Manhães protocol for early treatment of skeletal Class III

Fernando R. Manhães, Heloísa C. Valdrighi, Carolina C. de Menezes, Silvia A. S. Vedovello

The aim of this article is to describe the stages of the Manhães protocol for early treatment of Class III malocclusion. The Manhães protocol is indicated for patients with skeletal Class III due to maxillary deficiency, in the late stage of mixed, or young permanent dentition. The permanent mandibular canines must be erupted and the patient should preferably be in the stage before the pubertal growth spurt. In this protocol, two mini-implants are inserted in the anterior palatal parasuture after the third ruga for adaptation of the dentoskeletal palatal expander (hybrid Hyrax). In addition, two mini-implants are inserted between the mandibular lateral incisors and permanent canines, where the Manhães Bar will be adapted. After the devices have been inserted, the patient will begin to use the Class III intraoral elastics with 100 g of force in the first month, and 200 g as from the second month. The elastics must be changed every 12 hours. The hybrid Hyrax is activated by a 2/4 turn of the screw in the morning, and 2/4 at night, until the suture opens. At this time, the use of the nocturnal Petit facemask is indicated, associated with the use of extraoral elastic (1/2-in heavy) with 400 to 500 g of force. The authors concluded that the Manhães protocol may be used for the early treatment of Class III, with stages capable of being performed clinically by the orthodontist.

Keywords: Class III malocclusion. Early treatment. Mini-implants. Anchorage. Orthodontics.

How to cite: Como citar: Manhães FR, Valdrighi HC, Menezes CC, Vedovello SAS. Protocolo Manhães no tratamento precoce da Classe III esquelética. Rev Clín Ortod Dental Press. 2018 Jun-Jul;17(3):36-53. DOI: https://doi.org/10.14436/1676-6849.17.3.036-053.art

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