It is so important to manage space well with anchorage for Class III cases. Below are my “Class III Spacing Beads on a String Mechanics”.
At the heart of this is ANCHORAGE! The LLHA is my anchorage of choice for class 3 cases with lower spacing. If the class III case has only upper spacing, the LLHA isn’t helpful. As long as the LLHA is in you can just chain 6-6 on the lower (molar to molar)
The best way to manage this maxillary space is to close the space in units. Start with upper 3-3 (canine to canine). Once that is closed, you’ll
long-tie/undertie max 3-3. If not, please do that for anchorage. So undertie max 3-3 and chain 4-4 or 3-4 on both sides. Either way. Have the patient come back every 3 weeks for chain change.
Once the 4’s have fully protracted and uprighted, remove the lace/undertie and redo it to 4-4 and repeat, but this time to the 5’s (and so on, to the 6’s, to the 7’s, all the time wearing class 3 elastics.
If the patient is an elastic-wearing champ, this will all work out just perfect. Let him know that. If he’s not, he’ll be getting a lower incisor extracted. This is up to him. You will do everything you can to avoid this but he must wear 3/16 heavy class 3 elastics BILATERAL until the spaces are closed.
IF you get to edge to edge occlusion at ANY TIME and there’s still space left, the deal is off and a lower incisor comes out.
If you get to edge to edge and all the spaces are fully closed (including molar spaces), just add lower IPR.
This will realistically take 6-9 months. The more he wears elastics, the faster it goes. Also make sure you power chain is NEW!