a 10-year - old boy came with a complaint of anterior cross bite to our department .
the patient had no relevant past dental or medical history and no habits . on extra - oral examination
[ figure 1 ] , patient had a dolico - cephalic head shape , lepto - prosobic facial form , concave profile , anterior divergence and acute nasolabial angle .
pre - treatment extraoral photographs on intraoral examination [ figure 2 ] , all soft - tissues and hard tissues were normal .
molar , canine and incisor relationship were class iii on the both right and left side and there was a reverse overjet of 2 mm and overbite of 5 mm and anterior cross bite .
the patient had class iii skeletal base with retrognathic maxilla and prognathic mandible having average growth pattern with labially tipped mandibular incisors .
the objective of the treatment was ( 1 ) to intrude and proclined the upper incisors , ( 2 ) to retroclined the lower incisors .
( 3 ) obtaining class i canine relation . ( 4 ) obtaining ideal overjet and overbite . ( 5 ) obtaining ideal esthetics .
pre - treatment intraoral photographs patient was treated with a combination of face mask and rme [ figures 3 - 5 ] until 2 mm positive overjet was achieved .
the expansion screw was activated one to three turns ( 0.25 mm / turn ) at weekly visits until the desired amount of expansion had been achieved .
the face mask was adjusted to rest on the forehead and the chin of the patient .
elastics ( 5/16 inch by 14 ounces ) were worn from hooks located 2 - 3 cm in front of the lips to the intraoral attachments located on the expansion appliance , approximately at the gingival level of the canine .
rapid maxillary expansion appliance rapid maxillary expansion appliance the face mask applaince after duration of 9 months of orthopedic correction , then the pre - adjusted edgewise appliance was fixed with extraction of lower 1 premolar and treatment was continued for 12 months .
maxillomandibular relations [ figures 6 and 7 ] showed significant improvements during the treatment period , with changes due primarily to the increase in the sella nasion- point a angle ( sna ) angle .
the sella - nasion - point b ( snb ) angle showed no significant changes during protraction .
the dental measurements showed a tendency for the upper incisors to flare during treatment ; the lower incisors were uprighted significantly .
patient was treated with a combination of face mask and rme [ figures 3 - 5 ] until 2 mm positive overjet was achieved .
the expansion screw was activated one to three turns ( 0.25 mm / turn ) at weekly visits until the desired amount of expansion had been achieved .
the face mask was adjusted to rest on the forehead and the chin of the patient .
elastics ( 5/16 inch by 14 ounces ) were worn from hooks located 2 - 3 cm in front of the lips to the intraoral attachments located on the expansion appliance , approximately at the gingival level of the canine .
rapid maxillary expansion appliance rapid maxillary expansion appliance the face mask applaince after duration of 9 months of orthopedic correction , then the pre - adjusted edgewise appliance was fixed with extraction of lower 1 premolar and treatment was continued for 12 months .
maxillomandibular relations [ figures 6 and 7 ] showed significant improvements during the treatment period , with changes due primarily to the increase in the sella nasion- point a angle ( sna ) angle .
the sella - nasion - point b ( snb ) angle showed no significant changes during protraction .
the dental measurements showed a tendency for the upper incisors to flare during treatment ; the lower incisors were uprighted significantly .
this case report showed the results of the treatment of patients with class iii malocclusion at an early stage with an efficient orthodontic therapy of rme plus maxillary protraction .
class iii combination therapy is a comprehensive non - surgical treatment strategy designed for developing skeletal class iii malocclusions by incorporating orthodontic and orthopedic mechanics to effectively improve the patient 's occlusion and profile . in properly selected cases ,
this modality of treatment can be a successful alternative that satisfies a patient 's request to avoid surgery or premolar extraction .
 a case report is presented of a class iii malocclusion with a class iii skeletal pattern and maxillary retrusion . 
 patient , a 10-year - old boy was treated with an orthopedic face mask in conjunction with rapid maxillary expansion and standard pre - adjusted edgewise appliance . 
 treatment was completed after 3 years and proved to be stable following the active treatment . 
Case Report
Treatment progress
Treatment results
Discussion