Maxillary Skeletal Expander In An Adult With Class III Malocclusion

Micro-implant-assisted maxillary skeletal expander (MSE) therapy, have been shown an effective treatment protocol on non-growing patient with skeletal transverse deficiency recently. This case report describes successful treatment of an adult of posterior crossbite by MSE and uncommon lower incisor extraction. A 22-year-old female patient with a chief complaint of crowding, and presented with hyperdivergent facial morphology, Class III molar relationships, posterior/anterior crossbites, and round V-shape arch form. She was diagnosed with skeletal/dental Class III relationship and hyperdivergent pattern. A customized Hyrax MSE device are anchored by two molar bands and four miniscrews. To simplify the treatment, the selected extraction of mandibular right central incisor was conducted to solve dental crowding and anterior crossbite. The treatment was effective and the total treatment period was only 17-month, the final results demonstrated improvement of facial profile, aligned teeth and ideal overbite and overjet. 1-year follow-up showed stable occlusion and arch forms with a harmonious facial profile. MSE therapy was an innovative clinical orthodontic practice in treatment of adult maxillary deficiency cases, which can provide stable skeletal expansion effects, decrease dental tipping side effect by regular maxillary expansion, and reduce risk and cost compared with surgery. The extraction of the mandibular central incisor could effectively alleviate arch crowding, but it would affect final midline coordinate. Micro-implant-assisted maxillary skeletal expander and mandibular incisor extraction can be considered an effective camouflage treatment protocol of skeletal and dental Class III malocclusion in adult patient.