Orthodontic Management of a Growing Patient With a Skeletal Class III Malocclusion and an Anterior Open Bite: A Case Report

Class III malocclusion presents many challenges due to its varying elements of imbalance in skeletal, dental, and soft tissues. This necessitates a comprehensive treatment plan, including growth modification during the pre-pubertal growth phase, and long-term retention to reduce the chances of orthognathic surgery later. The components of Class III malocclusion include maxillary retrognathism, mandibular prognathism, or, in some cases, a combination of both. This article presents a case report of a pre-pubertal female patient, 11.5 years old, with skeletal Class III malocclusion, who sought orthodontic treatment for a backwardly positioned upper jaw. The case was complicated due to a vertical growth pattern with an FMA of 36 degrees, a constricted maxilla in a retrognathic position, unerupted maxillary canines, mandibular anterior crowding, and an anterior open bite. During the first phase of treatment, maxillary protraction with rapid palatal expansion was performed using a facemask appliance and a bonded Hyrax expander. Corrective orthodontics with a fully fixed labial appliance followed after the retention period for maxillary expansion. A functionally stable occlusion was achieved with good vertical control. The patient was satisfied with an aesthetically pleasing smile at the end of the treatment. However, orthognathic surgery might be needed to address the problem of a prominent chin and severe vertical growth pattern. Furthermore, the patient was recommended to wear a vertical pull chin cup for 12 hours daily to prevent any further mandibular growth. Early intervention yielded favorable outcomes, including improvement in skeletal discrepancy, spontaneous eruption of maxillary canines, and an aesthetically enhanced facial profile. The present case report highlights the importance of timely management of malocclusion in growing patients.