CORRECTION OF CLASS 3 SKELETAL
PROBLEMS
(Reverse pull headgear/facemask)
DR. MUHAMMAD SHARIQ SOHAIL
HOUSE OFFICER
DEPARTMENT OF ORTHODONTICS
ZIAUDDIN UNIVERSITY

CORRECTION OF CLASS 3 SKELETAL PROBLEM
1)If Maxillary Deficiency --> Frankel FR-3 functional appliance
-->Reverse pull headgear
-->Class 3 elastics to skeletal anchors
2)If Mandibular excess--> Class 3 funtional appliance
--> Extraoral force to a chincup
-->class 3 elastics to skeletal anchors

TYPES OF CLASS 3
1)TRUE CLASS 3: Can be due to Maxilla, Mandible or due to both
2)PSEUDO CLASS 3: Just because of funtional shift (CO-CR discrepancy)

ETIOLOGY OF CLASS 3
1)GENETIC
2)ENVIRONMENTAL:
A)Cleft surgery(Scar, maxilla deficient, growth potential low)
B)Mouth breather: usually class 2 but can be class 3
C)Enlarged tongue: Tongue pushes mandible forward

WHY TO TREAT CLASS 3???
1)Social well being
2)Prevent progressive soft tissue or bony changes
3)Provide favourable environment to mandibular growth
4)Improve occlusal function and stablize jaw position
5)facial esthetics
6)To simplify Phase 2 treatment.

REVERSEPULL HEADGEAR/ FACEMASK
DEFINITION: Facemask is an extraoral traction appliance used to correct
skeletal class 3 malocclusion. Facemask is a method by which
anterior directed forces to the teeth or skeletal structures are
delievered from an extraoral source.

REVERSEPULL HEADGEAR/ FACEMASK
INDICATIONS:
1)Primarliy used to correct skeletal class 3 due to maxillary retronagthism in
young pateint.
2)Psuedo class 3--> Facemask cane correct CO-CR discrepancy
3)After surgical correction of malocclusion--> facemask as a retainer

REVERSEPULL HEADGEAR/ FACEMASK
COMPONENTS OF FACEMASK:
1)Chincup: Restrain forward growth of mandible by changing direction of
growth downward and backward.
2)Forehead cap/support
3)Framework
4)Intraoral splint/device: For RME
5)Elastics: to give traction force to maxilla

REVERSEPULL HEADGEAR/ FACEMASK
TYPES OF FACEMASK:
1)Hickham: Chincup and forehead support
2)Delaire
3)Petit
4)Turbinger

REVERSEPULL HEADGEAR/ FACEMASK
FORCE PARAMETERS:
1)300-500 gms/side of force
2)30 degree downwards to occlusal plane--> to produce tranlsation of
maxilla
3)Duration: 12-14 hours/day
4)Timing: Eruption of C.I and First Permanent molar.
8 years--> best result
below 10 years--> good result
After 10 years--> dental effect is more as compare to skeletal
5)RME: Activated once daily usually before bedtime for a period of 2 weeks
or till desired expansion os achieved.

REVERSEPULL HEADGEAR/ FACEMASK
BIOMECHANICS: Elastic traction --> Pulls maxilla forward
TREATMENT COMPLETION INDICATIONS:
1)Attainment of "Positive Overjet"
2)Improvement from "Concave profile"
ADVANTAGES OF FACEMASK:
1)Is only extraoral traction device for correction of maxillary defiecny with
rapid improvement and early result
2)Improved complaince and patient confidence.

REVERSEPULL HEADGEAR/ FACEMASK
EFFECTS OF FACEMASK:
1)Forward movement of maxilla
2)Forward movement of maxillary teeth
3)Proclination of maxillay incisors
4)Correction of Ap crossbite
5)Downward and Backward rotation of manibile

REFERENCES:
1)Proffit
2)Premkumar
3)Balahji.

THANKYOU !!!