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Clinical Oral Investigations
Published in: Clinical Oral Investigations 6/2015

01-07-2015 | Review

Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis

Authors: Moritz Foersch, Collin Jacobs, Susanne Wriedt, Marlene Hechtner, Heinrich Wehrbein

Published in: Clinical Oral Investigations | Issue 6/2015

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Abstract

Objectives

Class III therapy using a face mask is a common approach for treatment of a deficient maxilla and reverse overbite. Usually, maxillary protraction is combined with transverse palatal expansion using intraoral appliances. The purpose of this study was to systematically review the effectiveness of face mask therapy in combination with concepts of palatal expansion and compression.

Material and methods

A systematic review and meta-analysis were performed to identify studies that address class III treatment using a face mask. The search was carried out using common electronic databases as well as hand search. Both screening and study eligibility analysis were performed with consideration of PRISMA and Cochrane Guidelines for systematic reviews. Several terms describing class III face mask treatment were searched. Particular attention was paid to new strategies of enhancing maxillary protraction.

Results

The initial search identified 2048 studies. After a thorough selection process, a total of 22 articles met the inclusion criteria. After assessment of the individual quality scoring of each article, eight studies were provided for meta-analysis of the cephalometric parameters. The statistical analysis of treatment changes advocates a positive influence on sagittal maxillary development, which is not primarily influenced by transverse expansion. Dental side effects are more distinct when no expansion was carried out. For the concept of alternating activation/deactivation of the expansion appliance (alt-RAMEC), two articles of high methodological scoring were identified. They indicate an enhancement of face mask treatment.

Conclusions

The findings are consistent with results of previous literature studies regarding the efficiency of class III face mask treatment. A further need for more randomized controlled studies was identified especially with regard to the new concept of alternating maxillary expansion and compression, which showed a positive influence on the maxillary protraction based on two studies.

Clinical relevance

Class III therapy using extraoral face mask anchorage is effective for maxillary protraction. The recently discussed new protocols potentially improve this treatment.
Literature
1.
2.
Jager A, Braumann B, Kim C, Wahner S (2001) Skeletal and dental effects of maxillary protraction in patients with angle class III malocclusion. A meta-analysis. J Orofac Orthop 62(4):275–284PubMedCrossRef
3.
4.
Frankel R (1970) Maxillary retrusion in class 3 and treatment with the function corrector 3. Rep Congr Eur Orthod Soc:249–259
5.
Frankel R (1971) Tooth eruption and alveolar process under the orthodontic effect of functional appliances. Fortschr Kieferorthop 32(2):217–228PubMedCrossRef
6.
Sakamoto T, Iwase I, Uka A, Nakamura S (1984) A roentgenocephalometric study of skeletal changes during and after chin cup treatment. Am J Orthod 85(4):341–350PubMedCrossRef
7.
Thilander B (1965) Chin-cap treatment for angle class 3 malocclusion. Rep Congr Eur Orthod Soc 41:311–327PubMed
8.
McNamara JR, Brudon WL (1993) Orthodontic and orthopedic treatment in the mixed dentition. Mich, Ann Arbor
9.
Delaire J (1971) Manufacture of the “orthopedic mask”. Rev Stomatol Chir Maxillofac 72(5):579–582PubMed
10.
Petit H (1983) Introduction to the biomechanical study of the facial mask and its accessories. Orthod Fr 54(2):353–365PubMed
11.
McNamara JA Jr (1987) An orthopedic approach to the treatment of class III malocclusion in young patients. J Clin Orthod 21(9):598–608PubMed
12.
Nanda R (1980) Biomechanical and clinical considerations of a modified protraction headgear. Am J Orthod 78(2):125–139PubMedCrossRef
13.
Hardy D, Cubas M, Orellana M (2012) Prevalence of angle class III malocclusion: a systematic review and meta-analysis. Open J Epidemiol 2012(2):75–82CrossRef
14.
Williams S, Andersen CE (1986) The morphology of the potential class III skeletal pattern in the growing child. Am J Orthod 89(4):302–311PubMedCrossRef
15.
Jacobson A, Evans WG, Preston CB, Sadowsky PL (1974) Mandibular prognathism. Am J Orthod 66(2):140–171PubMedCrossRef
16.
Williams MD, Sarver DM, Sadowsky PL, Bradley E (1997) Combined rapid maxillary expansion and protraction facemask in the treatment of class III malocclusions in growing children: a prospective long-term study. Semin Orthod 3(4):265–274PubMedCrossRef
17.
Ellis E 3rd, McNamara JA Jr (1984) Components of adult class III malocclusion. J Oral Maxillofac Surg 42(5):295–305PubMedCrossRef
18.
19.
Cohen PA (1992) Meta-analysis: application to clinical dentistry and dental education. J Dent Educ 56(3):172–175PubMed
20.
Kim JH, Viana MA, Graber TM, Omerza FF, BeGole EA (1999) The effectiveness of protraction face mask therapy: a meta-analysis. Am J Orthod Dentofacial Orthop 115(6):675–685PubMedCrossRef
21.
22.
Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer SJ, Nucera R (2014) Efficacy of orthopedic treatment with protraction facemask on skeletal class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res 17(3):133–143. doi:10.​1111/​ocr.​12040 PubMedCrossRef
23.
Akkaya S, Lorenzon S, Ucem TT (1999) A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 21(2):175–180PubMedCrossRef
24.
Wertz RA (1970) Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod 58(1):41–66PubMedCrossRef
25.
Pangrazio-Kulbersh V, Berger J, Kersten G (1998) Effects of protraction mechanics on the midface. Am J Orthod Dentofacial Orthop 114(5):484–491PubMedCrossRef
26.
Cozza P, Giancotti A, Petrosino A (2001) Rapid palatal expansion in mixed dentition using a modified expander: a cephalometric investigation. J Orthod 28(2):129–134PubMedCrossRef
27.
Sarver DM, Johnston MW (1989) Skeletal changes in vertical and anterior displacement of the maxilla with bonded rapid palatal expansion appliances. Am J Orthod Dentofacial Orthop 95(6):462–466PubMedCrossRef
28.
Liou EJ, Tsai WC (2005) A new protocol for maxillary protraction in cleft patients: repetitive weekly protocol of alternate rapid maxillary expansions and constrictions. Cleft Palate Craniofac J 42(2):121–127. doi:10.​1597/​03-107.​1 PubMedCrossRef
29.
Liou EJ (2005) Effective maxillary orthopedic protraction for growing class III patients: a clinical application simulates distraction osteogenesis. Prog Orthod 6(2):154–171PubMed
30.
PRISMA (2009) Reporting guideline for systematic reviews and meta-analyses
31.
Higgins J. GS (2009) Cochrane handbook for systematic reviews of interventions version 5.0.2
32.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339:b2700PubMedCentralPubMedCrossRef
33.
Cozza P, Baccetti T, Franchi L, De Toffol L, McNamara JA Jr (2006) Mandibular changes produced by functional appliances in class II malocclusion: a systematic review. Am J Orthod Dentofacial Orthop 129(5):599 e591–512. doi:10.​1016/​j.​ajodo.​2005.​11.​010, discussion e591-596 CrossRef
34.
35.
36.
Baccetti T, McGill JS, Franchi L, McNamara JA Jr, Tollaro I (1998) Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy. Am J Orthod Dentofacial Orthop 113(3):333–343PubMedCrossRef
37.
38.
da Silva Filho OG, Magro AC, Capelozza Filho L (1998) Early treatment of the class III malocclusion with rapid maxillary expansion and maxillary protraction. Am J Orthod Dentofacial Orthop 113(2):196–203PubMedCrossRef
39.
Gallagher RW, Miranda F, Buschang PH (1998) Maxillary protraction: treatment and posttreatment effects. Am J Orthod Dentofacial Orthop 113(6):612–619PubMedCrossRef
40.
41.
Kapust AJ, Sinclair PM, Turley PK (1998) Cephalometric effects of face mask/expansion therapy in class III children: a comparison of three age groups. Am J Orthod Dentofacial Orthop 113(2):204–212PubMedCrossRef
42.
Kurt G, Uysal T, Yagci A (2010) Soft and hard tissue profile changes after rapid maxillary expansion and face mask therapy. World J Orthod 11(4):e10–e18PubMed
43.
44.
Macdonald KE, Kapust AJ, Turley PK (1999) Cephalometric changes after the correction of class III malocclusion with maxillary expansion/facemask therapy. Am J Orthod Dentofacial Orthop 116(1):13–24PubMedCrossRef
45.
Mandall N, Cousley R, DiBiase A, Dyer F, Littlewood S, Mattick R, Nute S, Doherty B, Stivaros N, McDowall R, Shargill I, Worthington H (2010) Is early class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 15-month follow-up. J Orthod 37:149–161PubMedCrossRef
46.
47.
Ngan P, Hagg U, Yiu C, Merwin D, Wei SH (1996) Soft tissue and dentoskeletal profile changes associated with maxillary expansion and protraction headgear treatment. Am J Orthod Dentofacial Orthop 109(1):38–49PubMedCrossRef
48.
Ngan P, Hagg U, Yiu C, Merwin D, Wei SH (1996) Treatment response to maxillary expansion and protraction. Eur J Orthod 18(2):151–168PubMedCrossRef
49.
Saadia M, Torres E (2000) Sagittal changes after maxillary protraction with expansion in class III patients in the primary, mixed, and late mixed dentitions: a longitudinal retrospective study. Am J Orthod Dentofacial Orthop 117(6):669–680PubMedCrossRef
50.
Shanker S, Ngan P, Wade D, Beck M, Yiu C, Hagg U, Wei SH (1996) Cephalometric a point changes during and after maxillary protraction and expansion. Am J Orthod Dentofacial Orthop 110(4):423–430PubMedCrossRef
51.
52.
53.
Westwood PV, McNamara JA Jr, Baccetti T, Franchi L, Sarver DM (2003) Long-term effects of class III treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 123(3):306–320. doi:10.​1067/​mod.​2003.​44 PubMedCrossRef
54.
Yavuz I, Halicioglu, K., Ceylan, I., Dagsuyu, I., Erdem, A. (2012) The effects of face mask therapy with and without rapid maxillary expansion in adolescent patients. Aust Orthod J:63–71
55.
Masucci C, Franchi L, Giuntini V, Defraia E (2014) Short-term effects of a modified Alt-RAMEC protocol for early treatment of class III malocclusion: a controlled study. Orthod Craniofac Res 17(4):259–269. doi:10.​1111/​ocr.​12051 PubMedCrossRef
56.
Haas AJ (1970) Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 57(3):219–255PubMedCrossRef
57.
Levrini L, Filippi V (1999) A fan-shaped maxillary expander. J Clin Orthod 33(11):642–643PubMed
58.
Suzuki A, Takahama Y (1989) A jointed fan-type expander: a newly designed expansion appliance for the upper dental arch of patients with cleft lip and/or palate. Cleft Palate J 26(3):239–241, discussion 241 PubMed
59.
Huang C, Wang Y, Huang C, Liou E (2008) Maxillary displacement after rapid maxillary expansions: an animal study. J Taiwan Assoc Orthod 20(2):19–31
60.
Tsai WC, Huang C, Lin C, Liou E (2008) Dentofacial changes of combined double-hinged maxillary expansion and protraction facemask therapy. J Taiwan Assoc Orthod 20(2):5–18
61.
Smalley WM, Shapiro PA, Hohl TH, Kokich VG, Branemark PI (1988) Osseointegrated titanium implants for maxillofacial protraction in monkeys. Am J Orthod Dentofacial Orthop 94(4):285–295PubMedCrossRef
62.
Jackson GW, Kokich VG, Shapiro PA (1979) Experimental and postexperimental response to anteriorly directed extraoral force in young Macaca nemestrina. Am J Orthod 75(3):318–333PubMedCrossRef
63.
64.
65.
66.
Wilmes B, Ngan P, Liou EJ, Franchi L, Drescher D (2014) Early class III facemask treatment with the hybrid hyrax and Alt-RAMEC protocol. J Clin Orthod 48(2):84–93PubMed
Metadata
Title
Effectiveness of maxillary protraction using facemask with or without maxillary expansion: a systematic review and meta-analysis
Authors
Moritz Foersch
Collin Jacobs
Susanne Wriedt
Marlene Hechtner
Heinrich Wehrbein
Publication date
01-07-2015
Publisher
Springer Berlin Heidelberg
Published in
Clinical Oral Investigations / Issue 6/2015
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI
https://doi.org/10.1007/s00784-015-1478-4

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