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Facemask and Chin cup. Dr Abdul Jabbar. What are facemasks and chin cups? . Growth modification appliances for skeletal Class III. CLASS III MALOCCLUSION. The relative mesiodistal relation ship of arches are abnormal with all the lower teeth occluding mesial to

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facemask and chin cup

Facemask and Chin cup

Dr Abdul Jabbar

what are facemasks and chin cups
What are facemasks and chin cups?
  • Growth modification appliances for skeletal Class III.
class iii malocclusion
CLASS III MALOCCLUSION
  • The relative mesiodistal
  • relation ship of arches are
  • abnormal with all the lower
  • teeth occluding mesial to
  • normal ,producing marked
  • disharmony in the incisor
  • region and in the facial lines.
class iii molar relation ship
CLASS III MOLAR RELATION SHIP

Abnormal relationship in which

the mesiobuccal cusp of max. first

permanent molar occludes distal

to the buccal groove of mandibular

first molar.

types of class iii malocclusion
TYPES OF CLASS III MALOCCLUSION

DENTAL

FUNCTIONAL

SKELETAL

Short Maxilla

Prognathic Mandible

Composite

dental class iii
Dental Class III
  • Early loss of lower e`s
dentoalveolar mal relationship
DENTOALVEOLAR MAL-RELATIONSHIP

FEATURES

  • No apparent saggital discrepancy
  • ANB angle is with in normal limits
  • Lingual tipping of max. incisors & labial tipping of mand. incisors
dental factors
Dentalfactors
  • Ectopic eruption of maxillary central incisors
  • Premature Contact
  • Premature loss of C`s
functional factors
Functional factors
  • Anomalies in tongue position
  • Neuromuscular features
  • Naso-respiratoryor airway problems
skeletal factor
Skeletal Factor
  • Minor transverse maxillary discrepancy
features of pseudo class iii
FEATURES OF PSEUDO CLASS III
  • Mandible appear morphologically normal
  • Class I or mild Classlll sk. Relationship
  • Ant. cross bite and negative over jet is present due to a ant Displacement of mandible
  • Mandible can be pushed back to edge-edge relationship
slide14

1. GROWTH MODIFICATION

Pre Adolescents (late childhood , juvenile)

Adolescents (v. minimal effects)

2. CAMOFLOUGE (MILD)

Adolescents

Adults

3. Orthognathic SURGERY (moderate –severe)

Post adolescents

Adults

growth modification
GROWTH MODIFICATION
  • SK CLASS III

CAUSES

DEFICIENT MAXILLA

PROGNATHIC MANDIBLE

COMPOSITE

face mask therapy
FACE MASK THERAPY
  • Orthopedic face mask correct classIII malocclusion in:
  • Late decidious or early permenant dentition
  • Changes produced in all three plane of spaces
treatment effects produced by face mask therapy
TREATMENT EFFECTS PRODUCED BY FACE MASK THERAPY
  • Correction of CO_CR discrepancy
  • Maxillary sk. Protraction
  • Forward movement of max.dentition
  • Lingual tipping of lower incisors
  • Redirection of mand. Growth in more vertical direction
treatment in growing patients pre adolescents adolescents
TREATMENT IN GROWING PATIENTS(pre- adolescents , adolescents)
  • Skeletal Class III with
  • Short Maxilla
  • FR 3 (22-23 hrs)
  • Effects
  • Forward mov.of maxilla
  • Proclination of upper incisors
  • Backward rotation or repositioning of mand.
  • Increase in lower ant. Facial height
  • lingual tipping of lower incisors
treatment in growing patients pre adolescents adolescents1
TREATMENT IN GROWING PATIENTS(pre adolescents , adolescents)
  • Composite Skeletal Class III
  • -ive Family History
  • Face Mask or Reverse Headgear

Pre-requisite

Maxillary Expansion

  • Effects
  • Maxillary sk. Protraction
  • Forward movement of max.dentition
  • Lingual tipping of lower incisors
  • Redirection of mand. Growth in more vertical direction
treatment effects
Treatment effects
  • Incease in overjet (4.4 mm)Mesial mov. &flaring of upper incisors & up righting of lower incisors
  • & correction of molar position towards class I molar correction(3.1 mm)mesial mov. Of maxilla
  • Skeletal effects
  • ANB angle (2.4-2.8)& Witts appraisal(witts value 2.6mm)
treatment management in pre adolescence
Treatment & Managementin Pre-adolescence

DEFICIENT MAXILLA/COMPOSITE III

Expansion + face mask

  • 8 yrs ideal age for maxillary protraction.
  • more the age of the patient ,less will be the skeletal

effects.

  • early ages treatment ensures better skeletal effects.
slide23

Criterea for facemask:

  • Short face

Normal face

  • Lower incisors either normally inclined or proclined.
  • Upper incisors must be either retroclined or normally inclined.
  • Growing

8yrs age ideal for facemask

components of orthopedic facial mask therapy
Components of orthopedic facial mask therapy
  • Facial mask
  • Bonded max. expansion splint
  • Heavy elastics
face mask therapy1
FACE MASK THERAPY
  • Orthopedic face correct classIII malocclusion in
  • Late decidious or early permenant dentition
  • Changes produced in all three plane of spaces
facial mask
Facial mask
  • Facemask therapy often follows maxillary expansion since the latter disrupts the circummaxillarysutural system and facilitates the orthopedic effects of the facemask
  • children treated at an early age, showed a significant forward displacement of the maxillary complex and a significant upward and forward direction of condylar growth, leading to smaller increments in total mandibular length
types of facemasks
Types of facemasks
  • Delaire facemask

2. Petit facemask

facial mask1
Facial mask
  • made of two pads that contact the soft tissue in the forehead and chin regions..
  • The pads are connected by a rod
  • In the center of the midline framework is adjustable crossbow to which elastics are connected bilaterally
2 max expansion splint
2 .Max.expansionsplint
  • The second component of this orthopedic treatment is the maxillary splint. an acrylic and wire maxillary expansion appliance that is bonded to the posterior dentition.
  • In mixed dentition cases, the splint usually covers the first and second deciduous molars.
  • The upper canines may also be included in patients who present with complete deciduous dentitions.
max expansion splint
Max.expansion splint
  • maxillary splint is made of a framework of .045“(1.2mm) round stainless steel wire, to which an expansion screw is attached.
  • If second molars are present, an occlusal rest is extended to the second molars to prevent overeruption of these teeth during treatment (Two hooks, to which elastics are attached, are soldered to the wire framework.
  • These hooks usually lie adjacent to the canines or first deciduoud molars.
max expansion splint1
Max.expansion splint
  • , Rapid palatal expansion can produce a slight forward movement of Point A and a slightdownward and forward movement of the maxilla.
  • In the context of facial mask therapy, the effect of such expansion is to disrupt the maxillary sutural system, thus possibly enhancing the effect of the orthopedic facial mask by making sutural adjustments occur more readily.
slide36

Another advantage of maxillary expansion is the correction of the posterior crossbite that often accompanies a Class III malocclusion because of deficient transverse maxillary growth and the abnormal anteroposterior relationship of maxilla to mandible.

  • In addition, a palatal expansion appliance splints the maxillary dentition during protraction and helps transmit force from the teeth to the maxilla, thus limiting unwanted tooth movement.
activation of splint
Activation of splint
  • The patient is usually instructed to turn the midline jackscrew of the appliance once daily, generally before bedtime.
  • In the majority of Class III individuals in whom use of an orthopedic facial mask is indicated, some maxillary expansion is beneficial. In such a case, the maxillary splint is expanded until the desired transverse change is achieved.
activation of splint1
Activation of splint
  • In instances in which no transverse change is necessary, the maxillary splint is activated once a day for eight days to produce a disruption in the sutural system that facilitates the action of the facial mask
heavy elastics
Heavy elastics
  • The facial mask is secured to the face by stretching elastics from the hooks on the maxillary splint to the crossbow of the facial mask
  • Heavy forces are generated, usually through the use of 5/16", 14oz elastics bilaterally.
  • Lighter forces may be used during the break-in period, but forces should be increased as the patient adjusts to the appliance.
instructions
INSTRUCTIONS
  • Optimally, the patient is instructed to wear the facial mask on a full-time basis except during meals.
  • Young patients (5 to 9 years old) can usually follow this regimen, particularly if the patient is told that the full-time wear will last only three to five months.
  • In older patients, full-time wear may not be possible, in which case the appliance should be worn at all times except when the patient is in school or participating in contact sports
facial mask2
FACIAL MASK

The facial mask is usually worn until a positive overjet of 2-4mm is achieved interincisally. At this time, part-time or nighttime wear is recommended for an additional three to-six-month retention

FR-3 Frankel appliance1 can be worn as an active retainer.

skeletal classiii with large mandible
Skeletal classIII with large mandible
  • Extra oral force application can be accomplished in 2 ways:
  • EO force through condyles
  • EO force below the condyles.
what appliance
What appliance?

Chin cup

Types of chin cup

skelatal class iii with large mandible
SKELATAL CLASS III WITH LARGE MANDIBLE
  • Pre adolescents, mild, no family history, low angle

Chin Cup

  • Adolescents ,mild Class III ,low angle.

Chin Cup

or surgical preparation.

  • Adults

Camoflouge of surgery

growth philosophy
growth philosophy
  • Mandibular growth mechanisms
  • functional matrix theory
  • displacements primary and s

secondary.

3. Growth sites and growth centers.

4. Drift , relocation, sub periosteal deposition and resorption, modelling,remodelling.

treatment in growing patients
TREATMENT IN GROWING PATIENTS

Skeletal Class III with

PrognathicMandible

-iveFamily History

Reverse Twin Block ( appliances without lip pads)

Chin Cup

1. Occipital Pull

2. Vertical Pull

150-300 gm per side (INITIALLY)

450-700 gm (if force is directed through condyle & slightly less if below the condyle)

14 hrs per day

After correction of cross bite wear only at night as retention appliance

chin cup types
Chin cup types

CHIN CUP TYPE HEAD GEAR

2.VERTICAL PULLCHIN CUP

1.OCCIPITAL-

PULL CHIN CUP

occipital pull chin cup
OCCIPITAL- PULL CHIN CUP
  • Mild to moderate mand. Prognathism
  • Short lower ant. Facial hgt.
  • Normally positioned or slightly proclined lower incisors(some backward tipping of lower incisors)
direction of pull of chin cup
Direction of pull of chin cup

If below the condyle-----downward &backward rotation of mandible

If no opening of mand. Plane is required forceshould be directed through condyle to help restrict mand. Growth.

force
FORCE
  • 150-300 gms per side (INITIALLY)

OVER NEXT 2 MON.

  • 450-700 grams(if force is directed through condyle & slightly less if below the condyle )(16-24 ounce)
  • 14 hrs per day
  • After correction of cross bite wear only at night as retention appliance.
vertical pullchin cup
VERTICAL PULLCHIN CUP

INDICATIONS

Inc. ant. vertical dimention

Steep mand. Plane angle

2 vertical pullchin cup
2.VERTICAL PULLCHIN CUP

If no Inc. in lower ant. Facial ht. is required

EFFECTS PRODUCED

  • Dec. in Mandibular Plane angle & Gonialangle
  • Increase in posterior face height.
clinical management
Clinical Management
  • Could be
  • pre formed
  • custom made

metallic

plastic

Talcum powder

Soft chin cups Vs hard chin cups

effects of chin cup therapy
Effects of chin cup therapy
  • Mandibular growth is redirected in downward and backward direction.
  • Increased LAFH
  • LI are retroclined.
  • Decreased chin prominence.