Initial situation
- Skeletal deficiency indicated for facemask-based maxillary protraction
- Need for anchorage that limits dental side effects during protraction
The decision
Skeletal anchorage was established using onplants to support facemask therapy, enabling controlled maxillary protraction with less reliance on tooth-borne anchorage. This approach was intended to minimize dental side effects and produce a more predictable skeletal response than conventional facemask protocols alone.
Skeletal, rather than dental, anchorage changes what facemask therapy can accomplish.
The result
The onplant-supported facemask therapy produced a favorable skeletal correction with limited dental compensation, illustrated across the accompanying photographic series.
Onplant-supported anchorage can make facemask protraction more skeletally efficient and reduce compensatory dental movement compared with tooth-borne anchorage.
About skeletal expansion & MARPE
This case highlights skeletal anchorage as a variable in treatment planning, relevant not only to expansion but also to sagittal correction such as maxillary protraction. Comprehensive diagnostic planning increasingly weighs anchorage source, alongside transverse and sagittal skeletal relationships, before deciding whether an appliance can act on bone directly rather than through the dentition. In cases like this, clinicians typically assess whether skeletal or dental anchorage produces a more stable, predictable long-term result.
Questions clinicians ask
What is skeletal anchorage in the context of facemask therapy?
Skeletal anchorage uses a bone-supported device, such as an onplant, rather than the teeth, to apply protraction forces directly to the maxilla.
Why choose bone anchorage over conventional tooth-borne facemask protraction?
Bone anchorage can reduce unwanted dental side effects, such as tipping of the anchor teeth, and may produce a more predictable skeletal response.
Is facemask therapy still relevant with skeletal anchorage options?
Yes, facemask protraction remains a standard approach for maxillary deficiency, and skeletal anchorage is one way to refine how the forces are delivered.
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Original case shared by Dr. Mark Radzhabov on Instagram @orthodont_mark · Published for professional education.
