Treatment Of Severe Maxillary Hypoplasia In Deciduous Dentition

This case report describes maxillary protraction in a 4-year-old boy with severe maxillary hypoplasia whose chief complaint is anterior crossbite. The patient presented with a ​severe concave facial profile, ​mesial relationship of deciduous molars and canines, ​Class III reverse overbite, and ​Class I reverse overjet. Cephalometric analysis revealed critical skeletal discrepancies: ​ANB angle -4.2°, ​Wits appraisal -11.4 mm, ​Ptm-A distance 32.2 mm, and Po-NB 1.1mm. There was no special systemic or past medical history. Despite counseling the parents regarding the potential necessity for future ​orthodontic-orthognathic combined therapy, they insisted on immediate intervention due to observed ​psychosocial impacts - notably the child's reluctance to smile. A ​fixed bonded facemask protraction appliance was delivered with 226.8g per side, 16 months of active traction (minimum 12 hours daily), and hybrid design combining dental and skeletal support. Post-treatment evaluation demonstrated ​significant improvement in lateral facialprofile (conversion to balanced convexity) and normalization of anterior overbite/overjet. At the 29-month post-treatment follow-up, cephalometric evaluation demonstrated sustained maintenance of a balanced lateral facial profile, with normal anterior overbite and overjet. Our clinical series demonstrates that ​compliant patients in deciduous dentition achieve maxillary repositioning, ​psychosocial benefit via facial esthetic enhancement and ​functional optimization of mastication and speech. Maxillary protraction in deciduous dentition constitutes a viable therapeutic modality for severe maxillary hypoplasia.