Efficacy of RME and Facemask Therapy for Class III Malocclusion

Enhanced Efficacy of Early Orthopedic Intervention With Rapid Maxillary Expansion and Facemask Protraction on Skeletal and Quality of Life Outcomes in Class III Malocclusion: A Multicenter Randomized Controlled Trial

This multicenter randomized controlled trial compares the efficacy of Rapid Maxillary Expansion (RME) combined with facemask (FM) protraction versus FM protraction alone in treating growing children with skeletal Class III malocclusion. The study aims to evaluate the differences in vertical skeletal changes and Oral Health-Related Quality of Life (OHRQoL) between the two treatments.

Skeletal Class III malocclusion is a challenging craniofacial anomaly, particularly prevalent in Asian populations. Early orthopedic intervention aims to correct the discrepancy and guide favorable growth. While facemask (FM) protraction is a standard treatment, its efficacy can be enhanced by Rapid Maxillary Expansion (RME), which is thought to disarticulate the circummaxillary sutures and facilitate a better orthopedic response. This prospective, multicenter, randomized controlled trial was designed to rigorously compare the combined RME+FM therapy against FM therapy alone. The study's primary objective was to assess the impact of these interventions on vertical skeletal dimensions, a key concern in Class III treatment. The secondary objective was to evaluate the patient-centered outcome of Oral Health-Related Quality of Life (OHRQoL). Eligible patients aged 7-12 were randomly assigned to one of two treatment groups. Cephalometric and OHRQoL data were collected at baseline and after 12 months of active treatment to determine if the combined approach offers superior clinical outcomes.

Inclusion Criteria:

• Skeletal Class III malocclusion (ANB angle ≤ 0°) with a Wits appraisal ≤ -2 mm.
• Maxillary deficiency (SNA angle ≤ 80°).
• Prepubertal stage of skeletal development (Cervical Vertebral Maturation Stage CS1-CS3).
• Age between 7 and 12 years.
• Anterior crossbite or edge-to-edge incisor relationship.
• Angle Class III or end-on molar relationship.
• No previous orthodontic treatment.

Exclusion Criteria:

• Functional Class III malocclusion with no centric relation-centric occlusion discrepancy.
• Congenital craniofacial anomalies (e.g., cleft lip/palate).
• Severe systemic diseases.
• History of maxillofacial trauma.