Pacific Coast Society of Orthodontists Bulletin Summer 2021 - 67

Faculty Files
face mask with no expansion. Vaughn et al
(2005),19
however, found no statistical differences
between expansion and nonexpansion in
a prospective, randomized clinical trial on early
face mask therapy. It might be possible that the
expansion protocol we describe is not sufficient
enough to truly " disarticulate " the maxilla and
accentuate its advancement. Liou (2005)20
has
introduced a technique of opening the circummaxillary
sutures by alternate expansions
followed by constrictions. His clinical protocol of
Alt-RAMEC involves opening the suture 1 mm per
day for 1 week, followed by 1-mm constriction for
1 week. This schedule proceeds for seven weeks.
Liou reported that this protocol displaced the
maxilla anteriorly two times greater (5.3 mm)
than a single course of rapid maxillary expansion.
Face
Mask Protocol
We use a custom designed face mask that incorporates
an acrylic chin cup and forehead and an
interlabial bow with soldered hooks for elastics
(Figure 1). We take an alginate impression of
each child's face, which allows for a better fit and
increased comfort.21
The major objective of early
Class III treatment is to correct the malocclusion
sufficiently enough to avoid later orthognathic
surgery. With that in mind, we request 24/7 face
mask wear for the first six weeks. The patient becomes
so used to wearing the appliance that they
usually volunteer to wear it another six weeks
full-time. In this way, we usually get three to four
months of full-time wear, which gives us a greater
treatment effect. After three to four months
of full-time wear, the Class III is often corrected
or overcorrected. We then switch to wearing the
appliance when the patients is " in the house "
to continue overcorrection. After another three
to four months, we switch to having the patient
wear it to bed only. Most patients complete treatment
at 12 months. Most patients (about 75%)
will show good stability in the long term without
retention. Pangrazio-Kulbersh et al (1998),16
however, reported no failures when patients wore
a Frankel III appliance to bed following face mask
therapy.
Short-Term Effects of Face Mask and Palatal
Expansion Therapy
Although face mask and palatal expansion
therapy has been described as maxillary protraction,
the correction occurs by a combination
of skeletal and dental movements in all three
planes of space. A large range of response is
reported in the literature, with some articles
noting significant maxillary advancement and
others reporting minimal or no change with
Figure 1. (a) Custom face mask, (b) Palatal expansion appliance banded to two teeth per side
Summer 2021 PCSO Bulletin
67

Pacific Coast Society of Orthodontists Bulletin Summer 2021

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