Maxillary protraction and vertical control utilizing skeletal anchorage for midfacial-maxillary deficiency

INTRODUCTION: The efficacy and efficiency of early treatment of skeletal Class III patients with facemask therapy are well-documented; however, very few cases for adolescents or adults were reported. OBJECTIVE: The aim of this case report was to demonstrate skeletal and dental correction of a post-pubertal-growth-spurt patient whose malocclusion consisted of a skeletal Class III with slight transverse deficiency, a high mandibular plane angle, and a retrusive maxillary complex. CASE REPORT: A 13-year-5-months old Hispanic female was diagnosed as a retrognathic maxilla and mandible, a high mandibular plane angle, open bite pattern, a bilateral Angle Class I molar relationship with an anterior crossbite on the maxillary lateral incisors. A TAD-supported Haas rapid palatal expander was utilized for maxillary protraction combined with a facemask, vertical control, and maxillary molar distalization with fixed appliance. RESULTS: The total treatment time was 26 months. An improved facial profile with maxillary lip support and more prominent cheeks was established. Adequate vertical control prevented a change in the mandibular plane angle even though facemask treatment can increase the vertical dimension. After the 18-month retention, excellent stability of the treatment results was shown. CONCLUSION: With skeletal anchorage and facemask treatment, orthodontists have the ability of expanding and protracting the maxilla without tipping maxillary molars buccally and without the risk of unfavorable periodontal consequences. A TAD-supported Haas rapid palatal expander allowed to control the vertical dimension and distalize molars, while minimizing undesired consequences.