Torque control in camouflage treatment of a borderline adult skeletal class III malocclusion with en-masse mandibular distalization using buccal-shelf miniscrews: A case report

Rationale: Adult skeletal class III patients who decline orthognathic surgery may be treated with nonsurgical dentoalveolar camouflage. Extra-alveolar anchorage on the mandibular buccal shelf enables en-masse total-arch distalization and clinically meaningful sagittal correction without relying on patient compliance. Patient concerns: A 19-year-old male presented with an edge-to-edge anterior relationship and generalized spacing. He was satisfied with his facial appearance and declined surgery. Diagnoses: The patient was diagnosed with a borderline adult skeletal class III malocclusion characterized by a mildly hypodivergent pattern, concave profile, bilateral angle class III canine and molar relationships, edge-to-edge anterior relationship, anterior spacing, maxillary incisor proclination, and mild mandibular incisor lingual inclination. Interventions: Fixed self-ligating brackets were used with proactive torque control including lower incisor brackets inversion to express positive torque and 0.019 × 0.025-in stainless-steel archwires with added torque. After extraction of the mandibular third molars, 2 buccal-shelf miniscrews with power arms delivered distalizing forces. Outcomes: Bilateral class I relationships, space closure, and positive overjet were achieved. Cephalometric changes indicated approximately 4 to 5 mm of mandibular dentoalveolar distalization with controlled tipping and lingual root movement, while the Wits appraisal improved substantially despite slight changes in anteroposterior skeletal measures. Favorable sagittal changes were interpreted cautiously because they may reflect mandibular clockwise rotation and dentoalveolar effects rather than true basal skeletal correction. Lessons: In carefully selected borderline adult class III patients, buccal-shelf miniscrew–anchored en-masse mandibular distalization can deliver upper-range camouflage when torque- and vertical-control biomechanics are actively maintained. Soft-tissue improvements remain limited compared with orthognathic surgery.