10 reverse face mask therapy

8/11/2019 10 Reverse Face Mask Therapy

1/7

Reverse Face Mask Therapy


2/7

Straight WireConcepts: Diagnosis & Technique

Robert G. Gerety - Produced by Kay C. Gerety CDA296

Rapid Palatal Expansion Device

Function

1. Open the palatal suture.2. Expand the maxillary dental arch.

Instruments Used

1. Bird beak plier2. Heavy wire cutter3. 3-prong plier4. Soldering unit

Materials Used

1. Hyrax expansion screw2. Molar and bicuspid bands3. Large electrodes (solder)

4. Flux5. .032 round wire

Force System Used

1. Force due to turning of rapid palatal expan-sion screw.

When Placed

At the beginning of treatment when you have a crossbite present due to the constriction of the upper archor simply when there is a need to expand the upper arch. Best used when you have an ANB differenceof 3-4 or less. Best treatment results are on patients under 18 years of age.

After use, the expansion device will cause bite opening. A large diastema will appear during expansion;this is a positive sign that palatal separation is occurring. Patients should be checked quite frequentlywhile they are turning the appliance. You should get approximately 1mm expansion every 2 days. Afterturning is complete, ligate the palatal screw with .012 ligature wire and leave in place for 3-6 months.

Procedure

1. Size bands for the first molars and premolars in the mouth.

2. Take an alginate impression with the bands in the proper position on the teeth. Remove thebands and place them in the impression. Sticky wax the bands in the alginate impression andpour in plaster.

3. The palatal expansion screw has 4 extensions of wire. You should adapt these four extensionsto contact the lingual of all four bands. It will be helpful to place clay in the palate area or themodel to support the screw while you adapt the extensions. * Now cut two pieces of .032 wireto run from lingual of the premolar to molar. This seems to stabilize the appliance more and alsoprovides more of a segmental movement rather than individual teeth. Solder expansion screwand .032 wire to the bands, cut off excess wire and trim.

* Most expansion screws have an identifying mark that should always be placed toward theanteriors. If there is not mark present, make sure the screw is placed so that the key is inserted inthe front and turned to the posterior.

4. After cementation, activate the appliance by turning the screw 3-4 times until it becomes verydifficult to turn. This will be enough initial activation. Check in two days and give the parentinstructions for turning.


3/7297


Robert G. Gerety- Produced by Kay C. Gerety CDA

Instructions for Wearing your Hyrax

1. Your appliance has been cemented permanently. It is not to be removed for anyreason.

2. Take extra time in brushing your teeth regularly so that your new appliance will nottrap food around your teeth and cause decay.

3. You have been instructed as to how to turn your expansion device with the key givenyou. Be sure you do this once in the morning and once at night. Always record theturns in your calendar and be sure to bring it with you for your appointment.

4. Keep dental floss tied to the end of the key, so there will be no danger of dropping it.

5. If you should have any problems, call our office.

6. After you have completed the turns, you will need to wear the appliance to hold theposition of your teeth. Be sure to return for your monthly check-ups to make sure the

appliance is cemented securely.


4/7



Reverse Pull Headgear for Early Correctionof Class III Malocclusion

University of Oklahoma School of Dentistry

Introduction

The developing Class III malocclusion is one of the most challenging problems in orthodontics. Until recently, mostpractitioners believed that Class III malocclusions were primarily caused by overgrowth of the mandible.Difficultyin controlling growth of mandible has been recognized . Hence, most believed in waiting for the majority of growthto be completed and then correcting such a condition by means of orthodontics in combination with surgery.However, recent studies suggested that a majority of Class III malocclusions have maxillary retrusion or deficiency

as all or at least part of the structuraletiology.2 From these studies, it be-came obvious that management of alarge number of Class III malocclu-sions should include maxillary pro-traction as a major objective.

Several investigators have demon-strated dramatic skeletal changes thatcan be obtained in animals with con-tinuous protraction forces to the max-illa.3,4 Not only is Point A affectedthrough forward incisor movement,but the entire maxilla is said to bedisplaced anteriorly, with significanteffects as far posteriorly as the zygo-maticotemporal suture. Maxillaryprotraction methods have includedchin cup and spurs5, combined head

cap and chin cup6, pull down facialmask7, football helmet8, and facialmask with forehead and chin sup-port.9-11

Reverse pull headgear - FacialMask:

The facial mask with forehead andchin support has become popular dur-ing recent years for early maxillaryprotraction due to the simplicity ofthe appliance and better patient ac-

ceptance. This treatment modalitywas developed as early as the 1900's,and more recently was modified byDelaire from France and others likePetit9, McNamara10, and Turley11 inthe U.S.

The main objective of the facial mask

tiated for 10-15 days, either to correctcrossbites or to loosen sutures.The same expansion appliance canthen be used as an intraoral splint toattach the facial mask to transfer theprotraction forces to the maxilla.

The facial mask is adjusted for thepatient face. Recently, making a cus-tom mask for the individual patienthas been recommended for improvedcomfort.11

Anterior and downward forces in therange of 400-600gms are applied bymeans of elastics from the intraoralhooks on the expansion appliance andthe hooks on the facial mask. Formaximum and rapid correction, a 24-

hour per day wear is recommended.If patient complies, the treatment timewill range from 2-6 months. Part time(14 hours a day)wear of the facialmask may also give acceptable re-sults. However, the treatment time insuch a case will be longer.10,11

is to cause forward movement of theentire maxilla to improve the spatialrelationship between the maxilla andthe mandible in Class III malocclu-sions. If done early, this improve-ment in the oro-facial environment

may cause redirection of maxillo-man-dibular growth and hopefully theirnormal relationship in the future.

Palatal expansion:

A large number of Class III patientsrequire maxillary expansion due topresence of posterior crossbites.11

Palatal expansion, if needed, is donebefore protraction forces are com-menced on the maxilla. In addition,this expansion procedure aids in loos-

ening the sutures by which the max-illa articulates with nine other bonesof the craniofacial complex. In asense, palatal expansion disarticu-lates the maxilla and initiates cellu-lar response in the sutures, allowing amore positive reaction to protractionforces.10,11 Due to this reason, it hasbeen suggested that a palatal expanderof some kind should be used beforeprotraction, even if a patient does nothave crossbite, to help in looseningthe sutural system.

Treatment:

Treatment is commenced as early asthe problem of maxillary deficiencyis recognized. However, primary andmixed dentition stage are preferred.

First, expansion of the maxilla is ini-


5/7299



Reverse Pull Headgear for Early Correctionof Class III Malocclusion (cont.)

References:

1. Graber T.M.: Current Orthodontic Concepts and Techniques, W.B. Saunders Co.,Philadelphia, 1972.

2. Guyer E.C., Ellis E.E., McNamara J.A., Behrents R.G.: Components of Class IIIMalocclusions in Juveniles and Adolescents. Angle Orthodontics 56: 7-30, 1986.

3. Jackson GW, Kokick VG, Shapiro PA: Experimental Response to Anteriorly DirectedForce in Young Macaca Nemestrina, Am J Ortho 75: 319-333, 1979.

4. Nanda R: Protraction of Maxilla in Shesers Monkeys by Controlled Extraoral Forces AmJ Ortho 74: 121-131, 1978.

5. Irie M, Nakamusa S: Orthopedic Approach to Severe Skeletal Class III Malocclusion AmJ Ortho 67: 377-392, 1975.

6. Kettle MA, Burnapp DR: Occipito-mental Anchorage in the Orthodontic Treatment ofDental Defermities Due to Cleft-lip and Palate. Br Dent J 99: 11-14, 1955.

7. Cooke MS, Wreakes G: The Face Mask: A New Form of Reverse Headgear, Br J Ortho4: 163-168, 1977.

8. Nelson FO: A New Extraoral Orthodontic Appliance, Int J Ortho 6:24-27, 1968.

9. Petit H: Adaptations Following Accelerated Facial Mask Therapy. In: Clinical Alterationof the Growing Face. (Eds) JA McNamara et al. Monograph 14, Craniofacial

Growth Series, Center for Human Growth and Development, University of Michigan,Ann Arbor, 1983.

10. McNamara JA: An Orthopedic Approach to the Treatment of Class III Malocclusion inYoung Patients, J Clin Ortho 21: 598-608, 1987.

11. Turley P.K.: Orthopedic Correction of Class III Malocclusion with Palatal Expansion and

Custom Protraction Headgear, J Clin Ortho 22: 314-325, 1988.


6/7



Reverse Face Mark (RFM)Instructions and Criteria for Use

Indications: Class III Skeletal Treatment Time: 6-9 months average (varies greatly)Ideal Age: 5-8 years old

Mask therapy can provide effective treatment for midface insufficiency and mandibular prognathism.Elastics with combined force levels from 1-3 pounds couple the face mask to an intraoral appliance toelicit forward movement of the maxilla.

There are several options for the intraoral maxil-lary appliance depending on the dental classifica-tion and the amount of crowding, age of thepatient, and also the stage of orthodontic treatmentat which face mask therapy is initiated. Giventhese criteria, the patient should be prepared forface mask therapy with one of the below listedoptions for the maxillary arch.

1. Banded and cemented rapid palatal expan-sion device (RPE)This option is indicatedwhen the patient is in thepermanent dentition and theentire maxillary arch isconstricted and in crossbitewith the lower. It will benecessary to split the palateprior to the use of the RFM.When you have completed

active treatment with theRPE, this will be used forthe RFM. Elastics will beworn from the first molarhooks and first premolar bands to themouthbow.

2. Bonded RPE with acrylic coverageThis appliance is indicated in the primary ormixed dentition when the maxillary arch is incrossbite and constricted and it is necessary toexpand and develop the maxillary arch. With-

out the presence of the permanent premolars,the bonded acrylic RPE will work for theexpansion. You should instruct the lab thatfabricates this appliance to add hooks to theacrylic in the molar and cuspid area so that itcan be used for the RFM after expansion hasbeen completed.

3. Banded and cemented RFM applianceThis appliance can be used in the primary,

mixed or permanent dentition. Band either thesecond primary molar or the first permanentmolar. This appliance simply has a labial anda lingual wire encompassing the entire maxil-lary arch that is soldered to the molar bandslabial and lingual. Hooks are soldered in thecuspid area to the labial wire and molar hooksare used to attach the elastics for the RFM.

This appliance can be used when expansion ofthe maxillary arch is not necessary. Thereshould be no crowding or constrictionof the maxilla when using this appli-ance. It may be necessary to placesome composite in the posterior toopen the bite and allow the maxilla tocome forward.

4. Fully bracketed and bandedmaxillary arch

This can be in the mixed dentition in

which all primary teeth should bebracketed as well as in the permanentdentition. The arch should be pro-gressed in treatment up to a minimum

of .016 X .022 stainless steel archwire. Thearch will need to be ligated together frommolar to molar with steel ligature wire usingthe figure eight technique. Use the hooks onthe molars and the power arms on the cuspidbracket for elastics to the mouthbow of theRFM.

The Adaptable Class III Mask by Dr. Henri Petit isthe mask that is recommended. It is available


7/7301



*****Ordering Information:

Johns Dental Lab (800) 457-0504Space Maintainers of the Midwest Lab (800) 325-8921

from most commercial laboratories. SpaceMaintainers of the Midwest Lab and JohnsDental Labare familiar with our use and applica-tion of this mask and the different maxillary

intraoral appliances used in conjunction.

1. The first adjustment you will need to make tothe mask is to position the forehead rest andchin cup to fit the face. An allen wrench isprovided to loosen and move these two partsvertically up and down to adapt to theindividuals face. The forehead pad is posi-tioned just above the patients eyebrows andthe chin cup is centered over the patients chin.

2. Adjust the position of the mouthbow using the

allen wrench so that it is below the occlusalplane of the upper arch and there is a down-ward and forward pull from the elastics.

3. Place one 8 oz. elastic on each side from thecuspid hook to the mouthbow. Have thepatient wear the appliance 24 hours per daywith this one elastic per side for two weeks.At the beginning of the third week, have thepatient add one more 8 oz. elastic per sidefrom the molar hook to the mouthbow. Con-tinue these two elastics per side for two weeks.

After one month, add another 8 oz. elastic perside to the cuspid area hook. Your intentionsare to progress up to a 24 hour per day wearingschedule with three 8 oz. elastics per side. Theschedule for this varies from patient to patientdepending on the individuals tolerance leveland cooperation.

4. Continue wearing the RFM until you havecorrected the Class III malocclusion to a ClassII. Always over correct past ideal anticipatingrebound toward the Class III.

Adapt forehead rest and chincup to fit the patients face.

Adjust mouthbow so that thereis a downward and forwardpull

Adjusting the Face Mask

10 reverse face mask therapy

Documents