Orthopaedic and orthodontic treatment with hyrax, Class III elastics on mandibular miniplates, maxillary...

The treatment of Skeletal Class III malocclusion continues to be considered as one of the biggest challenges in orthodontics as the success of its correction is largely unpredictable. Early diagnosis and treatment are highly recommended to eliminate primary etiological factors and prevent an increase in severity of the existing malocclusion. However, if the diagnosis is delayed until adulthood, treatment becomes restricted to orthognathic surgery due to limited or no remaining growth potential left. The inherent risks involved with the surgical procedures often preclude the patients from opting for it, thus leaving the orthodontist with no option but to perform possible compensatory treatments to improve facial aesthetics and restore functional occlusion.

To report the case of a 15-year old boy (adolescent) with Skeletal Class III malocclusion, a concave facial profile with an anterior crossbite and no incisor visibility during smile.

Intra-oral skeletally anchored maxillary protraction (I-SAMP) and mini-implants associated with fixed appliance to aid in the correction of the skeletal bases and subsequently relieve the dental crowding.

After 36 months of treatment, functional normal occlusion with a Class I molar and canine relation was achieved. The consequential increase in upper lip thickness and decrease in lower lip fullness alongwith an increased exposure of maxillary incisors during smile resulted in a significant improvement of the patient's facial profile and an aesthetically pleasing smile.