PMC9214454_01
Pretreatment extraoral photographs. Patient reported with the chief complaint of forwardly placed lower jaw
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F1
The upper midline was co-incident with facial midline [Figure 1]. Hehad a nasolabial angle (110 ), retrusive upper lip (UL-E line = -3 mm) and protrusive lower lip (LL-E line = 3.9 mm) [Figure 4b, Table 1]. Antero posterior bite was corrected, and positive overjet was achieved [Figures 6-8 and Table 1]. Mandible was slightly rotated downwards and backward with change in FMA from 23.6  to 28  [Figure 15 and Table 1].
Pretreatment intraoral photographs with poor anterior relationship with Class III malocclusion
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F2
Lower midline was shifted towards left side by 2 mm ([Figure 2].
Pretreatment digital models
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F3
Evaluation of digital models [Figure 3] confirmed the clinical findings.
Pretreatment radiographs of the patient. (a)-Pretreatment orthopantomogram of patient at mixed dentition stage. (b)-Pretreatment lateral cephalogram showing skeletal Class III patient (c) Pretreatment posteroanterior cephalogram of patient
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F4
Screening of orthopantomogram (OPG) radiograph showed normal condyle glenoid fossa relationship [Figure 4a]. Hehad a nasolabial angle (110 ), retrusive upper lip (UL-E line = -3 mm) and protrusive lower lip (LL-E line = 3.9 mm) [Figure 4b, Table 1]. Postero-anterior cephalogram revealed no gross asymmetry but showed skeletal constriction of maxilla (J-J/Ag-Ag = 74%) [Figure 4c].
Hyrax expansion during first phase of orthopedic treatment
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F5
A bonded hyrax with facemask was delivered to the patient [Figure 5].
Superimposition of digital model showing pre and post-orthopedic transverse expansion
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F6
Antero posterior bite was corrected, and positive overjet was achieved [Figures 6-8 and Table 1].
Post orthopedic extraoral photographs exhibiting improvement in profile
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F7
Antero posterior bite was corrected, and positive overjet was achieved [Figures 6-8 and Table 1].
Post orthopedic Photographs and lateral cephalogram showing correction of overbite
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F8
Antero posterior bite was corrected, and positive overjet was achieved [Figures 6-8 and Table 1].
Chin cup retention after orthopedic phase
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F9
After the facemask therapy, the chin-cup appliance was given as a retention appliance to redirect the mandibular growth [Figure 9].
GTRV ratio of the patient
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F10
Horizontal changes of maxilla and mandible were determined by locating the point A and point B on cephalogram [Figure 10].
Record of patient before orthodontic treatment
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F11
Complete records including extraoral, intraoral photographs and radiographs were taken at this stage [Figure 11].
Pre(a) and post(b) treatment extraoral photographs of the patient
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F12
The post treatment records showed that the facial esthetics significantly improved [Figure 12] by forward positioning of the maxilla leading to less prognathic appearance of the mandible.
Pre(a) and post(b) treatment intraoral photographs of the patient
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F13
Upper and lower arches were aligned and transverse expansion of 5 mm in molar region and 2 mm in canine region was achieved [Figure 13].
Post orthodontic digital models of the patient
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F14
The patient achieved a good functional occlusion with acceptable interdigitation as evident by post treatment digital models [Figure 14].
Pre(a) and post(b) treatment lateral cephalogram of the patient
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F15
Mandible was slightly rotated downwards and backward with change in FMA from 23.6  to 28  [Figure 15 and Table 1].