Introduction: The need for an early identification and treatment of the skeletal Class III malocclusion is accepted worldwide. The treatment success in class III patients depends on the malocclusion type and the case individualization. The treatment choice is extremely difficult, and increases with involvement of the skeletal and occlusal structures. In certain situations, when growth pattern is unfavourable, combined surgical-orthodontic treatment needs to be applied. The aim of this paper is to discuss some aspects of the skeletal class III malocclusion. Subjects and methods: patients who addressed our Orthodontic Department, in Cluj-Napoca, Romania, during 2010-2013. Twenty-five subjects, diagnosed with class III malocclusion have been studied. The diagnosis has been established clinical and paraclinical. The treatment was individualized in each case based on patient’s age and difficulty index of the malocclusion. Lateral cephalometry was used to assess skeletal pattern before and after treatment. Skeletal vertical and horizontal relationships were evaluated according to Tweed, Sassouni and Hasund/Segner. Statistical data processing was performed using the Statistica 7.0 software version for Windows, using the Principal Component Analysis (PCA) and the Varimax method. Results and discussion: There were encountered associated anomalies: mandible shift (20%), asymmetries (20%), crowding (40%), canine impaction (4%), open bite (4%), tooth transposition (4%). Nineteen patients (76%) were treated without extractions; 6 patients (24%) had tooth removal (bicuspids or first molars). Six patients (24%) were treated by orthodontic treatment and orthognathic surgery. Conclusion: A stepwise analysis influences the individual treatment of skeletal class III malocclusion, which predicts the treatment choice: orthodontic treatment or a multidisciplinary approach.