الفهرس 
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Abstract
SUMMARY & CONCLUSIONS
Class III malocclusion is associated with a deviation in the sagittal relationship of the maxilla and the mandible, characterized by a deficiency and/or a backward position of the maxilla, or by prognathism and/or forward position of the mandible.
Early treatment of Class III malocclusion has been advocated to reduce the need of treatment in the permanent dentition to reach a good profile and balanced occlusion. Patients will need both maxillary protraction and expansion. Growth modification at an early age is important for patients with Class III even if full correction of the skeletal problem will not be achieved.
The aim of this study was to evaluate the skeletal and dental effects of the Tandem appliance three dimensionally for the correction of skeletal Class III malocclusion, also to assess the duration of the treatment and patient compliance.
The study was conducted on 22 growing female girls with retruded maxilla. CBCT records were taken before and after treatment. All cases were treated for about 6-15 months.
The skeletal anteroposterior measurements revealed significant forward movement of the maxilla, significant increase in mandibular length. An increase in the anterior and posterior facial heights also a counter clock wise rotation palatal and mandibular planes as well as significant increase in transverse dimensions has been reported.
The upper incisors showed a noticeable anterior proclination, there was a retroclination of the lower incisors. The maxillary first molars showed significant mesial movement distal movement of mandibular molars, significant increase in overjet after treatment. Soft tissue profile was improved as revealed by CBCT analysis and 3D superimpositions.
A survey was done to was to assess the knowledge, awareness, and attitude. It revealed increased cooperation of the patients during treatment which may lead to duration of treatment. 68.8% reported their feelings about the appliance to be good, it was found also that less percentage of patients in this study had pain in their teeth or TMJ while wearing the appliance.
The following conclusions could be derived from the results of this study:
1. The Tandem Appliance could be used effectively in management of skeletal Class III malocclusion with maxillary retrusion.
2. The Tandem appliance had a combination of skeletal and dental effects.
3. The Tandem Appliance enhanced soft tissue profile of the patients.
4. A great acceptance between patients was reported that reflected more cooperation during treatment.
RECOMMENDATIONS
• Follow up the patients for extended time after the peak of growth to evaluate the effect of Tandem appliance on long term.
• Further studies are needed to increase the retention of the Hyrax appliance to decrease its de-bonding and loss.
• The Tandem appliance needs a more resilient design to prevent breakage.