Case Report

Combining Circumvestibular Corticotomy with Maxillary Protraction as a Conservative Approach to Treatment in an Adolescent with Maxillary Deficiency: A Case Report with Long Term Follow-up


Maxillary protraction with a face mask is an effective treatment for class III children with maxillary hypoplasia. However, in late adolescence, orthopedic approaches are not very effective for treatment of maxillary deficiency. The aim of this study was to report a minimally invasive technique to orthopedically treat a 16-year-old female adolescent with mild to moderate maxillary deficiency, before the cessation of growth. A circumvestibular corticotomy technique was performed followed by a regimen of rapid maxillary expansion and application of heavy extra-oral forces. After termination of the orthopedic and orthodontic phases, the patient was monitored for ten years. The dental and skeletal results immediately after treatment were compared with the results ten years after termination of treatment. A noticeable anterior displacement of “A” point was observed after the orthopedic phase and this remained unchanged for ten years.


1. Ellis 3rd E, Mc Namara Jr. JA. Components of adult Class III open-bite malocclusion. Am J Orthod. 1984 Oct;86(4):277–90.
2. Lee WC, Shieh YS, Liao YF, Lee CH, Huang CS. Long-term maxillary anteroposterior changes following maxillary protraction with or without expansion: A meta-analysis and meta-regression. PLoS One 2021 Feb;16(2);e0247027.
3. Lin Y, Guo R, Hou L, Fu Z, Li W. Stability of maxillary protraction therapy in children with Class III malocclusion: a systematic review and meta-analysis. Clin Oral Investig. 2018 Sep;22(7):2639–52.
4. Esenlik E, Aglarci C, Albayrak GE, Findik Y. Maxillary protraction using skeletal anchorage and intermaxillary elastics in Skeletal Class III patients. Korean J Orthod. 2015 Mar;45(2):95–101.
5. Meazzini MC, Torre C, Cappello A, Tintinelli R, De Ponti E, Mazzoleni F. Long-term follow-up of late maxillary orthopedic advancement with the Liou-Alternate rapid maxillary expansion-constriction technique in patients with skeletal Class III malocclusion. Am J Orthod Dentofac Orthop. 2021 Aug;160(2):221– 30.
6. Kircelli BH, Pektas ZO. Midfacial protraction with skeletally anchored face mask therapy: a novel approach and preliminary results. Am J Orthod Dentofac Orthop. 2008 Mar;133(3):440–9.
7. Salari B, Nikparto N, Babaei A, Fekrazad R. Effect of delayed photobiomodulation therapy on neurosensory recovery in patients with mandibular nerve neurotmesis following traumatic mandibular fracture: A randomized triple-blinded clinical trial. J Photochem Photobiol B. 2022 Jul,232:112460.
8. Maino G, Turci Y, Arreghini A, Paoletto E, Siciliani G, Lombardo L. Skeletal and dentoalveolar effects of hybrid rapid palatal expansion and facemask treatment in growing skeletal Class III patients. Am J Orthod Dentofac Orthop. 2018 Feb;153(2):262–8.
9. Moon W. Class III treatment by combining facemask (FM) and maxillary skeletal expander (MSE). Semin. Orthod., vol. 24, Elsevier; 2018 Mar;24(1):95–107.
10. Yilmaz HN, Garip H, Satilmis T, Kucukkeles N. Corticotomy-assisted maxillary protraction with
skeletal anchorage and Class III elastics. AngleOrthod. 2015 Jan;85(1):48–57.
11. Pelo S, Boniello R, Gasparini G, Longobardi G. Maxillary corticotomy and extraoral orthopedic traction in mature teenage patients: A case report. J Contemp Dent Pract. 2007 Jul;8(5):076–84.
12. Al-Namnam NMN, Hariri F, Rahman ZAA. Distraction osteogenesis in the surgical management of syndromic craniosynostosis: a comprehensive review of published papers. Br J Oral Maxillofac Surg. 2018 Jun;56(5):353–66.
13. Cheung LK, Chua HD. A meta-analysis of cleft maxillary osteotomy and distraction osteogenesis. Int J Oral Maxillofac Surg. 2006 Sep;35(1):14–24.
14. Daher W, Caron J, Wechsler MH. Nonsurgical treatment of an adult with a Class III malocclusion. Am J Orthod Dentofac Orthop. 2007 Aug;132(2):243–51.
15. Hisano M, Chung CR, Soma K. Nonsurgical correction of skeletal Class III malocclusion with lateral shift in an adult. Am J Orthod Dentofac Orthop. 2007 Jun;131(6):797–804.
16. Furquim LZ, Janson G, Furquim BD, Iwaki Filho L, Henriques JF, Ferreira GM. Maxillary protraction after surgically assisted maxillary expansion. J Appl Oral Sci. 2010 May- Jun;18(3):308–15.
17. Rachmiel A, Aizenbud D, Ardekian L, Peled M, Laufer D. Surgically-assisted orthopedic protraction of the maxilla in cleft lip and palate patients. Int J Oral Maxillofac Surg. 1999 Feb;28(1):9–14.
18. Masucci C, Franchi L, Defraia E, Mucedero M, Cozza P, Baccetti T. Stability of rapid maxillary expansion and facemask therapy: A long-term controlled study. Am J Orthod Dentofac. Orthop 2011 Oct;140(4):493–500.
19. Nevzatoglu S, Kucukkeles N. Long-term results of surgically assisted maxillary protraction vs regular facemask. Angle Orthod. 2014 Nov;84(6):1002–9.
20. Daniels C, Richmond S. The development of the index of complexity, outcome and need (ICON). J Orthod. 2000 Jun;27(2):149–62.
IssueVol 19 (Continuously Published Article-Based) QRcode
SectionCase Report
Malocclusion Angle Class III Maxilla Retrognathia Orthopedic Adolescent Activator Appliances

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How to Cite
Piroozmand F, Salari B, Shirazi M, Zarnegar H. Combining Circumvestibular Corticotomy with Maxillary Protraction as a Conservative Approach to Treatment in an Adolescent with Maxillary Deficiency: A Case Report with Long Term Follow-up. Front Dent. 2022;19.