# Correction of Severe Class III Malocclusion by mandibular
## 4 Discussion
After analyzing the TSADs' effects on the mandibular transverse dimension, [PERSON] et al. concluded that the ramal plates produced the least amount of buccal crown tipping, whereas the SAS miniplates showed the largest [12]. Therefore, the type of TSADs should be recognized as an important factor that could attenuate the degree to which the lower archive would be expanded during interarch coordination. The presence of bone support at the distal area of the second molars may be considered a prerequisite for successful mandibular molar retraction. [PERSON] et al. reported the lingual cortex of the mandibular body as the molar distalization limit in the mandible after an anatomical survey of three-dimensional (3D) data from cone-beam computed tomography (CBCT) [25]. According to a more recent meta-analysis [26], the patients with Class III malocclusion displayed an average of 4.43 mm for the mandibular retromolar space length (MRSL). Since our patients exhibited 3.65 mm and 1.81 mm for the retraction of the molar crowns and root tips, respectively, it may be suggested that most Class III patients have a sufficient amount of retromolar bone support to correct the full-cusp discrepancy through molar distalization. However, it should also be noted that the Class III group in the meta-study showed considerable variation with a 3.14 mm MRSL at the lower end of a 95% confidence interval. Therefore, clinicians may consider implementing safeguards by confirming the availability of MRSL based on CBCT images prior to the active molar distalization phase. This investigation presents several important strengths. First, this is one of the rare attempts to analyze the effects of nonextraction camouflage treatment through mandibular distalization among severe Class III non-growers. The minimum requirement of a full-cusp discrepancy in our inclusion criteria was more stringent than those of similar previous studies [10; 13; 24]. In fact, the rigor of the sample selection used in this study could be met only with a limited number of case reports currently available in the literature [11; 16; 17; 18; 27]. Another noteworthy advantage of the present study is that, despite the employment of lateral cephalograms limited to the sagittal and vertical planes, the changes in the transverse dimension have also been assessed through a dental cast analysis. Thus, the treatment effects were evaluated in all three planes of space, at least at the crown level, where the focus of most orthodontic treatments lies. However, the limitations of this study are also apparent. We could not assess the evolving relationship between the inner cortical bone and dental root surfaces since it would require 3D treatment records such as CBCT. The reason why the CBCT has not been part of clinical records among the selected patients may have been influenced by various factors such as a low cost-benefit ratio and unnecessary radiation exposure risk. Also, it should be considered that routine orthodontic cases may not be recommended for supplementary CBCT scans [28]. Another limitation may be that we could not evaluate the long-term retention stability of our camouflage treatment, which should be an important aspect, especially given the severe nature of the pretreatment malocclusion. Finally, it is important to recognize the implications of the present retrospective study design. It inherently limits the grounds to establish a control group, which is important in reducing biases and confirming causal relationships. Thus, in the future, prospective randomized controlled studies may be beneficial to include well-designed control groups, 3D diagnostic records, and a more extended follow-up period to analyze the post-retention changes.