Facemask Therapy — Upper Jaw Protraction for Children

A class III bite — where the lower jaw is prominent relative to the upper, resulting in an underbite — can have both a dental and a skeletal component. In growing children, where the upper jaw is underdeveloped or held back relative to the lower, facemask therapy offers a non-surgical way to advance the upper jaw forward using the child’s own growth potential.

This is a treatment that is only effective in growing children. The window for facemask therapy is limited — it is most effective before the mid-facial growth plates begin to close, typically before the age of 10, though selected cases can be treated successfully up to the early teenage years. Once growth is complete, the same correction requires surgical intervention. Acting within this window can make a profound difference to the outcome — and potentially avoid surgery altogether.

What Is a Facemask?

A facemask (also called a reverse pull headgear or protraction facemask) is an orthodontic device worn externally, resting against the forehead and chin, with elastic bands that attach to hooks inside the mouth — typically to a palatal expander or fixed appliance inside the upper arch. The elastics apply a gentle forward force to the upper jaw, stimulating its forward growth and bone remodelling at the mid-facial sutures.

The device is worn at home — typically for 12 to 16 hours per day, including during sleep — and is removed for school, sport, and social occasions. Because it is worn mainly at home, most children find it more acceptable than it might initially appear.

Facemask Combined with Palatal Expansion

In most children, facemask therapy is used in combination with palatal expansion. There are two reasons for this.

First, many children with a class III bite also have a narrow upper arch — widening the palate simultaneously with protraction addresses both the transverse and the anteroposterior dimensions of the jaw relationship.

Second, separating the midpalatal suture through expansion loosens the bony sutures of the mid-face, making the upper jaw more responsive to the forward protraction forces of the facemask. The combination of expansion and protraction produces more consistent and significant forward movement of the upper jaw than protraction alone.

In selected cases, MARPE combined with a facemask can be used in older children where the suture is less responsive — delivering the expansion needed to mobilise the suture before forward protraction is applied.

What Facemask Therapy Can Achieve

In a growing child with a skeletal class III pattern driven by an underdeveloped upper jaw, facemask therapy can:

• Advance the upper jaw forward, improving the bite and reducing or eliminating the underbite
• Improve the facial profile — particularly the flatness of the mid-face and upper lip area associated with maxillary deficiency
• Create a more favourable jaw relationship as a foundation for subsequent orthodontic treatment
• Reduce or eliminate the need for jaw surgery in adulthood — or, where surgery remains the long-term plan, minimise the extent of correction required at that stage

Results are most significant and stable when treatment is initiated early and when the child is compliant with the wearing schedule.

What Happens After Facemask Therapy?

Following the active facemask phase, the child typically wears a retaining appliance to maintain the correction achieved while growth continues. In most cases, comprehensive orthodontic treatment — fixed braces or aligners — is carried out in the teenage years to align the teeth and finalise the bite once the permanent dentition has fully erupted.

Monitoring throughout and after treatment is important, as the jaw relationship may change during the adolescent growth spurt. Some children with a significant underlying skeletal discrepancy will ultimately benefit from orthognathic surgery in adulthood to achieve the best possible skeletal result — but early facemask therapy maximises the non-surgical correction achieved and reduces the degree of surgical correction subsequently required.

Book a Children’s Orthodontic Assessment

If your child has an underbite, a class III bite, or a flat mid-face, an early specialist assessment is important. Book an appointment at Lusk Orthodontics to find out whether facemask therapy is appropriate and whether your child is still in the optimal treatment window.