Introduction
Class III malocclusion, characterized by maxillary deficiency, mandibular prognathism, or a combination of both, poses both functional and esthetic challenges. Early orthopedic intervention can redirect growth and improve skeletal harmony. Reverse pull headgear (facemask therapy) combined with a 2×4 fixed appliance is a proven interceptive approach to stimulate maxillary growth and correct anterior crossbite. This case series highlights the successful management of growing patients with skeletal and dental Class III malocclusion corrected to Class I occlusion.
Chief complaint
Anterior cross bite with very short upper lip
History
Age group: 8.5 to 9.5 years
Diagnosis: Skeletal and dental Class III with anterior crossbite and retrognathic maxilla
Growth status: Pre-pubertal patients (favorable growth modification window)
Treatment objective
Forward displacement of maxilla, correction of anterior crossbite, establishment of positive overjet and Class I molar relationship.
Treatment Protocol
Orthopedic Phase
Appliance: Reverse pull headgear with maxillary splint
Duration: 6–9 months depending on severity
Effect achieved: Forward movement of maxilla, correction of sagittal discrepancy, improvement in facial convexity.
Orthodontic Phase
Appliance: 2×4 fixed appliance (bands on first molars, brackets on upper incisors)
Objective: Alignment of incisors, elimination of anterior crossbite, coordination of arches, achieving Class I incisor relationship.
Duration: 4 -8weeks
Results
Skeletal correction: SNA increased, ANB angle improved toward Class I values.
Dental correction: Positive overjet achieved, elimination of anterior crossbite, Class I molar and canine relation established.
Facial esthetics: Marked improvement in profile with forward positioning of upper lip and balanced facial appearance.
Stability: Follow-up at 1–2 years showed stable results with continued growth modification.
Discussion
Early interceptive treatment with reverse pull headgear and 2×4 appliance significantly improves skeletal and dental relationships in growing Class III patients. The combination enhances skeletal changes while minimizing dental compensations. Success depends on early diagnosis, compliance, and close monitoring of growth.
Conclusion
Reverse pull headgear combined with a 2×4 appliance is an effective protocol in managing skeletal and dental Class III malocclusion in growing patients. This approach corrects sagittal discrepancies, improves esthetics, and reduces the likelihood of future surgical intervention.