Reverse-Pull Headgear in Shelby Township
At Fredal Orthodontics, Dr. Thomas Fredal Jr. treats an underbite in growing children with a reverse-pull facemask, a removable frame worn on the face. In an underbite, the lower front teeth sit in front of the upper ones.
It starts with nighttime wear in the weeks right after rapid palatal expansion (expansion of the palate, the roof of the mouth). Most cases finish the active facemask phase in approximately 3 to 6 months.
*For new patients only. Patients transferring from another orthodontist: $250 consultation fee, credited toward treatment if they start here.
What Is Reverse-Pull Headgear (a Facemask)?
Reverse-pull headgear, also called a facemask, is a removable frame worn on the face, outside the mouth.
At Fredal Orthodontics in Shelby Township, the facemask is part of a Phase 1 (early treatment) plan for growing children.
How Dr. Fredal Decides on a Facemask
Every case at Fredal Orthodontics is diagnosed in three dimensions, with an i-CAT CBCT scan (a 3D X-ray) and an iTero digital scan. Dr. Fredal evaluates the following on 3D CBCT imaging and the records review:
Skeletal Relationships
Skeletal relationships are how the upper and lower jaws line up with each other. The scans show him the roots of the teeth, the surrounding bone and the facial structures, not only the crowns.
Growth and Dental Development
He weighs growth, dental development and the goals of treatment. That tells him not only how to treat, but when treatment should begin.
The Airway
Airway screening is part of every comprehensive orthodontic consultation at Fredal Orthodontics. Because the records include an i-CAT CBCT, the upper airway is evaluated in three dimensions.
Facial Balance and the Bite
Dr. Fredal also looks at facial balance, lip support, the smile arc (the curve of the upper front teeth in a smile) and the bite. These findings can completely change decisions such as whether to expand the upper jaw or to modify growth.
Correcting a Class III Skeletal Underbite
Orthodontists call an underbite a Class III bite. It is skeletal when it involves the jaw bones, not only the teeth.
Phase 1 Treatment at Fredal Orthodontics
Dr. Fredal is an advocate of early treatment. When it is indicated, he uses growth-guided approaches, such as palatal expansion, while a child is still developing.
Most Phase 1 treatments at Fredal Orthodontics combine a palatal expander with limited braces. In some cases, an expander alone is the most appropriate treatment. Every recommendation is based on the child’s own growth pattern, bite and orthodontic needs.
The Fredal Orthodontics Phase 1 Protocol
Facemask treatment at Fredal Orthodontics runs in a set order: the consultation and records, then rapid palatal expansion, then the facemask.
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1
Consultation and 3D Records
Every new-patient consultation includes a free 3D CBCT scan, an iTero digital scan and photos. Dr. Fredal goes over all the records with you himself. You get his advice and the exact cost, in writing.
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2
Rapid Palatal Expansion First
The palatal expander comes first. Parents turn its expansion screw at home once per day.
A typical expander case has 28 to 42 days of active turning.
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3
Facemask Wear Begins
Facemask wear begins immediately after rapid palatal expansion, with the expander still in place.
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4
Month 1, Evening and Nighttime Wear
This is the most productive month of the protocol. The maxillary sutures are still responsive following expansion and will gradually begin to re-consolidate over the following weeks. For this reason, Fredal Orthodontics recommends wearing the facemask as much as possible during the evening and consistently throughout the night while sleeping.
Patients should put the facemask on when they are home for the evening and continue wearing it overnight. Consistent evening and nighttime wear during this early period takes advantage of the increased skeletal responsiveness following expansion and helps maximize the desired forward movement of the upper jaw.
The facemask does not need to be worn during school, work, meals, active sports, or normal daytime activities.
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5
Months 2–3, Evening and Nighttime Wear
During months 2 and 3, Fredal Orthodontics recommends continuing consistent evening and nighttime facemask wear to maintain progress and support the desired forward movement of the upper jaw.
Check-ups allow Dr. Fredal to monitor progress, evaluate the skeletal response, and make adjustments to the facemask or elastic force as needed.
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6
Re-Evaluation After Approximately 3 Months
Facemask treatment typically continues for approximately 3 to 6 months, depending on the amount of correction needed and the patient’s individual response. Some patients need facemask wear for up to 10 months to reach the desired correction. Consistent evening and nighttime wear is one of the most important factors in treatment success and in overall treatment time.
Progress is evaluated clinically throughout treatment, and Dr. Fredal determines when sufficient correction has been achieved and facemask wear can stop. The palatal expander is typically left in place for the whole of facemask therapy to maintain the expansion and support the orthopedic correction.
At the completion of facemask therapy, a follow-up CBCT is taken to verify and evaluate the skeletal correction achieved. Depending on the patient’s stage of dental development and treatment needs, the patient then transitions to monitoring or to Phase 1 braces to fine-tune alignment.
How the Expander and Facemask Work Together
Dr. Fredal uses the facemask together with a palatal expander, an appliance fitted to the palate. Expanders at Fredal Orthodontics are custom 3D-printed.
What to Expect Day to Day
Discomfort
Tylenol can be used as needed for discomfort. Follow the recommended dosing.
Questions Between Visits
If something seems wrong, call/text the office. The team will help decide if it needs care right away or can safely wait for the next visit.
Every patient can also text photos and questions to the team through Weave. The clinical team looks at them during business hours and replies with next steps. After hours, current patients can call/text the main line. The team usually replies within 24 hours.
Sports and School
Facemask wear is focused on evening and nighttime hours, so the appliance comes off for school, sports, and other physical activities. This schedule is designed to fit treatment into a child’s normal school and activity routine while still reaching the prescribed daily wear time.
Consistent evening and overnight wear is essential. Compliance is one of the most important factors in achieving the desired correction and completing treatment efficiently.
Why Fredal Orthodontics Does Not Recommend Headgear for Adults
Fredal Orthodontics does not recommend headgear for adults because the skeletal growth and suture responsiveness that make these appliances effective in younger patients are no longer present to the same degree.
Reverse-pull headgear, or facemask therapy, is generally most effective when started before approximately 8.5 years of age. Its skeletal effect becomes increasingly limited as a patient matures. In teenagers the orthopedic benefit is very limited, and in adults facemask therapy is not considered effective for meaningful skeletal correction.
For adults with a Class III pattern, Dr. Fredal instead evaluates treatment options based on the individual patient’s skeletal and dental needs. Mild to moderate cases may be treated with braces or Invisalign and Class III elastics.
Patients with a narrow upper jaw may be candidates for MARPE, while more significant skeletal discrepancies may require coordinated orthodontic and orthognathic surgical treatment.
Traditional cervical or pull-back headgear for Class II correction is also not recommended for adults at Fredal Orthodontics.
Modern orthodontic approaches, including Herbst, MARA, Forsus, Carriere appliances and Class II elastics, provide more appropriate and predictable alternatives without relying on an external appliance and the compliance it demands. The appropriate option depends on the patient’s age, bite, skeletal relationship and individual treatment needs.
Dr. Fredal evaluates each adult patient individually and recommends treatment based on the underlying skeletal relationship, bite and treatment goals.
How Much Does Reverse-Pull Headgear Cost in Shelby Township?
Phase 1 Facemask Therapy Fee
Phase 1 facemask therapy: $4,180 total.
This is the full Phase 1 fee with facemask therapy, not an added charge on top of a Phase 1 fee. The prescribed facemask therapy is included as part of the Phase 1 treatment plan.
The fee does not change with how long treatment takes, and treatment fees at Fredal Orthodontics include every appliance a case needs. Phase 1 and Phase 2 are not sold together. If your child goes on to Phase 2, $500 comes off the Phase 2 fee.
- Insurance: Fredal Orthodontics is in-network with Delta Dental and accepts most major PPO plans. It files claims on your behalf, and you get your benefits verification in writing.
- In-house financing: 0% interest and no credit check, with $500 down for Phase 1.
- Monthly payments: starting as low as $179, with plans of up to 30 months. Amounts vary with the treatment cost, the down payment and the financing terms.
- Cherry: down payments as low as $189.99. CareCredit financing is also offered.
- HSA and FSA: accepted.
- Pay in full: 5% off by cash, check or ACH (a bank transfer), or 3% by credit card, on the part you pay after insurance. Phase 1 qualifies, and it can be combined with an eligible community discount.
To get your child’s exact cost in writing, book a free consultation. It is free for new patients. Patients transferring from another orthodontist pay a $250 consultation fee, credited toward treatment if they start here. A return consultation before you start is free too, unless you missed one as a no-show; then it is $100.
A $250 community discount is offered to military service members and veterans, teachers and school staff, first responders, healthcare workers, students, and additional family members in treatment. One applies per patient, and it comes off what you pay after insurance. It is not limited to comprehensive treatment.
Frequently Asked Questions About Reverse-Pull Headgear
What is reverse-pull headgear?
Reverse-pull headgear, also called a facemask, is a removable frame worn on the face, outside the mouth. At Fredal Orthodontics, Dr. Fredal treats growing children with it as part of Phase 1 (early treatment). He uses it together with a palatal expander, and facemask wear begins immediately after rapid palatal expansion.
How long does a child need to wear a facemask?
At Fredal Orthodontics, the active facemask phase is approximately 3 to 6 months, with consistent evening and nighttime wear beginning immediately after rapid palatal expansion and continuing through months 2 and 3.
Dr. Fredal re-evaluates after approximately 3 months, and progress is evaluated clinically throughout treatment. Some patients need facemask wear for up to 10 months, and he decides when wear can stop.
What happens after facemask treatment?
A follow-up CBCT scan is taken at the end of facemask therapy, to verify the skeletal correction achieved. The palatal expander typically stays in place for the whole of facemask therapy. The child then moves on to monitoring or to Phase 1 braces, depending on dental development and treatment needs.
When should my child be checked for an underbite?
Dr. Fredal follows the American Association of Orthodontists’ recommendation that every child have an orthodontic evaluation by age 7. Seven is also the youngest age he treats. Each evaluation includes a 3D i-CAT CBCT scan, so he can assess jaw growth, erupting teeth and the airway.
Is headgear an option for adults?
No. Fredal Orthodontics does not recommend headgear for adults. For adults with a Class III pattern, Dr. Fredal evaluates treatment options based on each patient’s skeletal and dental needs.
He recommends treatment based on the underlying skeletal relationship, bite and treatment goals. He coordinates with an oral surgeon when orthognathic (jaw) surgery is part of the plan.
How much does reverse-pull headgear cost?
Phase 1 facemask therapy at Fredal Orthodontics is $4,180 in total. That is the full Phase 1 fee with the facemask included, not an added charge. Most PPO plans are accepted, and the practice is in-network with Delta Dental. In-house financing has 0% interest and no credit check, with $500 down for Phase 1.
Concerned About Your Child’s Underbite?
At Fredal Orthodontics in Shelby Township, the consultation is free for new patients. It includes a free 3D CBCT scan. Dr. Fredal goes over the records with you. Then he gives you his advice and the exact cost, in writing. Community discounts take $250 off what you pay after insurance.
*For new patients only. Patients transferring from another orthodontist: $250 consultation fee, credited toward treatment if they start here.