Correction of Class III Malocclusion in Late Adolescent Patient with Hyrax Appliance and Facemask Using Alt-RAMEC Protocol: A Case Report

Abstract

Class III malocclusion is always a challenging treatment and has been the subject of interest in many investigations due to the challenges it poses. It can be caused by maxillary retrognathism, mandibular prognathism, or a combination of the two. In around 40% of Class III patients, the cause is maxillary retrognathia. The condition can be treated either by camouflage or by surgery to correct the skeletal disharmony. However, camouflage treatment doesn’t result in a drastic change to the facial profile when it involves skeletal disharmony and may recur after treatment is completed. To increase the stability of this treatment, the patient’s growth and age phase are decisive factors. In young children, the circumaxillary sutures are patent, and protraction of the maxilla can be aided by opening these sutures with orthopaedic force. Protraction appliances like face masks are used to support the growth of a deficient maxilla in cases of maxillary retrognathism. The current case report of a 13-year-six-month-old male presented the correction of class III skeletal malocclusion with an anterior crossbite in a growing patient using the “Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol” and face-mask treatment with the Hyrax appliance. Skeletal class III can be due to mandibular excess, maxillary deficiency, or a combination of both. The treatment time was 18 months, and a notable improvement was observed in the soft tissue profile when assessed through cephalometric measurements and photographs