Making skeletal class III malocclusion treatment more effective by using a facemask and a modified skeletal expander

INTERVENTION: Patients will be randomly allocated into two groups using Microsoft® Excel electronic randomization: Arm 1: Experimental group: Each Patient in this group will be treated with a modified skeletal expander and face mask appliance. The treatment will begin with the placement of bonded expander on the upper arch. The patients will be instructed to activate the expander twice a day until the desired transverse width is achieved (two weeks). The patients will be given facemasks immediately after the expansion ends, and will be instructed to wear the appliance for a minimum of 14 hours per day. All patients will be treated at least to a positive, over‐corrected dental overjet before discontinuing treatment with the facemask appliance. *The expander used in this group was modified by adding buccal and labial acrylic pads. Arm 2: Control group: Each Patient in this group will be treated with a traditional bonded skeletal expander and face mask appliance. The treatment protocol used in this group is the same as described in the experimental group. CONDITION: Skeletal class III and maxillary transverse deficiency. ; Oral Health PRIMARY OUTCOME: ; 1. Sagittal and vertical skeletal changes before and after treatment will be assessed using cone‐beam computed tomography‐generated cephalograms.; 2. Dentoalveolar changes including:; 2.1. Upper incisor angle changes.; 2.2. The permanent maxillary first molar inclination changes.; 2.3. Height and thickness of alveolar bone.; Dentoalveolar changes before and after treatment will be assessed using cone‐beam computed tomography.; SECONDARY OUTCOME: ; 1. Soft tissue changes before and after treatment will be assessed using profile photography.; 2. Levels of pain and discomfort measured using a questionnaire given to the patients.; INCLUSION CRITERIA: 1. Skeletal class III caused by maxillary deficiency with or without mandibular prognathism. 2. Maxillary transverse deficiency. 3. Patients with normal or horizontal growth patterns. 4. Patients in early mixed dentition (7‐10 years old).