Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients

Introduction: The purpose of this study was to describe the skeletal and dentoalveolar changes in a group of growing skeletal Class III patients treated with hybrid rapid palatal expansion and facemask. Methods: Twenty-eight growing patients with skeletal Class III malocclusion were treated using a rapid maxillary expander with hybrid anchorage according to the ALT-Ramec protocol (SKAR III; E.P.), followed by 4 months of facemask therapy. Palatal miniscrew placement was accomplished via digital planning and the construction of a highprecision, individualized surgical guide. Pretreatment and posttreatment cephalometric tracings were analyzed, comparing dental and skeletal measurements. Results: Point A advanced by a mean of 3.4 mm with respect to the reference plane Vert-T. The mandibular plane rotated clockwise, improving the ANB (+3.41 degrees) and the Wits appraisal (+4.92 mm). The maxillary molar had slight extrusion (0.42 mm) and mesialization (0.87 mm). Conclusions: The use of a hybrid-anchorage expander followed by 4 months of facemask treatment improves the skeletal Class III relationship with minimal dental effects, even in older patients (mean age, 11 years 4 months, +/- 2.5 years).