Management of a Class III malocclusion combining MARPE with anterior nasomaxillary complex traction and clear aligners with telemonitoring support: Case report and workflow model

AI-assisted telemonitoring can be used in a MARPE-supported expansion and protraction of the nasomaxillary complex followed up with clear aligners in late-adolescent Class III malocclusion management. A case report is used to illustrate a workflow protocol. Telemonitoring ran across two phases: (1) expansion (weekly remote scans to verify jackscrew activation and soft-tissue status) and (2) clear aligners (rule-based GO/NO-GO triage for progression). Target transverse correction with full midpalatal suture opening was confirmed radiographically. No miniscrew mobility occurred; minor mucosal irritations were handled remotely with over-the-counter procedures and oral hygiene coaching. In the clear aligner phase, 58 scans yielded 39 GO and 19 NO-GO decisions; most NO-GO events were resolved by brief extensions of the current aligner wear time without an in-office visit. Approximately 40% of patient's submissions were late (mostly 2–7 days) yet clinically inconsequential as they were absent of red-flag alerts. About one quarter of the flagged scans were related to biofilm/gingivitis, highlighting variable oral hygiene despite reminders. The workflow protocol communicated to the clinician only unresolved notable misfits after repeated scan or urgent events (e.g., suspected miniscrew mobility). Other lower-risk alerts were managed by trained staff using standardized remote communication with the patient. In conclusion, telemonitoring enabled effective remote supervision (activation, soft tissues/microscrews, clear aligner triage) with fewer scheduled visits and no noted outcome compromise. Telemonitoring clinical value depended on clear GO/NO-GO rules, streamlined team roles, and targeted in-person reinforcement when oral hygiene or scan consistency remained suboptimal.