The role of the mandibular third molar in late incisor crowding remains controversial. Detailed examination of frequently quoted studies indicates a small, but statistically significant relationship. The clinical relevance of this is discussed.

Skeletal and dental changes were examined in 15 patients presenting with a Class III malocclusion treated by a sagittal split osteotomy. All patients received orthodontic treatment with Straightwire appliances both prior to and following surgery. These appliances were also used for fixation. The lower incisors were proclined by 8.4 degrees before surgery with little change in upper incisor inclination. With surgery, there was a mean reduction of 4.3 degrees in the angle SNB. Following surgery, the relapse in mandibular position was minimal and was not related to the dental changes during this period. Changes in the vertical skeletal parameters were generally small. The individual cases exhibited a wide variation in the changes.

A modification to the standard quadhelix transpalatal expansion arch is presented in which the wire passes distal to the most posterior molar and enters the mesial end of the headgear tube. Laboratory measurements were carried out on small, average and large sized appliances with this modification using a special rig fitted with strain gauges. For the three sizes of appliance, the modified quadhelix is more flexible than the standard quadhelix for both displacement and rotation of the molar arms. Also it is less time consuming to fit and remove it is concluded that this appliance is capable of producing clinically useful forces and couples with increased precision.