Treatment of Open Bite Based on Skeletal Anchorage Using Extrusion Lever Arms and Class III Elastics

A 26-year-old woman had a masticatory dysfunction, straight profile, retrognathic maxilla and mandible, and Angle’s class I with a tendency to class III malocclusion on both sides, with bilateral posterior crossbites and a 4 mm anterior open bite. Orthognathic surgery and orthodontic camouflage with and without tooth extraction were considered as treatment options. The patient’s preferred method of treatment was orthodontic camouflage without extraction. The transpalatal arch had been placed for the bilateral molars’ derotation. After 3 months, the upper segmented fixed appliance was implanted to address the posterior crossbites in the premolar’s region. One mini-implant was inserted into the anterior palatum after the transpalatal arch was removed, and a supporting device was attached to the first permanent molars to give indirect skeletal stability. Orthodontic treatment’s active phase lasted 23 months, and all treatment objectives were achieved during that time: the desired facial profile, adequate occlusion, appropriate overbite, and overjet.