Class III malocclusion in growing patients: facemask vs. functional appliance: experimental study

Objective: We compared the skeletal effects of postero-anterior facemask (PAF) and func- tional appliance (FA) therapy in growing patients with Class III malocclusion. Materials and Methods: A total of 85 patients (mean age 9 ± 0.2 years) were treated with either a PAF (n = 50) or a FA (n = 35). Pre- and post-treatment cephalometric records were analyzed to assess sagittal (SNA, SNB, ANB, Wits appraisal) and vertical changes. Treatment outcomes were compared using Student’s t test for paired samples. Results: PAF therapy produced significantly greater improvements in the ANB angle (mean increase 4.1◦ vs. 1.7◦) and Wits appraisal (2.4 mm vs. 0.9 mm) compared to FAs. Vertical control was superior in the PAF group, which showed a reduction in lower facial height, whereas FA patients exhibited a slight increase. Conclusions: PAF therapy was more effective than FAs in improving both sagittal and vertical skeletal relationships in growing Class III patients. Functional appliances provided only modest skeletal effects, mainly influencing mandibular position. Early intervention with a PAF should be considered the treatment of choice when maxillary protraction and vertical control are required.