Multiloop Edgewise Archwire Research Articles

Properties and Application of the Gummetal Wire for the Treatment of an Open Bite—Brief Narrative Review and Case Report

The swift integration of ‘Gummetal’ into the orthodontic armamentarium can be attributed to its distinct advantages as an entirely new Ti-Nb-based beta titanium alloy. Developed by Toyota Central R&D Labs and publicly revealed in April 2003, this innovative material is rapidly reshaping orthodontic practices. Its sui generis properties allow its use as a potential substitute for the Multi-Loop Edgewise Archwire (MEAW) method. Three-dimensional orthodontic movement using this new alloy could eliminate the disadvantages of the MEAW method, such as its technical complexity and patient discomfort. In our comprehensive review of the current literature, we examined relevant publications sourced from the PUBMED database and explored one seminal work on Gummetal from the journal literature. Characteristic properties of Gummetal, such as its exceptional flexibility, superelasticity, and malleability (approximately 10 times greater than conventional metals), enable seamless formation of bends without posing challenges, thereby allowing precise control over orthodontic force application. Also worthy of mention are Gummetal’s biocompatibility and non-toxic properties, along with its low coefficient of friction. The wire seems to be a relatively easy way to achieve good occlusion. Its usage does not require extensive experience in terms of manual skill, and it is not time consuming. Diligent usage of any prescribed plastics by the patient is crucial to prevent complications and ensure successful orthodontic outcomes.

Improved Super-elastic Ti-Ni Alloy Wire for Nonsurgical Treatment of Skeletal Class III Malocclusion Combined with Anterior Crowding and Anterior Crossbite Case

The article reported the use of improved super-elastic Ti-Ni alloy wire (ISW), which was developed by Tokyo Medical and Dental University, to correct a case of skeletal Class III malocclusion combined with anterior crowding and anterior crossbite. An 18-year-old male with a chief complaint of poor dental alignment and protruded lower incisors showed up in our clinic for treatment. Clinical examination revealed skeletal Class III facial profile. Anterior crowding and anterior crossbite could be also noted. Because the patient refused orthognathic surgery, we tried camouflage orthodontic treatment. First, we used ISW crossbite arch to eliminate the anterior interference in order to observe the change of the mandibular position. After that, we use ISW multiloop edgewise arch wire (MEAW) technique and intermaxillary elastics to achieve midline correction and adequate overjet with the bite raising process. The treatment was finished with the improvement of facial appearance and a stable occlusion.

Multi-Loop Edge Wise Arch Wire Technique (MEAW) – A Review

Anterior open bite treatment is considered to be a complex treatment in the field of orthodontics. Orthognathic surgery is often the treatment of choice for these types of malocclusions and prognosis of the results are still questionable. With the introduction of Multiloop edgewise archwire therapy, treatment of open bite has started showing efficient results. Moreover, MEAW is versatile as it is capable of correcting various malocclusions as well such as Class II, Class III, deep overbite, and malocclusions with marked midline deviations. Since the advent of the MEAW, its treatment modality has been used worldwide and numerous reports of successful results have been published. Some orthodontists have described the MEAW technique as “magical” or “unbelievable,” but it certainly is not. The diagnosis and treatment plan must be correct and construction of the MEAW must be precise to deliver the necessary forces to move the teeth to an optimal, stable relationship.Hence this article aims to review the multiloop edge wise arch wire technique in detail along with its biomechanics.

Tratamento de má oclusão de Classe III subdivisão com mordida cruzada posterior unilateral através da técnica multiloop edgewise archwire (MEAW) – relato de caso

The aim of this study was to report a clinical case of treatment of Class III subdivision malocclusion with unilateral posterior crossbite using the Multiloop Edgewise Archwire (MEAW) technique. A 19-year-old male patient reported mandibular prognathism as the main complaint. He had Angle Class III malocclusion, unilateral posterior crossbite on the right side, top bite in the anterior region, non-coincident midlines and facial asymmetry. Due to the patients refusal of surgical treatment, dentoalveolar orthodontic compensation was proposed. The MEAW technique associated with 3/16” intermaxillary elastics were used. At the end of the treatment, a Class I occlusal relationship between canines and molars, correction of the unilateral posterior crossbite and coincidence between the midlines was obtained. The MEAW technique was effective in correcting Class III subdivision malocclusion and unilateral posterior crossbite.

Management of the Vertical Dimension in the Camouflage Treatment of an Adult Skeletal Class III Malocclusion

Treating skeletal class III malocclusions is one of the biggest challenges in Orthodontics. Given the complexity of these cases, orthognathic surgery is often the best treatment option. However, many patients refuse this treatment due to its risks, morbidity, and costs involved. Alternatively, dental compensation can be planned for some of these skeletal problems. This case report presents a dentoalveolar compensation in the orthodontic treatment of a 20-year-old female patient with class III malocclusion, concave profile, anterior crossbite, mandibular prognathism, maxillary retrusion, and a vertical deficiency in the posterior region. Treatment planning involved a multiloop edgewise archwire (MEAW) associated with intermaxillary elastics with counterclockwise rotation of the occlusal plane in the posterior region of the maxilla aiming at obtaining an increased posterior vertical dimension. After 24 months of treatment, the severe anterior crossbite was corrected, and the skeletal class III relationship was camouflaged. At the end of the orthodontic treatment, it was possible to observe an improved facial profile, a nice smile, and a functional occlusion. The results remained stable at a three-year follow-up. The MEAW, associated with the use of elastics, seems to be an effective treatment option for class III camouflage with reduced posterior vertical dimension with no need for additional anchoring devices but requiring adequate bending of wires and patient compliance.

CBCT Analysis of Changes in Dental Occlusion and Temporomandibular Joints before and after MEAW Orthotherapy in Patients with Nonlow Angle of Skeletal Class III.

This study focus on the changes of the position and morphology of jaw and condyle after MEAW (the multiloop edgewise arch wire) treatment in adults with a nonlow angle (mean angle or high angle SN − MP > 27°) of skeletal class III (mild to moderate skeletal classs III means −5° < ANB < 0°) malocclusions measured by CBCT (cone beam computed tomography). Twenty adult patients (aged 17-26) with a nonlow angle of skeletal class III malocclusions were selected in this study taken orthodontic treatment by MEAW. CBCT was taken before and after the treatment to analyze the changes of the jaw and condyle. After treatment, the angle of L7-MP decreased 12.2°, L6-MP decreased 10.5°, L1-MP decreased 8.8° (P < 0.001 for each) and U1-SN increased (P < 0.05). There was no significant changes between anterior and posterior APDI index and between anterior and posterior spaces of the TMJ (temporomandibular joint) (P > 0.05). The linear ratio of the TMJ was the LR > 12 before treatment, while it was −12 < LR < 12 after treatment; however, there was no statistically significant difference between them (P > 0.05). There was also no significant change in anterior and posterior position and morphology of the condyle within the joint fossa after the treatment by MEAW in this study. MEAW technology in correcting the class III with nonlow angle patients mainly relies on the compensation of distally and posterior mandibular teeth, rather than the mandible and condyle moving backward to establish a neutral occlusal. This study was approved by the institutional ethics committee of the Second Hospital of Tianjin Medical University (No. KYJJ2013002).

ISW for the Treatment of Angle Class II Division 1 Combined with Unstable Mandibular Position

Introduction: This article presents a case of Angle Class II division 1 with completed treatment. We used improved super-elastic Ti–Ni alloy wire (ISW) and the modified multiloop edgewise arch wire (MEAW) technique to create space and to relieve anterior and posterior crowding in an adult female patient with poor dental alignment and facial asymmetry. Intermaxillary elastics were also used to improve the mandibular position and intercuspal interdigitation. The patient was treated by crowding relief, facial asymmetry correction, the MEAW technique, and overjet reduction. Findings: The patient was treated successfully using ISW. Conclusion: In this case, we rapidly corrected poor dental alignment by using ISW and the MEAW technique. Compared with conventional stainless steel wire treatment, ISW provides an efficient and easy approach to correct such malocclusion. Successful treatment outcomes were attained, and the patient was pleased with the treatment results.

Non-extraction and multiloop edgewise technique versus orthognathic surgery and fixed appliance in adult class II patients: a cephalometric comparative study.

An alternative approach to surgery for treating class II adult borderline patients is the non-extraction and multiloop edgewise archwire (MEAW) technique. The aim of the present study is to compare dentoskeletal effects of the orthognathic surgery with the MEAW technique. Thirteen adults (ten women, three men; mean age, 27.8 years) were consecutively treated using the MEAW approach. The control group was made of 13 adults (nine women, four men; mean age, 26.2 years) treated by orthognathic surgery and the multibracket appliance before and after surgery. Lateral headfilms before and after all the treatments were traced for linear and angular measurements, and data were blindly analyzed. ANOVA was conducted to compare any difference over time between the two treatments. Differences over time for each variable, separately for surgery and MEAW, were assessed by Wilcoxon test. No significant differences between the two groups were detected at baseline. Both treatments were effective in correcting dental discrepancies. A significant difference over time between the two treatments was found in several cephalometric measurements. Considering the limits of the present sample the following conclusion emerged: in the MEAW group, the malocclusion correction was predominantly dentoalveolar, and a significant profile change was observed. Significant skeletal and occlusal plane changes were obtained with the orthognathic surgery approach.

Class III treatment with occlusal plane reconstruction – clinical case

Introduction: The therapeutic approach of anterior open bites and class III is a challenge in orthodontic treatment, especially when it is performed without Orthognathic Surgery. Several treatment modalities for this type of malocclusion have been proposed over the years, such as Kim’s proposed Multiloop Edgewise Arch Wire (MEAW) technique, which was described 20 years ago [1,2]. The objective of this study is to present a clinical case of anterior open bite and skeletal class III, whose clinical approach consisted of the use of three plane arches with the same principle of the technique previously described. Materials and methods: A 29-years-old male patient came to Egas Moniz orthodontic clinic with the main complaint “I know I have a jaw problem and I want to treat it” SIC. In clinical and radiographic analysis, an anterior open bite, skeletal class III, and transverse dimension reduction were diagnosed. After obtaining informed consent, the treatment consisted of the use of fixed bimaxilar apliance with modified arches in the lower jaw, straight arch in the upper jaw and intermaxillary elastics (3/16 6oz). Results: Following the proposed treatment plan, it was possible to close the anterior open bite by promoting the intrusion and upright of the posterior mandibular teeth, alteration of the occlusal plane and a slight extrusion and retroinclination of the anterior teeth. Discussion and conclusions: The three plane arches technique presents the same principles of the MEAW technique since they incorporate tip-back bends that promote intrusion forces in the posterior and anterior teeth. The elastics used between the upper canines and the lower canines promote an anterior extrusion force and enhance the forces of the arch that promote intrusion of the posterior teeth [3,4]. Using this technique, it was possible to obtain satisfactory results and long-term stability in orthodontic treatment without orthognathic surgery. Figure 1. Initial Intraoral photos and x-rays. Figure 2. Final Intraoral photos and x-rays.

Three-dimensional analysis of tooth movement in Class II malocclusion treatment using arch wire with continuous tip-back bends and intermaxillary elastics.

ObjectiveThe aim of this study was to analyze three-dimensional (3D) changes in maxillary dentition in Class II malocclusion treatment using arch wire with continuous tip-back bends or compensating curve, together with intermaxillary elastics by superimposing 3D virtual models.MethodsThe subjects were 20 patients (2 men and 18 women; mean age 20 years 7 months ± 3 years 9 months) with Class II malocclusion treated using 0.016 × 0.022-inch multiloop edgewise arch wire with continuous tip-back bends or titanium molybdenum alloy ideal arch wire with compensating curve, together with intermaxillary elastics. Linear and angular measurements were performed to investigate maxillary teeth displacement by superimposing pre- and post-treatment 3D virtual models using Rapidform 2006 and analyzing the results using paired t-tests.ResultsThere were posterior displacement of maxillary teeth (p < 0.01) with distal crown tipping of canine, second premolar and first molar (p < 0.05), expansion of maxillary arch (p < 0.05) with buccoversion of second premolar and first molar (p < 0.01), and distal-in rotation of first molar (p < 0.01). Reduced angular difference between anterior and posterior occlusal planes (p < 0.001), with extrusion of anterior teeth (p < 0.05) and intrusion of second premolar and first molar (p < 0.001) was observed.ConclusionsClass II treatment using an arch wire with continuous tip-back bends or a compensating curve, together with intermaxillary elastics, could retract and expand maxillary dentition, and reduce occlusal curvature. These results will help clinicians in understanding the mechanism of this Class II treatment.

Tratamiento de maloclusión de clase III con arco multiloop edgewise arch wire (meaw) reporte de caso clínico

En la actualidad hay diferentes formas de abordar la maloclusión de clase III,todas las formas tienen como objetivo principal solucionar la maloclusión y están encaminadas a diagnosticar y llevar al paciente a una oclusión estable,estética y sobretodo sin daño alguno a los tejidos que conforman e lsistema estomatognático. Se muestra en este artículo el manejo de la maloclusión de clase III con arcos de Multiloop Edgewise Arch Wire (MEAW)como una opción rápida, estable y de excelentes resultados para la solución de este tipo de discrepancias. La maloclusión de clase III puede ser tratada de diferentes formas como el tratamiento temprano, la compensacióndental, el camuflaje esquelético y la opción quirúrgica. La compensación dental puede ser de diferentes formas, como por ejemplo: exodoncias de premolares inferiores, torque inferior negativo y positivo superior, con ayuda de anclaje esquelético (mini tornillos) y muchas más que no se enuncian.En los casos que se involucra el perfil o la simetría facial y su origen es de características de ADF (Anomalía Dentocranéo Maxilofacial) requirieran de cirugía ortognatica para su solución, puesto que es de origen esquelético y debido a severidad es no compensable. Este articulo muestra un manejo diferente como opción de compensación de maloclusión de clase III. Es un reporte de caso clínico de un paciente del Posgrado de Ortodoncia de la Universidad Antonio Nariño de la clínica de arco recto manejado con brackets de prescripción MBT Gemini Unitek 3M slot 0.022”x0.025” los cuales se les coloca arcos de Multiloop Edgewise Arch Wire (MEAW) después de ocho meses de tratamiento, cuatro meses en alineación y nivelación y cuatro meses del uso arcos de Multiloop Edgewise Arch Wire (MEAW) lacorrección dentoalveolar se corrige gracias a la retracción canina y molar de 6mm bilateral haciendo rotar el plano de oclusión según la filosofía del tratamiento de Multiloop Edgewise Arch Wire (MEAW) obteniendo las seis llaves de la oclusión de Andrews.

Multiloop Edgewise Arch-wire Technique for Skeletal Class III Openbite: A Case Report

Skeletal Class III with openbite is one of the most difficult malocclusion to treat orthodontically. Generally, the morphological characteristics of this malocclusion are poor antero-posterior growth of the maxilla or excessive growth of the mandible with high angle. An 18-year-old male had Class III malocclusion with retrognathic maxilla and normal mandible with high angle. All third molars except on fourth quadrant were extracted to eliminate the posterior crowding. Multiloop Edgewise Arch-wire (MEAW) technique was used to upright the mesially inclined buccal teeth and to correct occlusal plane. In nine month time, anterior cross bite and open bite were corrected; normal overjet, overbite and Class I canine relation were achieved.

Orthodontic treatment with the meaw technique following high condylectomy for the treatment of condylar hyperplasia: case series.

Unilateral condylar hyperplasia (UCH) is a pathological condition affecting not only facial appearance and occlusal relationships, but also mandibular joints health. The accurate and timely diagnosis, along with a therapeutic work and a multidisciplinary approach, help reduce the morphological alterations caused by this pathology. Orthodontics plays an important role in the various treatment modalities because of its role not only in presurgical dentoalveolar decompensation but also in dentoalveolar compensation with vertical management when the asymmetry allows it. The following therapeutic proposal describes the treatment of patients with active UCH subjected to high condylectomy surgery immediately after orthodontic dentoalveolar compensation with Multi-Loop Edgewise Archwire (MEAW) for the vertical handling of occlusal canting and maintenance of the orthopedic position of the mandible. All cases were satisfactorily resolved with the same diagnostic and treatment protocol. The conclusion is that, with adequate diagnosis and orthodontic management following condylectomy, non-severe cases of UCH may be treated. DOI: http://dx.doi.org/10.17533/udea.rfo.v29n2a11

Aesthetic and functional outcomes using a multiloop edgewise archwire for camouflage orthodontic treatment of a severe Class III open bite malocclusion

Occasionally, orthodontists will be challenged to treat malocclusions and skeletal disharmonies, which by their complexity one might think that the only treatment alternative is the surgical-orthodontic approach. A male patient, aged 17 years old, was diagnosed with a skeletal Class III malocclusion, anterior open bite and negative overjet. An unpleasant profile was the patient's 'chief complaint' showing interest in facial aesthetics improvement. Nevertheless, the patient and his parents strongly preferred a non-surgical treatment approach. He was treated with a multiloop edgewise archwire to facilitate uprighting and distal en-masse movement of lower teeth, correct the Class III open bite malocclusion, change the inclination of the occlusal plane and obtain the consequent morphological-functional adaptation of the mandible. The Class III malocclusion was corrected and satisfactory changes in the patient's profile were obtained. Active treatment was completed in 2 years, and facial result remained stable at 2 years 6 months after debonding.

Maxillary Orthopedic Expansion with Periodontally Accelerated Osteogenic Orthodontics

Background: A transverse skeletal discrepancy of the adult patient compromises occlusal stability and possibly implies muscular, articular, and aesthetic repercussions that depend on its severity. Historically, the treatment of transverse skeletal discrepancy has been accompanied by orthognathic surgery to disrupt sutures in order to expand the maxilla with disjunction devices. Purpose: To analyze current therapeutic approaches, such as periodontally accelerated osteogenic orthodontics, which become alternative treatment options for complex cases, decrease the severity of surgical procedures and adverse effects on the periodontal supporting tissue, improve the prognosis, and even reduce duration of treatment. Results: This report present the case of an adult female patient with complete unilateral left posterior crossbite and limitations of incisors’ crown/root ratio. The patient was successfully treated with transversal growth stimulation of the second quadrant by orthopedic expansion, performed immediately after corticotomies and lyophilized bone graft placement, followed by orthodontic treatment and multiloop edgewise arch wire technique. KEYWORDS transverse skeletal discrepancy; posterior crossbite; maxillary expansion; corticotomies; adult patient; multiloop edgewise arch wire; accelerated osteogenic orthodontics

Perawatan Ortodontik Gigitan Terbuka Anterior

Perawatan gigitan terbuka anterior telah lama dianggap sebagai tantangan bagi ortodontis. Prevalensi gigitan terbuka anterior antara 3,5% hingga 11% terdapat pada berbagai usia dan kelompok etnis, serta ada sekitar 17% pasien ortodonti memiliki gigitan terbuka. Stabilitas hasil perawatan gigitan terbuka anterior sangat sulit, karena adanya kombinasi diskrepansi anteroposterior dengan gigitan terbuka skeletal sehingga dibutuhkan tingkat keterampilan diagnosis dan klinis yang tinggi. Etiologi gigitan terbuka anterior sangat kompleks karena dapat melibatkan skeletal, dental, dan faktor-faktor habitual. Eliminasi faktor etiologi merupakan hal yang penting dalam perawatan gigitan terbuka anterior. Berbagai cara perawatan untuk koreksi gigitan terbuka anterior diantaranya bedah ortognatik dan perawatan ortodontik kamuflase, seperti high-pull headgear, chincup, bite blocks, alatfungsional, pencabutan gigi, multi-loop edgewise archwires dan mini implan. Stabilitas hasil perawatan adalah kriteria yang paling penting dalam menentukan cara perawatan gigitan terbuka anterior.Orthodontic Treatment of Anterior Open Bite. An anterior open bite therapy has long been considered a challenge to orthodontist. The prevalence of anterior openbite range from 3,5 % to 11% among various age and ethnic groups and it has been shown that approximately 17% of orthodontic patients have open bite. Stability of treatment result of anterior open bite with well-maintained results is difficult, because the combination of anteroposteriorly discrepancy with skeletal open bite requires the highest degree of diagnostic and clinical skill. The etiology is complex, potentially involving skeletal, dental and habitual factors. The importance of an anterior open bite therapy is to eliminate the cause of the open bite. Various treatment modalities for the correction of an anterior open bite have been proposed, orthognatic surgery and orthodontic camouflage treatment such as high-pull headgear, chin cup, bite blocks, functional appliances, extractions, multi-loop edgewise arch wires and mini implant. The stability is the most important criterion in deciding the treatment method for anterior open bite malocclusion.

Camouflage Treatment of a Severe Open Bite Case

Skeletal open bite is a complex and multifactorial anomaly. There are many reasons for the occurrence of open bite, including skeletal abnormal growth pattern; dental, respiratory, neurologic, and habitual factors; and tongue posture and function. Anterior open bite is one of the most difficult problems to treat in orthodontics. Various treatment modalities for the correction of an anterior open bite have been proposed such as extrusion of anterior teeth using intermaxillary elastics, multiloop edgewise archwire technique developed by Kim, inhibition of molar eruption using bite blocks and high-pull headgear during growth, and extraction therapy. The most effective treatment option in adult patients is the repositioning of both the maxilla and mandible through a surgical correction. Although satisfactory results can be achieved with orthognathic surgery, the complexity, risks and costs of surgery are disadvantages of the surgical treatment. With the advent of skeletal anchorage, a number of studies were released to introduce the treatment of anterior open bite by intrusion of maxillary posterior teeth. This report presents the treatment and long-term stability of an adult case of a severe anterior open bite treated by means of extraction of the 4 first molars.

Orthodontic Treatment of Severe Crowding Malocclusion with Extraction of premolars.

Space deficiency in a crowded dentition is a main indication for premolar extraction therapy. Class I malocclusions with severe crowding in non growing patients can be treated by upper lower first premolar extraction using an edgewise technique with multi loop edgewise arch wire (MEAW). The following case report describes a patient with severe tooth crowding, where the result of the treatment was acceptable and relatively stable. It was concluded that the elimination of tooth tissue discrepancy by the extraction of first premolars provides a good means in the treatment of crowding malocclusions. DOI: http://dx.doi.org/10.3329/bjodfo.v2i2.16161 Ban J Orthod &amp; Dentofac Orthop, April 2012; Vol-2, No.2, 30-33

Nonsurgical correction of a Class III malocclusion in an adult by miniscrew-assisted mandibular dentition distalization

This article reports the successful use of miniscrews in the mandible to treat a 20-year-old Mongolian woman with a chief complaint of anterior crossbite. The patient had a skeletal Class III malocclusion with a mildly protrusive mandible, an anterior crossbite, and a deviated midline. In light of the advantages for reconstruction of the occlusal plane and distal en-masse movement of the mandibular arch, we used a multiloop edgewise archwire in the initial stage. However, the maxillary incisors were in excessive labioversion accompanied by little retraction of the mandibular incisors; these results were obviously not satisfying after 4 months of multiloop edgewise archwire treatment. Two miniscrews were subsequently implanted vertically in the external oblique ridge areas of the bilateral mandibular ramus as skeletal anchorage for en-masse distalization of the mandibular dentition. During treatment, the mandibular anterior teeth were retracted about 4.0 mm without negative lingual inclinations. The movement of the mandibular first molar was almost bodily translation. The maxillary incisors maintained good inclinations by rotating their brackets 180° along with the outstanding performance of the beta-titanium wire. The patient received a harmonious facial balance, an attractive smile, and ideal occlusal relationships. The outcome was stable after 1 year of retention. Our results suggest that the application of miniscrews in the posterior area of the mandible is an effective approach for Class III camouflage treatment. This technique requires minimal compliance and is particularly useful for correcting Class III patients with mild mandibular protrusion and minor crowding.

Camouflage treatment of skeletal Class III malocclusion with multiloop edgewise arch wire and modified Class III elastics by maxillary mini-implant anchorage

To evaluate the effect of the multiloop edgewise arch wire (MEAW) technique with maxillary mini-implants in the camouflage treatment of skeletal Class III malocclusion. Twenty patients were treated with the MEAW technique and modified Class III elastics from the maxillary mini-implants. Twenty-four patients were treated with MEAW and long Class III elastics from the upper second molars as control. Lateral cephalometric radiographs were obtained and analyzed before and after treatment, and 1 year after retention. Satisfactory occlusion was established in both groups. Through principal component analysis, it could be concluded the anterior-posterior dental position, skeletal sagittal and vertical position, and upper molar vertical position changed within groups and between groups; vertical lower teeth position and Wits distance changed in the experimental group and between groups. In the experimental group, the lower incisors tipped lingually 2.7 mm and extruded 2.4 mm. The lingual inclination of the lower incisors increased 3.5°. The mandibular first molars tipped distally 9.1° and intruded 0.4 mm. Their cusps moved 3.4 mm distally. In the control group, the upper incisors proclined 3°, and the upper first molar extruded 2 mm. SN-MP increased 1.6° and S-Go/N-ME decreased 1. The MEAW technique combined with modified Class III elastics by maxillary mini-implants can effectively tip the mandibular molars distally without any extrusion and tip the lower incisors lingually with extrusion to camouflage skeletal Class III malocclusions. Clockwise rotation of the mandible and further proclination of upper incisors can be avoided. The MEAW technique and modified Class III elastics provided an appropriate treatment strategy especially for patients with high angle and open bite tendency.