Non-surgical treatment of adult skeletal class III patient with severe alveolar bone loss by sequential segmental displacement and third molar extraction: A case report

Abstract

Compromised periodontal conditions pose challenges in orthodontic treatment. In particular, maxillomandibular skeletal discrepancies may require large-scale tooth movement, making it essential to avoid round-tripping movements to minimize dental and periodontal side effects. This case report describes a 49-year-old male patient with skeletal Class III malocclusion and severe alveolar bone loss, particularly affecting the anterior teeth, who sought non-surgical treatment with aesthetic lingual orthodontic appliances. A comprehensive diagnosis and treatment plan were formulated to establish a flat occlusal plane and Class I molar relationship while minimizing round-tripping of the anterior segment. Segmental distalization of mandibular molars, followed by intrusion of the mandibular incisors, was performed with the aid of miniscrews to achieve normal occlusion and an improved facial profile without further alveolar bone loss. This case report highlights the use of segmental archwires and an orthodontic force system based on the centre of resistance to preserve periodontal support in a middle-aged patient with skeletal Class III malocclusion and severe alveolar bone loss.