Pacific Coast Society of Orthodontists Bulletin Summer 2023 - 73

Case Report
Figure 7. Progress extraoral radiographs
Figure 9. Most recent radiographs at age 20 years and 11 months
Figure 8. Most recent extra- and intraoral photographs (L.L. 20 years,
11 months). This patient is currently in the finishing stage, during which
bite seating and correction of minor tooth positions with finishing bends
and elastics will be performed. The peg lateral (#7) will be restored with a
composite build up.
removed after attaining overcorrection and a Class II malocclusion
with a 5-mm overjet. During the distraction, the leveling and alignment
of the mandibular and maxillary dentition were accomplished
with a wire progression that included 0.014-, 0.016-, 0.018 × 0.018-,
and 0.019 × 0.025-inch nickel titanium wires, and 0.019 × 0.025-inch
stainless steel wires. The intercuspation was improved with short
Class III parallelogram elastics. As a result of the missing premolars,
the left maxillary canine was juxtaposed against the first molar by
diverging the dental roots (Figures 6 and 7).
Treatment Result
This case is finishing after 28 months of treatment. The transverse
width was corrected with the SARPE and the Class III malocclusion
with maxillary distraction. Her profile and maxillary lip position
improved with treatment (Figures 8 and 9). The cephalometSummer
2023 PCSO Bulletin
Figure 10. Cephalometric superimposition: black, 18 years 6 months; red,
20 years 11 months
ric superimpositions illustrate that the Class III correction was
attained by three mechanisms: maxillary advancement, dental
compensation, and clockwise rotation of the occlusal plane
(Figure 10 and Table 2). The peg lateral incisor (#7) will be restored
with dental composites at the end of treatment.
The challenge for correcting a Class III malocclusion in patients
with cleft lip and palate has been maxillary advancement against
resistant scar tissue from prior surgeries, especially the primary
palate repair. Treatment relapse can occur with both orthognathic
surgery and maxillary distraction.1-3
In maxillary advancement of
73

Pacific Coast Society of Orthodontists Bulletin Summer 2023

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