Management of Skeletal Class III Malocclusion With Complex Problems of Severe Crowding and Open Bite by Two-Arch Distalization Using Clear Aligners and Miniscrews: A Case Report

Background : Clear aligner treatment is gradually becoming popular in orthodontics not only for its aesthetic appeal and convenience but also for its effectiveness in certain types of tooth movements, particularly molar distalization. There are many reports on molar distalization using or not using temporary skeletal anchorage devices; however, methods involving distalizing both upper and lower jaws to correct complex malocclusion cases are still rare. Case presentation : A 26-year-old Vietnamese patient presented with skeletal Class III malocclusion due to maxillary retrognathism. Clinical examination revealed a concave profile, Class I molar on the right and Class III on the left, bilateral class II canine. The patient exhibited anterior open bite and bilateral posterior crossbite, with severe crowding in the maxilla. The treatment plan involved non-extraction orthodontics using clear aligners, combined with skeletal anchorage miniscrews placed in the buccal shelf of the mandible to enhance distalization of both jaws simultaneously, along with maxillary expansion. The final outcome showed successful correction of malocclusion, preservation of molar relationships, established bilateral Class I canines, achievedproper tooth alignment, resultedin normal overjet and overbite. Patient’s profile has improved with reduced retrusion of upper and lower lips. Conclusions : This case report describes a treatment approach combining clear aligners and miniscrews to distalize both jaws, along with maxillary expansion, effectively managing a complex skeletal Class III malocclusion.