# Correction of Severe Class III Malocclusion by mandibular
## 4 Discussion  
The present investigation aimed to evaluate the skeletal, dental, and soft tissue changes after mandibular dentitional distalization aided by using the ramal plates in nonextraction camouflage treatment among skeletally mature patients. The pretreatment cephalometric values of our sample included a mean ANB angle of \(-1.07\lx@math@degree\), Wits appraisal of \(-7.06\) mm, and a minimum of full-cusp Class III at the first molars. Such severe dentoskeletal discrepancies would often require considerations for the camouflage treatment involving premolar extractions or even orthognathic surgical approaches. Instead, our attempt to treat through mandibular total arch distalization facilitated with the ramal plates resulted in a significant amount of molar retraction with the correction of anterior crossbites. Despite insignificant post-treatment skeletal changes, the soft tissue relationship improved with the retraction of the lower lip and soft tissue pogonion. The overall ramal plate treatment effects demonstrated successful camouflage treatment outcomes for severe Class III adult patients without premolar extractions. Figure 7: (**A**) Pre- and (**B**) post-treatment cephalometric radiographs for one of the ramal plate treatment cases. \begin{table}
\begin{tabular}{c c c c c} \hline \hline
**Maxillary Arch** & **Pretreatment** & **Post-Treatment** & **Treatment** & \\
**Dimensions (mm)** & & & & \\ \hline Arch depth & 37.51 \(\pm\) 2.90 & 37.84 \(\pm\) 2.49 & 0.33 & 0.387 \\ Intercanine width & 35.52 \(\pm\) 1.90 & 37.17 \(\pm\) 1.49 & 1.65 & 0.000 ** \\
1 st Interpremolar width & 44.01 \(\pm\) 2.74 & 46.86 \(\pm\) 1.45 & 2.85 & 0.000 ** \\
2 nd Interpremolar width & 50.64 \(\pm\) 3.52 & 52.22 \(\pm\) 1.64 & 1.58 & 0.044 * \\
1 st Interpolar width & 56.22 \(\pm\) 3.41 & 56.05 \(\pm\) 3.20 & \(-\)0.17 & 0.966 \\ \hline
**Mandibular Arch** & & & & \\
**Dimensions (mm)** & & & & \\ \hline Arch depth & 34.17 \(\pm\) 2.54 & 33.89 \(\pm\) 1.83 & \(-\)0.28 & 0.227 \\ Intercanine width & 27.75 \(\pm\) 1.88 & 27.17 \(\pm\) 1.73 & \(-\)0.58 & 0.110 \\
1 st Interpremolar width & 34.28 \(\pm\) 2.93 & 37.21 \(\pm\) 1.63 & 2.93 & 0.000 ** \\
2 nd Interpremolar width & 41.44 \(\pm\) 3.49 & 43.92 \(\pm\) 1.68 & 2.48 & 0.000 ** \\
1 st Interpremolar width & 47.81 \(\pm\) 3.05 & 48.75 \(\pm\) 2.03 & 0.94 & 0.041 * \\ \hline \hline \end{tabular} Notes. All data are presented as the mean \(\pm\) standard deviation, * \(p<0.05\), ** \(p<0.01\). \(\uparrow\), analyzed by the Wilcoxon Signed Rank test; otherwise, the paired \(t\)-test was used to compare pretreatment and post-treatment measurements. Treatment effects are described as post-treatment subtracted by pretreatment values.  
\end{table} 
Table 5: Change in the arch dimensions of the maxillary and mandible dentition. Among TSADs, the miniscrews became popular due to their relatively low cost, easy maneuverability, and biomechanical versatility. However, their need for frequent repositioning during active retraction has remained a weakness. Also, the retromolar region could not be regarded as attractive alternative miniscrew insertion sites because of its frequent association with soft tissue irritation and lower survival rates of TSADs compared to other areas of the mouth [20]. The failure rate of orthodontic miniscrews was reported as 16.4% after a meta-analysis [21], but when limited to the premolar and molar areas, it increased to 29.0% with 27 failures out of 93 in a more recent study [22]. Similarly, the miniscrews placed in the retromolar region showed a failure rate of 23.2% [20]. On the contrary, the miniplate displayed significantly higher stability, with a success rate of 92.7% to 98.6% [21, 23]. [PERSON] et al. reported that the miniplates reached a success rate of 98.7% with their heads exposed in the mandibular molar areas, while none of the plates failed during the lower total retraction for Class III correction [22]. Similarly, our ramal plates showed a 100% success rate during this investigation.