Non-Extraction Management fo a Camouflaged Class III with Mandibular Repositioning Due to Occlusal Interferences and Severe Dental Wear in an Adult Patient Using Distalization Technique with Skeletal Anchorage

Abstract

Class III malocclusion results from a combination of hereditary and environmental factors and affects various populations, with higher prevalence in Asians and Hispanics. Characteristics include maxillary deficiency, mandibular prognathism, or both, often leading to a pseudo-Class III if left untreated. Traditional treatments involve extractions or interproximal reductions (IPR), but these approaches can be time-consuming and less acceptable to patients, especially in aesthetic zones. Skeletal anchorage with mini-screws offers a modern solution, enabling movements such as full arch distalization, intrusion beyond 1 mm, and multi-planar adjustments without excessive root stress. This method reduces treatment time and avoids complications like bowing effects often seen in conventional techniques. The case study describes a 30-year-old patient with Class III malocclusion, lower arch crowding, and incisor wear. Treatment involved using mini-screws for asymmetrical distalization in all quadrants. Bite blocks facilitated mandibular repositioning, and space was created to align the lower incisors without compromising periodontal health. The treatment took 16 months, including temporary incisal reconstructions and final restoration with lithium disilicate veneers. The patient’s malocclusion, mandibular deviation, and tooth wear were successfully addressed. The skeletal anchorage allowed precise control over movements, maintaining facial height and achieving stable occlusion. Condylar repositioning eliminated zigzag deviation and discomfort. Compared to traditional methods, this approach was faster and tailored to the patient’s needs, avoiding extractions while improving aesthetics and function. Skeletal anchorage proves effective in addressing challenges that traditional orthodontics cannot resolve, offering faster treatment times, better control in all three spatial planes, and improved patient satisfaction. This technique represents a significant advancement in orthodontic care for complex cases.