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VOLUME 16 , ISSUE 6 ( November-December, 2023 ) > List of Articles

REVIEW ARTICLE

Posttreatment Stability Following Facemask Therapy in Patients with Skeletal Class III Malocclusion: A Systematic Review

Yuvashree Raghupathy, Venkateswaran Ananthanarayanan, Vignesh Kailasam, Sridevi Padmanabhan

Keywords : Facemask, Protraction facemask, Relapse, Stability

Citation Information : Raghupathy Y, Ananthanarayanan V, Kailasam V, Padmanabhan S. Posttreatment Stability Following Facemask Therapy in Patients with Skeletal Class III Malocclusion: A Systematic Review. Int J Clin Pediatr Dent 2023; 16 (6):897-907.

DOI: 10.5005/jp-journals-10005-2686

License: CC BY-NC 4.0

Published Online: 01-02-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Skeletal class III malocclusion is a challenging condition that orthodontists frequently come across. The facemask (FM) is a device commonly used to treat this malocclusion. However, the stability of this orthopedic correction remains unclear, and collective documentation of the short-, mid-, and long-term stability after FM therapy is necessary. Aim: The aim of the systematic review was to assess posttreatment stability following FM therapy in patients with skeletal class III malocclusion. Materials and methods: Through a predefined search strategy, electronic searching was conducted in PubMed, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane, Ovid, Embase, Scopus, and Web of Science until 30th June 2022. Eligible study selection, data extraction, and evaluation of the risk of bias were performed independently by two review authors according to the Cochrane tool for assessing the risk of bias in randomized trials (RoB 2.0 tool) and the Risk of Bias in Nonrandomized Studies–of Interventions (ROBINS-I) tool for nonrandomized trials. A total of 14 studies were finally considered eligible. The systematic review revealed that the maxillo-mandibular differential reverted to class III. The maxillary changes achieved were variable, with SNA angles ranging between −0.7° and 1.9°. Changes in the mandible were greater with an increase in the SNB angle ranging between 0.33° and 3.62°. The lower anterior facial height increased. The maxillary and mandibular incisors were proclined, and the overjet and overbite decreased. The soft tissue changes were insignificant. Conclusion: The effects of FM therapy were found to be stable in the short-term follow-up period. The long-term follow-up revealed that the effects of FM therapy remained stable for the maxilla. However, the mandible continued to grow in a horizontal and unfavorable direction until the adolescent growth spurt. Clinical significance: The major variable that determines the long-term success of FM therapy is the amount and direction of mandibular growth during the adolescent growth spurt. More focus on restricting unfavorable mandibular growth and duration of retention is needed for post-FM therapy. Others: PROSPERO (CRD42021218960).

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  1. Graber TM. Orthodontic Current Principles and Techniques. Philadelphia: WB Saunders Company; 1969.
  2. Hardy DK, Cubas YP, Orellana MF. Prevalence of angle Class III malocclusion: a systematic review and meta-analysis. Open J Epidemiol 2012;2:75–82. DOI: 10.4236/ojepi.2012.24012
  3. Iwagaki H. Hereditary influence of malocclusion. Am J Orthod Oral Surg 1938;24:328–336.
  4. Ellis E 3rd, McNamara JA Jr. Components of adult Class III malocclusion. J Oral Maxillofac Surg 1984;42(5):295–305. DOI: 10.1016/0278-2391(84)90109-5
  5. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. St. Louis, Mo: Mosby Elsevier; 2007.
  6. Chong YH, Ive JC, Artun J. Changes following the use of protraction headgear for early correction of Class III malocclusion. Angle Orthod 1996;66(5):351–362. DOI: 10.1043/0003-3219(1996) 066
  7. Baccetti T, Franchi L, McNamara JA Jr. Treatment and posttreatment craniofacial changes after rapid maxillary expansion and facemask therapy. Am J Orthod Dentofacial Orthop 2000;118(4):404–413. DOI: 10.1067/mod.2000.109840
  8. Kapust AJ, Sinclair PM, Turley PK. Cephalometric effects of face mask/expansion therapy in Class III children: a comparison of three age groups. Am J Orthod Dentofacial Orthop 1998;113(2):204–212. DOI: 10.1016/s0889-5406(98)70141-6
  9. Macdonald KE, Kapust AJ, Turley PK. Cephalometric changes after the correction of class III malocclusion with maxillary expansion/facemask therapy. Am J Orthod Dentofacial Orthop 1999;116(1):13–24. DOI: 10.1016/S0889-5406(99)70298-2
  10. Ngan P, Hägg U, Yiu C, et al. Soft tissue and dentoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop 1996;109(1): 38–49. DOI: 10.1016/s0889-5406(96)70161-0
  11. Cozza P, Marino A, Mucedero M. An orthopaedic approach to the treatment of Class III malocclusions in the early mixed dentition. Eur J Orthod 2004;26(2):191–199. DOI: 10.1093/ejo/26.2.191
  12. Westwood PV, McNamara JA Jr, Baccetti T, et al. Long-term effects of Class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 2003;123(3):306–320. DOI: 10.1067/mod.2003.44
  13. Shanker S, Ngan P, Wade D, et al. Cephalometric A point changes during and after maxillary protraction and expansion. Am J Orthod Dentofacial Orthop 1996;110(4):423–430. DOI: 10.1016/s0889-5406(96)70046-x
  14. Ngan P, Yiu C, Hu A, et al. Cephalometric and occlusal changes following maxillary expansion and protraction. Eur J Orthod 1998;20(3):237–254. DOI: 10.1093/ejo/20.3.237
  15. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviewsSyst Rev. 2021;88:105906. DOI: 10.1016/j.ijsu.2021.105906
  16. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in nonrandomized studies of interventions. BMJ 2016;355:i4919. DOI: 10.1136/bmj. i4919
  17. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomized trials. BMJ 2019;366:l4898. DOI: 10.1136/bmj. l4898
  18. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336(7650):924–926. DOI: 10.1136/bmj.39489.470347.AD
  19. Wendl B, Stampfl M, Muchitsch AP, et al. Long-term skeletal and dental effects of facemask versus chincup treatment in Class III patients: a retrospective study. J Orofac Orthop 2017;78(4):293–299. DOI: 10.1007/s00056-017-0083-3
  20. Pangrazio-Kulbersh V, Berger JL, Janisse FN, et al. Long-term stability of Class III treatment: rapid palatal expansion and protraction facemask vs LeFort I maxillary advancement osteotomy. Am J Orthod Dentofacial Orthop 2007;131(1):7.e9–7.e19. DOI: 10.1016/j.ajodo.2006.04.024
  21. Ngan PW, Hagg U, Yiu C, et al. Treatment response and long-term dentofacial adaptations to maxillary expansion and protraction. Semin Orthod 1997;3(4):255–264. DOI: 10.1016/s1073-8746(97)80058-8
  22. Masucci C, Franchi L, Defraia E, et al. Stability of rapid maxillary expansion and facemask therapy: a long-term controlled study. Am J Orthod Dentofacial Orthop 2011;140(4):493–500. DOI: 10.1016/j.ajodo.2010.09.031
  23. Chen L, Chen R, Yang Y, et al. The effects of maxillary protraction and its long-term stability–a clinical trial in Chinese adolescents. Eur J Orthod 2012;34(1):88–95. DOI: 10.1093/ejo/cjq185
  24. Nevzatoğlu S, Küçükkeleş N. Long-term results of surgically assisted maxillary protraction vs regular facemask. Angle Orthod 2014;84(6):1002–1009. DOI: 10.2319/120913-905.1
  25. Williams MD, Sarver DM, Sadowsky PL, et al. Combined rapid maxillary expansion and protraction facemask in the treatment of Class III malocclusions in growing children: a prospective long-term study. Semin Orthod 1997;3(4):265–274. DOI: 10.1016/s1073-8746(97)80059-x
  26. Mandall N, DiBiase A, Littlewood S, et al. Is early Class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 15-month follow-up. J Orthod 2010;37(3):149–161. DOI: 10.1179/14653121043056
  27. Mandall N, Cousley R, DiBiase A, et al. Is early Class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 3-year follow-up. J Orthod 2012;39(3):176–185. DOI: 10.1179/1465312512Z.00000000028
  28. Mandall N, Cousley R, DiBiase A, et al. Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial. J Orthod 2016;43(3):164–175. DOI: 10.1080/14653125.2016.1201302
  29. Ngan P, Hägg U, Yiu C, et al. Treatment response to maxillary expansion and protraction. Eur J Orthod 1996;18(2):151–168. DOI: 10.1093/ejo/18.2.151
  30. Yavuz I, Halicioğlu K, Ceylan I. Face mask therapy effects in two skeletal maturation groups of female subjects with skeletal Class III malocclusions. Angle Orthod 2009;79(5):842–848. DOI: 10.2319/090308-462.1
  31. Yüksel S, Uçem TT, Keykubat A. Early and late facemask therapy. Eur J Orthod 2001;23(5):559–568. DOI: 10.1093/ejo/23.5.559
  32. Takada K, Petdachai S, Sakuda M. Changes in dentofacial morphology in skeletal Class III children treated by a modified maxillary protraction headgear and a chin cup: a longitudinal cephalometric appraisal. Eur J Orthod 1993;15(3):211–221. DOI: 10.1093/ejo/15.3.211
  33. Franchi L, Baccetti T, McNamara JA. Postpubertal assessment of treatment timing for maxillary expansion and protraction therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 2004;126(5):555–568. DOI: 10.1016/j.ajodo.2003.10.036
  34. Behrents R. JCO/interviews Dr. Rolf Behrents on adult craniofacial growth. J Clin Orthod 1986;20(12):842–847.
  35. Bjork A, Palling M. Adolescent age changes in sagittal jaw relation, alveolar prognathy, and incisal inclination. Acta Odontol Scand 1955;12(3-4):201–232. DOI: 10.3109/00016355509028164
  36. Foley TF, Mamandras AH. Facial growth in females 14 to 20 years of age. Am J Orthod Dentofacial Orthop 1992;101(3):248–254. DOI: 10.1016/0889-5406(92)70094-Q
  37. Kakali L, Christopoulou I, Tsolakis IA, et al. Mid-term follow up effectiveness of facemask treatment in class III malocclusion: a systematic review. Int Orthod 2021;19(3):365–376. DOI: 10.1016/j.ortho.2021.07.003
  38. Lee WC, Shieh YS, Liao YF, et al. Long-term maxillary three dimensional changes following maxillary protraction with or without expansion: a systematic review and meta-analysis. J Dent Sci 2021;16(1):168–177. DOI: 10.1016/j.jds.2020.06.016
  39. Garattini G, Levrini L, Crozzoli P, et al. Skeletal and dental modifications produced by the Bionator III appliance. Am J Orthod Dentofacial Orthop 1998;114(1):40–44. DOI: 10.1016/s0889-5406(98)70235-5
  40. Solow B. The dentoalveolar compensatory mechanism: background and clinical implications. Br J Orthod 1980;7(3):145–161. DOI: 10.1179/bjo.7.3.145
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