Nonsurgical camouflage of adult skeletal Class III malocclusion with severe crowding and open bite by two-arch distalization using clear aligners and buccal-shelf miniscrews: A case report

Distalization of both arches with clear aligners remains challenging in the camouflage treatment of adult skeletal Class III malocclusion. This case report describes the non-extraction management of a 26-year-old woman with skeletal Class III malocclusion due to maxillary retrusion, anterior open bite, bilateral posterior crossbite, and severe maxillary crowding who declined orthognathic surgery. Treatment was performed with clear aligners, maxillary expansion, and mandibular buccal-shelf temporary skeletal anchorage devices to support two-arch distalization. After 32 months, crowding, anterior open bite, and posterior crossbite were corrected, bilateral Class I canine relationships were achieved, and normal overjet and overbite were established. Facial profile and smile esthetics improved, and the major treatment objectives were largely maintained at the 1-year follow-up, despite limited relapse. This case suggests that clear aligners combined with mandibular buccal-shelf mini-screws may provide a feasible non-extraction camouflage option in carefully selected adults who refuse surgery.