New orthopedic and orthodontic treatment modality for adult patients with skeletal Class III malocclusion with insufficient maxillary incisor exposure

Abstract

This paper aims to offer a new orthopedic and orthodontic treatment modality for treating adult patients with mild-to-moderate skeletal Class III discrepancy and insufficient maxillary incisor exposure who reject orthognathic surgery. For Phase I treatment, a rapid palatal expansion or miniscrew-assisted rapid palatal expansion is activated on the maxilla, and a modified lip bumper is installed on the mandibular dentition. At night, a facemask with a forward and downward orthopedic force is applied, whereas during the day, modified lip bumper and intraoral heavy Class III elastics are used. During Phase II treatment, intraoral elastics from the miniscrews between the mandibular premolars to the hooks between the maxillary lateral incisors and canines are activated to increase the maxillary incisor showing. In addition, activating elastomeric chains between the mandibular miniscrews and hooks between the mandibular lateral incisors and canines, the whole mandibular dentition is distally moved, and the mandibular incisors are intruded. Orthopedic and orthodontic treatment using a facemask, modified lip bumper, and mandibular miniscrews is an efficient way to improve adult skeletal Class III malocclusion and deficient maxillary incisor exposure.