MANAGEMENT OF BRITISH STANDARDS INSTITUTE (BSI) CLASS III MALOCCLUSION WITH SINGLE ANTERIOR CROSSBITE, SEVERE CROWDING, AND MIDLINE SHIFTS

Abstract

BACKGROUND: This case report details the orthodontic management of a 12-year-old male presenting with severe dental crowding and esthetic concerns. Clinical and radiographic evaluation revealed a British Standards Institute (BSI) Class III malocclusion complicated by a single anterior crossbite, an ectopic eruption of the maxillary left canine, and midline deviations, all on a Skeletal Class III base pattern. The case is noteworthy due to the simultaneous presentation of multiple complex malocclusion traits in a growing adolescent, necessitating a comprehensive management approach, and contributes to the growing body of literature by supporting individualized and extractionbased protocols in early adolescent patients with complex occlusal disharmonies.
CASE DESCRIPTION: Acomprehensive orthodontic treatment plan was formulated, which included the extraction of all first premolars to create space for alignment, correction of midline discrepancies, and incorporation of ectopic teeth. Space closure and arch coordination were facilitated using fixed appliances with supplementary anchorage devices such as a transpalatal arch and a lingual holding arch. Following 21 months of active treatment, a functional and esthetically satisfactory occlusion was achieved. The post-treatment assessment demonstrated a significant improvement in incisor, canine, and molar relationships, as well as the resolution of midline discrepancies and the alignment of previously ectopic and rotated teeth. Space closure and arch coordination were facilitated using fixed appliances with supplementary anchorage devices such as a transpalatal arch and a lingual holding arch. The Peer Assessment Rating (PAR) score improved from 46 to 7, indicating substantial therapeutic success.
CONCLUSION: This case underscores the efficacy of an extraction-based protocol combined with anchorage reinforcement in managing severe dental crowding with Class III skeletal and dental discrepancies. Timely intervention, individualized biomechanics, and patient compliance contributed to favorable treatment outcomes.