Treatment of severe skeletal Class III patient with buccally impacted canines and severe crowding using a bone-anchored facemask and Alt-RAMEC protocol: A case report

A 14-year-10-month-old female patient presented with a chief complaint of being dissatisfied with the looks of her teeth and face. She had a pronounced misalignment of her dentition, defined by a Class III skeletal relationship and an average vertical proportion of the face. The patient had an anterior crossbite and bilateral posterior crossbites, with the upper left canine impacted in a buccal position. After a comprehensive consultation with the patient and her parents, we decided to implement a treatment strategy that entailed utilizing a maxillary bone borne expander in conjunction with a facemask. This treatment followed a protocol that consisted of alternating between rapidly expanding and contracting the maxilla. The purpose of this was to stimulate the advancement of the midface. After the treatment was carried out to treat the crossbites, a fixed appliance (MBT prescription) was bonded on the maxillary and mandibular arches. In addition, four premolars were extracted, and the upper left canine was brought to occlusion. Temporary anchorage devices were used in the lower arch to provide skeletal anchorage. The patient underwent active treatment for a period of 24 months following which we were able to achieve satisfactory occlusal and esthetic results.