Alt-Ramec & Myotherapy For Maxillary-Deficient Class III Malocclusion Child

We describe a case of a prepubertal girl in early mixed dentition who underwent maxillary protraction therapy using the alternative expansion-contraction protocol, combined with lingual muscle training. The patient is a 6.5-year-old girl with anterior crossbite, without family history of skeletal malocclusion, no prior deciduous dentition intervention. She presented with a history of recurrent allergic rhinitis contributing to nighttime mouth breathing. Clinical examination showed facial asymmetry with 2 mm right chin deviation, a concave profile and reduced nasolabial angle. Intraoral examination showed anterior crossbite, 2 mm lower midline deviation, and ectopic eruption of teeth #16 and 26; Functional assessment identified habitual tongue thrusting, grade II tonsillar hypertrophy, and CO-CR discrepancy. Cephalometrics analysis confirmed skeletal Class III malocclusion with maxillary deficiency associated with average growth pattern. Theatment protocol comprised Alt-RAMEC-driven maxillary protraction combined with myofunctional therapy targeting lingual posture correction. After 12 months, normal overjet and overbite were achieved with complete midline correction. Continued lingual muscle training was maintained during the retention phase. Fourteen-month follow-up comfirmed stable bilateral Class I molar relationships. Cephalometric superimposition revealed favorable SNA increase (75.7°→78.5°) and L1-MP reduction with controlled vertical development. This case highlights three key determinants: prepubertal maxillary protraction timing; coordinated airway-neuromuscular adaptation; and Alt-RAMEC-driven sutural biomechanics, which potentiate the biomechanical responsiveness of subsequent orthopedic intervention. This case report demonstrates the efficacy of early orthopedic intervention for skeletal Class III malocclusion characterized by maxillary deficiency and impaired tongue posture.