Early correction of class III malocclusion with rapid maxillary expansion and face mask therapy
A 10-year-old boy came with a complaint of anterior cross bite to our department. The patient had no relevant past dental or medical history and no habits. On extra-oral examination [], patient had a dolico-cephalic head shape, lepto-prosobic facial form, concave profile, anterior divergence and acute nasolabial angle. All functional examination was normal.\nOn intraoral examination [], all soft-tissues and hard tissues were normal. Maxillary arch was constricted while mandibular arch was broad. Molar, canine and incisor relationship were class III on the both right and left side and there was a reverse overjet of 2 mm and overbite of 5 mm and anterior cross bite. The patient had class III skeletal base with retrognathic maxilla and prognathic mandible having average growth pattern with labially tipped mandibular incisors. The objective of the treatment was (1) to intrude and proclined the upper incisors, (2) to retroclined the lower incisors. (3) obtaining class I canine relation. (4) obtaining ideal overjet and overbite. (5) obtaining ideal esthetics.\nPatient was treated with a combination of face mask and RME [Figures -] until 2 mm positive overjet was achieved. The expansion screw was activated one to three turns (0.25 mm/turn) at weekly visits until the desired amount of expansion had been achieved. The face mask was adjusted to rest on the forehead and the chin of the patient. Elastics (5/16 inch by 14 ounces) were worn from hooks located 2-3 cm in front of the lips to the intraoral attachments located on the expansion appliance, approximately at the gingival level of the canine. The force generated by the elastics was 600-800 g bilaterally.\nAfter duration of 9 months of orthopedic correction, then the pre-adjusted edgewise appliance was fixed with extraction of lower 1st premolar and treatment was continued for 12 months.\nMaxillomandibular relations [Figures and ] showed significant improvements during the treatment period, with changes due primarily to the increase in the Sella –nasion- point A angle (SNA) angle. The Sella-nasion-point B (SNB) angle showed no significant changes during protraction. The dental measurements showed a tendency for the upper incisors to flare during treatment; the lower incisors were uprighted significantly. Upper or lower molar angulations did not change during treatment.