Korean J Orthod.  2019 Sep;49(5):338-346. 10.4041/kjod.2019.49.5.338.

Correction of Class III malocclusion with alternate rapid maxillary expansions and constrictions using a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment: A case report

• Martínez-Smit R
• Aristizabal JF
• Pereira Filho VA

• KMID: 2458622
• DOI: http://doi.org/10.4041/kjod.2019.49.5.338

Abstract

In this report, we describe the successful use of alternate rapid maxillary expansions and constrictions with a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment for the management of severe Class III malocclusion due to maxillary hypoplasia in an 11-year-old girl. The devices were removed after 20 months of treatment, and the family was instructed about a careful control and retention program that should be followed in accordance with the patient's growth. The final result included the correction of Class III malocclusion with adequate function and excellent facial esthetics, which restored the patient's self-esteem and provided personal motivation. The outcomes showed good stability after 24 months of retention. The decrease in the duration of active treatment is the most important finding from the present case. Considering that facial esthetics in adolescence is a determining factor for the development of a personality and interpersonal relationships, we recommend the use of this protocol for growing patients, who will exhibit not only an improved physical appearance but also a better quality of life.

Keyword

Orthopedics; Bone anchorage; Maxillary protraction; Class III malocclusion

MeSH Terms

Adolescent
Body, Physical Appearance
Child
Constriction*
Esthetics
Female
Humans
Malocclusion*
Motivation
Orthopedics
Quality of Life

Figure

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  Figure 1 Pretreatment extra- and intra-oral photographs of a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 2 Pretreatment lateral cephalogram, panoramic radiograph, and cone-beam computed tomography images for a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 3 Silicone impression for the fabrication of a hybrid hyrax appliance for alternate rapid maxillary expansions and constrictions in a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 4 A fabricated hybrid hyrax appliance for alternate rapid maxillary expansions and constrictions in a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 5 Intraoral photographs after an 8-week alternate rapid maxillary expansions and constrictions protocol with simultaneous orthodontic treatment in a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 6 Fixation of mandibular miniplates after an 8-week alternate rapid maxillary expansions and constrictions protocol with simultaneous orthodontic treatment in a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 7 Fixation of intermaxillary elastics extending from the mandibular miniplates to the hybrid hyrax appliance and from the mandibular to the maxillary brackets in a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 8 Final intra- and extra-oral photographs after 20-month treatment involving alternate rapid maxillary expansions and constrictions with a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment for a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 9 Final radiographs after a 20-month treatment period involving alternate rapid maxillary expansions and constrictions with a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment for a young girl with severe Class III malocclusion due to maxillary hypoplasia. A, Lateral cephalogram; B, superimposition of pre- (T0) and post-treatment (T1) lateral cephalograms; C, panoramic radiograph.

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  Figure 10 Extra- and intra-oral photographs obtained after 24 months of retention following treatment involving alternate rapid maxillary expansions and constrictions with a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment for a young girl with severe Class III malocclusion due to maxillary hypoplasia.

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  Figure 11 Radiographs obtained after 24 months of retention following treatment involving alternate rapid maxillary expansions and constrictions with a hybrid hyrax-mandibular miniplate combination and simultaneous orthodontic treatment for a young girl with severe Class III malocclusion due to maxillary hypoplasia. A, Lateral cephalogram; B, superimposition of post-treatment (T1) and post-retention (T2) lateral cephalograms; C, panoramic radiograph.

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