Early class III protraction facemask treatment reduces the need for orthognathic surgery: a multi-centre, two-arm parallel randomized, controlled trial

Abstract

Objective: To evaluate whether patients who had received early class III protraction facemask treatment were less likely to need orthognathic surgery compared with untreated controls. This paper is a 6-year follow-up of a previous clinical trial. Design: Multi-centre 2-arm parallel randomized controlled trial. Setting: Eight United Kingdom hospital orthodontic departments. Participants: Seventy three 7- to 9–year-old children. Method: Patients were randomly allocated, stratified for gender, into an early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). The primary outcome, need for orthognathic surgery was assessed by panel consensus. Secondary outcomes were changed in skeletal pattern, overjet, Peer Assessment Rating (PAR), self-esteem and the oral aesthetic impact of malocclusion. The data were compared between baseline (DC1) and 6-year follow-up (DC4). A per-protocol analysis was carried out with n = 32 in the CG and n = 33 in the PFG. Results: Thirty six percent of the PFG needed orthognathic surgery, compared with 66% of the CG (P = 0.027). The odds of needing surgery was 3.5 times more likely when protraction facemask treatment was not used (odds ratio = 3.34 95% CI 1.21–9.24). The PFG exhibited a clockwise rotation and the CG an anti-clockwise rotation in the maxilla (regression coefficient 8.24 (SE 0.75); 95% CI 6.73–9.75; P < 0.001) and the mandible (regression coefficient 6.72 (SE 0.73); 95% CI 5.27–8.18; P < 0.001). Sixty eight per cent of the PFG maintained a positive overjet at 6-year follow-up. There were no statistically significant differences between the PFG and CG for skeletal/occlusal improvement, self-esteem or oral aesthetic impact. Conclusions: Early class III protraction facemask treatment reduces the need for orthognathic surgery. However, this effect cannot be explained by the maintenance of skeletal cephalometric change.

Skeletal and dental effects of Class III orthopaedic treatment: a systematic review and meta‐analysis

“…Moreover, 68% of patient treated with FM maintained a positive overjet. Nevertheless, no improvement in quality of life in treated patients respect to untreated subjects was reported .…”

“…Skeletal class III malocclusion is one of the most investigated topics in orthodontics . The skeletal and dental components of Class III malocclusions are usually established since early childhood and may worsen with growth .…”

“…In the majority of cases, without any treatment during childhood, orthognathic surgery is the only option to establish a correct occlusion . However, early interception of this malocclusion may represent an opportunity to avoid or reduce the risk of surgery .…”

Effect of face mask therapy on mandibular rotation considering initial and final vertical growth pattern: A longitudinal study

“…Studies comparing treated patients with an untreated control group have shown RPE/FM therapy to be effective, especially when used at an early age (Cordasco et al, 2014;Kiliçoglu & Kirliç, 1998;Mandall et al, 2010;Nevzatoğlu & Küçükkeleş, 2014). Additionally, RPE/FM therapy has also been reported to reduce the need of subsequent surgical treatment (Mandall et al, 2016). However, counterclockwise maxillary rotation and clockwise mandibular rotation, which can be unfavorable for patients presenting clockwise vertical growth pattern, have been associated to RPE/FM treatment (Cordasco et al, 2014;Jamilian, Cannavale, Piancino, Eslami, & Perillo, 2016;Kiliçoglu & Kirliç, 1998;Nevzatoğlu & Küçükkeleş, 2014).…”

Soft tissue characteristics and gender dimorphism in class iii malocclusion: A cephalometric study in adult Greeks

“…Early orthodontic and/or orthopedic treatment of Class III malocclusion results in an acceptable occlusion, function and facial esthetics 19 . For adults with skeletal Class III malocclusion treatment is always a kind of camouflage resulting in an acceptable occlusion but cannot extensively affect facial esthetics 10 as the patient retains his or her characteristic concave profile.…”