Nonsurgical Orthodontic Camouflage of Adult Skeletal Class III Malocclusion With Anterior and Posterior Crossbites and Pre-existing Alveolar Bone Loss: A Case Report.

Adult skeletal Class III malocclusion in non-growing patients may be managed with combined orthodontic-orthognathic surgery or, in carefully selected mild discrepancies, orthodontic dentoalveolar camouflage. We report a 33-year-old Mongolian woman evaluated at the first documented presentation (Day 0) with maxillary anterior and posterior crowding, an anterior crossbite, a left posterior crossbite, and a mild skeletal Class III intermaxillary relationship. Pretreatment cephalometry showed sella-nasion-A point angle (SNA) 74.3°, sella-nasion-B point angle (SNB) 76.0°, and A point-nasion-B point angle (ANB) -1.7°, a pattern indicating predominant maxillary retrusion relative to the mandible. Pretreatment records also demonstrated alveolar bone loss. Treatment used a 0.022-inch high-torque self-ligating fixed appliance, extraction of the maxillary first premolars (Fédération Dentaire Internationale (FDI) 14 and 24), and sequential copper-nickel-titanium, stainless-steel, and titanium-molybdenum alloy archwires, with elastic-chain mechanics during alignment. Active treatment lasted 17 months. The anterior and left posterior crossbites were corrected, maxillary crowding was resolved, dental midlines were aligned, and bilateral Angle Class I canine relationships were achieved. Changes were predominantly dentoalveolar: maxillary central incisor long axis to Frankfort horizontal angle (U1-FH) increased from 103.0° to 108.7° (+5.7°) and maxillary central incisor to nasion-pogonion line (U1-NPog) from 2.8 to 6.1 mm (+3.3 mm), whereas ANB changed minimally from -1.7° to -1.3°. Available records showed stable periodontal supporting tissues, no progression of alveolar bone loss, and no clinically apparent radiographic root resorption. This case illustrates the feasibility of carefully planned nonsurgical camouflage in a selected adult with mild skeletal Class III discrepancy and reduced periodontal support, without establishing the superiority of the self-ligating appliance.