## 4 Discussion  
The point of view that orthognathic surgery is the best solution for Class III patients was established many years ago [17]. The RME/FM protocol was thought to be effective from deciduous dentition up to 12 years of age [3; 4; 5; 6; 7; 8; 9; 17; 28; 37; 38; 39], despite the results by [PERSON] et al. that indicated that the late use of the RME/FM protocol, i.e., during postpubertal growth stages, induced a significant mandibular growth limitation [31]. It has been shown that RME/FM treatment can produce a backward mandibular rotation, an undesirable change in hyperdivergent Class III patients [37; 38; 39]. Contrary to RME/FM, Bollard miniplates with Class III elastics enable good orthopedic results up to early adolescence [37]. Class III elastics can stimulate a change in mandibular growth, in addition to a forward mandibular rotation similar to a chin-cup alone or together with elastics [37; 38; 40; 41; 42]. The condylar growth direction change, most visible in patient 2, was a classical, desired effect for Class III patients usually found in younger subjects [37; 38; 39; 42; 43]. It limits or even prevents relapse, since such a change is effective in inducing a decrease in the Condylion-Menton distance [37; 38; 40; 41; 42; 44; 37; 42]. The counterclockwise change of the occlusal plane of our adolescents was similar to the results achieved in purely camouflaged orthodontic treatment in prepubertal patients [45]. In the above study, the occlusal plane change with Class III mechanics alone allowed the anteroposterior discrepancy (WITS) to improve about 1.18 mm. In our severe Class III patients, an even higher increase in Wits appraisal was noticed. The present results are even better than those reported in 2022 in severe postpubertal patients (initial average WITS \(-\)9.1 mm) with hybrid-hyrax (HH), alt-RAMEC and minis-crews supported by intraoral Class III elastics [27]. In the above paper, Wits improved on average +2.2 mm, whereas in all of our patients, a greater improvement was observed. The mandibular growth increment (Co-Go-Gn) was +8.9 mm in the hybrid-hyrax study whereas, in ours, it was lower. However, it should be noted that the A-point change was lower in the present study. The more pronounced mandibular growth restriction in our patients was probably the result of the consecutive use of two extraoral appliances, i.e., the chin-cup and face mask, which doubled the action influencing the still-growing mandible. It could also mean that the use in one patient of two extraoral devices has the greatest potential to modify the development of the mandible during the pubertal and postpubertal stages compared to other treatment modalities. It is also in agreement with the classical research related to RME/FM versus chin-cup treatment, where in high-angle patients, the chin-cup was more beneficial than the facemask [38]. During our treatments, a proclination of the upper incisors and a retroclination of lower incisors appeared (Table 1). The CBCTs of the incisor area of all patients, made 3 to 7 years after treatment cessation, revealed a favorable bone condition, especially around the upper incisors' roots, despite changes in their inclination. Contrary to the concerns, the maxillary incisors' proclination did not cause periodontal problems in either short- or long-term observations (Figures 20, 24 and 25). In untreated skeletal Class III patients, compensation tends to worsen with age [1; 2; 3; 37; 38; 40; 41; 43; 42; 43; 41; 43]. Stability problems after significant movement of the upper and/or the lower jaw during orthognathic surgery seem relevant to the difficulties in neuromuscular adaptation [18; 19]. The treatment protocol proposed in the present report, requiring a treatment time about 1.5 to 3 years, produced skeletal modifications slowly and enabled easier neuromuscular adaptation.