Bone-anchored Facemask Combined with the Alt-RAMEC Protocol for Treatment of Severe Skeletal Class III Patient Complicated by Buccally Impacted Canine and Severe Crowding: A Case Report

A 14-year-old S.F.Iraqi female patient presented with a main issue of being dissatisfied with the aesthetics of her teeth and face.She had a pronounced misalignment of her teeth, defined by a Class III skeletal relationship and a decrease in vertical dimension.The patient had an anterior crossbite and bilateral posterior crossbite, with the upper left canine impacted in a buccal position, it was not feasible to implement the typical early treatment for Class III cases, which entails utilizing rapid palatal expansion in conjunction with a facemask.After a comprehensive consultation with the patient and her parents, we have decided to implement a treatment strategy that entails utilizing a maxillary bone expander in conjunction with a facemask.This therapy will entail a procedure that consists of alternating between rapidly enlarging and narrowing the upper jaw.The purpose of this is to stimulate the advancement of the central region of the face.After the treatment was carried out to repair an anterior crossbite, a fixed appliance (MBT prescription) on the upper and lower teeth.In addition, the fourth premolars were removed and the upper left canine was freed from impaction.Temporary anchorage devices (TADs) were used in the lower arch to provide secure and steady support.The patient underwent active treatment for a period of 24 months, during which they experienced substantial tension in the upper jaw and a notable change in their facial profile.The girl and her parents expressed satisfaction with the result of the treatment, despite the requirement for ongoing monitoring due to the uncertain residual growth of the lower jaw.