Nonsurgical recovery of a deficient premaxilla because of multiple impacted anterior teeth via repeated maxillary expansion in skeletal Class III malocclusion

Abstract

This case report describes a successful nonsurgical treatment approach for a 16-year-old female with a recessive premaxilla hyperdivergent skeletal Class III malocclusion and multiple impacted maxillary anterior teeth. Transverse analysis, done at the estimated center of resistances of the posterior segment using cone-beam computed tomography, revealed a severe transverse discrepancy. Consequently, repeated application of the miniscrew-assisted rapid palatal expander was performed to achieve large-scale orthopedic maxillary expansion, creating sufficient space for the eruption of the impacted teeth. The skeletal Class III malocclusion was further corrected through a strategic mandibular total arch distalization. After 45 months of active treatment, resultant premaxillary development was evident, the impacted teeth were successfully aligned, and a stable Class I occlusion was established with significant enhancement in the patient’s facial profile and smile esthetics. The outcomes remained stable after 2 years and 9 months of retention. © © 2025. Published by Elsevier Inc.