Early Alt-RAMEC and facial mask protocol in Class III malocclusion

The first patient in this report (Case 1) showed an increase of 5.5º in SNA and almost 9º of improvement in ANB. In both of our cases, the maxilla showed bodily movement with an equal amount of forward and downward displacement, but Case 1 demonstrated a greater amount of both sagittal and vertical displacement of the maxilla. In Case 1, SNB was reduced by about 3º and the mandibular plane angle increased by only 1º. Case 2 showed less maxillary advancement than Case 1 at the end of treatment, with SNA increasing by 3.3º and ANB by 3.7º. These figures are similar to those reported for conventional RME/FM therapy. SNB remained about the same, and the mandibular plane angle increased by only 1º, as in Case 1. It should be noted that compliance with the facial mask was optimal in Case 1, but only moderate in Case 2, especially during the first three months of orthopedic therapy. Patient motivation and collaboration in the use of extraoral elastics and the facial mask have been shown to be key factors in the outcome of Class III orthopedic treatment.