Reverse-Pull Headgear in Kent and Sammamish
Freelove Orthodontics & Smile Design treats Class III skeletal underbite in growing children with a post-expansion facemask protocol, full-time wear in the weeks right after rapid palatal expansion, while the maxillary sutures are still loose and most responsive to forward force.
Reviewed and approved by Dr. Cameron Freelove, DDS, MS · Last updated
Most cases finish the active facemask phase in roughly 3 months.
What Is Reverse-Pull Headgear (a Facemask)?
Reverse-pull headgear, often called a protraction facemask, is an orthopedic appliance that gently pulls the upper jaw forward to correct an underbite (Class III malocclusion). A soft-padded frame rests on the forehead and chin, and light elastics run from hooks on a palatal expander inside the mouth to the outer frame.
The elastic force coaxes forward growth of the maxilla (upper jaw and midface), not just the teeth.
Unlike traditional "bird cage" headgear, the older appliance that pushes the upper jaw backward, a reverse-pull facemask works in the opposite direction. Push-back headgear is rarely used in modern Phase 1 treatment; the facemask has replaced it as the orthopedic tool of choice for skeletal underbite in growing children.
Most Freelove Orthodontics & Smile Design headgear patients are young children whose diagnostic scan shows a true Class III skeletal pattern that will worsen without intervention during active jaw growth.
Timing is everything. At age 10 and younger, the maxillary sutures are more open and responsive to orthopedic force. After that window, the bony sutures that allow the upper jaw to move forward begin to consolidate, and MARPE may need to be considered in conjunction with orthodontic facemask at older ages.
This is why the American Association of Orthodontists recommends a first orthodontic evaluation no later than age 7, and why Freelove Orthodontics & Smile Design screens every new young patient in Kent and Sammamish for early signs of Class III growth.
Freelove Orthodontics & Smile Design starts facemask treatment from age 6 when a child’s growth pattern calls for it. The facemask can be anchored to small temporary mini-screws rather than to the teeth.
When a Kent and Sammamish Child Needs a Facemask
At Freelove Orthodontics & Smile Design, reverse-pull headgear is recommended only when the diagnostic records show a clear skeletal (not purely dental) underbite in a child still in active growth. Dr. Freelove evaluates the following on 3D CBCT imaging and clinical exam:
Skeletal Underbite (Class III Malocclusion)
The upper jaw sits too far back relative to the lower jaw, so the lower front teeth bite in front of the upper front teeth. Left untreated during active growth, the pattern tends to worsen through adolescence as the lower jaw continues to grow past the upper.
Many untreated Class III cases eventually require orthognathic (jaw) surgery in adulthood. A well-timed facemask during childhood can eliminate or dramatically reduce that risk.
Midface Deficiency
The middle third of the face, cheekbones, upper lip base, and area beneath the eyes, appears flat or recessed. This is the hallmark of an underdeveloped maxilla. A facemask does not just move teeth: it stimulates forward growth of the entire maxillary complex, which improves both bite and facial balance.
Anterior Crossbite From a Skeletal Cause
One or more upper front teeth bite behind the lowers. When the cause is skeletal (not just a tipped tooth), braces alone mask the problem without addressing the underlying jaw position. A facemask combined with expansion treats the root cause.
Family History of Underbite
Class III patterns carry a strong genetic signal. If a parent, grandparent, or sibling has an underbite or had jaw surgery, Freelove Orthodontics & Smile Design urges early evaluation. Ideally no later than age 7. So the narrow growth window is not missed.
This is especially important for families across Kent and Sammamish and the surrounding communities who may not realize how early the Class III treatment window closes.
Correcting a Class III Skeletal Underbite
Class III correction with a facemask is an orthopedic procedure, not simply an orthodontic one. The goal is to remodel the position of the upper jaw itself, the maxilla, during the limited years when that bone can still be moved forward. This is fundamentally different from later teen or adult orthodontics, where brackets and elastics reposition teeth within jaws that are already mature.
Why Freelove Orthodontics & Smile Design Treats Phase 1 Class III Cases
Dr. Freelove views Phase 1 intervention as appropriate for a narrow set of structural problems, true skeletal underbites, multi-tooth crossbites with functional shift, severely constricted palates, severe crowding that would trap adult canines, and airway issues caused by under-developed jaws.
Cosmetic crowding that growth is likely to resolve on its own is not a Phase 1 indication. When a child in Kent and Sammamish does show a true Class III pattern, however, the cost of waiting is high: the difference between a 3–6 month facemask phase at age 8 and a two-jaw surgery at age 18.
A facemask with traditional expander cannot reverse a skeletal underbite that has already settled into an adult jaw. Once the maxillary sutures become fully interdigitated, usually in the mid-teens for boys, a bit earlier for girls, MARPE with facemask may be necessary for the best chance at upper jaw forward growth.
For teens whose growth window has closed, Freelove Orthodontics & Smile Design coordinates alternative pathways: MARPE (Miniscrew-Assisted Rapid Palatal Expansion) for transverse correction in adults, Class III elastics with braces for camouflage of mild-to-moderate cases, and orthognathic surgery for severe skeletal discrepancies.
The Freelove Orthodontics & Smile Design Phase 1 Protocol
Phase 1 Class III treatment at Freelove Orthodontics & Smile Design is sequenced, not improvised. The goal in the Phase 1 growth window (beginning around age 7) is to correct the skeletal relationship once, then monitor growth until the adult teeth are ready for any finishing work.
-
Free Consultation and Diagnostic Imaging
Dr. Freelove evaluates the child’s bite, facial balance, and airway, and takes diagnostic imaging. The scan confirms whether the underbite is skeletal, dental, or both, shows the maturity of the maxillary sutures, and reveals how much forward growth potential remains. Parents see the 3D images on-screen and receive a clear plan.
-
Rapid Palatal Expansion First
Most Class III children also have a narrow upper jaw. Expansion is the first step, because widening the palate simultaneously loosens the maxillary sutures, which primes the bone to respond to the facemask that follows.
Freelove Orthodontics & Smile Design uses a slim, molar-only rapid palatal expander custom-fit to the child’s jaw.
-
Facemask Fitted and Elastics Connected
As soon as the expander is placed, the facemask is fitted. Elastic bands connect from hooks on the expander inside the mouth to the facemask frame outside. Dr. Freelove adjusts the force level and direction and shows the child and parent how to attach and remove the elastics at home. Fresh elastics go on each morning.
-
Month 1, Full-Time Wear
This is the most productive month of the entire protocol. The maxillary sutures are still loose from expansion and will not stay open indefinitely, within 4 to 6 weeks they begin to re-consolidate. Freelove Orthodontics & Smile Design recommends wearing the facemask as much as possible during this window: at home, during homework, during sleep.
The appliance comes off only for meals, brushing, active sports, and school time. Applying full-time force while the sutures are still mobile produces meaningfully more skeletal change (forward jaw movement) than the same force applied once the bone has settled.
-
Re-Evaluation After Approximately 3 Months
A follow-up CBCT or clinical exam confirms the skeletal correction. Most patients discontinue the facemask at this point and transition either to watchful monitoring (if the adult teeth have not yet erupted) or to Phase 1 braces to fine-tune alignment.
The palatal expander is typically left in place for 4 to 6 months after initial placement so the widened palate can stabilize.
Why the Expander and Facemask Work Together
Expansion and facemask therapy are not two separate treatments. They are one coordinated orthopedic procedure.
Freelove Orthodontics & Smile Design’s palatal expander page explains the expansion side in detail, but the short version matters here: rapid palatal expansion disrupts the circummaxillary sutures that connect the upper jaw to the rest of the skull. For 4 to 6 weeks afterward, those sutures are in a state of active remodeling.
That remodeling window is exactly when the facemask delivers the most skeletal correction per ounce of force. The maxilla can be drawn forward through sutures that are, temporarily, still flexible. Outside that window, the same elastics mostly move teeth rather than bone, which is why Class III camouflage treatment in older teens looks very different from Phase 1 correction in an 8-year-old.
This is also why Freelove Orthodontics & Smile Design does not postpone facemask placement after expansion is complete. Waiting a few months for convenience quietly trades skeletal correction for dental compensation.
What to Expect Day to Day
First Few Days
Most children feel mild pressure on the forehead and chin for the first 2 to 3 days, similar to the sensation of wearing a new helmet or breaking in a pair of shoes. The pressure is not sharp pain; it is the feeling of gentle, continuous forward pull. Padding adjustments at the first check-up resolve any specific comfort issues.
Sleep
Sleeping in the facemask takes a few nights to get used to. Back sleeping works best, and a slightly flatter pillow often helps. Most families report the child settles into a routine by the end of the first week.
Eating and Brushing
The facemask comes off for every meal and every brushing session. The palatal expander stays in. Regular hygiene, fluoride toothpaste, gentle brushing around the expander, water-flossing as needed, is all that is required. No special products.
Speech
Speech is not affected by the facemask itself, because the frame sits entirely outside the mouth. The palatal expander inside may temporarily affect "s" and "sh" sounds for a few days; most children adapt within a week.
Sports and School
During Month 1 full-time wear, the facemask comes off for active sports and can come off for school if the child prefers. After Month 1, it is worn only at home. Because the active phase is short, most Kent and Sammamish families find the at-home-only schedule workable alongside schoolwork and activities.
Visible Results
Parents often notice improved facial profile within the first month, a fuller upper lip, more forward cheek projection, and a bite that is beginning to look balanced at rest. Because the correction is skeletal, those changes hold as the face continues to grow.
Headgear for Adults, Why Freelove Orthodontics & Smile Design Rarely Recommends It
Reverse-pull headgear depends on open maxillary sutures for its effect. Once the sutures have become heavily interdigitated, generally by the late teens, a facemask can no longer deliver meaningful skeletal correction, regardless of how long it is worn. MARPE can prolong the age at which facemask is effective, though results become less predictable at older ages, and a surgical correction may be necessary. For adults with a Class III pattern, Freelove Orthodontics & Smile Design evaluates:
- Mild to moderate cases: Camouflage treatment with braces or clear aligners plus Class III elastics, which compensates at the tooth level without moving the jaws.
- Transverse (narrow palate) cases: MARPE (Miniscrew-Assisted Rapid Palatal Expansion) placed in-office by Dr. Freelove, which uses skeletal anchorage to open an interdigitated, expansion-resistant suture.
- Severe skeletal discrepancies: Coordination with an oral and maxillofacial surgeon for orthognathic surgery, with the orthodontic work at Freelove Orthodontics & Smile Design sequenced before and after the procedure.
Traditional "pull-back" cervical headgear (sometimes called "bird cage" headgear) for Class II correction is likewise rarely used at Freelove Orthodontics & Smile Design today. Modern Class II mechanics, Herbst, MARA, Forsus, Carriere, and Class II elastics, typically achieve the same correction without headgear strap compliance issues.
Each of those alternatives is discussed with families when a Class II growth pattern is diagnosed.
How Much Does Reverse-Pull Headgear Cost in Kent and Sammamish?
Included With a Phase 1 Treatment Plan
No separate charge for the facemask appliance or elastics.
The reverse-pull facemask is included as part of a comprehensive Phase 1 orthodontic treatment plan at Freelove Orthodontics & Smile Design. The total Phase 1 fee, which typically bundles expansion, facemask therapy, monitoring visits, and any Phase 1 braces, depends on the complexity of the case and is quoted in writing at the free consultation.
Many dental insurance plans cover a portion of Phase 1 interceptive orthodontic treatment. Freelove Orthodontics & Smile Design accepts most PPO plans and verifies benefits before treatment begins. For families without orthodontic insurance, or for the portion insurance does not cover, the following financing options are available:
- In-House Financing: 0% financing options available, no credit check.
- CareCredit: $0 down with approved credit.
- Pay in Full: 5% discount when treatment is paid up front.
For a personalized estimate, schedule a free consultation, the visit includes a bite evaluation and a full written cost breakdown at no charge. See the insurance guide for coverage verification, and the community discounts page for Military, Teacher, and Family discounts, which also apply to comprehensive Phase 1 plans.
Frequently Asked Questions About Reverse-Pull Headgear
What is reverse-pull headgear?
Reverse-pull headgear, also called a protraction facemask, is an orthopedic appliance that gently pulls the upper jaw forward to correct a Class III (underbite) skeletal pattern in growing children. A padded frame rests on the forehead and chin, and elastics connect to hooks on a palatal expander inside the mouth.
It is most effective in children age 10 and younger, before the maxillary sutures begin to interdigitate.
How long does a child need to wear a facemask?
At Freelove Orthodontics & Smile Design, the active facemask phase is approximately 3-6 months, with wear time as much as possible, 14 hours minimum.
This post-expansion protocol takes advantage of the window when the maxillary sutures are still loose and most responsive to forward force, producing a greater share of skeletal (as opposed to dental) correction.
What is the best age for reverse-pull headgear?
Ideally age 10 and younger, before the maxillary sutures begin to mature. Earlier treatment takes advantage of active jaw growth and produces the most skeletal correction.
The American Association of Orthodontists recommends a first orthodontic evaluation no later than age 7, which is early enough to identify underbite and begin treatment during the optimal growth window. Children who present at Freelove Orthodontics & Smile Design closer to age 10 or 11 can often still be treated, but the window narrows quickly.
Does reverse-pull headgear hurt?
Most children feel mild pressure on the forehead and chin for the first 2 to 3 days, more like the feeling of a new helmet than sharp pain. The elastics deliver a gentle, continuous forward pull. If something feels genuinely uncomfortable, padding adjustments at the next check-up usually resolve it.
Can a teen or adult wear a facemask?
Reverse-pull headgear depends on open maxillary sutures, which typically become interdigitated and resistant to expansion in the late teens. For older teens and adults with Class III patterns, MARPE may potentially still be used successfully with reverse-pull headgear. Freelove Orthodontics & Smile Design discusses alternatives, Class III elastics with braces or aligners for mild cases, MARPE for transverse correction, and coordination with an oral surgeon for orthognathic surgery when the skeletal discrepancy is severe.
How is this different from “regular” (push-back) headgear?
Traditional cervical or high-pull headgear pushes the upper jaw or upper teeth backward, used historically for Class II (overjet) cases. Reverse-pull headgear does the opposite: it pulls the upper jaw forward for Class III (underbite) cases. The appliances look different and treat opposite problems.
Most Class II cases at Freelove Orthodontics & Smile Design today are treated with functional appliances, elastics, or clear aligner mechanics rather than push-back headgear.
How much does reverse-pull headgear cost?
At Freelove Orthodontics & Smile Design, the facemask appliance and elastics are included at no additional charge as part of a Phase 1 treatment plan. The total Phase 1 fee depends on case complexity and is quoted in writing at the free consultation. Most PPO plans cover a portion of Phase 1 interceptive orthodontic treatment.
Conditions Headgear Treats
Concerned About Your Child’s Underbite?
A free consultation at Freelove Orthodontics & Smile Design in Kent and Sammamish includes a bite evaluation and a clear written plan for whether facemask therapy can correct the underbite during the Phase 1 growth window. Community discounts apply to Phase 1 plans.