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Background: Deep bite is one of the main common occlusal discrepancies of mixed dentition period and anterior bite plate is recommended in early mixed dentition to correct the trait and prevent the future malocclusion. The aim of this study was to assess the effect of anterior bite plate on the correction of deep bite in early mixed dentition. Methods: This retrospective semi-experimental clinical trial was conducted on 16 patients (8 males, 8 females) with deep bite and class II malocclusion in early mixed dentition. Cephalometric radiographs were obtained from patients’ records before and after the application of anterior bite plate. Changes in 11 various angular, ratio and distance measures were evaluated by tracing the cephalograms. Collected data were then analyzed using paired t-test. Results: Statistical differences were evaluated before and after the use of anterior bite plate appliance. Change in overbite, overjet, ANB angulation, anterior facial height, posterior facial height and Jarabak index were calculated with results indicative of significant changes (P < 0.017, P < 0.041, P < 0.001, P < 0.0001, P < 0.0001, P < 0.012). However, no significant difference in the degree of SNA, SNB, Go.Gn.SN, Y-axis and incisor to the mandibular plane angle (IMPA) was noted following the application of the appliance (P > 0.914, P > 0.219, P > 0.753, P > 0.276, P > 0.062). Conclusions: Treatment with the anterior bite plate was shown to be effective in correction of the deep bite in cases with class II malocclusion with little need for complex fixed appliance therapy.

Background and aim: Cleft lip and cleft palate are among the most common orofacial abnormalities. Patients with these deformities commonly present with midface deficiency and need challenging treatment modalities that focus on improving the position of the maxilla. Tongue plate appliance is an intraoral device that has shown promising results in the treatment of growing patients with maxillary deficiency. Nonetheless, the effects of tongue plate on patients with cleft lip and cleft palate have not been evaluated yet. This study aimed to assess the effects of tongue plate on growing patients with cleft lip and palate. Materials and methods: Twenty-four growing patients (12 girls and 12 boys) with non-syndromic unilateral cleft lip and cleft palate between the ages of 6-12 years volunteered to participate in this quasi-experiment. All the patients had undergone the preliminary stages of lip and palate closure during infancy, but none of them had received bone grafts. They were treated with tongue plate appliance for 18±3 months. Lateral cephalograms were obtained and were analyzed at the beginning and at the end of the treatment. Paired t-test was used for statistical analysis of normally-distributed data; otherwise, Wilcoxon test was used. Results: Paired t-test showed that the Sella-Nasion-Point A (SNA) angle was increased from 76.3±0.2 to 77.3±0.14 degrees, and the Point A-Nasion-Point B (ANB) angle was enhanced from -2.26±0.17 to 0.93±0.82 degrees (P

Objective: The present study was designed to compare the effects of two surgical methods, anterior maxillary segmental distraction (AMSD) versus conventional Le Fort I osteotomy, on cephalometric changes of velopharyngeal area of patients with cleft lip and palate. Materials and Methods: This study was conducted on 20 CLP in two groups. The first group had classic Le Fort I maxillary advancement and the second group had AMSD with a modified hyrax as an intraoral tooth-borne distractor. In the second group, 1 week after the surgery, activation of hyrax screw was started with the rate of 2 times a day for about 10 days. Initial and final lateral cephalograms were traced and analyzed by OrthoSurgerX software. Results: The changes in variables evaluating velopharyngeal status showed a significant difference between the two groups. In Group A (conventional), the mean of nasopharyngeal area and Nasopharynx floor length showed a significant increase (P < 0.05) after the surgery, while in Group B (DO), the trend of changes was vice-versa. The changes in SNA, overjet, and soft-tissue convexity were similar in both groups. Conclusion: AMSD can improve facial profile, almost similar to the conventional Le Fort I advancement, while there is a significant decrease in nasopharyngeal; hereby there is no increase in the velopharyngeal sphincter.

BACKGROUND: Distraction osteogenesis (DO) is rapidly becoming a mainstream surgical technique for correction of maxillary deficiency. The aim of this study was to compare the effectiveness of a newly designed tooth-borne osteogenic distraction device with conventional Le Fort 1 osteotomy in maxillary advancement of cleft lip and palate patients. METHODS: The DO group consisted of 10 subjects (7 males, 3 females) with a mean age of 21.2 (SD 4.2) years. In these patients, the newly designed distraction device which exerted force anteroposteriorly was cemented after mobilization of the maxilla. After a latency period of 7 days, the distractor was activated twice daily by a total amount of 0.5 mm per day. The activation was continued for 3 weeks. A fter an 8-week consolidation period, the distraction appliance was removed. Cephalograms of DO patients were obtained at the start of distraction and at the end of consolidation. The Le Fort 1 group consisted of 11 subjects (6 males, 5 females) with a mean age of 22.3 (SD 3.7) years. Pre and postsurgery lateral cephalograms were obtained. t-test and paired t-test were used to evaluate the data. RESULT S: At the end of treatment, the SNA angle of Le Fort 1 patients increased by 5.5° (SD 2.3) (P

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the effect of DO done by a hyrax screw incorporated in an acrylic plate in the treatment of two maxillary deficient cases with cleft lip and palate. Two patients, a 24-year-old female and a 29-year-old male who suffered from maxillary deficiency and cleft lip and palate, were treated by DO. After making vertical cuts between the premolars on both sides and horizontal cuts similar to Le Fort 1, a hyrax screw was mounted on an acrylic plate for the slow anteroposterior expansion of maxillary arch. The expansion was achieved by turning the hyrax screw 0.8 mm per day after the latency period. Treatment was discontinued after achieving satisfactory over jet and occlusion. This study showed that anterior maxillary distraction is a reliable technique for correction of midfacial deformity arising out of cleft lip and palate. Incidences of complications are negligible compared to total maxillary distraction.

Objectives The purpose of this randomized trial study was to compare the effects of facemask and Tongue appliance in treatment of Class III malocclusion with maxillary deficiency in growing patients. Materials & methods 45 patients (22 males, 23 females) with maxillary deficiency were selected and randomly assigned to 2 groups. 22 patients (10 boys, 12 girls) with the mean age of 9.3 years ± 1.2 years were treated with facemask. 23 patients (12 boys, 11 girls) with the mean age of 10.1 years ± 0.7 years were treated by Tongue appliance. Lateral cephalograms obtained at the beginning and end of the study were analyzed. Results Paired t-tests and Wilcoxon test showed that SNA and ANB significantly increased in both groups. Mann-Whitney test showed that there were no statistically significant differences between the two groups except for Jarabak ratio and Upper 1 to SN. U1 to SN increased by 11.1 ± 6.9° in fixed facemask group and 2.5 ± 6.1° in Tongue appliance group (P Both treatment modalities were successful in moving the maxilla forward. However, the upper incisors had more labial inclination in the facemask group.

Introduction. Numerous devices have been introduced for correction of Class III malocclusion and maxillary deficiency. Aim. To assess the dentoskeletal effects of miniplates combined with Class III traction in treating Cl III malocclusion and maxillary deficiency in growing patients. Methods. This case describes the treatment of a maxillary-deficient 11-year-old boy by using miniplates. The patient's parents rejected the use of extraoral appliances and major surgical correction; therefore the treatment was done by using Class III elastics connected from two mandibular miniplates to an upper removable appliance. Two miniplates were inserted in the anterior part of the mandible in the canine areas under local anaesthesia. The treatment lasted for 10 months after which favourable correction of the malocclusion was observed. Results. The SNA and ANB angles increased by 5.1° and 4.4°, respectively. Lower 1 to mandibular plane decreased by 3.4°. Conclusions. This case demonstrates that miniplates can be a suitable method to extraoral appliances and major surgery in maxillary deficiency cases.

The purpose of this study was to compare the effects of a differently designed functional appliance (the R-appliance) with a twin-block (TB)-treated group. Thirty patients (18 girls and 12 boys) with a mean age of 10.5 ± 0.7 years were treated with the R-appliance for 16.2 ± 0.3 months and 25 (11 boys and 14 girls) with a mean age of 11.2 ± 1.3 years with a TB for 16.1 ± 1.4 months (control). All had a Class II division 1 malocclusion due to mandibular deficiency. Lateral cephalograms obtained at the beginning (T1) and end (T2) of the study were analysed. Paired t -tests showed that SNB significantly increased in both groups. The incisor mandibular plane angle (IMPA) was reduced in the R-appliance group by 1.9 ± 4.9 degrees ( P < 0.04) but increased by 0.5 ± 5.1 degrees ( P < 0.6) in the TB group. SNA in the R-appliance group showed an increase of 0.2 ± 1.8 degrees ( P < 0.5), while it was decreased by 0.2 ± 1.3 degrees ( P < 0.3) in the TB group. Both treatment modalities were successful in moving the mandible forward. However, with the R-appliance, this was achieved without retroclination of the lower incisors.

The purpose of this single blind, prospective, parallel randomized trial study was to compare the effects of face mask and fixed tongue appliance in treatment of Class III malocclusion with maxillary deficiency in growing patients.88 patients with maxillary deficiency were selected. 60 fulfilled the study requirements. The patients were randomly assigned to 2 groups by computer generated tables. One group was treated with removable face mask and the other group was treated by fixed tongue appliance. 4 of the patients dropped out of study leaving a final number of 56 patients. Thus, the face mask group included 30 patients (13 males, 17 females) with the mean age of 8.5 (SD 1.4) years and the fixed tongue appliance group included 26 patients (13 males, 13 females) with the mean age of 8.9 (SD 1.7) years. The patients Lateral cephalograms obtained at the beginning and end of the study were analyzed.Paired t-tests showed that SNA increased by 1.3° (SD 1.1°) in face mask group (P0.001) and it increased by 1.8° (SD 0.9°) in fixed tongue appliance group (P0.001). T-test showed that there were no statistically significant differences between the two groups except for SNB. IMPA decreased significantly in both groups.Both treatment modalities were successful in moving the maxilla forward and improving the profile of the patients; however, the bulky size of face masks might reduce patients' compliance and make them less favorite choice of treatment.

Maxillary setback of patients with protruded maxilla is a complex procedure. This complexity is aggravated when combined with thalassemia. The Aim of this case report was to treat a beta-thalassemia major girl with severe maxillary protrusion. A 16 year-old beta-thalassemia major girl presented with excessive maxilla, incompetent lips and an everted upper lip was referred for treatment. She had her spleen removed at the age of 9 and her blood transfusion was stopped 3 month before referral. After leveling and aligning with 018 standard edgewise system the patient was sent for Lefort 1 osteotomy. Segmental osteotomy was denied due to excessive bleeding in the procedure. The results showed that the thalassemic patient was effectively treated with presurgical orthodontics, Lefort 1 osteotomy followed by post surgical orthodontics. Very satisfactory esthetic results were obtained in the patient after 4.5 years of active treatment.

This case illustrates the treatment of a 12-year-old boy with an open bite, a slight Class II jaw relationship, Class I molar relationship, and a steep lower occlusal plane. The patient needed a surgical procedure due to the severity of openbite; however the surgery option was rejected. Therefore, he was treated by a Hyrax, fixed tongue appliance, posterior bite plate, reverse chin cup and fixed orthodontics. His second premolars and lower second molars were extracted during treatment. The active treatment lasted for 34 months after which favorable correction of the malocclusion was observed. The SNA angle increased by 4 degrees and the GoGn-Sn decreased by 6 degrees. This patient was treated nonsurgically and favorable profile and occlusion were obtained.

This case illustrates the treatment of a 10.5-year-old girl with Class II Division I malocclusion and mandibular deficiency combined with vertical growth pattern. The patient was treated by a modified R-Appliance and extraction of upper and lower first bicuspids. Modified R-Appliance was used for 18 months followed by 17 months of Posterior bite plate, after which favorable correction of the malocclusion was observed. The SNB angle increased by 5 degrees and the IMPA decreased by 11 degrees. This case demonstrates that modified R-Appliance can be a suitable method for treatment of mandibular deficient cases with verticalgrowth pattern.

The aim of this randomized clinical trial was to assess differences in the effects of face mask and reverse chin cup therapy on maxillary deficient growing patients.The sample consisted of 42 class III patients with maxillary deficiency randomly divided into two equal groups. Twenty-one patients (10 males and 11 females) with a mean age of 8.9 (SD: 1.4) years were treated with a face mask for 18 (SD: 2) months. Twenty-one patients (9 males and 12 females) with the mean age of 9.2 (SD: 1.1) years were treated with a reverse chin cup for 19 (SD: 4) months. Cephalometric radiographs were taken at the beginning and end of treatment and the cephalometric measurements were analysed. Paired t-tests and a Wilcoxon test were used for intra-group evaluations. Mann-Whitney test was used for inter-group evaluations.Sella-Nasion-A point (SNA) was increased by 1° (SD: 1.7°) (P0.003) and 1.8° (SD: 1.7°) (P0.001) in the face mask and reverse chin cup groups, respectively. The IMPA decreased by 4.1° (SD: 6.5°) in face mask group (P0.009) and 3.1° (SD: 4.7°) in the reverse chin cup group (P0.008). However, no statistically significant differences were seen in changes between the two groups.Both face mask and reverse chin cup appliances are successful at moving the maxilla forward.

To compare the effects of two different types of face masks in the treatment of Class III malocclusions with maxillary deficiency in growing patients.Forty-three patients (21 boys and 22 girls) with maxillary deficiencies were selected. Twenty-one patients (10 boys and 11 girls) with a mean age of 8.9 ± 1.4 years were treated with maxillary removable appliances and face masks. Twenty-two patients (10 boys and 12 girls) with a mean age of 9.3 ± 1.2 years were treated with maxillary fixed appliances and face masks. Lateral cephalograms obtained at the beginning and end of the study were analyzed.Paired t tests and Wilcoxon tests showed that SNA and ANB significantly increased in both groups. The Mann-Whitney test showed that there were no statistically significant differences between the two groups except for U1-SN, which increased by 6.2 ± 7.1 degrees in the removable face mask group and 11.1 ± 6.9 degrees in the fixed face mask group (P.02).Both treatment modalities were successful in moving the maxilla forward. However, the maxillary incisors had more labial inclination in the fixed appliance group.

OBJECTIVES: The purpose of this study was to compare the effects of a differently designed functional appliance (R-appliance) and the Anterior Inclined Bite Plate (AIBP) in Class II Division I (Cl II Div I) cases. MATERIAL AND METHODS: Fifty patients (28 girls, 22 boys) were chosen for the study: 25 patients (13 girls, 12 boys) with mean age of 10.4±0.8 years were treated with R-appliance for 11±2 months, the other 25 patients (15 girls, 10 boys) with mean age of 9±1.2 years were treated with AIBP for 10±2 months. All patients had Cl II Div I malocclusion due to mandibular deficiency. Lateral cephalograms were analyzed at the beginning (T1, T 1) and end of the study (T2, T 2). RESULTS: Paired T-test showed that SNB had a significant increase in both groups. The same test revealed that IMPA was reduced in R-appliance for 3.1±4.7 (p

The aim of this study was to compare the effects of face mask and miniscrew combined with Class III traction on Class III malocclusion maxillary deficiency in growing patients. 10 patients were treated with facemask and 10 other patients were treated by means of miniscrew and Class III traction. Pre- and post-treatment cephalometric data were analyzed and compared between the two groups. Both groups were successfully treated; however, IMPA increased in miniscrew group while it decreased in facemask group.

Distraction osteogenesis (DO) has become a mainstream surgical technique for patients with jaw deformities. The aim of this study was to report the use of internal DO in the treatment of maxillary hypoplasia in a patient with cleft lip and palate. The case illustrates a 17-year-old boy with class III malocclusion, maxillary deficiency, and cleft lip and palate. Because the patient was experiencing severe hypernasality, it was decided to treat him by DO. The treatment process began by mounting a hyrax in the upper jaw for lateral expansion. A second hyrax was mounted in a way to create anteroposterior expansion. One day after the second hyrax application, the patient underwent a modified Le Fort I osteotomy. He was instructed to turn the screws twice per day for 12 days. The treatment was continued by means of a conventional face mask for 2 months. After 16 months of active treatment, favorable correction of the skeletal problem was observed. The S-N-A angle increased by 5 degrees, and patient's hypernasality was comprehensively improved.

The skeletal Class III malocclusion may be characterised by mandibular prognathism, maxillary deficiency or both.To describe the early treatment of a skeletal Class Ill patient.This case report presents a 10 year-old boy with a Class III malocclusion comprising a combination of maxillary deficiency and mandibular prognathism. Two treatment plans were considered. The first was to correct maxillary deficiency at an early age, while the second aimed to postpone treatment until after skeletal growth completion and then offer bimaxillary surgery. The case was treated early and a tongue appliance was used for maxillary protraction.The post-treatment SNA angle showed a 5 degree increase and a positive overbite and overjet were achieved after 23 months of active treatment. However, mandibular prognathism was still evident.Both treatment options have advantages and disadvantages which require informed clinical consideration.

This case illustrates the treatment of a 6-year-old girl with Class III malocclusion and maxillary deficiency. The patient was treated by a tongue plate in the upper jaw. The tongue plate had two Adams clasps on the first maxillary molars, two C clasps on the deciduous maxillary canines and an acrylic plate posterior to the maxillary incisors. The active treatment lasted for 24 months after which favorable correction of the malocclusion was observed. The SNA angle increased by 4 degrees and the IMPA decreased by 11 degrees. This case demonstrates that tongue plate might be an alternative method to extraoral appliances in Class III and maxillary deficient cases.

Accelerating the speed of orthodontic tooth movement should contribute to the shortening of the treatment period. This study was designed to determine whether a pulsed electromagnetic field (PEMF) affects orthodontic tooth movement.The canines of one side of 10 patients (mean age 23.0 ± 3.3 years) who needed canine retraction were exposed to a PEMF; the canines on the contralateral sides of the same patients were not similarly exposed. After extraction of the maxillary first premolars, both canines were retracted with coil springs. A circuit and a watch battery were used to generate a PEMF (1 Hz). The generator was embedded in a removable appliance. Foil was used to obstruct the contol group from PEMF exposure. Patients were instructed to use the device from the commencement of canine retraction, and it was removed when Class I canine relationship was achieved in either of the canines after 5.0 ± 0.6 months. The changes in the space between the maxillary canine and first molar were measured to indicate the amount of tooth movement. The canine retraction distances were compared by paired t test. Afterward, the treatment plan was continued.With exposure to a PEMF, canine retraction was 1.57 ± 0.83 mm more than the control group (P.001).These findings suggest that application of a PEMF can accelerate orthodontic tooth movement.

Objectives: Prosthodontic rehabilitation using dental implants has become a common practice in dentistry at the present time. Although severe complications related to dental osseointegrated implants are uncommon, in recent years several cases of oral squamous cell carcinoma adjacent to dental implants have been published. Study Design: A 67-year-old edentulous woman developed an oral squamous cell carcinoma around right mandibular implant about 12 months after receiving dental implants. The treatments involve chemotherapy, explantation of the implants and radiotherapy. Result and Conclusions: The use of endosseous implants has been associated with a low risk for the development of cancer. However, this case report serves as evidence to the importance of careful screening at routine dental examinations especially if the patient suffers from peri-implantitis, any mucosal erosion or discoloration, leukoplakia around implant, pain, implant loosening, bone loss around implant, mucosal erythema, and soft tissue inflammation.

Mandibular deviation due to premature contact of teeth in crossbite may be associated with facial asymmetry.To describe the non-surgical treatment of mandibular deviation associated with a marked facial asymmetry.A 13.5 year-old girl presented with a unilateral posterior crossbite, noticeable facial asymmetry, anterior crossbite and displacement of the mandible on closure. She had no history of head injury or significant medical problems and her parents rejected surgical correction. A removable appliance was used to correct the crossbite followed by fixed appliances to complete treatment.Treatment resulted in a marked improvement in facial symmetry and elimination of the mandibular displacement.Early correction of a functional deviation associated with a unilateral facial asymmetry may avoid the need for surgery.

The aim of this study was to evaluate the effectiveness of a newly designed small-sized extraoral appliance on Class III malocclusion and maxillary deficiency in growing patients. The case series included 10 patients (4 males, 6 females) with a mean age of 8.9 +/- 1.72 years who suffered from maxillary deficiency. All the patients were treated with an extra oral appliance which was named as reverse chin cup. This appliance consisted of a high pull cap, a chin cup with two vertical hooks, a removable appliance on the upper jaw, and two elastics which connected the hooks of the cup to the hooks of the removable appliance. The mean treatment time was 24 +/- 9 months. Mean SNA and ANB were significantly increased by 3.1 degrees +/- 1.6 degrees and 3.5 degrees +/- 1.7 degrees, respectively (p0.001). The level of significance was set at P0.05. The increase of SNA angle and ANS-PNS distance (p0.001) and the decrease of nasolabial angle (P0.004) indicated that the reverse chin cup was effective in moving the maxilla in a forward position. Moreover, the smaller size of this appliance makes it more favorable for patients.

This case report illustrates the treatment of a 12-year-old boy with maxillary deficiency using miniscrew implants. The patient rejected the use of extraoral appliances and future surgical correction; therefore the patient was treated using Class III elastics connected from two mandibular miniscrew implants to an upper removable appliance. The miniscrews were inserted between the permanent canines and first premolars under local anaesthesia. The treatment lasted for 8 months after which favourable correction of the malocclusion was observed. The SNA and ANB angles increased by 3 degrees and the IMPA increased by 4 degrees . This case demonstrates that miniscrews can be a suitable alternative method to extraoral appliances and possibly surgery in mild Class III cases.

Various treatment approaches are applied for correction of CL III malocclusion due to maxillary deficiency. However, the benefits of a simple intraoral appliance that can move the maxilla in forward position have not been reported. 25 Cl III patients with SNA78 degrees, SNBor = 80 degrees and ANBor = 0 were selected for this study. All the patients received a tongue appliance, which originally was a habit breaker. Pre- and post-treatment cephalometric images were obtained and paired t-test revealed significant increase in SNA and significant decrease in IMPA. The tongue appliance can move the Maxilla in forward position. Therefore, this simple appliance can be an alternative method for protraction of Maxilla.

The aim of this study was to compare the effects of a differently designed functional appliance (R-appliance) with control group in Class II Division I (Cl II Div I) cases.18 girls treated with R-Appliance were selected as the experimental group. The control group consisted of 20 untreated girls. All of the patients had Cl II Div I malocclusion due to mandibular deficiency. Lateral cephalograms were analyzed at the beginning (T'1, T'2) and end of the study (T'1, T2).Increase of IMPA and reduction of SNA are two prevalent side effects of most functional appliances; however, results of this study showed SNA and IMPA had no significant changes in experimental group in comparison with the control group.

Midfacial deficiency is a common feature of cleft lip and palate patients due to scar tissue of the lip and palate closure procedure. The aim of this study was to evaluate the effectiveness of the physiological force of the tongue to move the maxilla in forward position. This research has been done experimentally by, before and after treatment following up in private practice. Ten patients (6 female, 4 male) with complete bilateral cleft lip and palate were selected. All of them had Cl III malocclusion with maxillary deficiency due to scar tissue of lip and palate surgery. Their age ranged from 7.6 to 9.8 years. All the patients were delivered tongue appliance to transfer the force of the tongue to maxillary complex. The mean observation time was 13±2 months to achieve positive overjet. Pre- and post-lateral cephalograms were compared to evaluate the skeletal changes with paired t-test. The results showed that after the application of tongue appliance, normal sagittal maxillomandibular relationship was achieved. SN-ANS angle was increased 1.9±1.8 - P < 0.05. Nasolabial angle was decreased 10.3±10.8 - P < 0.03. This study showed that the tongue appliance could transfer considerable force during rest and swallowing period to the maxilla. This method might be considered to improve the deficient maxilla by means of growth modification and redirect concept.

Aims: The aim of this study was to evaluate hard and soft tissue change after bimaxillary surgery in class III patients by focusing on sella, nasion, A point (SNA) and sella, nasion, B point (SNB) angle and aesthetic outcome. Materials and Methods: The sample consisted of 96 skeletal Class III patients (42 women, 54 men) with a mean age of 25 years with standard deviation (SD) of 8.4. The youngest patient was 16-years-old and the oldest 51-years-old at the time of surgery. In total, seven skeletal parameters, eight soft tissue parameters, and two dental parameters were evaluated on the cephalograms. Result: At the beginning of the treatment 49 Patients had SNA between 80° and 84°, 34 had SNA of less than 80° and 13 had SNA of more than 84°. Post surgically, 25 patients had SNA of 78°–84°, 19 had SNA less than 78° and 52 patients had SNA of more than 84°. Out of 96 patients 22 had SNB of 78°–82° before surgery, 16 had less than 78° and 58 had SNA of more than 84°. Postoperatively, we measured SNB of 78°–80° in 42, less than 78° in 18 and of more than 82° in 36 patients. The inclination of the maxilla relative to the cranial base changed from 7.2° (SD = 4)–8° (SD = 5.1) and the mandible changed from 35.7° (SD = 6.6) to 36° (SD = 6.3) postoperatively which was not significant. The distance from upper lip to E-line increased by 2.6 mm (SD = 3.9) after surgery (P < 0.001), while, the lower lip distance to E-line decreased slightly by 0.9 mm (SD = 3.2) (P < 0.01). Nasolabial angle was decreased by 9.5° (SD = 9.4) after surgery (P < 0.001). The nose prominence also decreased from 18.2 mm (SD = 3.5) –16.5 mm (SD = 3.3). Conclusion: Although in many cases we did not have a SNA angle or SNB angle in normal range but a good aesthetic outcome have been observed. Consequently our study showed that soft tissue change and aesthetic aspects should be considered in surgical planning and achieving SNA angle or SNB angle of norm range should not be the only goal. As we could show the advancement of maxilla will result in a better lip and nose profile and this should be considered in treatment planning.

This case report presents a 22-year-old girl with class III malocclusion due to maxillary deficiency. The patient was referred for presurgical orthodontics; however, she rejected the surgery. This case was treated by means of Tongue appliance and slow palatal expansion, followed by lower fixed appliance, reverse chin cup, and upper fixed appliance. Tongue appliance and slow palatal expansion were used at the beginning of the treatment. After 6 months, reverse chin cup and lower fixed appliance were added. Six months later reverse chin cup was removed and upper fixed appliance was mounted. Positive overbite and over jet were achieved after 24 months of active treatment. Nasolabial angle also showed improvement. Nonsurgical treatment of adult class III patients is a difficult procedure; however, this patient was treated nonsurgically.