Nonextraction treatment of a skeletal Class III adolescent girl with expansion and facemask: Long-term stability

•A maxillary protraction facemask was effective after the patient's peak of pubertal growth spurt.•Midpalatal suture opening with rapid maxillary expansion enhanced the orthopedic effect of the facemask and vice versa.•Combined rapid maxillary expansion and facemask effects optimized anterior tooth display and reduction of lateral negative spaces.•Individual dentofacial characteristics may allow clinicians to push the envelope of treatment beyond central tendencies.

This article describes the combined use of maxillary expansion and a protraction facemask in the correction of a skeletal Class III malocclusion after the patient's pubertal growth spurt. Treatment efficacy and the effects on facial and smile esthetics are presented. The nonextraction option with an arch-size increase and stability issues is discussed.