ABSTRACT 

This case report presents the early orthopedic and comprehensive orthodontic treatment of a growing male patient whose chief complaint was a retruded maxilla. At the start of treatment (age 12 years 7 months), examination revealed an asymmetric facial appearance, a concave profile, a hypodivergent (low-angle) skeletal growth pattern (Jarabak ratio, 68.8%), a borderline skeletal Class I relationship (ANB, 0.6°) with maxillary retrusion (N-A, -2.1 mm; Wits, -4.2 mm), an asymmetric Class III molar relationship, and a negative overjet (-1.5 mm). Model analysis showed a 6.4-mm maxillary arch-length deficiency, no mandibular crowding, bilateral impaction of the maxillary canines and the maxillary left second premolar, and congenital absence of both mandibular second premolars. Treatment consisted of a hybrid-anchorage rapid maxillary expander combined with a protraction facemask, followed by comprehensive fixed appliance therapy, over 2 years 6 months. At the end of treatment (age 15 years), a stable skeletal Class I relationship was achieved (ANB, 3.5°; SNA increased by 4.9°), together with a bilateral Class I molar and canine relationship, a positive overjet and overbite of 2 mm each. This case illustrates that a hybrid RME/facemask protocol followed by fixed appliance therapy can be an effective approach for growing patients with an asymmetric, low-angle skeletal Class III tendency complicated by multiple dental anomalies.

KEYWORDS

skeletal Class III malocclusion; hybrid rapid maxillary expansion; protraction facemask; early orthodontic treatment; cephalometric analysis; case report

REFERENCES

1) Bolton WA. Disharmony in tooth size and its relation to the analysis and treatment of malocclusion. Angle Orthod. 1958;28(3):113-130.
2) Nance HN. The limitations of orthodontic treatment. I. Mixed dentition diagnosis and treatment. Am J Orthod Oral Surg. 1947;33(4):177-223.
3) Jarabak JR, Fizzell JA. Technique and Treatment with Light-Wire Edgewise Appliances. 2nd ed. St. Louis: C.V. Mosby; 1972.
4) Steiner CC. Cephalometrics for you and me. Am J Orthod. 1953;39(10):729-755.
5) Jacobson A. The Wits appraisal of jaw disharmony. Am J Orthod. 1975;67(2):125-138.
6) Maino G, Turci Y, Arreghini A, Paoletto E, Siciliani G, Lombardo L. Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients. Am J Orthod Dentofacial Orthop. 2018;153(2):262-268.
7) Maino GB, Cremonini F, Maino G, Paoletto E, De Maio M, Spedicato GA, Palone M, Lombardo L. Long-term skeletal and dentoalveolar effects of hybrid rapid maxillary expansion and facemask treatment in growing skeletal Class III patients: a retrospective follow-up study. Prog Orthod. 2022;23:33.
8) Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer S, Nucera R. Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res. 2014;17(3):133-143.
9) Woon SC, Thiruvenkatachari B. Early orthodontic treatment for Class III malocclusion: a systematic review and meta-analysis. Am J Orthod Dentofacial Orthop. 2017;151(1):28-52.
10) Laganà G, Venza N, Lione R, Chiaramonte C, Danesi C, Cozza P. Associations between tooth agenesis and displaced maxillary canines: a cross-sectional radiographic study. Prog Orthod. 2018;19:26.
11) Williams R, Park JH, Chae JM, Vaden JL. The congenitally missing second premolar: Space closure. A viable option. Am J Orthod Dentofacial Orthop. 2020;157(4):571-583.

Cite this article

SAĞIR, E. (2026). Early Orthopedic and Comprehensive Orthodontic Treatment of a Growing Patient with an Asymmetric, Low-Angle Skeletal Class III Tendency using a Hybrid Rapid Maxillary Expander and Facemask: A Case Report. INTERNATIONAL JOURNAL OF HEALTH & MEDICAL RESEARCH, 5(9), 901-907. https://doi.org/10.58806/ijhmr.2026.v5i9n06