Two-phase Treatment of Growing Skeletal Class III Malocclusion with Facial Asymmetry Using a Tooth-borne Appliance and Intermaxillary Class III Elastics: A Case Report

Background Growing skeletal Class III malocclusion with facial asymmetry presents a significant orthodontic challenge, particularly when orthognathic surgery is declined. Case Report A 13-year-old girl with growing skeletal Class III malocclusion and functional facial asymmetry was treated in two phases. Phase 1 consisted of a removable posterior bite plane, rapid maxillary expansion, sequential bite plane reduction, and intermaxillary Class III elastics. Phase 2 comprised comprehensive fixed appliance treatment to refine the occlusion. Treatment was completed in 34 months. Results A positive overjet, Class I canine and molar relationships, improved facial symmetry, and a more balanced facial profile were achieved. The treatment results remained stable after two years of retention. Conclusion Two-phase orthodontic treatment using a tooth-borne appliance and intermaxillary Class III elastics may provide a nonsurgical treatment option for selected growing Class III patients with functional facial asymmetry.