Protramax: A Novel Device for Directing Class III Orthopedic Force

Facemask has been widely used in the successful correction of Class III malocclusion. A vast majority of the literature noted forward and a counter-clockwise rotation of the maxilla with facemask therapy. Although the counter-clockwise rotation is beneficial in the treatment of hypodivergent Class III patients, it is not advisable in high-angle Class III patients with anterior open bite. In order to minimize this undesirable side effect, the direction of protraction force at an angle of 30° downward from the plane of occlusion has been recommended. By directing the protraction force from a point 5 mm above the palatal plane and 15 mm above the occlusal plane minimized the counter-clockwise rotation of the maxilla. These attempts showed that the counter-clockwise rotation of the maxilla during protraction was unavoidable but can be reduced significantly. Hence, the angulation of the extraoral elastics applied to the facemask for maxillary protraction is extremely important to reduce the counter-clockwise rotation of the maxilla. This clinical pearl demonstrates an accurate and easy method to measure the angulation of the elastics applied to the facemask to reduce the above-mentioned side effect.