Second group of reviewers find some evidence for use of facemask for class III malocclusions


The aim of this review was to evaluate the short-term skeletal effects of facemask treatment on growing Class III patients.

Searches were conducted in PubMed, Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, LILACS, and Google Scholar. Randomised controlled trials (RCTs) conducted on growing class III patients using protraction facemask were included. Two reviewers independently conducted the study selection, data extraction, and risk of bias assessments

  • Three RCTs were included involving a total of 155 patients.
  • Two studies were considered to be at low risk of bias the other at uncertain risk
  •  The treated group showed the following significant changes:-
    • ANB° +3.66° [95%CI (2.58, 4.74)];
    • SNA° +2.10 [95%CI (1.14, 3.06)];
    • SNB° -1.54 [95%CI (-2.13, -0.95)];
    • SN-palatal plane -0.82° [95%CI (-1.62, -0.02)]; and
    • SN-mandibular plane +1.51 [95%CI (0.61, 2.41)].

The authors concluded

Facemask is effective correcting Class III malocclusion in the short term. The skeletal modifications induced by facemask are forward displacement of maxilla, backward displacement of mandible, clockwise rotation of the mandibular plane, and counterclockwise rotation of the maxillary plane.


A recently updated Cochrane review by Watkinson et al (Dental Elf 18th Oct 2013) looked at treatments for class III malocclusions including use of the facemask. All 3 of the studies included in this review had been published at the time of the Cochrane review but only 2 of them were included.   The Cochrane reviewers concluded: –

There is some evidence that the use of a facemask to correct prominent lower front teeth in children is effective when compared to no treatment on a short-term basis. However, in view of the general poor quality of the included studies, these results should be viewed with caution. Further randomised controlled trials with long follow-up are required.

While perhaps it is reassuring that two groups of reviewers have come to similar conclusions from the available evidence this does represent duplication of effort.


Cordasco G, Matarese G, Rustico L, Fastuca S, Caprioglio A, Lindauer SJ, Nucera R. Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: a systematic review and meta-analysis. Orthod Craniofac Res. 2014 Apr 14. doi: 10.1111/ocr.12040. [Epub ahead of print] PubMed PMID: 24725349.

Dental Elf  18th Oct 2013  – Some evidence to support use of facemask appliance for class III malocclusions


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