Face Mask

The orthodontic face mask, also known as a protraction facemask or reverse pull headgear, is a specialized appliance used in the treatment of Class III malocclusions. This condition arises when the upper jaw (maxilla) is underdeveloped or positioned too far back in relation to the lower jaw (mandible). The face mask applies gentle forward and downward traction to the upper jaw, encouraging proper alignment and growth, often preventing the need for future invasive procedures such as orthognathic surgery.

Face mask therapy is most effective in children whose growth has not yet completed, typically between the ages of 6 and 9. Early intervention is crucial, as it promotes balanced facial development and minimizes future complications.

For information about all early orthodontic treatments, I recommend you to read my Early Orthodontic Treatment Treatments article.

Components and Design

The face mask appliance consists of two main parts: an intraoral and an extraoral component.

• Intraoral Component: This part varies based on the patient’s specific needs and may include devices such as a rapid palatal expander (RPE) or other devices, which help create space in the upper jaw by widening the palate.
• Extraoral Component: The external structure is fairly standardized, comprising a metal framework with adjustable supports for the forehead and chin. These supports are cushioned for comfort and can be tailored to fit the patient’s facial height. Elastic bands connect the intraoral and extraoral parts, creating the necessary tension to pull the upper jaw forward.

The metal bar acts as a stabilizing frame, while the elastic bands generate the forward and downward force necessary for treatment.

Treatment Process

The Reverse pull headgear treatment can be divided into three distinct phases: expansion, protraction, and retention.

• Expansion: In many cases, the treatment begins with a rapid palatal expander (RPE) to widen the upper jaw. This creates additional space, making it easier to shift the upper jaw forward.
• Protraction: During this phase, the actual forward movement of the upper jaw occurs. The face mask exerts a continuous force, generally applied for 14-16 hours daily, primarily at night when the body is more relaxed and responsive to treatment. The amount of time the mask is worn directly impacts the treatment’s success.
• Retention: Once the desired forward movement is achieved, retention devices are used to maintain the results. This prevents the upper jaw from reverting to its previous position as the bones and tissues stabilize.

Indications and Benefits

The Reverse pull headgear is primarily used in cases of Class III malocclusion caused by maxillary hypoplasia (an underdeveloped upper jaw). It is particularly beneficial for children between 6 and 9 years of age, where the first molars and incisors have erupted. Treating Class III malocclusion early prevents further skeletal discrepancies and reduces the risk of future dental compensations, like shifting of teeth or jaw misalignments.

The benefits of early reverse pull headgear treatment include:

• Advancing the upper jaw: By pulling the maxilla forward, the face mask corrects the jaw imbalance and improves the patient’s profile.
• Improving occlusal function: Face mask therapy corrects the bite by improving the relationship between the upper and lower teeth.
• Reducing the need for surgery: Early intervention can reduce or even eliminate the need for orthognathic surgery later in life.
• Enhancing facial aesthetics: This treatment significantly improves facial symmetry, contributing to better psychosocial development during childhood.

Wearing and Maintenance

The effectiveness of the reverse pull headgear relies on patient compliance. For the best results, it must be worn for at least 14-16 hours daily, ideally during the evening and night. Daytime wear is not always necessary but may be recommended based on the severity of the case. It’s important to build up the wear time gradually, especially during the initial adjustment period.

Cleaning and Care

• Intraoral Component: This part should be cleaned regularly using a toothbrush and toothpaste, much like regular oral hygiene.
• Extraoral Component: The outer framework can be wiped down with a damp cloth to maintain cleanliness. Additionally, the forehead and chin pads may wear out over time, but replacements are usually provided with the appliance.

Outcomes and Long-Term Stability

Face mask therapy has a high success rate, with approximately 70% to 75% of patients experiencing significant correction of their Class III malocclusion. Even in cases where the malocclusion persists, the early treatment generally results in less invasive surgical interventions later on.

However, it’s important to note that not every Class III patient will respond to face mask therapy. In about 25% to 30% of cases, more invasive treatments like orthognathic surgery may still be required. Despite this, early treatment with a face mask may make any future corrections less extensive.

I suggest you take a look at the Long-term efficacy of reverse pull headgear therapy article published in The Angle Orthodontist. I leave the conclusion part of the article below for reference:

Conclusion

Orthodontic face mask treatment is an essential early intervention for children with Class III malocclusions caused by an underdeveloped upper jaw. By addressing the skeletal imbalance at a young age, it promotes better facial development, improves bite function, and reduces the need for future surgical corrections. With proper compliance and care, the face mask offers a non-invasive and effective solution for enhancing both dental health and facial aesthetics.