## 4 Discussion  
According to the literature, a Wits appraisal is considered an important discriminating factor in determining whether Class III malocclusion should be treated by camouflage treatment or surgery [17]. If the initial face profile seems to be pleasant and the patient does not submit a specific request to improve the proportions of the face (as in our case), compensatory treatment, using the most appropriate biomechanical methods, may produce satisfactory occlusal results, whereas orthodontic-surgical treatment causes more remarkable changes to the profile compared to camouflage orthodontic treatment alone [18]. This article shows the orthodontic treatment of a young patient with skeletal Class III in which the extractions of the first lower premolars were performed to obtain a class III camouflage. The refusal of our patient to undergo surgery and her good profile led to the development of a camouflage treatment with only lower extractions, thereby changing the upper and lower incisors inclination minimally. The post-treatment cephalometric superimposition and radiographs showed a great control of the upper and lower inclination. The  
Figure 7: Final extraoral and intraoral views. upper incisors to the PP were retroclined 3.5\({}^{\circ}\) and the lower incisors kept good sagittal and vertical control with a reduction of 1.1\({}^{\circ}\) to the MP (Figures 8 and 9). The possibility of being able to use the miniscrews made good incisal control simpler, thus avoiding excessive retraction of the lower incisors. Mesialization of the lower hemiarch, carried out with miniscrew anchorage, showed a bodily movement of the first molar. The \"Pseudoankylosis System\" allowed us to maintain excellent control of the lower incisors without over-retraction, and then control of the lower midline, which limited the risk of shifting and kept it centered during the space closure phase in the mandible, when we had to pay attention to the thickness of the buccal plate to avoid excessive lingual inclination during retraction [19]. Furthermore, this approach required less compliance from the patient who had to wear the Class II elastics for much less time than for a traditional treatment. This method allowed direct biomechanical traction from the molar to the canine, which, with a reverse curve of Spee inserted in the lower arch, promoted a bodily mesialization without causing vertical bowing, thus maintaining good control of lower incisor torque. Finally, the extraction of the lower premolars allowed the eruption of the third molars, which were inserted into the fixed appliance and aligned. Figure 8: Final radiographs. The choice of extracting only the two lower premolars arose from the high risk of causing further damage to the roots of the upper incisors, which had a degree of resorption, most likely caused by the previous treatment, which lasted 3 years. In orthodontic retreatments, as in our case, it is the orthodontist's responsibility to investigate risk factors carefully before starting tooth movements, especially when the patient has a long history of previous treatment. In addition to the initial clinical exam and anamnesis, a pretreatment radiographic evaluation can often identify root resorption as in our patient at the beginning of the treatment. The treatment that included the four extractions would have been the easiest and more rational choice considering the occlusal and biomechanical features, and it would probably have avoided the use of the skeletal anchor. As shown by recent research, the extraction of the upper premolars would have definitely required more accurate upper-incisor root control during the space closures, thereby resulting in a greater risk of worsening apical root resorption of the upper incisors [20; 21; 22; 23]. The need for orthodontic treatments that maximize anchorage control, minimize patient compliance requirements, limit treatment time and promote healthy teeth has led to the development of a fourth option of therapy with implant-assisted orthodontics.