# Correction of Severe Class III Malocclusion by mandibular
## 3 Results  
The intraclass correlation test confirmed the intraexaminer reliability, ranging from 0.910 to 0.999 for the tested variables. At the end of the orthodontic treatment, a positive overjet was gained in all patients. The mean treatment duration was 27.8 \(\pm\) 7.8 months from initial bonding to bracket removal, while active distalization force was applied on the ramal plates for 16.2 \(\pm\) 5.7 months. In the evaluation of dental treatment effects, the mandibular first molars and incisors displayed a significant distalization at the level of crowns and roots, as shown in Figure 6. The lower first molars distalized significantly by 3.65 mm at the crown and 1.81 mm at the root apex with distal tipping of 6.36\({}^{\circ}\) (\(p<0.01\), respectively; Table 3). Similarly, the lower incisors showed a significant retraction of 3.32 mm at the crown and 0.81 mm at the root, with a lingual tipping of 8.02\({}^{\circ}\) (\(p<0.01\), respectively). In contrast, both crowns of the lower first molars and incisors exhibited insignificant extrusions by 0.18 mm and 0.76 mm. Also, the overjet and overbite increased by 3.48 mm and 1.57 mm (\(p<0.01\) for both). Figure 5: Measurements of the dental cast used in this study. (**A**) Maximally arch (1, Arch depth; 2, Intercanine width; 3, 1 st interpremolar width; 4, 2 nd interpremolar width; 5, 1 st interpolar width). (**B**) Mandibular arch (1, Arch depth; 2, Intercanine width; 3, 1 st interpremolar width; 4, 2 nd interpremolar width; 5, 1 st intermolar width). Figure 6: A schematic illustration to depict the changes in mandibular dentition at the crown and root levels after distalization with the ramal plates. Regarding skeletal treatment effects, [PERSON]'s appraisal showed a significant increase of 1.56 mm from \(-\)7.06 mm to \(-\)5.50 mm (\(p<\) 0.01; Table 4). However, both the ANB angle and pogon to the nasion-perpendicular line showed insignificant sagittal skeletal alterations. In addition, the stability of the vertical mandibular position was marked by little changes in FMA and facial height ratio values throughout the treatment (\(p=\) 0.550 and 0.496, respectively). Changes in soft tissue variables demonstrated that the lower lip displayed a significant retraction of 1.26 mm (\(p=\) 0.003), as shown in Table 4. A similar change in the soft tissue pogon was also observed as it was significantly retruded by 0.85 mm after treatment (\(p<\) 0.01). To illustrate the typical treatment changes associated with the ramal plates, the pre- and post-treatment lateral cephalograms are presented in Figure 7.  
Pre- and post-treatment dental cast analyses revealed that the arch depth did not significantly change in the maxilla and mandible. However, the mandible showed an increase in the interdental width in the first premolars, second premolars, and first molars by 2.93 mm, 2.48 mm, and 0.94 mm, respectively (\(p<\) 0.01, except the first molar with \(p=\) 0.041; Table 5). A similar trend of arch width expansion was evident in the maxillary canines and first and second premolars, where they increased by 1.65 mm, 2.85 mm, and 1.58 mm, respectively (\(p<\) 0.01, except the second prem