The so-called reverse pull face mask or reverse pull headgear is designed to have the opposite effect of the headgear. It is most often used in children with an underbite (the lower teeth overlap the upper ones), but great results can be achieved in adults as well. The patient’s upper lip is thin and drawn in, while the lower lip is thicker and more pronounced, making the profile appear concave. The cause of the problem is insufficient growth of the upper and/or excessive growth of the lower jaw.
The reverse pull face mask has a dual effect – skeletal and dental; it moves both the upper jaw and the teeth. With the help of a fixed appliance and elastics, the appliance exerts light force to pull the upper teeth and jaw forward, thus stimulating the growth of the maxilla. The skeletal effect is most evident in children under 9 years of age, when it is often combined with a hyrax. With the reverse pull face mask, it is possible to achieve forward movement of the upper jaw of up to 2 mm. After nine years of age, the skeletal effect is less and the dental effect more pronounced.
Although it is primarily indicated in children, it is also used in adult patients with a certain subtype of the anomaly and good periodontal condition. In these patients, we try to achieve tooth movement in the part of the maxilla that holds the teeth – the alveolar ridge. We pull the upper teeth forward to better support the upper lip. This significantly improves the appearance of the face – the upper teeth finally overlap the lower, the upper lip becomes more pronounced and fuller, and the profile more beautiful. Given such beneficial effects, patients are extremely happy to wear a reverse pull face mask.
The appliance consists of a main vertical metal bar that connects the forehead and chin pads, and a horizontal bar in line with the lips. Elastics are attached to the horizontal bar of the reverse pull face mask on one side and to the hooks on the fixed appliance on the upper teeth on the other.
The appliance is most effective when worn consistently as instructed, preferably 10 to 12 hours a day (whenever possible).
Proper indication and good communication between the patient and the orthodontist are a guarantee of success!