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Objective: This case report describes the interdisciplinary treatment of a 10-year-old girl with asymmetric Class III malocclusion, severe maxillary crowding, and bilaterally impacted maxillary canines. Clinical considerations: The clinical decision-making factors regarding treatment alternatives and the final treatment plan are discussed. A two-phase nonextraction therapy was implemented to relieve severe crowding, eliminate the maxillary canine impactions, and compensate for skeletal Class III malocclusion. The first treatment phase involved aligning the left canine through conventional orthodontic traction, while the more deeply horizontally impacted right canine was corrected through transalveolar transplantation. In the second phase, the Class III dental relationship was corrected through mandibular molar retraction. The effective use of various temporary skeletal anchorage devices such as modified c-palatal plates and mini-implants was illustrated. Conclusions: At the end of the treatment, esthetic dental alignment was achieved, along with improved facial balance. The transplanted maxillary right canine showed good health and a favorable long-term prognosis over six years after the procedure.

Introduction: This study aimed to evaluate mandibular molar changes after distalization using Class III elastics and modified C-palatal plates (MCPPs) in the maxilla and to use CBCT to specifically analyze the third-molar position after long-term retention in adolescents. Methods: The sample consisted of 65 mandibular third molars from 35 subjects, divided into two groups. Twenty-six of the third molars were from fourteen adolescent patients with Class I bimaxillary protrusion (mean age, 12.8 years) who had undergone bilateral maxillary distalization using an MCPP and mandibular distalization with Class III elastics with non-extraction treatment. For the control group, 39 third molars from 21 Class I normal-occlusion subjects were used. In the treated group, CBCT images were taken before distalization (T1), after molar distalization (T2), and at a long-term observation point (6.1 ± 2.7 years) (T3). Repeated measures ANOVA and a post hoc test with Bonferroni correction were used to analyze significant differences in the positions at the three points in time. Results: There were 2.3 and 1.7 mm of distal movement at the crown of the mandibular first and second molars, with distal tipping of 5.2° and 5.3°, respectively, and 3.0° of distal tipping of the third molars. Comparing the treated group with the control group at T3, there was a significant change in the angulation of the third molars (p < 0.001). In the long-term, the third molars from the treated group showed a downward and buccal position after distalization. Conclusions: In the long term, the developing mandibular third molar buds had downward and buccal positional changes after total arch distalization. These findings suggest the need for clinicians to consider the possibility of the impaction of developing third molars after mandibular total arch distalization in adolescents.