Nonsurgical Management of Skeletal Class III Malocclusion with Anterior Open Bite Using a Customized Angel Aligner Pro Protocol: A Case Report

Background: Skeletal Class III malocclusions with anterior open bite are considered among the most difficult orthodontic challenges in adult patients. They are frequently associated with functional limitations, compromised smile esthetics and reduced quality of life. Orthognathic surgery has traditionally been the treatment of choice, whereas orthodontic camouflage with fixed appliances, extractions or skeletal anchorage has been reserved for mild to moderate cases. However, many patients decline surgical approaches due to their invasiveness, risks and costs. Clear aligner therapy has recently emerged as a less invasive alternative, with documented advantages in vertical control, sagittal correction and patient acceptance. Methods and Findings: A 34-year-old Caucasian female presented with skeletal, dental and dentoalveolar Class III malocclusion characterized by anterior crossbite and anterior open bite. The patient declined surgical correction and was treated using a customized Angel Aligner Pro protocol. A 4×4 staging sequence was implemented, with 4 days per aligner and 8 days per stage, for a total active treatment time of 30 weeks. Biomechanical strategies included: A high posterior trim line to maximize retention and anchorage A specific attachment design to promote controlled extrusion of anterior teeth and sagittal correction of the lower incisors An accelerated staging protocol designed to maintain biological predictability while enhancing treatment efficiency The patient showed excellent compliance. At the end of treatment, all six Andrews’ keys of occlusion were satisfied, with a positive overjet of 2 mm, overbite of 2 mm and bilateral Class I molar and canine relationships. Smile esthetics and incisor display were significantly improved and no refinements were required. The treatment was completed without adverse effects in less than eight months. Conclusion: This case demonstrates that customized clear aligner biomechanics can effectively manage skeletal Class III malocclusion with anterior open bite in adult patients who decline surgery. The combination of high-trim line mechanics, customized attachments and accelerated aligner staging allowed for a predictable and efficient correction within a short timeframe. These results reinforce the role of aligner therapy not only for mild camouflage but also for more complex Class III scenarios requiring vertical control and precise anterior guidance.