Early Protraction Facemask Followed by Fixed Appliance Therapy in a Growing Patient With Skeletal Class III Malocclusion: A Case Report

Background: Skeletal Class III malocclusion remains a significant orthodontic challenge because of its multifactorial aetiology, strong genetic influence, and the unpredictability of mandibular growth. Although early protraction facemask therapy is widely advocated for maxillary deficiency, the optimal timing of intervention and long-term stability remain controversial. This report describes successful management of a growing patient with borderline skeletal Class III malocclusion using a non-expansion facemask protocol initiated beyond the conventionally recommended early treatment age. Case Presentation: A 10.5-year-old female presented with anterior crossbite, mild skeletal Class III malocclusion, maxillary retrusion and an anterolateral functional mandibular shift, with a positive family history of mandibular prognathism. Orthopaedic treatment was initiated at cervical vertebral maturation stage CS2 using a non-expansion protraction facemask protocol, followed by comprehensive non-extraction fixed appliance therapy. Intervention and Outcomes: Serial clinical and cephalometric evaluations demonstrated forward displacement of the maxilla, improvement in sagittal skeletal relationship, favourable dentoalveolar compensation, elimination of functional mandibular shift and improvement in facial profile and smile aesthetics. At treatment completion, stable Class I canine and molar relationships, positive overjet and overbite, improved facial symmetry and balanced facial proportions were achieved. Conclusion: This case highlights that biologically timed protraction facemask therapy, even when initiated beyond the conventional early age, combined with careful case selection and comprehensive fixed appliance treatment, may achieve favourable functional and aesthetic outcomes in selected growing patients with borderline skeletal Class III malocclusion.