Management of anterior and posterior crossbites with lingual appliances and miniscrew-assisted rapid palatal expansion: A case report

Rationale: Current literature describes only 2 cases combining miniscrew-assisted rapid palatal expansion (MARPE) with lingual appliances. These cases require 2 impressions, 1 before and 1 after palatal expansion, to ensure accurate lingual appliance placement, potentially increasing treatment time and cost. This case report aimed to demonstrate a modified workflow of combining MARPE and lingual appliances in managing an adult patient with anteroposterior and transversal discrepancies, requiring only a single digital impression for both fabrication and positioning. Patient concerns: A 29-year-old female presented with anterior and posterior crossbites, a class III skeletal relationship, and maxillary constriction. The patient desired a nonsurgical and esthetic treatment approach. Diagnoses: The patient was diagnosed with a class III malocclusion with anterior and posterior crossbite on a skeletal hypodivergent class III relationship and upper posterior constriction. Interventions: Treatment included MARPE for skeletal expansion, digitally planned lingual appliances for tooth alignment, and lower arch distalization for class III correction. A modified appliance sequence was utilized for optimal expansion retention and lingual bracket transfer accuracy. Outcomes: The treatment successfully corrected the crossbites, improved dental and facial esthetics, and achieved partial skeletal correction. Lessons: The combination of MARPE and lingual appliances offers a viable treatment alternative that prioritizes both esthetics and effective skeletal expansion for nonsurgical and esthetic management of adult class III malocclusion with maxillary constriction. The modified workflow, employing a single digital impression, may offer several advantages, including reduced treatment duration and associated costs, prolonged postexpansion retention, and minimized aesthetic impact of midline diastema.