Original Research

Year : 2026 | Volume : 17 | Issue : 3 | Page : 15-26

Comparative Evaluation of Pharyngeal Airway Changes following Reverse-Pull Headgear with Rapid Maxillary Expansion versus Modified SEC III Therapy in Growing Skeletal Class III Patients

Renjini KS-1, Muhamed Shaloob-2, Vincy Antony-3, Indu Nambiar-4, Sinjimol Thomas-4, Haritha Haridas-4

1-Postgraduate Resident, 2-Professor, 3-Professor and Head, 4-Assistant Professor, Department of Orthodontics, MES Dental College, Perinthalmanna, Malappuram, Kerala, Affiliated to KUHS.

Address for Correspondence:

Dr Vincy Antony,

Professor and Head, Department of Orthodontics,

MES Dental College, Perinthalmanna,

Malappuram, Kerala 679338.

Email-vincyantony2008@yahoo.com

ABSTRACT

INTRODUCTION: Skeletal Class III malocclusion is not a single entity - some children present with isolated maxillary deficiency, while others present with maxillary deficiency combined with mandibular prognathism, and the interceptive appliance chosen depends on which subtype is present. Because these two skeletal presentations tend to differ in pharyngeal dimensions even before treatment begins, a fair comparison of their airway response requires adjusting for this baseline difference rather than simply comparing post-treatment values.

OBJECTIVE: To compare pharyngeal airway change over a standardised 10–12-month course of active treatment in growing Class III children treated with either rapid maxillary expansion (RME) combined with reverse-pull headgear or a modified SEC III appliance.

METHODS: Thirty children aged 10–14 years (CVMI stage 2–3) with developing skeletal Class III malocclusion were recruited into this prospective cohort study. Fifteen with isolated maxillary deficiency and a normally positioned mandible (SNA <80°) were treated with RME and reverse-pull headgear (Group I); fifteen with maxillary deficiency and mandibular prognathism (SNB >82°) received a modified SEC III appliance (Group II). Lateral cephalograms taken before treatment (T1) and at the end of 10–12 months of active treatment (T2) were used to measure PNS–AD1, PNS–AD2, and the superior, middle and inferior pharyngeal spaces (SPS, MPS, IPS). Within-group change was tested with paired t-tests; the T2 comparison between groups used analysis of covariance (ANCOVA), with the T1 value entered as covariate.

RESULTS: Every parameter improved significantly in Group I (p<0.001), most markedly at MPS. Group II improved at PNS–AD1, PNS–AD2, SPS and IPS, but MPS fell slightly (p<0.001). After adjustment for baseline values, Group I still showed significantly greater improvement than Group II at SPS, MPS and IPS (p<0.01); the two groups no longer differed at the adenoidal/nasopharyngeal level once baseline was accounted for (p>0.05).

CONCLUSION: Both protocols widened the sagittal pharyngeal airway over 10–12 months, but RME with reverse-pull headgear produced more consistent gain through the middle and lower pharynx than the modified SEC III appliance, a difference that persisted after baseline phenotypic differences between groups were statistically controlled.
KEYWORDS: Airway changes; Analysis of covariance; Cephalometric analysis; Modified SEC III appliance; Reverse-pull headgear; Skeletal Class III malocclusion.

CONFLICT OF INTERESTS

The authors declare that they have no conflicts of interest.

SOURCE OF FUNDING

Nil

How to cite this article: Renjini KS, Muhamed Shaloob, Vincy Antony, Indu Nambiar, Sinjimol Thomas, Haritha Haridas. Comparative Evaluation of Pharyngeal Airway Changes following Reverse-Pull Headgear with Rapid Maxillary Expansion versus Modified SEC III Therapy in Growing Skeletal Class III Patients.

Int J Orthod Rehabil 2026; 17 (3): 15-26.

Doi: 10.56501/Intjorthodrehabil.172.ijor0134