Early orthopedic Class III treatment with a modified tandem appliance.

JCO/APRIL 2003 G patients with dentofacial deformities characterized by either a midfacial deficiency or true mandibular prognathism are perhaps the most challenging cases for the clinician to manage. In patients with midfacial deficiency, the current clinical protocol calls for orthopedic maxillary protraction by means of elastics to either an extraoral facemask or a chin cup.1,2 A maxillary expander is often used to enhance the orthopedic effect.3,4 If the patient is motivated enough to wear a facemask, treatment is likely to be successful.5,6 Downward and forward movement of the maxilla, an increase in overjet,7-12 and a backward rotation of the mandible with increased anterior facial height have all been documented with facemask therapy.13-16 The major problem, however, has been one of compliance, due to both the physical appearance of the extraoral appliance and skin irritation from the anchorage pads. This article presents an intraoral appliance that has been used clinically to achieve successful results in such cases without relying on unusual patient cooperation.