TITLE:
When Orthodontics Prevails: Non-Surgical Management of a Borderline Adult Skeletal Class III Malocclusion: A Case Report
AUTHORS:
Meryem Lahlou, Meriem Bellamine, Ihsane Ben Yahya
KEYWORDS:
Skeletal Class III Malocclusion, Facially Driven Orthodontics, Camouflage Orthodontics, Borderline Orthodontics
JOURNAL NAME:
Open Access Library Journal,
Vol.13 No.4,
April
23,
2026
ABSTRACT: Background: Skeletal Class III malocclusion in adults is commonly managed with combined orthodontic and orthognathic surgical treatment. However, when surgery is declined, orthodontic camouflage may be considered in carefully selected cases. Borderline Class III cases are particularly challenging because treatment decisions must balance skeletal discrepancy, dentoalveolar compensation, and facial esthetics. This report describes the non-surgical management of a borderline adult skeletal Class III malocclusion using controlled orthodontic biomechanics. Case Description: A 30-year-old patient presented with mandibular crowding, bilateral crossbite, and an edge-to-edge anterior relationship. Cephalometric analysis revealed a skeletal Class III pattern with maxillary retrognathia (SNA = 75˚), hyperdivergence, and a marked AO-BO discrepancy (−9 mm), although the pretreatment ANB of 0˚ placed the case in the borderline category. As the patient declined orthognathic surgery, orthodontic camouflage was planned. Treatment involved extraction of the mandibular first premolars followed by comprehensive fixed appliance therapy. Sequential archwires and Class III elastics were used to correct sagittal, transverse, and vertical discrepancies. However, long-term follow-up could not be completed because the patient did not attend the scheduled post-treatment follow-up appointments. Conclusion: Orthodontic camouflage can provide satisfactory functional and esthetic outcomes in selected borderline skeletal Class III cases when orthognathic surgery is declined, provided that careful diagnosis and controlled biomechanics guide treatment planning.