{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:09:53Z","timestamp":1760058593377,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T00:00:00Z","timestamp":1744588800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Protraction facemasks are commonly used to treat Class III malocclusion in growing patients. Personalized facemasks designed using 3D modeling software and based on individual 3D face images are now available. This study aimed to assess the mechanical properties of three novel designs of Petit-type facemask appliances through three-dimensional Finite Element Analysis (FEA). Methods: Three novel designs of the facemask were modeled by Solidworks 3D CAD (2023): anatomic, V-shape, and arc-shape. FEA was performed by Ansys 2021 (R2) software. The elements\u2019 sizes, shapes, and numbers were identified, and the material property was set on Acrylonitrile butadiene styrene copolymer (ABS) plastic. The support and loading conditions of two different intensities of load, 7.8 and 9.8 N, respectively, were applied in three angulations to the occlusal plane: 0\u00b0, 30\u00b0, and 50\u00b0. Stress, strain, and total deformation results were obtained. Results: The minimum stress was reported with the anatomic design at a 30\u00b0 angulation, whereas the maximum value was reported in the arc-shape design at 50\u00b0; however, there was no significant difference among the three designs. The von Mises yield criterion showed that the overall stresses were distributed on the larger areas of the facemask structure at 30\u00b0 angulation for all designs. The stresses induced in all facemask appliance designs did not cause permanent deformation. Conclusions: Anatomic design has better mechanical behavour than the V-shape or arc shape design. Downward inclination of 30\u00b0 to the occlusal plane induces less stress. These findings support the use of customized anatomic facemasks for the effective and efficient treatment of Class III malocclusions in growing patients, potentially improving clinical outcomes and patient comfort. Further research, particularly clinical trials, is needed to validate the results of the present study.<\/jats:p>","DOI":"10.3390\/jcm14082676","type":"journal-article","created":{"date-parts":[[2025,4,14]],"date-time":"2025-04-14T09:06:51Z","timestamp":1744621611000},"page":"2676","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of Load and Stress Distribution for a Novel Design of Maxillary Protraction Facemask by Finite Element Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9617-8756","authenticated-orcid":false,"given":"Ghassan Bahir","family":"Abdulkareem","sequence":"first","affiliation":[{"name":"Department of Orthodontics, College of Dentistry, Al-Bayan University, Baghdad 10070, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2857-0315","authenticated-orcid":false,"given":"Martyn T.","family":"Cobourne","sequence":"additional","affiliation":[{"name":"Centre for Craniofacial Development and Regeneration, Faculty of Dentistry, Oral and Craniofacial Sciences, King\u2019s College London, Guy\u2019s Hospital, Floor 27, London SE1 9RT, UK"},{"name":"Department of Orthodontics, Faculty of Dentistry, Oral and Craniofacial Sciences, King\u2019s College London, Floor 21, Guy\u2019s Hospital, Guy\u2019s and St Thomas NHS Foundation Trust, London SE1 9RT, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8171-7465","authenticated-orcid":false,"given":"Mushriq","family":"Abid","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, College of Dentistry, University of Baghdad, Baghdad 10070, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,14]]},"reference":[{"key":"ref_1","first-page":"399","article-title":"Skeletal Malocclusion: A Developmental Disorder with a Life-Long Morbidity","volume":"6","author":"Nishitha","year":"2014","journal-title":"J. Clin. Med. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1177\/14653125211042891","article-title":"The consequences of living with a severe malocclusion: A review of the literature","volume":"49","author":"Leck","year":"2022","journal-title":"J. Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/ocr.12143","article-title":"Zygomaticomaxillary suture maturation: A predictor of maxillary protraction? Part I\u2014A classification method","volume":"20","author":"Angelieri","year":"2017","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1080\/14653125.2016.1201302","article-title":"Early class III protraction facemask treatment reduces the need for orthognathic surgery: A multi-center, two-arm parallel randomized, controlled trial","volume":"43","author":"Mandall","year":"2016","journal-title":"J. Orthod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"8","DOI":"10.4103\/jos.JOS_47_20","article-title":"Mothers\u2019 knowledge and experience concerning presurgical orthopedic management for infants with cleft lip and palate","volume":"10","author":"Abid","year":"2021","journal-title":"J. Orthod. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.ajodo.2016.07.017","article-title":"Early orthodontic treatment for Class III malocclusion: A systematic review and meta-analysis","volume":"151","author":"Woon","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Watkinson, S., Harrison, J.E., Furness, S., and Worthington, H.V. (2013). Orthodontic treatment for prominent lower front teeth (Class III malocclusion) in children. Cochrane Database Syst., 9.","DOI":"10.1002\/14651858.CD003451.pub2"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/ocr.12040","article-title":"Efficacy of orthopedic treatment with protraction facemask on skeletal Class III malocclusion: A systematic review and meta-analysis","volume":"17","author":"Cordasco","year":"2014","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Abid, F.M., Al-Attar, M.A., and Akram, A.F. (2020). Retention Protocols and Factors Affecting Retainer Choice among Iraqi Orthodontists. Int. J. Dent., 2020.","DOI":"10.1155\/2020\/8810641"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"561","DOI":"10.2319\/030207-108.1","article-title":"Orthopedic treatment outcomes in Class III malocclusion. A systematic review","volume":"78","author":"Toffol","year":"2008","journal-title":"Angle Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.ajodo.2010.09.031","article-title":"Stability of rapid maxillary expansion and facemask therapy: A long-term controlled study","volume":"140","author":"Masucci","year":"2011","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.2319\/101807-498.1","article-title":"Stability factors after double-jaw surgery in Class III malocclusion","volume":"78","author":"Mucedero","year":"2008","journal-title":"A systematic review. Angle Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"927","DOI":"10.2319\/052414-366.1","article-title":"Short-term effects produced by rapid maxillary expansion and facemask therapy in Class III patients with different vertical skeletal relationships","volume":"85","author":"Pavoni","year":"2015","journal-title":"Angle Orthod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40510-018-0217-1","article-title":"Facemask performance during maxillary protraction: A finite element analysis (FEA) evaluation of load and stress distribution on Delaire facemask","volume":"19","author":"Gazzani","year":"2018","journal-title":"Prog. Orthod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"12","DOI":"10.26477\/jbcd.v34i1.3087","article-title":"Compliance of patients with Class III malocclusion to orthodontic treatment","volume":"34","author":"Abdulhussein","year":"2022","journal-title":"J. Bagh. Coll. Dent."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1093\/ejo\/23.3.263","article-title":"Location of the center of resistance of the upper dentition and the nasomaxillary complex","volume":"23","author":"Billiet","year":"2001","journal-title":"An experimental study. Eur. J. Orthod."},{"key":"ref_17","first-page":"ZH01","article-title":"Clinical Tip for Adjusting Reverse Pull Facemask\/Headgear Assembly","volume":"10","author":"Jain","year":"2016","journal-title":"J. Clin. Diagn. Res."},{"key":"ref_18","first-page":"387","article-title":"Effect of varying the force direction on maxillary orthopedic protraction","volume":"72","author":"Keles","year":"2002","journal-title":"Angle Orthod."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1093\/ejo\/cjt091","article-title":"Optimal force for maxillary protraction facemask therapy in the early treatment of class III malocclusion","volume":"36","author":"Yepes","year":"2014","journal-title":"Eur. J. Orthod."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Zhao, Y.J., Xiong, Y.X., and Wang, Y. (2017). Three-Dimensional Accuracy of Facial Scan for Facial Deformities in Clinics: A New Evaluation Method for Facial Scanner Accuracy. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0169402"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"104533","DOI":"10.1016\/j.jdent.2023.104533","article-title":"Accuracy (trueness and precision) of four tablet-based applications for three-dimensional facial scanning: An in-vitro study","volume":"135","author":"Kuhlman","year":"2023","journal-title":"J. Dent."},{"key":"ref_22","first-page":"79","article-title":"Validity of Digital and Rapid Prototyped Orthodontic Study Models","volume":"29","author":"AlSamarrai","year":"2017","journal-title":"J. Bagh. Coll. Dent."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Tsolakis, I.A., Gizani, S., Tsolakis, A.I., and Panayi, N. (2022). Three-Dimensional-Printed Customized Orthodontic and Pedodontic Appliances: A Critical Review of a New Era for Treatment. Children, 9.","DOI":"10.3390\/children9081107"},{"key":"ref_24","unstructured":"Kayvon, M., and Sina, E. (2014). Plastics Used in Medical Devices. Handbook of Polymer Applications in Medicine and Medical Devices, Elsevier."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Xiao, L., Shimamura, N., Kamio, T., Ide, R., Mochizuki, M., and Nakahara, T. (2025). Polycarbonate-Acrylonitrile Butadiene Styrene Three-Dimensional Printing Material Exhibits Biocompatibility and Enhances Osteogenesis and Gingival Tissue Formation with Human Cells. Cells, 14.","DOI":"10.3390\/cells14030167"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Tse, I., Jay, A., Na, I., Murphy, S., Ni\u00f1o-Mart\u00ednez, N., Mart\u00ednez-Casta\u00f1on, G.A., Magrill, J., and Bach, H. (2021). Antimicrobial Activity of 3D-Printed Acrylonitrile Butadiene Styrene (ABS) Polymer-Coated with Silver Nanoparticles. Materials, 14.","DOI":"10.3390\/ma14247681"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Zi\u0105bka, M., Dziadek, M., and Menaszek, E. (2018). Biocompatibility of Poly(acrylonitrile-butadiene-styrene) Nanocomposites Modified with Silver Nanoparticles. Polymers, 10.","DOI":"10.3390\/polym10111257"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Odian, G. (2004). Principles of Polymerization, Wiley. [4th ed.].","DOI":"10.1002\/047147875X"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1108\/13552540110395547","article-title":"Mechanical behavior of acrylonitrile butadiene styrene (ABS) fused deposition materials. Experimental investigation","volume":"7","author":"Rodriguez","year":"2001","journal-title":"Rapid Prototyp. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1093\/ejo\/cju033","article-title":"Effects of palate depth, modified arm shape, and anchor screw on rapid maxillary expansion: A finite element analysis","volume":"37","author":"Matsuyama","year":"2015","journal-title":"Eur. J. Orthod."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Zhang, D., Zheng, L., Wang, Q., Lu, L., and Ma, J. (2015). Displacements prediction from 3D finite element model of maxillary protraction with and without rapid maxillary expansion in a patient with unilateral cleft palate and alveolus. Biomed. Eng. Online, 19.","DOI":"10.1186\/s12938-015-0074-9"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.ajodo.2008.02.021","article-title":"Maxillary protraction with and without maxillary expansion: A finite element analysis of sutural stresses","volume":"136","author":"Gautam","year":"2009","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s11517-019-02104-9","article-title":"Finite element analysis of bone and implant stresses for customized 3D-printed orthopaedic implants in fracture fixation","volume":"58","author":"Yan","year":"2020","journal-title":"Med. Biol. Eng. Comput."},{"key":"ref_34","unstructured":"(2022). ASTM International. Standard Test Method for Tensile Properties of Plastics (Standard No. ASTM D638-22). Available online: https:\/\/www.astm.org\/d0638-22.html."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Letcher, T., Rankouhi, B., and Javadpour, S. (2015, January 13\u201319). Experimental Study of Mechanical Properties of Additively Manufactured ABS Plastic as a Function of Layer Parameters. Proceedings of the ASME 2015 International Mechanical Engineering Congress and Exposition, Houston, TX, USA.","DOI":"10.1115\/IMECE2015-52634"},{"key":"ref_36","first-page":"352","article-title":"A chairside customized chin cup","volume":"47","author":"Cacciatore","year":"2013","journal-title":"J. Clin. Orthod."},{"key":"ref_37","first-page":"45","article-title":"Skin irritation from a facial mask in Class III malocclusion: Evaluation of individual silicone chin cups in a group of 100 children","volume":"67","author":"Ierardo","year":"2018","journal-title":"Minerva Stomatol."},{"key":"ref_38","first-page":"314","article-title":"Orthopedic correction of Class III malocclusion with palatal expansion and custom protraction headgear","volume":"22","author":"Turley","year":"1988","journal-title":"J. Clin. Orthod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"846","DOI":"10.2319\/090811-584.1","article-title":"The short-term treatment effects of face mask therapy in Class III patients based on the anchorage device: Miniplates vs rapid maxillary expansion","volume":"82","author":"Lee","year":"2012","journal-title":"Angle Orthod."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ajodo.2016.06.026","article-title":"Displacement and stress distribution by different bone-borne palatal expanders with facemask: A 3-dimensional finite element analysis","volume":"151","author":"Park","year":"2017","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1016\/j.ajodo.2005.04.030","article-title":"The effects of maxillary protraction therapy with or without rapid palatal expansion: A prospective, randomized clinical trial","volume":"128","author":"Vaughn","year":"2005","journal-title":"Am. J. Orthod. Dentofac. Orthop."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2676\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:14:21Z","timestamp":1760030061000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/8\/2676"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,14]]},"references-count":41,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["jcm14082676"],"URL":"https:\/\/doi.org\/10.3390\/jcm14082676","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,4,14]]}}}