See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/349967102

Alternative treatment strategies for pseudo-Class III malocclusion with mild

asymmetry

Article  in  Praktische Kieferorthopädie · March 2021

CITATIONS

7 authors, including:

Adith Venugopal S. Jay Bowman

University of Puthisastra Saint Louis University
37 PUBLICATIONS   39 CITATIONS    83 PUBLICATIONS   1,281 CITATIONS   

SEE PROFILE SEE PROFILE

Anand Marya Anuraj Kochhar

University of Puthisastra Max Healthcare
26 PUBLICATIONS   37 CITATIONS    33 PUBLICATIONS   73 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Short study View project

COVID - 19 View project

All content following this page was uploaded by Adith Venugopal on 11 March 2021.

The user has requested enhancement of the downloaded file.

 INTERNATIONAL ORTHODONTICS

Adith Venugopal, Federico M. Nadela, S. Jay Bowman, Anand Marya, Anuraj Singh Kochhar,
Rajiv Yadav, Mohammad Khursheed Alam

Alternative treatment strategies for pseudo-Class III

malocclusion with mild asymmetry

KEY WORDS
pseudo-Class III, COTS protocol, intermaxillary elastics, jaw asymmetry, dental asymmetry

ABSTRACT
A pseudo-Class III patient often displays the presence of premature contacts that direct the man-
dible to slide forward in such a manner that the posterior teeth may occlude; otherwise, in an end-
on anterior position, the posterior teeth most often do not contact each other. Early intervention,
apt diagnosis, and formulating a case-specific treatment plan are necessary to appropriately treat
pseudo-Class III malocclusions. This early intervention in mixed dentition may prevent the dental
discrepancy from evolving into a true Class III skeletal discrepancy with possible skeletal asym-
metries. The patient cases presented in this article demonstrate a successful alternative approach
to correct pseudo-Class III malocclusions by employing a combination of ‘rounded’ bite turbos,
accentuated NiTi archwires and intermaxillary elastics.

Receipt of manuscript: 15.01.2021, Acceptance: 20.01.2021

Introduction upper lip retrusion, excessive maxillomandibular

anterior displacement, and retroclined or upright
Management of Class III malocclusions is a chal- maxillary incisors with normal vertical develop-
lenging scenario, partially complicated by various ment2,3. Bowman2, Tweed4 and Moyers5 classified
factors such as the diagnosis, treatment approach Class III malocclusions into three subtypes: skele-
and the timing of treatment. While a skeletal tal, dentoalveolar and pseudo. While Tweed4 em-
Class III may present clearly as a skeletal discrep- phasized the importance of the shape of the man-
ancy caused by an overdeveloped mandible, an dible in classifying these malocclusions, Moyers5
underdeveloped maxilla or both, a pseudo-Class considered these a result of neuromuscular reflex.
III malocclusion does not display the same obvious A pseudo-Class III patient often displays the
skeletal features1. Dentally, a true skeletal Class III presence of premature contacts that direct the
typically demonstrates the presence of dento- mandible to slide forward in such a manner that
alveolar compensations: retroclined mandibular the posterior teeth may occlude; otherwise, in
incisors, proclined maxillary incisors and a nega- an end-on anterior position, the posterior teeth
tive overjet. On the other hand, a pseudo-Class most often do not contact each other. An impor-
III usually results from an anterior functional shift tant point to consider in the diagnosis of pseu-
of the mandible resulting from anterior prema- do-Class III malocclusions is the assessment of the
ture contacts1,2. Pseudo-Class III patients typically sagittal maxillomandibular relationship in centric
have deficient midfacial and maxillary arch length, relation (CR) or, more specifically, ‘terminal hinge

Kieferorthopädie 2021;35(1):27–42 27
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 1 ‘Rounded’ These changes would, in turn, correct the prema-

bite turbos.
ture contacts and promote a more stable func-
tional occlusion with the condyles seated properly
in the fossae2,3,14.
Advancement of the maxillary incisors has been
the most common treatment approach for the
correction of premature anterior contacts in pseu-
do-Class III patients2,3. Proclining the maxillary
incisors may be performed utilising a number of
different methods, including: ‘advancing loops’15,
compressed superelastic wires and compressed coil
springs16, 2 × 4 appliances15, face masks17, etc.
Unfortunately, if the maxillary incisors are not
substantially retruded or upright, consideration of
axis’6,7. If the patient’s mandible can be directed gingival or periodontal coverage is crucial. In this
posteriorly to an end-on position of the incisors, regard, incisor advancement could lead to overly
this often points to a favourable prognosis for a proclined maxillary incisors that may be more
nonsurgical treatment alternative. In addition, prone to gingival recession or dehiscence18.
this may essentially distinguish a pseudo-Class The case series presented here demonstrates
III, where the profile changes from straight to an alternative approach using the Center for Or- r
concave as the mandible positions forward to an thodontic Training Seminars (COTS) protocol to
occlusion, compared with a true skeletal Class III, correct pseudo-Class III cases. The intention of this
where there is absolutely no change in the profile. article is to describe an easy approach that involves
As there are differences in occlusion reported the use of ‘rounded’ bite turbos (Fig 1), accentu-
between CR and a habitual occlusion, pseu- ated NiTi archwires and intermaxillary elastics.
do-Class III patients have been found to be at
higher risk of developing temporomandibular
disorders (TMD)8. Such disorders have numerous Case Report 1
etiological factors, among which, the effect of
morphological and functional occlusion on mus-
History and diagnosis
cular activity has been extensively studied9-11.
Occlusal interferences, usually seen in pseu- A 24-year-old male presented with the chief com-
do-Class III malocclusions, may cause damage in plaints of an uneven smile, inability to chew prop-
terms of wear facets, attrition, changes in occlusal erly and a deviation of his chin. Initial evaluation
rest patterns, etc. These may go unnoticed for years revealed a jaw deviation to the right upon mouth
but could incrementally create long-term issues. closure with a corresponding 5 mm midline shift of
Nonworking side interferences have been suggested the mandible with a unilateral crossbite on the right
as occlusal risk factors contributing to TMD12. side. His canine relationship was a Class III on the left
Pseudo-Class III malocclusions should be and a Class II on the right. Radiographic evaluation
treated as soon as they are detected, but that is revealed a Class I profile with mutilated mandibular
contingent on the patient benefitting from an first molars bilaterally (Fig 2). The left and right con-
early diagnosis; often that is not the case13. Func- dyles were not seated properly in the fossae.
tional or fixed appliances might be used for the
management of pseudo-Class III malocclusions in
Treatment progress
situations that allow for an increase in the max-
illary arch perimeter, extrusion of the maxillary The crossbite and underbite were corrected with
molars and a favourable rotation of the mandible. a sequence of mandibular ‘accentuated curve’

28 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 2 Pretreatment extraoral and intraoral photographs and radiographs.

NiTi wires (0.014”; 0.016”) combined with long favour of mandibular repositioning with the inter- r
Class III elastics (3/16”, 3.5 oz) and ‘cross-arch’ maxillary elastics (see Fig 1). At the end of 6 months
midline elastics (1/4”, 3.5 oz). of treatment, the maxillary and mandibular mid-
The bite was raised at the terminal mandibular lines coincided, but a large posterior open bite had
molar with flowable composite shaped in the form developed, which was subsequently corrected with
of a ‘rounded ball’ to avoid any kind of static bite, in the use of box elastics (1/4”, 3.5 oz) (Fig 3).

Kieferorthopädie 2021;35(1):27–42 29
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

1 month

4 months

6 months

10 months

13 months

15 months

17 months

Fig 3 Mechanics demonstrating the use of ‘rounded’ bite turbos and intermaxillary elastics to correct the functional mandibular shift.

30 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 4 Posttreatment extraoral and intraoral photographs and radiographs.

Next, rectangular stainless steel wires were At the end of 20 months, most of the dental
employed to generate adequate torque control discrepancy was resolved. Posttreatment photo-
during space closure. Tooth 43 displayed exces- graphs reveal a bilateral Class I molar and canine
sive lingual crown torque, so an inverted MBT relationship with favourable crown angulations.
prescription 12 bracket (featuring more torque) The final occlusion was retained using fixed lingual
was bonded to produce more positive crown an- retainers on the maxillary and mandibular arches
gulation (see Fig 3). in addition to Essix removable retainers (Fig 4).

Kieferorthopädie 2021;35(1):27–42 31
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 5 Facial (frontal) photographs showing limited correction of facial asymmetry.

There was a visible, gradual shift of the jaw to Case Report 2

the left with the change in occlusion, but there
was still a residual asymmetry that could not be History and diagnosis
corrected by orthodontic therapy alone (Fig 5).
Posttreatment radiographs (see Fig 4) demon- A 29-year-old male presented with the chief com-
strated improved root angulations and positioning plaints of not being able to chew properly, spaces
of the condyles in the fossae. between his teeth, edge-to-edge bite and a devi-
Table 1 shows a comparison of the cephalo- ation of his chin. Initial evaluation revealed a jaw
metric values for Case Report 1. deviation to the right upon closure with a 3 mm
mandibular shift to his right along with a unilateral
Table 1 Cephalometric values for Case Report 1 anterior and posterior crossbite on the right side.
In addition to spacing in the anterior region, his ca-
Variable Mean Pretreatment Posttreatment
SNA (dg) 82 ± 3 80.75 81.17
nine relationship was Class I on the left and Class II
SNB (dg) 79 ± 3 83.17 82.62 on the right. Radiographic evaluation revealed a
ANB (dg) 3±1 -2.42 -1.45 mild Class III skeletal profile with a missing man-
IMPA (dg) 92 ± 5 94.32 92.75 dibular right first molar and an endodontically
U1-SN (dg) 102 ± 6 112.90 114.78 treated mandibular left first molar. The condyles
FMA (dg) 26 ± 3 24.30 26.85 appeared to be well seated in the fossae (Fig 6).

32 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 6 Pretreatment extraoral and intraoral photographs and radiographs.

Kieferorthopädie 2021;35(1):27–42 33
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

1 month

8 months

13 months

Fig 7 Mechanics demonstrating correction of the functional shift of the mandible.

Treatment progress Facial asymmetry was not corrected largely

due to a remaining skeletal component: a jaw size
The patient’s crossbite and underbite were cor- discrepancy between the left and right sides of the
rected using a sequence of accentuated curve mandible (Fig 9).
NiTi wires (0.014”; 0.016”) followed by heavy SS Final radiographs demonstrate favourable root
wires, alongside a combination of long Class III parallelism and condylar morphology (see Fig 8).
elastics (3/16”, 3.5 oz) and midline elastics (1/4”, Table 2 shows a comparison of the cephalo-
3.5 oz). Posterior ‘rounded’ bite turbos, similar metric values for Case Report 2.
to those used in the previous case, were added
to correct the functional shift during the levelling
process (Fig 7).
Once the midlines were matched, closing
loops bent on rectangular stainless steel arch Table 2 Cephalometric values for Case Report 2
wires (0.019” × 0.025” SS) were used to close the
Variable Mean Pretreatment Posttreatment
spaces. At the end of 18 months, the dental asym- SNA (dg) 82 ± 3 79.72 79.75
metry was corrected with Class I molars and ca- SNB (dg) 79 ± 3 81.68 80.95
nines. The final occlusion was retained using fixed ANB (dg) 3±1 -1.96 -1.20
lingual retainers on the maxillary and mandibular IMPA (dg) 92 ± 5 92.75 88.91
arches in addition to coverage with Essix remov- U1-SN (dg) 102 ± 6 109.12 110.56
able retainers (Fig 8). FMA (dg) 26 ± 3 24.65 24.90

34 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 8 Posttreatment extraoral and intraoral photographs and radiographs.

Kieferorthopädie 2021;35(1):27–42 35
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 9 Pre and post facial (frontal) photographs showing limited correction of facial asymmetry.

Case Report 3 Treatment progress

Treatment involved raising the bite on the termi-
History and diagnosis nal mandibular molars using a ‘rounded ball’ of
flowable composite and the continuous use of
A 13-year-old female presented with the chief midline elastics (right: Class II 3/16”, 3.5 oz; left:
complaints of an unaesthetic smile, an underbite Class III 3/16”, 3.5 oz) until the midlines approx-
and a protruded lower lip. Clinical evaluation re- imated (Fig 11).
vealed a jaw deviation to her right upon closure,
with an associated anterior crossbite and lower
midline shift of 5 mm to the right. Radiographs
revealed a mild Class III profile with a normodiver-
gent mandible (Fig 10).

36 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 10 Pretreatment extraoral and intraoral photographs and radiographs.

Kieferorthopädie 2021;35(1):27–42 37
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

2 months

6 months

10 months

Fig 11 Mechanics demonstrating correction of the functional mandibular shift.

Once arch levelling and occlusal prematuri- Table 3 Cephalometric values for Case Report 3
ties were corrected, the functional shift was cor- Variable Mean Pretreatment Posttreatment
rected with the aid of intermaxillary elastics. An SNA (dg) 82 ± 3 84.20 85.65
improved occlusion with Class I canine and molar SNB (dg) 79 ± 3 84.53 85.47
relationships was achieved in 12 months. These ANB (dg) 3±1 -0.33 0.18
IMPA (dg) 92 ± 5 87.99 85.38
results were retained using a fixed lingual retainer
U1-SN (dg) 102 ± 6 100.33 112.72
along with Essix retainers for both the maxillary
FMA (dg) 26 ± 3 25.75 26.10
and mandibular arches (Figs 12 and 13).
Posttreatment photographs (see Fig 12) show
that most of the dental and skeletal asymmetries
have been corrected with a Class I canine and mo-
lar relationship. Posttreatment radiographs show
favourable root positions and a good condylar
position. Table 3 shows a comparison of the ceph-
alometric values for Case Report 3.

38 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 12 Posttreatment extraoral and intraoral photographs and radiographs.

Kieferorthopädie 2021;35(1):27–42 39
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Fig 13 Pre and post facial (frontal) photographs showing almost complete correction of facial asymmetry.

Discussion suggested that such an interference was consid-

ered potentially traumatic and capable of causing
Pseudo-Class III patients have forwardly placed damage to the stomatognathic system21,22.
mandibles in maximum intercuspation (MI), usu- Consequently, it is paramount that such occlu-
ally due to anterior premature contacts12. This is sal interferences be corrected during fixed appli-
often associated with a unilateral crossbite and ance therapy by relieving premature contacts or
deviation towards the crossbite side1,19. Early in- by third order correction and arch coordination,
tervention has been associated with best prog- etc22,23 in order to develop a better occlusal equi-
nosis to intercept the ‘pseudo’ malocclusion from librium.
progressing to a full-blown skeletal defect, per- When early dentoalveolar correction is indi-
haps with one side of the jaw growing more than cated, some simple biomechanics may be em-
the other2,3. ployed to improve predictability, efficiency and
There are innumerable contributing factors effectiveness in eliminating those premature con-
associating TMD with pseudo-Class III malocclu- tacts. Most reported treatment options suggest
sions, some of which include a shift from CR to advancing the maxillary incisors, often involving
the habitual bite of MI, occlusal factors such as options such as a 2 × 4 appliance14,15, compressed
contacts on the working and nonworking side, ab- coil springs16, inclined planes, face masks17, etc.
sence of lateral or protrusive guides and interfer- Problems may arise when the maxillary incisors
ence in the disclusion guides12,20. Valle-Corotti et are already upright with a thin gingival biotype.
al12 suggested that interferences on the nonwork- In those instances, maxillary advancement may
ing side are usually associated with TMD. While prove detrimental to the periodontal health of the
studying the occlusal characteristics, those authors maxillary incisors.

40 Kieferorthopädie 2021;35(1):27–42
 Venugopal et al Treatment strategies for pseudo-Class III malocclusion

The use of flowable composite in the form of a References

‘rounded ball’ bonded to the posterior teeth may
help to avoid a static bite and possibly deprogram- 1. Rabie AB, Gu Y. Diagnostic criteria for pseudo-Class III mal-
occlusion. Am J Orthod Dentofacial Orthop 2000;117:1–9.
ming jaw muscles. When a patient no longer has 2. Bowman SJ. A quick fix for pseudo-Class III correction.
a static occlusion, the bite might be easily man- J Clin Orthod 2008;42:691–697.
3. Ibrahim S, Hafez AM, El Bialy AA, Bowman SJ. Effects of
ipulated using appropriately selected intermax- the Quick Fix appliance in the correction of pseudo-Class
illary elastics. These bite blocks can be gradually III malocclusion. J Clin Orthod 2012;46:165–171.
4. Tweed CH. Clinical Orthodontics. St Louis: Mosby,
trimmed as the dental deviation is corrected and 1966:715–726.
5. Moyers RE. Handbook of Orthodontics, ed 4. Chicago:
the midlines coincide. Year Book 1988:410–415.
For the cases reported in this article, levelling 6. Ngan P, Moon W. Evolution of Class III treatment in ortho-
dontics. Am J Orthod Dentofacial Orthop 2015;148:22–36.
and alignment, followed by disclusion, led to elim- 7. Luzia DS. Consideraciones generales en el diagnostico y
ination of prematurities, especially those on the tratamiento de las maloclusiones de clase III. Revista lati-
noamericana de ortodoncia y odontopediatria, Julio de
nonworking side. Simultaneous correction of the 2005
dental asymmetry occurred with the usage of in- 8. Lila-Krasniqi ZD, Shala KS, Pustina-Krasniqi T, Bicaj T, Dula
LJ, Guguvčevski L. Differences between centric relation
termaxillary elastics. In instances where a ‘pseudo’ and maximum intercuspation as possible cause for devel-
bite had not transformed into a true skeletal opment of temporomandibular disorder analyzed with
T-scan III. Eur J Dent 2015;9:573–579.
malocclusion, correction of the asymmetry was 9. Giancotti A, Maselli A, Mampieri G, Spanò E. Pseudo-Class
III malocclusion treatment with Balters’ Bionator. J Orthod
also achieved (see Fig 13). In contrast, when the 2003;30:203–215.
discrepancy was actually skeletal in nature, only 10. Hirata RH, Heft MW, Hernandez B, King GJ. Longitudi-
nal study of signs of temporomandibular disorders (TMD)
partial correction of the skeletal asymmetry was in orthodontically treated and nontreated groups. Am J
achieved (see Figs 5 and 9). Orthod Dentofacial Orthop 1992;101:35–40.
11. Mohlin B, Axelsson S, Paulin G, et al. TMD in relation to
malocclusion and orthodontic treatment. Angle Orthod
2007;77:542–548.
12. Valle-Corotti K, Pinzan A, do Valle CV, Nahás AC, Corotti
Conclusion MV. Assessment of temporomandibular disorder and
occlusion in treated class III malocclusion patients. J Appl
Oral Sci 2007;15:110–114.
Early intervention, apt diagnosis and formulat- 13. Wyatt WE. Preventing adverse effects on the temporo-
mandibular joint through orthodontic treatment. Am J
ing a case-specific treatment plan are necessary Orthod Dentofacial Orthop 1987;91:493–499.
to appropriately treat pseudo-Class III malocclu- 14. Turley PK. Treatment of the Class III malocclusion with
maxillary expansion and protraction. Seminars in Ortho-
sions. This early intervention in mixed dentition dontics 2007;13:143–157.
may prevent the dental discrepancy from evolv- 15. Rabie AB, Gu Y. Management of pseudo Class III maloc-
clusion in southern Chinese children. Br Dent J 1999;186(4
ing into a true Class III skeletal discrepancy with Spec No.):183–187.
possible asymmetries. The patient cases presented 16. Wilson WL, Wilson RC. Modular orthodontics manual.
Denver: Rocky Mountain Orthodontics, 1981.
in this article demonstrate successful alternative 17. Gu Y, Rabie AB, Hägg U. Treatment effects of simple
approaches using the COTS protocol to cor- fixed appliance and reverse headgear in correction of
anterior crossbites. Am J Orthod Dentofacial Orthop
rect pseudo-Class III malocclusions, employing 2000;117:691–699.
18. Flores-Mir C. Does orthodontic treatment lead to gingival
‘rounded’ bite turbos, accentuated NiTi archwires recession? Evid Based Dent 2011;12:20.
and intermaxillary elastics. 19. Reyes A, Serret L, Peguero M, Tanaka O. Diagnosis and
treatment of Pseudo-Class III malocclusion. Case Rep Dent
2014;2014:652936. doi:10.1155/2014/652936.
20. Al-Hummayani FM. Pseudo Class III malocclusion. Saudi
Funding Med J 2016;37:450–456.
21. McNeill C (ed). Craniomandibular Disorders: Guidelines
No grants or funding were received by any of the for Evaluation, Diagnosis, and Management. Chicago:
Quintessence, 1990.
authors of this article. 22. Magnusson T, Enbon L. Signs and symptoms of mandibular
dysfunction after introduction of experimental balancing-side
interferences. Acta Odontol Scand 1984;42:129–135.
23. Hesse JR, Van Loon LA, Naeije M. Subjective pain report
Disclaimer and the outcome of several orthopaedic tests in cranio-
mandibular disorder patients with recent pain complaints.
The authors declare no conflicts of interest. J Oral Rehabil 1997;24:483–489.

Kieferorthopädie 2021;35(1):27–42 41
Venugopal et al Treatment strategies for pseudo-Class III malocclusion

Alternative Behandlungsstrategien für Pseudo-Klasse-III-Patienten mit

leichter Asymmetrie
INDIZES
Pseudo-Klasse III, COTS-Protokoll, intermaxilläre Gummizüge, Kieferasymmetrie,
Zahnasymmetrie

ZUSAMMENFASSUNG
Der Artikel stellt kieferorthopädische Behandlungsmöglichkeiten bei Pseudo-Klasse-III-Relationen vor.
Im Vergleich zu internationalen Klassifikationen ist der im deutschsprachigen Raum geläufige Begriff
Pseudoprogenie (maxilläre Retrognathie) abzugrenzen. Die Patientenbeispiele weisen im Vergleich zu
asiatischen Referenzwerten keine ausgeprägten skelettalen Klasse-III-Relationen auf. Die Abweichun-
gen sind überwiegend dentoalveolär bedingt. Die Diskrepanzen der Zahnbögen sind ursächlich für
die Fehllage der Mandibula und für neuromuskuläre Störungen. Deshalb sollten craniomandibuläre
Befunde bei Patienten mit einer Pseudo-Klasse III besonders beachtet werden und eine Behandlung
so früh wie möglich eingeleitet werden. Die Autoren zeigen anhand der drei gut dokumentierten Pa-
tientenbeispiele auf, dass mit vergleichsweise geringem Aufwand und bei guter Reaktion eine Kom-
pensation gelingt. Als wesentlich für den Behandlungserfolg werden angesehen: seitliche Aufbisse,
intermaxilläre Gummizüge, differenzierter Einsatz von NiTi-Bögen und Druckfedern.

Adith Venugopal Anand Marya

BDS, MS, PhD BDS, MSc.D
Assistant Professor, Department of Assistant Professor, Department of
Orthodontics Orthodontics
University of Puthisastra, Phnom Penh, University of Puthisastra, Phnom Penh,
Cambodia Cambodia
Distinguished Adjunct Faculty, Saveetha
Dental College and Hospital Anuraj Singh Kochhar
Chennai, India BDS, MDS
and Former Consultant Orthodontist Max
Adjunct Faculty Hospital Gurgaon, India
Department of Orthodontics
Saveetha Dental College, Saveetha Institute Rajiv Yadav
Adith Venugopal of Medical and Technical Sciences, Chennai, BDS, MSc.D
India Associate Professor
Tribhuvan University Dental Teaching
Federico M. Nadela, Jr. Hospital, Institute of Medicine,
DMD, MSO, C Prof Ortho Chair Kathmandu, Nepal
Cebu Doctors’ University MSD Orthodontics
Past Chair, Manila Central University MSD Mohammad Khursheed Alam
Orthodontics BDS, PhD
Associate Professor, University of the East Associate Professor
MSD Orthodontics Orthodontic Division Preventive Dentistry
Department
S. Jay Bowman College of Dentistry, Jouf University
DMD, MSD Sakaka 72721 Aljouf, Saudi Arabia
Adjunct Associate Professor, Saint Louis
University
Assistant Clinical Professor, Case Western
Reserve University
Instructor, The University of Michigan

Corresponding author:
Adith Venugopal, BDS, MS, PhD; Email: [email protected]

42 Kieferorthopädie 2021;35(1):27–42

View publication stats