Dr Nicky Mandall BOSF Grant 2002

Is early Class III protraction facemask treatment effective?

BOSF Grant 2002

Primary investigator

Nicky Mandall


To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years of age. 

Design: Multi-centre randomised controlled trial

Subjects and settings

Seventy three patients were recruited from 8 U.K. hospital orthodontic units. 


Patients were randomly allocated, stratified for gender, into an early class III protraction facemask treatment group (n=35) and a control/ no treatment group (n=38).  The following outcomes were recorded:  Dentofacial changes from lateral cephalograms and occlusal changes using the Peer Assessment Rating (PAR).  Self esteem was assessed using the Piers Harris questionnaire and the psychosocial impact of malocclusion with an Oral Aesthetic Subjective Impact Scores (OASIS) questionnaire.  Temporomandibular joint (TMJ) signs and symptoms were also recorded.  The time points for data collection were at registration (DC1) and 15 months later (DC2). 


The following mean skeletal and occlusal changes occurred from the class III starting point:  SNA:  Protraction group moved forwards 1.4O   (control group forward 0.3 O)(P=0.018);  SNB:  Protraction group moved backwards -0.7 O (control group forward 0.8 O)(P< 0.001);  ANB: Protraction group class III base improved  +2.1 O  (control group worsened by -0.5 O)(P< 0.001). This contributed to an overall difference in ANB between protraction and control groups of 2.6 degrees in favour of early protraction facemask treatment.  The overjet improved  +4.4 millimetres (mm) in the protraction group and marginally changed + 0.3mm in the control group (P< 0.001).  A 32.2% improvement in PAR was shown in the treatment group and the control group worsened by 8.6%.  There was no increased self esteem (Piers Harris score) for treated children compared with controls (P = 0.22). However, there was a reduced impact of malocclusion (OASIS score) for the protraction facemask group compared with controls (P= 0.003), suggesting treatment resulted in slightly less concern about the tooth appearance.  TMJ signs and symptoms were very low at DC1 and DC2 and none were reported during active facemask treatment.


 Early class III orthopaedic treatment, with protraction facemask, in patients under 10 years of age, is skeletally and dentally effective in the short term and does not result in TMJ dysfunction. Seventy per cent of patients had successful treatment, defined as achieving a positive overjet.  However, early treatment does not seem to confer a clinically significant psychosocial benefit. 



Mandall N1, DiBiase A, Littlewood S, Nute S, Stivaros N, McDowall R, Shargill I, Worthington H, Cousley R, Dyer F, Mattick R, Doherty B.  Is early Class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 1

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