Journal of Indian Society of Pedodontics and Preventive Dentistry
Journal of Indian Society of Pedodontics and Preventive Dentistry
                                                   Official journal of the Indian Society of Pedodontics and Preventive Dentistry                           
Year : 2020  |  Volume : 38  |  Issue : 1  |  Page : 88--90

A simplified de novo approach for vector control in facemask therapy


Harpreet Singh1, Raj Kumar Maurya2, Chandresh Shukla3, Tanmay Mittal1, Pranav Kapoor1, Poonam Sharma1, Babita Niranjan4, Devashri Awasthi5,  
1 Department of Orthodontics and Dentofacial Orthopedics, ESIC Dental College and Hospital, New Delhi, India
2 Department of Orthodontics, Army Dental Centre (Research and Referral), New Delhi, India
3 Department of Orthodontics, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
4 Department of Pedodontics and Preventive Dentistry, Peoples College of Dental Sciences, Bhopal, Madhya Pradesh, India
5 Department of Oral Medicine, Diagnosis and Radiology, LN Medical College and Hospital, Bhopal, Madhya Pradesh, India

Correspondence Address:
Dr. Raj Kumar Maurya
Department of Orthodontics, Army Dental Centre (Research and Referral), New Delhi
India

Abstract

One of the most common clinical challenges encountered with facemask therapy for early correction of skeletal Class III malocclusions is the delivery of appropriate direction of force for effecting the pure translation of maxilla. This technical note describes a novel method involving the use of Begg's auxiliary for achieving efficient and predictable delivery of protraction forces. With this modified assembly, effective vector control for facemask can be achieved without the need to remove the bonded Hyrax assembly. This chairside modification is an effective and invaluable method for predictable force delivery in facemask therapy.



How to cite this article:
Singh H, Maurya RK, Shukla C, Mittal T, Kapoor P, Sharma P, Niranjan B, Awasthi D. A simplified de novo approach for vector control in facemask therapy.J Indian Soc Pedod Prev Dent 2020;38:88-90


How to cite this URL:
Singh H, Maurya RK, Shukla C, Mittal T, Kapoor P, Sharma P, Niranjan B, Awasthi D. A simplified de novo approach for vector control in facemask therapy. J Indian Soc Pedod Prev Dent [serial online] 2020 [cited 2021 Aug 4 ];38:88-90
Available from: https://www.jisppd.com/text.asp?2020/38/1/88/280520


Full Text



 Introduction



Class III malocclusions often pose management and prognostic challenge to the clinician. Protraction facemask is being widely used in the early treatment of skeletal Class III malocclusions with maxillary deficiencies.[1] A critical aspect of successful facemask therapy is the application of optimal force at the desired level and angulation.

Application of orthopedic force below the center of resistance of the maxilla tends to tip the palatal plane, thus producing counter-clockwise maxillary rotation, which may be undesirable in patients with hyperdivergent growth patterns. Translation is produced if the force is applied along the zero-moment line of force.[2]

To minimize tipping of the palatal plane, it is recommended to attach the protraction elastics to hooks located near the maxillary canines with a downward and forward pull of 30° from the occlusal plane.[1] However, slippage of the elastics, thus altering the angulation of pull, is a frequently encountered problem. Moreover, in patients with a reduced depth of the vestibular sulcus, accurate positioning of the hooks poses a clinical challenge. In certain clinical situations, it may also be required to change the desired vector of protraction midtreatment, which necessitates the removal of Hyrax assembly and repositioning of the hooks, thus requiring a cumbersome second clinical laboratory procedure and causing inconvenience to the patient. Presented here is a practical and clinically effective method of avoiding these problems by simply attaching a Begg's auxiliary (molar tube) to the hooks of Hyrax assembly, intraorally, without removal of the assembly from the patient's mouth [Figure 1].{Figure 1}

 Clinical Presentation



Technique for achieving improved vector control

The patient complained of slippage of the elastics from the hook attached to the Hyrax assembly. A 0.036” slot weldable Begg's auxiliary molar tube was used, and its flanges were opened with the aid of Weingart plier as shown in [Figure 2]. The auxiliary tube with opened flanges was secured at the desired position on the vertical segment of the 0.036” wire with carding wax and was carefully crimped with a Weingart plier [Figure 3]. The properly secured auxiliary prevented any slippage of the elastics and allowed traction at the desired angulation [Figure 4].{Figure 2}{Figure 3}{Figure 4}

 Discussion



Since two decades, facemask in conjunction with expansion therapy has emerged as a most effective treatment modality for the management of skeletal Class III malocclusion with retrusive maxilla especially in pediatric patients with hypodivergent growth pattern.[3],[4] Absolute patient compliance and high motivational levels regarding adherence to the recommendations for the duration of appliance wear are crucial for ensuring treatment success.[3],[5]

Facemask therapy, when used as per prescription, has also been employed to achieve significant anterior maxillary movements in aptly selected patients with unilateral cleft lip and palate.[3],[6]

Regarding the position of the hooks of the Hyrax assembly, it has been suggested that the hooks should be positioned in canine-premolar (or deciduous first molar) area in horizontal growers. However, in vertical growers, hooks can be placed more anteriorly and slightly at a higher position.[7]

As for the effects of varying the direction of force on maxillary protraction, the force applied intraorally from the canine region, at a 30° angle to the occlusal plane (below the center of resistance of the maxilla) is effective in protracting the maxilla with a counter clockwise rotation. On the contrary, the force applied with a modified extraoral facial arch, 20 mm above the maxillary occlusal plane (closely approaching the center of resistance of the maxilla) is particularly effective to translate the maxilla anteriorly without rotation especially in Class III malocclusion combined with an anterior open bite.[8] Thus, adequate vector control is imperative to achieve predictable outcomes in different clinical presentations.

For obtaining adequate vector of protraction forces mid-treatment, the Begg's auxiliary tube was chosen as it is easy to handle, has an ergonomic design (round cross-section), and relatively inexpensive. The simple modified assembly described for achieving effective vector control offers the following advantages:

Placement of auxiliary at appropriate position prevents slippage of elastics, thus ensuring better patient compliancePatient can engage the elastics with greater ease and minimum effortThis technique precludes the need for removal and replacement of bonded Hyrax assembly mid-treatment, hence considerably reducing the chairside timeEliminates the need for relocating the bend in the hooks for securing elastics.

 Conclusion



This simple chairside technique enables predictable and efficient delivery of protraction forces with facemask, without removing the Hyrax assembly.

 Clinical Relevance



A simple and effective chairside modification for achieving effective vector control for facemask therapy using economical and easily available Begg's auxiliary is described, which avoids the need to remove the Hyrax assembly midtreatment, thus reducing discomfort to the patient.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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