Modification Protocol for an Early Class III Treatment Using 3 Miniplates for Bone-Anchored Maxillary Orthopedic Traction

Introduction: This article introduces the modification of 4-miniplate-assisted orthopedic protocol for class III correction. Instead of bilateral mandibular miniplates between lateral incisors and canine, the single modified Y-type C-tube with extension arms can replace 2 miniplates for temporary skeletal anchorage with advantages. Methods: Y-type C-tube was modified to have 2 extension arms for the application of class III elastics to replace 2 separate miniplates on either side of the mandible. A patient who declined a facemask therapy was selected to receive the modified protocol using only 3 C-tubes for bone-anchored maxillary orthopedic traction. The modified Y-type C-tube was inserted at the mandibular symphysis, and the bifurcation of the extension arms exited the tissue near the mucogingival junction. Results: The modified Y-type C-tube was placed on the mandibular symphysis, and this provided 3 advantages compared with conventional miniplates: (1) 1 C-tube placement warrants less surgical sites than 2-miniplate installation, (2) placing the C-tube in between mandibular incisors prevents damage to developing or erupting permanent canines and allows early treatment start, and (3) the characteristic bendability of extension arms permits easy alteration on position and results in the vertical and sagittal vector controls of class III elastics. When the treatment is finished, it can be also simply removed like any other C-tubes with simple detachment of extension arms. Conclusions: Themodification of 4-miniplate-assisted orthopedic protocol for class III correction provides easier surgical placement of miniplates by minimizing complications, early initiation of treatment, and more vector control with bendable extension arms of the modified Y-type C-tube.