Managing a Class III hyperdivergent case with combined clear aligner therapy and mini-implants through delicate control of the occlusal and mandibular planes

A 32-year-old woman with a hyperdivergent Class III malocclusion, a Class III molar relationship, mild anterior open bite and crossbite, mandibular midline deviation and a high mandibular plane angle underwent clear aligner treatment. The molar relationship was almost full-cusp Class III on the right side and cusp-to-cusp Class III on the left side. Two treatment plans (orthognathic surgery and orthodontic camouflage) were proposed, and the patient opted for orthodontic camouflage with clear aligners. Mandibular molar distalisation was prescribed and mini-implants were placed in bilateral buccal shelf regions to facilitate it. With anticlockwise rotation of the occlusal plane and maintenance of the mandibular plane, a Class I molar relationship was achieved and the mandibular midline deviation was corrected, with a normal horizontal and vertical overlap. The clear aligner treatment lasted for 27 months with 104 (75 + 29) aligners. The patient was satisfied with the treatment outcome. This case report suggests that delicate control of the occlusal and mandibular planes is crucial for Class III hyperdivergent patients treated with combined clear aligner therapy and mini-implants. Keywords: Class III malocclusion, clear aligner treatment, hyperdivergent, mini-implants, occlusal plane control