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In this case report, we present the treatment of a 28-year-old patient with lip incompetence and vertical maxillary excess (VME), using a combination of a midpalatal miniscrew-anchored cantilever clip appliance and submerged buccal shelf miniscrews. The patient exhibited a convex profile, long face, gummy smile, and protrusion, with a Class II skeletal relationship and mentalis strain. The patient declined conventional orthognathic surgery, leading to an orthodontic camouflage treatment plan involving extraction of four first premolars, maximum retraction, and active vertical control with skeletal anchorage devices. Treatment included the use of infrazygomatic crest miniscrews, anterior subapical miniscrews, and a cantilever clip appliance for molar intrusion, resulting in significant improvement in facial profile, reduction of gummy smile, resolution of lip incompetence, and alleviation of mentalis strain. This case demonstrates the effectiveness of a nonsurgical orthodontic intervention in managing a complex case of VME and lip incompetence.

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In this case report, we show a strategic approach to prolonging the lifespan of pathologically migrated maxillary canines with a hopeless prognosis in a 57-year-old female patient, highlighting the potential of orthodontic management for middle-aged patients to enhance both occlusion and facial esthetics while minimizing the need for extensive prosthetic treatment. According to the visual treatment objective, the nonextraction treatment plan showed advantages in the type of orthodontic tooth movement and final occlusal relationship. Therefore, considering the favorable periodontal treatment results and single-root teeth, the hopelessly migrated maxillary canines were relocated, eliminating the existing trauma from occlusion. Segmental tooth movement was performed, and orthodontic temporary skeletal anchorage devices were used to support strategic orthodontic tooth movement. After 27 months of treatment, proper occlusion was established with a significant improvement in facial esthetics. The periodontally compromised teeth were preserved with adequate periodontal support. The patient expressed satisfaction with the results, and the 30-month follow-up records confirmed the stability of treatment outcomes.

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Class III malocclusion due to a retrognathic maxilla is common in patients with cleft lip and palate. Skeletally anchored maxillary protraction using screw-anchored mini-plates combined with intraoral elastics has shown promising results in achieving orthopedic changes and maintaining the outcome until the completion of the growth. This case report presents the course of treatment in a patient with unilateral cleft lip and palate and multiple congenitally missing teeth treated with bone-anchored maxillary protraction until the end of growth. Four mini-plates (Bollard plates) were used during comprehensive fixed orthodontic treatment to protract the dentition and close the space where teeth were missing, extrude the canine, and force eruption of the second premolar using extension arms and cantilevers. A 2-year follow-up at age 17 showed stable occlusion and maintenance of soft tissue results. Bone-anchored maxillary protraction treatment in a patient with cleft lip and palate demonstrates proper orthopedic results and could be a viable alternative to orthognathic surgery.