ORIGINAL ARTICLE

Facemask therapy with and without expansion

Tuba Tortop,a Alaadin Keykubat,b and Sema Yuksela
Ankara, Turkey

Introduction: The aim of this study was to compare the effects of facemask treatment with and without
expansion in patients with skeletal Class lll malocclusion. Methods: The material for this study consisted of
the pretreatment and posttreatment lateral cephalograms of 28 subjects with skeletal and dental Class lll
malocclusions, divided into 2 groups of 14. In the facemask with expansion group (FMEXP; 8 girls, 6 boys;
mean age, 11 years 1 month), each subject wore a Delaire-type facemask and a bonded rapid maxillary
expansion appliance. In the facemask only group (FM; 8 girls, 6 boys; mean age, 11 years 6 months), each
subject wore a Delaire-type facemask with a removable appliance. A third group of untreated children with
Class lll malocclusion (7 girls, 7 boys; mean age, 10 years 2 months) was used as the control sample.
Results: The forward displacement of the maxilla in both treated groups was significantly greater than in the
control group. The forward displacement of pogonion and increase in facial depth in the control group
showed significant differences compared with the treatment groups. Extrusion of the maxillary molars was
significantly greater in the FM group than in the control group. The increase in the mandibular plane angle and
the decrease in the facial axis were significantly different between the FMEXP group and the control group.
Molar relationship increased more in the FM group than in the FMEXP group; this was the only significant
difference between the treatment groups. In both treatment groups, dental and skeletal treatment of subjects
with Class lll malocclusion were achieved. Conclusions: If the treatment indications are appropriate,
facemask therapy can be an effective method for Class III treatment. (Am J Orthod Dentofacial Orthop 2007;
132:467-74)

T
he aim of nonsurgical correction of dentofacial
anomalies is to improve occlusal relationships
and provide a favorable environment for normal
growth.1-3 Clinical and experimental studies show that
early treatment with maxillary protraction appliances is
effective in promoting the growth of a deficient maxilla
and correcting Class III malocclusion.4-9
Class III skeletal patterns often exhibit a high
incidence of deficient transverse maxillary growth. In
the treatment of Class III malocclusions, maxillary
expansion is frequently needed to increase the trans-
verse width of the maxilla. Also, maxillary expansion
alone has been believed to be beneficial in the treatment
of certain types of Class III malocclusion. Haas10-12
reported that, with rapid palatal expansion, the maxilla
might move slightly forward and downward. The max-
illa articulates with 9 other bones. According to several
authors, rapid maxillary expansion disrupts the circum-
maxillary sutural system, initiates cellular response in
the sutures, and enhances the protraction effect of the
mask.13-15 To disrupt the maxillary sutural system,
a
Professor, Department of Orthodontics, Gazi University, Ankara, Turkey.
b
Private practice, Ankara, Turkey.
Reprint requests to: Tuba Tortop, Gazi Universitesi, Diş Hekimliği Fakültesi,
Ortodonti Anabilim Dalı, 06510/Emek-Ankara, Turkey; e-mail, tubatortop@
gazi.edu.tr.
Submitted, July 2005; revised and accepted, September 2006.
0889-5406/$32.00
Copyright © 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2006.09.047
rapid palatal expansion for 8 to 10 days has been
recommended for patients with no deficiency in the
transverse dimension.13,14,16
Baik5 compared 47 patients treated with facemasks
and rapid palatal expansion with 13 patients treated
with facemasks and labiolingual appliances and found
significantly greater forward movement of Point A in
the expansion group. Kim et al17 evaluated facemask
therapy in a meta-analysis study and reported that the
results of protraction with or without expansion were
similar, but the average duration of treatment was
longer in the nonexpansion group. There are few
studies concerning the effect of expansion during face-
mask therapy. Thus, it might be advantageous to
evaluate this with matched treatment groups and a
control group.
In this study, we aimed to compare facemask
treatment results between expansion and nonexpansion
groups and between treated groups and a control group;
all groups were matched by age and sagittal skeletal
relationship.
MATERIAL AND METHODS
The material of this study consisted of the lateral
cephalograms of 42 children with skeletal and dental
Class III malocclusion due to maxillary retrusion or a
combination of maxillary retrusion and mandibular
protrusion. Each patient had a negative ANB angle, a
467
468 Ucem, Keykubat, and Yuksel American Journal of Orthodontics and Dentofacial Orthopedics
October 2007

Class III molar relationship, and a negative overjet.

Two treatment groups and a control group were formed
with 14 subjects in each. The groups were matched
by sex, ANB angle, and mandibular plane angle
(SNGoGn). The control group was retrospectively
formed.
The facemask plus expansion (FMEXP) group con-
sisted of 14 patients (8 girls, 6 boys; mean age, 11 years
1 month) with maxillary bilateral posterior crossbite
accompanying the Class III malocclusion. Each subject
was treated with a Delaire-type facemask and a bonded
rapid maxillary expansion appliance (hyrax). The bonded
appliance had vestibular hooks at the canine region for
extraoral elastics. The hyrax screws were activated twice
a day with a quarter turn until the desired change in the
transverse dimension was achieved (ie, the palatal cusp
of the maxillary molar was in a similar plane to the
buccal cusp of the mandibular molar). Facemasks were
used either at the beginning of expansion or at the end
of the first week.
Fig 1. Cephalometric measurements used in the study: 1,
The facemask (FM) group consisted of 14 patients
Co-A; 2, Co-Gn; 4, maxillary depth (NA/FH); 5, facial depth
(8 girls, 6 boys; mean age, 11 years 6 months) with no
(N-Pg/FH); 6, SNA; 7, SNB angle; 8, ANB angle; 9, Wits
posterior crossbite. Each subject was treated with a appraisal; 10, maxillary height (N-CF/CF-A); 11, palatal plane
Delaire-type facemask and a removable intraoral appli- (ANS-PNS/FH); 12, facial axis (N-Ba/CC-Gn); 13, SN/GoGn;
ance. The removable intraoral appliance had 2 Adams 14, GnGoAr.
clasps at the molars, 2 ball clasps, a labial bow, and 2
hooks at the anterior region for extraoral elastics.
The total force of the facemask was 600 g, the angle
between the occlusal plane and the direction force
applied by the facemask was approximately 20°, and
the patients were instructed to wear the appliance 16
hours a day in both treatment groups.
At the beginning and after Class I molar occlusion
and a minimum 2 mm overjet were obtained, lateral
cephalometric radiographs were taken. The avarage
treatment times were 8 months for the FMEXP group
and 7 months for the FM group.
A retrospective control group of 14 children (7
girls, 7 boys; mean age, 10 years 4 months) was
observed without treatment for 10 months. Lateral
cephalometric radiographs were taken at the beginning
and the end of the observation period.
All radiographs were traced, digitized, and eval-
uated with the JOE program (version 5.0, Rocky
Mountain Orthodontics, Denver, Colo). Ten linear
Fig 2. Cephalometric measurements used in the study
and 13 angular measurements were evaluated (Figs 1 (continued): 15, SN/occlusal plane; 16, molar relation-
and 2). ship; 17, overjet; 18, overbite; 19, U6PTV; 20, U1-NA
To differentiate dental and skeletal effects, total (mm); 21, U1-NA (°); 22, NSBa; 23, SN.
superimpositions were made on sella-nasionline (SN) at
sella (Fig 3). For the total superimposition, the pretreat-
ment tracing SN plane was used as the horizontal the sella turcica at the junction with the tuberculum
reference plane, and vertical perpendicular to SN at sella) was used as the vertical reference (T1). On total
point T (the most superior point of the anterior wall of superimpositions, vertical and horizontal movements of
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 132, Number 4
Fig 3. Measurements on the total superimposition: 1,
ANSx; 2, Pgx; 3, ANSy; 4, Pgy.
Fig 4. Measurements on local superimposition: 1, U6x;
2, U1x; 3, U6y; 4, U1y.
anterior nasal spine (ANS) and pogonion (Pg) were
evaluated according to the reference grid formed in the
first cephalogram. Local superimpositions were made
on palatal plane at ANS for maxilla (Fig 4). For the
maxillary superimposition, the pretreatment tracing
ANS-posterior nasal spine (PNS) plane was used as the
horizontal reference plan, and vertical perpendicular to
Ucem, Keykubat, and Yuksel 469
ANS-PNS at point T was used as the vertical reference
plane (T2). On local superimpositions, vertical and
horizontal movements of maxillary incisors and molars
were evaluated according to the reference grid formed
in the first cephalogram.
All cephalometric radiographs were retraced and
redigitized, and superimpositions and measurements
were repeated after 15 days. Method error coefficients
were calculated and found to be within acceptable
limits (range, 0.94-0.99).18
Statistical analysis was undertaken with software
(Win version 6.0; SPSS, Chicago, Ill). The Wilcoxon
test was used to evaluate the treatment effects and
changes during the observation period in each group.
Differences between the groups were determined by
variance analysis and the Duncan test.
RESULTS
Comparison of the pretreatment values showed that
maxillary height was significantly greater in the FM
group compared with the FMEXP and the control
groups (P ⬍.05). The pretreatment facial axis value in
the control group was significantly greater than in the
FM group (P ⬍.05) (Table I).
Of the cephalometric measurements, CoA and
CoGn showed significant increases (P ⬍.001 and P
⬍.01, respectively) in the FMEXP group. The signifi-
cant increase in SNA angle (P ⬍.05) and the significant
decrease in SNB angle (P ⬍.01) resulted in a signifi-
cant increase in ANB angle (P ⬍.001). Maxillary depth
and the Wits appraisal increased significantly during
FMEXP therapy (P ⬍.01). A significant decrease in
facial axis and an increase in SNGoGn were ob-
served (P ⬍.01). The increase in SN dimension was
found to be statistically significant (P ⬍.05) (Table
II). Molar relationship, overjet, and U6PTV also
showed significant increases in the FMEXP group (P
⬍.01 and P ⬍.001, respectively) (Table II).
In the FM group, significant increases in CoA and
CoGn were found (P ⬍.01 and P ⬍.05, respectively),
and the maxillomandibular differential decreased sig-
nificantly (P ⬍.05). SNA angle, ANB angle, and the
Wits appraisal showed significant increases (P ⬍.01, P
⬍.001, and P ⬍.001, respectively). The decrease in
gonial angle (GnGoAr) was statistically significant in
the FM group. The SN dimension showed a signicant
increase in this group (P ⬍.05) (Table II).
The occlusal plane decreased significantly during
FM therapy (P ⬍.05). There were significant increases
in molar relationship, overjet, and U6PTV (P ⬍.01).
The increase in U1-NA angle was statistically signifi-
cant (P ⬍.05) (Table II).
470 Ucem, Keykubat, and Yuksel American Journal of Orthodontics and Dentofacial Orthopedics
October 2007

Table I. Pretreatment mean values and statistical differences between groups

FMEXP (1) FM (2) Control (3)
(n ⫽ 14) (n ⫽ 14) (n ⫽ 14)

Mean SE Mean SE Mean SE 1-2 1-3 2-3

1. CoA (mm) 80.7 1.2 80.1 0.9 78.2 0.9

2. CoGn (mm) 114.1 1.7 113.4 1.3 109.6 1.5
3. Maxillomandibular differential (mm) 33.4 1.2 33.4 1.1 31.4 1.0
4. Maxillary depth (°) 84.5 1.0 83.3 0.7 83.7 0.9
5. Facial depth (°) 87.2 1.0 86.5 1.1 86.8 1.1
6. SNA angle (°) 77.2 0.8 76.9 0.9 78.1 1.0
7. SNB angle (°) 79.5 0.7 79.4 1.1 80.5 1.1
8. ANB angle (°) ⫺2.3 0.5 ⫺2.5 0.5 ⫺2.5 0.6
9. Wits appraisal (mm) ⫺8.2 0.9 ⫺8.7 0.9 ⫺8.8 0.9
10. Maxillary height (°) 59.0 1.0 62.3 1.2 58.9 0.9 * (0.41)*
11. Palatal plane to Frankfort horizontal (°) ⫺0.3 1.1 ⫺1.0 0.8 ⫺3.0 0.9
12. Facial axis (°) 90.0 0.8 88.1 1.3 91.7 1.1 (0.73)*
13. SNGoGn (°) 35.8 1.0 34.5 1.4 33.3 1.2
14. GnGoAr (°) 128.6 0.8 125.4 2.0 127.8 1.4
15. Occlusal plane (°) 18.8 1.2 19.6 1.0 19.7 1.5
16. Molar relationship (mm) ⫺4.3 1.1 ⫺5.0 0.5 ⫺3.8 0.6
17. Overjet (mm) ⫺2.0 0.5 ⫺1.3 0.5 ⫺2.3 0.2
18. Overbite (mm) 2.3 0.8 1.8 0.7 3.0 0.6
19. U6PTV (mm) 11.6 1.0 8.6 0.9 9.1 0.9
20. U1-NA (mm) 5.1 0.4 5.7 0.3 4.7 0.4
21. U1-NA (°) 23.6 1.2 23.8 1.2 21.6 1.3
22. NSBa (°) 128.3 1.6 128.5 0.9 126.5 1.1
23. SN (mm) 68.5 0.6 68.0 0.9 66.6 0.7

*P ⬍.05.

In the control group, CoA, CoGn, and maxilloman-
dibular differential increased significantly without
treatment (P ⬍.01, P ⬍.001, and P ⬍.001, respec-
tively). There were significant increases in maxillary
depth and facial depth (P ⬍.05 and P ⬍.01, respec-
tively). A sigificant increase in the SN dimension was
observed (P ⬍.01) (Table II).
Overbite and U6PTV showed significant increases
during the observation period (P ⬍.05 and P ⬍.01,
respectively) (Table II).
On the superimpositions, ANSx showed significant
increases in both treatment groups (P ⬍.001). The
increase in Pgy was sigificant only in the FMEXP
group (P ⬍.05). In the control group Pgx, ANSy, and
Pgy increased significantly (P ⬍.01). Significant dif-
ferences were observed in U6x and U6y in the FM
group (Table III).
The increases in CoA in the FMEXP and the FM
groups showed significant differences compared with
the control group (P ⬍.05 and P ⬍.001, respectively).
The decrease in maxillomandibular difference in the
FMEXP and FM groups was significantly different
compared with the increase in the control group (P
⬍.05 and P ⬍.001, respectively). A significant differ-
ence was observed in facial depth between the treat-
ment groups and the control group (P ⬍.05). The
increases in SNA angle in the FMEXP and the FM
groups showed significant differences compared with
the control group (P ⬍.05 and P ⬍.001, respectively).
There was a significant difference in SNB angle be-
tween the FMEXP and the control groups (P ⬍.05).
Increases in ANB angle and Wits appraisal in the
treatment groups were significantly different compared
with the control group (P ⬍.001 and P ⬍.01, respec-
tively). A significant difference was observed in max-
illary height between the FM and the control groups (P
⬍.05). Changes in facial axis and SNGoGn in the
FMEXP group showed significant differences com-
pared with the control group (P ⬍.05). Increases in
molar relationship in the treatment groups were signif-
icantly different compared with the control group (P
⬍.01 and P ⬍.001, respectively). Also, the increase in
molar relationship in the FM group was significantly
greater than in FMEXP group (P ⬍.01). Increases in
overjet in the treatment groups showed significant
difference compared with the control group (P ⬍.001).
There was a significant differences in overbite between
the FM and the control groups (P ⬍.05). The increase
in U6PTV in the FMEXP group was significantly
greater than in the control group (P ⬍.05). (Table II).
The superimpositions showed that changes in
ANSx and Pgx in the treatment groups were signifi-
American Journal of Orthodontics and Dentofacial Orthopedics Ucem, Keykubat, and Yuksel 471
Volume 132, Number 4

Table II. Treatment changes in treatment groups, observed changes in control group, and comparisons among groups
FMEXP (1) FM (2) Control (3)
(n ⫽ 14) (n ⫽ 14) (n ⫽ 14)

D SD D SD D SD 1-2 1-3 2-3

‡ † † †
1. CoA (mm) 2.1 0.3 3.1 0.8 0.6 0.2 *
† ‡
2. CoGn (mm) 1.9 0.6 1.4 * 0.6 2.1 0.4
3. Maxillomandibular differential (mm) ⫺0.3 0.5 ⫺1.6 * 0.6 1.5 ‡
0.3 * ‡

†
4. Maxillary depth (°) 2.1 0.5 1.6 0.9 1.4 * 0.6
5. Facial depth (°) ⫺0.3 0.6 ⫺1.4 0.9 2.0 †
0.7 * *
6. SNA angle (°) 1.0 * 0.4 2.1 †
0.5 ⫺0.3 0.3 * ‡

7. SNB angle (°) ⫺1.4 †

0.4 ⫺1.0 0.7 0.3 0.2 *
8. ANB angle (°) 2.4 ‡
0.5 3.2 ‡
0.5 ⫺0.6 0.3 ‡ ‡

9. Wits appraisal (mm) 3.9 †

1.0 6.1 ‡
1.0 ⫺0.3 0.6 † †

10. Maxillary height (°) ⫺0.2 0.7 ⫺1.0 0.6 1.0 0.6 *
11. Palatal plane to Frankfort horizontal (°) 1.3 0.7 0.7 0.7 0.2 1.0
12. Facial axis (°) ⫺2.2 * 0.8 ⫺1.3 0.7 0.3 0.5 *
†
13. SNGoGn (°) 2.0 0.6 1.2 0.9 0.1 0.3 *
14. GnGoAr (°) ⫺0.6 0.8 ⫺1.3 * 0.5 ⫺0.4 0.4
15. Occlusal plane (°) ⫺0.8 0.8 ⫺3.4 * 1.4 ⫺0.8 0.7
16. Molar relationship (mm) 2.6 †
0.8 5.2 †
0.8 ⫺0.4 0.2 † † ‡

17. Overjet (mm) 4.6 ‡

0.6 5.1 †
0.6 ⫺0.2 0.2 ‡ ‡

18. Overbite (mm) ⫺1.1 0.7 ⫺1.7 0.8 0.8 * 0.3 *

‡ † †
19. U6PTV (mm) 4.1 0.6 3.8 0.8 1.9 0.6 *
20. U1-NA (mm) 0.1 0.3 0.7 0.4 0.3 0.3
21. U1-NA (°) 0.2 0.9 2.4 * 1.0 1.8 1.0
22. NSBa (°) 0.2 0.6 ⫺0.5 0.5 0.4 0.7
23. SN (mm) 0.8 * 0.3 0.6 * 0.3 1.0 † 0.2

D, Mean difference; SD, standard error of mean difference.

*P ⬍.05.
†
P ⬍.01.
‡
P ⬍.001.

cantly different compared with the control group (P
⬍.001 and P ⬍.05, respectively). The increase in U6y
in the FM group was significantly greater than in the
control group (P ⬍.05) (Table III).
DISCUSSION
In this investigation, treatment changes were ana-
lyzed and compared after orthopedic therapy of Class
III malocclusion with the FMEXP and the FM. To
evaluate the changes during these treatments, a control
group was formed of children with untreated Class III
malocclusion.
Significant increases in CoA, SNA angle, and
ANSx demonstrated the forward movement of the
maxilla in both treatment groups, and this agreed with
several facemask studies with or without expan-
sion.9,14,19-23
Several authors showed that the maxilla can dis-
place in a forward and downward direction during
maxillary expansion.10,12,24 Surgically assisted rapid
palatal expansion induced a slight forward movement
of the maxilla.25 However, da Silva et al26 reported
downward and backward rotation of the maxilla and
concluded that anterior displacement of the maxilla
with significant changes in SNA angle should not be
expected. Palatal expansion might disarticulate the max-
illa and initiate cellular response in the sutures, allowing a
more positive reaction to protraction forces.11,27 As a
result of this belief, the use of bonded rapid palatal
expansion appliances before or at the beginning of the
facemask therapy have been recommended to facilitate
maxillary movement.13,15,28
Baik5 compared 2 intraoral appliances during face-
mask therapy; 47 patients were treated with rapid
palatal expansion and 13 patients with labiolingual
appliances. He found significantly greater forward
movement of Point A in the expansion group (2 mm)
compared with the labiolingual group (0.9 mm), but the
angular change was similar in the expansion and the
nonexpansion groups. In this study, in the FMEXP
group, expansion was used primarily to correct the
posterior crossbites rather than to disarticulate the
maxillary sutures. Our results indicated that increases
in CoA and SNA angle had no significant differences
between the treatment groups. On the total superimpo-
sition, the forward movements of ANS were 3 mm in
472 Ucem, Keykubat, and Yuksel American Journal of Orthodontics and Dentofacial Orthopedics
October 2007

Table III.
Treatment changes of treatment groups and observed changed of control group and comparisons between
groups for total and local superimpositions
FMEXP (1) FM (2)
(n ⫽ 14) (n ⫽ 14)

Pretreatment Posttreatment Pretreatment Posttreatment

Mean SE Mean SE P Mean SE Mean SE

Total superimposition
‡
1. ANSx 56.7 1.0 59.7 0.9 56.1 0.9 58.4 1.0
2. Pgx 42.6 1.3 41.0 1.5 45.0 2.3 43.3 2.2
3. ANSy 50.4 0.9 51.2 1.0 51.5 0.9 52.0 0.6
4. Pgy 107.2 1.8 110.0 1.8 * 108.2 1.9 110.6 2.1
Local superimposition
1. U6x 18.5 1.1 19.4 1.4 18.2 1.2 19.5 1.3
†
2. U1x 49.4 1.4 49.5 1.5 50.2 1.4 51.1 1.2
3. U6y 63.4 1.1 64.8 1.2 65.3 1.4 67.2 1.4
4. U1y 77.9 1.3 78.6 1.4 77.1 1.8 77.6 1.8

*P ⬍.05.
†
P ⬍.01.
‡
P ⬍.001.

the FMEXP group and 2.3 mm in the FM group, and no
significant difference was determined between these
groups. In a meta-analysis study, it was concluded that
the results of protraction were similar for the expansion
and the nonexpansion groups.17
On the total superimposition, the backward move-
ment of pogonion (Pgx) in the treatment groups was
significantly different compared with the forward
movement in the control group. In addition, changes in
SNB angle, facial depth, facial axis, and SNGoGn were
similar to measurements in previous studies reporting
clockwise rotation of the mandible.8,9,14,28-30
As a consequence, the forward movement of the
maxilla, and the downward and backward rotation of
the mandible improved the maxillomandibular skeletal
relationship in the sagittal dimension. Increases in ANB
angle and Wits appraisal and the decrease in the
maxillomandibular differential in both treatment
groups indicated succesful treatment of the sagittal
skeletal relationship. In this study, molar relationship
and overjet also improved significantly in both treat-
ment groups; similar changes were reported in previous
facemask studies.4,8,9,14,19,20,28,29,31-34
The increase in molar relationship in the FM group
was significantly greater than in the FMEXP group.
Although the dental and skeletal contributors to the
Class III correction showed no significant differences
between the treatment groups, the overall changes
resulted in a greater increase in molar relationship in
the FM group.
Vertical change in the maxillary molar (U6y)
showed a significant difference only between the FM
and the control groups. Increased eruption of the
maxillary molars in the FM group might be attributed to
the decrease in overbite. Merwin et al35 reported
maxillary molar extrusion with increased lower facial
height during facemask therapy with a banded expan-
sion appliance. Wertz36 suggested that the bite-opening
effect of the maxillary splint might reduce the tendency
toward extrusion of the posterior teeth. In the FMEXP
group, a 1.1 mm decrease in overbite and a 1.4 mm
eruption of the maxillary molars were observed; these
results were consistent with the findings of a previous
maxillary expansion and protraction study.32
In a meta-analysis study, Kim et al17 suggested that
the use of an expansion appliance enhances the protrac-
tion effect in terms of time with less dental effect. In
our study, treatment times were similiar in the FMEXP
and the FM groups.
CONCLUSIONS
1. Both treatment procedures were effective in the
dental and skeletal therapy of patients with Class III
malocclusions.
2. The skeletal contribution to Class III treatment was
statistically significant, but the dental contribution
showed no significance in the treatment groups.
3. With the acrylic splint of the bonded expansion
appliance, the eruption of the maxillary molar
seemed to be less compared with the removable
intraoral appliance.
The treatment effects of protraction facemask ther-
apy are a combination of skeletal and dental changes.
American Journal of Orthodontics and Dentofacial Orthopedics Ucem, Keykubat, and Yuksel 473
Volume 132, Number 4

Table III. Continued

Control (3)
(n ⫽ 14)

Pretreatment Posttreatment P

P Mean SE Mean SE P 1-2 1-3 2-3

‡ ‡ ‡
55.2 1.1 55.1 1.1
†
44.3 2.2 45.5 2.2 * *
†
49.3 0.9 50.6 0.9
†
102.2 1.3 104.5 1.4

†
19.8 1.2 20.0 1.2
50.1 1.4 50.5 1.3
†
59.6 0.7 60.2 0.8 *
74.2 1.1 74.6 1.2

However, there was no significant anteroposterior
dental change in the treatment groups. The evaluation
of total and local superimpositions showed that skeletal
changes seemed to be more effective than dental
changes during facemask therapy with or without
expansion. Thus, if the treatment indication is appro-
priate, facemask therapy can be an effective method for
Class III treatment.
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