and other challenging cases. Conclusions: The SEC III and Modified SEC III protocols offer an effective, stable, and patient-friendly approach to the management of dento-skeletal Class III malocclusion in growing children. By achieving sagittal dento-skeletal correction, controlling vertical dimension, and enhancing long-term stability, these protocols improve facial harmony, reduce psychological burden, and may decrease the need for surgical intervention after growth completion.