University of Kirkuk

College of dentistry
Orthodontics
Reverse Facial mask

Name:-‫محمد عبدالهادي إسماعيل‬

Stage:-4th
Group-E-
introduction

is type of extra oral orthodontic appliance typically used in used to treat cases
of “underbite” when the lower teeth are the lowers forward of the upper teeth.
(known as a Class III orthodontic problem) by pulling forward and assisting the
growth of the upper jaw (the maxillary), allowing the upper jaw
(mandibular bone) to catch up.
Reverse Facemasks needs to be worn approximately 12 to 22 hrs to be truly
effective in correcting the under bite, usually anywhere from 6 to 18 months
depending on the severity of the bite and how much a patient is growing.
A reverse face mask will help to move your upper jaw forward with growth,
which is critical to do at a young age, thereby reducing or possibly eliminating
the need for very involved jaw surgery later in life. This treatment is to be taken
very seriously and followed precisely if an acceptable result is to be achieved.
The device itself attaches on the upper jaw and patients literally wear it as a
facemask. This extraoral device uses rubber bands, secured on already known
orthodontic tools. Such are, for instance, braces, splints, or expanders. The main
goal is to drag the upper jaw forward, by putting the elastics (rubber bands) to
work.

Indications of reverse Facial mask

1-Skeletal class III malocclusion(mild to moderate)
2-Anterior mandibular shift with moderate overbite
3- Bending the condylar neck for stimulating temporo- mandibular joint
adaptations to posterior displacement of the chin

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4-post surgical relapse correction after osteotomies
5-Accessory problem associated with nose morphology such as lateral deviation
Contraindications of reverse Facial mask
1-Severe skeletal class III malocclusion cases
2-hyperdivergent growth pattern
3-minimal overbite
Component of the reverse facial mask
1-chin cup
It’s primary function is taking anchorage from the chin area.
It’s either
 ready made
 or fabricated from an impression of patients genial region.
2-Forhead cap
Aid in establishing anchorage from forehead
3-Elastics
For applying forward traction on the upper arch Vertical posts of the chin cup
are used to attach the elastics onto the molar tubes or hook soldered on the arch
wire .it’s mainly for tooth movement
4-intraoral appliance
Represented with traction hook , which’s placed on the molar or premolar
region
5-Metal frame
Attached to the chin cup and forehand cap , it also receive the elastics from
intraoral appliance

Sites of anchorage
1-Anchorage from chin in which force will transmitted from condylar cartridge
so it will affect or alter mandibular growth
2-Anchorage from skull which’s discomfortable and patient and expensive

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3-Anchorage from chin and forehead which doesn’t apply excessive forces on
the growth cartridge
Types of reverse facial mask
1-Hickham which provide better esthetic and comfort
2-Delaire provide support by using chin and forehead
3-Pelit forehead cap, chin cup & the cross bar can be adjusted to suit the patient
4-Turbinger it avoid the interference of the nose
Biomechanical considerations about reverse facial mask
1-Magnitude of the force
The magnitude of force is determined as 1pound in order to cause skeletal
change
2-Duration of the force
Determined as 13months for low forces(250gm/side) and 4-21 days for high
forces (1600-3000gm)
3-Direction of force
Determined as 15 – 20 degree downward pull to the occlusal plane to produce a
pure forward translatory motion of the maxilla. If the line of force is parallel to
the occlusal plane, a forward translation as well as an upward rotation takes
place
4-using frequency
12-14 hour of wearing per day
Procedures of wearing reverse facial mask

 After a diagnosis and initial preparation, the orthodontist will install the
reverse facial mask. With that, there is an initial expansion the jaw,
supported by a set of rubber bands.
 The appliance itself will immediately start working on applying pressure
on the rubber bands.
 -This pressure will later lead to upper jaw bone growth, which ultimately
pulls the jaw forward. Make sure to change the elastics before putting the
reverse facial mask on daily

Complications of wearing reverse facial mask

 Sleeping problem the appliance’s strength can shape the airways in

children, If the appliance interfered with the airways, it can lead to
obstructive sleep apnea

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  Muscular tension, The jaw and facial muscles engage in plenty of
activity when the appliance is active.
Possibility of irritation and soreness with reverse facial mask
Criss-crossing the elastics will take pressure off of the corners of the mouth and
reduce irritation. It will be tighter this way, but it’s not a problem.

The teeth will feel sore or tender for the first few days. Sleeping will be
different at first until you get used to sleeping with the headgear on your face.

The best time to wear reverse facial mask for children

There are three stages: 4 to 7 years, 7 to 10 years and 10 to 14 years. If a child

is taken to the dentist when they are 7 to 10 years of age, it has a bigger chance
of wearing the face mask with Hyrax for fewer hours each day than older kids.

Treatment of Class III skeletal malocclusion using reverse facial mask

Class III skeletal malocclusion is a change in the position of the maxilla, the
mandible, or both results in a class III malocclusion. The first possibility is a
small maxilla. True midface deficiency can be treated by using a reverse
facemask to exert anteriorly directed force on the maxilla. The reverse
facemask applies force to the maxilla through an appliance (either a removable
splint or fixed appliance) attached to the teeth; tooth movement also occurs.
Some clinicians use the facemask with maxillary expansion (either rapid or
slow) to enhance the transverse coordination of the arches and to facilitate
anterior movement of the maxilla due to alteration of the bony interfaces with
other skeletal structures. A comparison of clinical studies found that less
maxillary incisor movement occurs when expansion accompanies
protraction. One prospective study found no difference between the expansion
and nonexpansion approaches.
Another approach is to use a facemask with miniplates attached to the
maxilla. This method can be used in the late mixed dentition, probably at
approximately 10 to 11 years of age, and shows greater skeletal change and
movement in the zygomatic area as well.

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Causes of early treatment of Class III skeletal malocclusion using reverse
facial mask
 Permanent changes to bone and enamel (hard tissues) and gingival
ligament (soft tissues) can be prevented.
 The skeletal discrepancy between the upper jaw and lower jaw will be
corrected. This will boost jaw growth, enabling a normal intermaxillary
relationship.
 Occlusal function will be enhanced.
 It makes the next major treatment (Phase 2 orthodontic treatment) easier
when a child enters adolescence.

References

Reverse pull headgear https://ivanovortho.com/facemask-correcting-underbite/

Reverse face mask or reverse pull headgear

https://hodgesorthodontics.com/orthodontic-instructions/reverse-pull-headgear/

Treatment of class Class III skeletal malocclusion using reverse facial mask

https://www.sciencedirect.com/topics/nursing-and-health-professions/reverse-pull-headgear

Reverse face mask https://www.slideshare.net/mshariqs/facemaskreverse-pull-headgear

Extraoral appliance https://www.slideshare.net/rababkhursheed/extraoral-appliances