A comparative study of the effects of customized facemask therapy or headgear to the lower arch on the developing Class III face

This retrospective, cephalometric study examined the effects of treatment in a group of 83 Class III, Skeletal III children, who were considered suitable for orthodontic correction of their malocclusions. All children completed therapy successfully: 44 individuals were treated with headgear to the mandibular dentition and for 39 a customized facemask was prescribed. These two groups were compared with 30 untreated Class III controls. Data were examined at the beginning and end of active treatment for the treated groups, and over a similar time interval for the controls. Where differences between the sexes were apparent, data for each sex are given separately. Where no significant differences were seen, data are pooled. In order to standardize the results, treatment (or observation) effects are presented as average changes per year. Surprisingly, despite the very different methods of applying the extra-oral force, the two treated groups showed strikingly similar therapeutic effects. The reverse overjet was corrected with little alteration in overbite. Upper incisors proclined whilst the lowers retroclined, becoming less prominent in relation to APo. The mandible hinged downwards and backwards, whilst the maxillary complex advanced. Lower face height increased more than would be expected by growth alone. Mirroring the hard tissue changes, the soft tissue profile improved and the relationship between the upper and lower lips became more harmonious. For only three parameters did the facemask children demonstrate a significantly better performance than their headgear peers: the overjet and the antero-posterior position of the lower lip and chin in females. It was concluded that, despite their differing approaches, the customized facemask and headgear to the mandibular dentition have very similar treatment effects. Both are clinically effective. However, treatment can begin earlier, and both the skeletal and profile changes are marginally superior when a facemask is worn.