A novel method for treatment of Class III malocclusion in growing patients

BACKGROUND: Management of Class III malocclusion is one of the most challenging treatments in orthodontics, and several methods have been advocated for treatment of this condition. A new treatment protocol involves the use of an alternating rapid maxillary expansion and constriction (Alt-RAMEC) protocol, in conjunction with full-time Class III elastic wear and coupled with the use of temporary anchorage devices (TADs). The aim of this study was to evaluate the dento-skeletal and profile soft tissue effects of this novel protocol in growing participants with retrognathic maxilla. METHODS: Fourteen growing participants (7 males and 7 females; 12.05 ± 1.09 years), who displayed Class III malocclusions with retrognathic maxilla, were recruited. Pre-treatment records were taken before commencing treatment (T1). All participants had a hybrid mini-implant-supported rapid maxillary expansion (MARME) appliance that was activated by the Alt-RAMEC protocol for 9 weeks. Full-time bone-anchored Class III elastics, delivering 400 g/side, were then used for maxillary protraction. When positive overjet was achieved, protraction was ceased and post-treatment records were taken (T2). Linear and angular cephalometric variables were blindly measured by one investigator and repeated after 1 month. An error measurement (Dahlberg’s formula) study was performed to evaluate the intra-examiner reliability. A paired-sample t test (p < 0.05) was used to compare each variable from T1 to T2. RESULTS: Treatment objectives were achieved in all participants within 8.5 weeks of protraction. The maxilla significantly protracted (SNA 1.87°± 1.06°; Vert.T-A 3.29± 1.54 mm p < 0.001), while the mandibular base significantly redirected posteriorly (SNB −2.03° ± 0.85°, Vert.T-B − 3.43± 4.47 mm, p < 0.001 and p < 0.05 respectively), resulting in a significant improvement in the jaw relationship (ANB 3.95°± 0.57°, p < 0.001; Wits 5.15± 1.51 mm, p < 0.001). The Y-axis angle increased significantly (1.95° ± 1.11°, p < 0.001). The upper incisors were significantly proclined (+ 2.98°± 2.71°, p < 0.01), coupled with a significant retroclination of the lower incisors (− 3.2°± 3.4°, p < 0.05). The combined skeletal and dental effects significantly improved the overjet (5.62± 1.36 mm, p < 0.001) and the soft tissue Harmony angle (2.75° ± 1.8°, p < 0.001). CONCLUSIONS: Class III elastics, combined with the Alt-RAMEC activation protocol of the MARPE appliance, is an efficient treatment method for mild/moderate Class III malocclusions. The long-term stability of these changes needs further evaluation.