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My original diagnoses for this patient indicated class III skeletal pattern with mid-face deficiency and mandibular excess. The arches themselves were crowded and maxillary teeth in cross bite. By initiating treatment at an early age we can often reverse the skeletal problem and that was my original plan for this patient.

We used rapid expansion appliance in the maxilla and reverse face mask to advance the maxilla. Initially we obtained a good result, however the class III pattern re-established itself so that eventually a surgical procedure was necessary, this was carried out and JC now has an ideal skeletal and dental class I pattern.

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