American Journal of ORTHODONTICS

Volume 71, Number 6, June, 1977

ORIGINAL ARTICLES

Continuous versus intermittent extraoral

traction: An experimental study
Michel Brousseau, D.D.S., MAD., and Raymond G. W. Kubisch, D.D.S.,
M.S.D.
Dollar&des-Ormeuux, Quebec, Cwlada, and Bellevue, Wash.

E xtraoral traction to the maxilla has proved to be clinically effective in

the correction of anteroposterior discrepancies in occlusion. Recently, the effect
of such traction on the bones of the craniofacial complex has also been recog-
nized.5y i, 9, I*, 13,l6 In all previous experimental studies, with one exception,16 ex-
traoral traction to the maxillas of monkeys has been achieved with continuously
applied force (24 hours per day). However, the intermittent application of ex-
t,raoral traction is a common clinical procedure, and investigation is indicated to
compare different force-application schedules. This article will describe the treat-
ment effects and the posttreatment stability of extraoral high-pull traction ap-
plied to the maxilla of Macaca nemestrina on an intermittent versus a continuous
schedule. Duration of force application is the independent variable of study.

Materials and methods

The experimental protocol used in this study is described in articles by Elder

and Tuenge.5s I3 Modifications were made and are noted in this description.
Subjects (Table I). The subjects were eight male Macaca nemestrina monkeys
provided by the Regional Primate Research Center at the University of Washing-
ton. All subjects had complete deciduous dentitions with the maxillary first per-

From the Department of Orthodontics and Regional Primate Research Center, Uni-
versity of Washington, Seattle, Wash.
This research was supported by Grants DE 02931 and DE 02918 from the United
States Public Health Service, by a grant from the University of Washington Ortho-
dontic Memorial Fund, and by NIH Grant RR00166.
This article is hased on research submitted by the authors in partial fulfillment of
the requirements for the Master of Science in Dentistry degree, Department of
Orthodontics, University of Washington.

607
 Am. J. Orthod.
608 Brausseau und Kubisch June 1971

Table I. General data concerning the experimental animals

I Continuous* I Intermittent
Animal No. M74039 M74040 M74080 M74050 M74064 M74206 T74074
Code c-39 c-40 C-80 I-50 1-64 I-06 I-74
Age at beginning of
active treatment (mo.) 15 I5 I5 I5 14 II 16
Duration of active
treatment (days) 87 84 75t 8X 84 96 673
Weight at beginning of
active treatment (kg.) 2.10 2.30 1.86 1.95 2.30 2. IO 2.70
Weight at end of active
treatment (kg.) 2.4 2.2 1.6 2.2 2.6 2.2 2.6
Weight at end of relapse
period, 6 months (kg.) 2.8 2.5 2.0 2.8 3.4 2.4 3.7
“M 74240, the fourth animal of the continuow group, died 6 days into the experimental period.
t Treatment stopped because of excessive distal movement of maxilla.
:Treatment stopped because of loss of headgear plug and bow resorption.

ma,ncnt molars unerupted. Two groups of four each were randomly assigned : one
group to receive intermittent estraoral traction (12 hours per day) and the other
to receive continuous traction (24 hours per day).

IMPLANTS. Tantalum implants were placed with a modified Bjiirk implant

gun. Implant,ation was done in a sterile surgical field, exposing the individual
sutures for visual identification. This technique assured proper placement of the
implants on each side of the sutures. Twent>--two implants were used in each
animal. Implant sites were the facial sutures, the maxilla, the prcmaxilla, the
mandible, and the cranial base, as described by Elder and Tuenges and Van
Ncss.~.~
IMPLANTED CEI'HALOMETRIC III&U) POSITIONER (FIG. I). To minimize error i?1
positioning of animals in the cephalostat, a custom-fnbricatetl Vitallium implant
was attached to the front,al bone of each animal, anterior to the coronal suture, in
a sterile surgical procedure in whicdh general ancsthcsia wils cniplo;vcd. A custom
coupling device was fabricated for each animal by means of a stereotaxic instru-
melit, with the head orientctl so that Frankfort plane was perpendicular to the
coupler. In this way, the animal was consistently repositioned in the cephalostat
and the central ray entered the three planes of the head at a right angle. The
details of this procedure are described by Van Ness and associates.l”
SPLINT AND HEADGEAR AI’I’I,IANCES (FIG. 1 ) Rubber-base impressions of each
maxillary arch were taken and a cast-Vitallium splint. was constructed to cover
the hard palate, the alveolus, and the labial a,nd lingual surfaces of the teeth. The
splints were fixed by intcrproximal ligatures. An 0.045 inch (1.143 mm.) round
buccal tube was soldered lateral to the terminal molar (maxillary deciduous
second molar) to receive an 0.045 inch (1.143 mm.) inner bow of a commercially
available Kloehn-style face-bow. The outer bow terminated eren with the tube
and was bent 10 degrees a,bo\To the occlusal plant. Extracranial anchorage was
obtained by direct. bony attac*hmcnt. An ovoid arca of scalp orcr the lamhdoidal
Volume
Number
71
6
Contiv~u0u.s z’ersus intermittent e‘xtraoral traction 609

MODIFIED
CEPHALOSTAT

Fig. 1. Extraoral traction and head-positioning devices.

suture was surgically exposed, a stainless steel screw was placed in each parietal
bone, and two screws were placed in the occipital bone. Cold-cure acrylic was
molded over the screw heads and an 0.059 inch (1.49 mm.) round wire was em-
bedded in the acrylic. This wire was adapted to the hea,d so that it coursed supe-
rior to the ear. The outer bow was connected to the anchorage wire with a SAW
spring (Northwest Orthodontics, Inc., Seattle, Wash.) at 30 degrees to the oe-
clusal plane to deliver a force of 400 Gm. per side. Nylon bands with perfora-
tions connected the springs to the anchorage wire, allowing selective variation of
force between 0 and 400 Gm. for the intermittent group.
Protocol and records. A complete series of cephalometric radiographs consist-
ing of (1) a lateral view of the head positioner, (2) a lateral view of the ear
rods, (3) a posteroanterior (frontal) view of the head positioner, and (4) an in-
ferosuperior (basilar) view of the head positioner, was taken on the following
schedule : (1) prior to active treatment, (2) at 3-week intervals during active
treatment, (3) at cessation of active treatment (one series with the splint and
one series after splint removal), (4) 5 weeks posttreatment, and (5) at irregular
intervals until 6 months posttreatment.
Dental casts were obtained at the start of active treament, at the end of active
treatment, and 6 months posttreatment to supplement the serial cephalometric
records. In animals of the intermittent group the traction force was activated
normally on a daily basis at 11 P.M. and deactivated at 11 A.M. Animals of the
continuous group had 24 hours of active traction per day and needed no addi-
tional attention other than the usual care. During the active treatment phase, the
animals were kept in restraining chairs which allowed maximal freedom without
contact of their heads and hands. The splint and headgear appliances were re-
moved at the end of active treatment and the animals were maintained in cages
610 Brousseau and Kubisch Am. J. Orthod.
June 1977

1.5-23 MONTHS
Fig. 2. Lateral head film tracing and 8-month composite of a normal untreated Macaca
nemestrina.

from this point on. No attempt was made to retain the created malocclusion dur-
ing the posttreatment observation period.
Method of amnaZysis.After confirmation of implant stability, sutural changes
were measured radiographically from implants on either side of the sutures.
Skeletal change was measured from the postsphenoidal cranial base implants to
the maxillary implants. Rotational effects wcrc evaluated from the change in oc-
clusal plane on cranial base superimpositions. Dental change was measured from
the maxillary implants to the splint for the active treatment evaluation and from
the maxillary implants to the canine for the posttreatment evaluation. The under-
jet (negative overjet) was measured on lateral head films from the labial surface
of the mandibular central incisor to the labial surface of the maxillary central
incisor and to the mesial surface of the maxillary canine, respectively.
All superimpositions were done from films taken with the implanted head
positioner. Over-all lateral superimpositions were registered on the implants in
the postsphenoidal portion of the cranial base, the general contour of sella turcica,
and anterior and posterior cranial outlines. For superimpositions of the maxilla
and mandible, the best fits of stable implants and bony outlines were used.
Fig. 2 provides a comparison with a normal untreated McwK~~, nemestri?za.
Further data on normal growing macaque monkeys can be found in previous
studies.F, 8, lo
Time intervals are designated by code as follows :
T, = Beginning of active treatment.
T, = End of active treatment.
T, = 5 weeks posttreatment.
T,? = 6 months posttreatment.
Volume 71 Continuous cersus intermittent extraoral traction 611
Number 6

Table II. Changes that occurred during the active treatment phase

Active Treatment
(initial-final) c-39 c-40 C-80 1-64 I-06 1-74 I-50
Zygomaticotemporal
suture (mm.) -2.8 -2.3 -2.0 -0.7 -1.0 -1.3 -0.8
Zygomaticomaxillary
suture (mm.) -1.8 -2.1 -2.2 -0.8 -1.0 -0.7 -0.6
Zygomaticofrontal
suture (mm.) f0.4 -0.4 -0.4 0.0 +0.2 0.0 -0.3
Cranial base-maxillary
implants (mm.) -4.6 -5.5 -4.4 -1.7 -2.2 -2.4 -1.7
Splint-maxillary
implants (dental) (mm.) -2.0 -1.5 -1.5 -1.5 -2.0 -1.5 *
Splint-cranial base
implants (over-ail) (mm.) -1.9 -6.8 -6.5 -4.0 -4.8 -3.8 *
Occlusal plane clockwise
rotation splint (degrees) 14.0 6.5 11.0 12.0 7.0 4.5 *
Mandibular plane Counterclockwise Counterclockwise
rotation (degrees) 4.0 -3.0 0.5 1.5 -3.5 -1.0 *
Net underjet l/l after
splint removal (mm.) 9.0 11.0 9.0 6.0 5.0 4.5 7.0
Net underjet 3/l after
splint removal (mm.) 20.0 19.0 19.0 16.5 15.0 16.0 15.0
*Splint unreliable.

Results

One animal of the continuous group died of unknown causes 6 days into the
active treatment phase. All other animals experienced general good health, with
no apparent discomfort and with weight gain throughout the experimental period
(Table I).
Active treatment (TO-T,) (Table II).
DENTITION. At the end of active treatment (T,) , all three monkeys in the con-
tinuous group showed the maxillary canine occluding with the mesial cusp of the
mandibular second deciduous molar (Figs. 3 and 5). The four monkeys in the in-
termittent group showed the maxillary canine oeeludipg with the mandibular
first deciduous molar (Figs. 4 and 6). The continuous group exhibited an average
of 4 mm. more underjet than the intermittent group. The average incisor under-
jet of animals subjected to an intermittent force was 5.6 mm. (Table II). The
amount of intramaxillary dental change ranged from 1.5 to 2.0 mm. for all
seven animals, with no distinction in the amount of dental tipping between the
two groups.
FACIAL SKELETON. All subjects showed a clockwise rotation of the midfacial
complex and especially of the maxilla and premaxilla. The amount of maxillary
rotation varied from 4.5 to 14 degrees. A marked clockwise tipping of the pre-
maxilla with an opening at the superior aspect of the pr~maxillomaxillary suture
was observed in three monkeys of the intermittent group. The amount of linearly
measured skeletal change was significantly greater for animals with continuous
 Am. J. Orthod.
612 Brousseau avzd Kubisch June 1977

FIf$AC ACTIVE TREATMENT

\-,., ._.._._- --
PCJsjTTREATMENT CHANGES

6 MONT‘NS POSTTREATMENT

Fig. 3. Models and lateral head film tracings of animal C-39, representative of the con-
tinuous group during active treatment and posttreatment.

force, with an average reduction in the distance between the implants of the cranial
base and maxillary bone of 4.8 mm. for the continuous group and 2.0 mm. for the
intermittent group; that is, there was 2.4 times more skeletal change in the con-
tinuous group (Fig. 7).
Over-all superimposition revealed rotation of the mandibular plane in a range
 Continuous versus intermittent extraoral traction 613

FlNkL ACTiVE TREATMENT

POSTTREATMENT CtfAh’SES

6 MONTHS POSTTR EATMENT

Fig. 4. Models and lateral head film tracings of animal I-06, representative of the inter-
mittent group during active treatment and posttreatment.

of 3.5 degrees counterclockwise to 4 degrees clockwise, and no relationship was

seen between subjects receiving intermittent force and those receiving continuous
force. A counterclockwise rotation of the mandible was observed when maxillary
rotation was less than 10 degrees, and a clockwise rotation when maxillary rota-
tion was more than 10 degrees.
 Am. J. Orthod.
614 Rrousseau a?ld Kubisch JU?Lt? 1977

Fig. 5. Occlusion tracings of animals of the continuous group at the end of active treot-
ment (T,) (left) and 6 months posttreatment (T,) (right).

DESTITIOS. The underjet at, the incisors was reduced by au average of 5.7 mm.
for the continuous grciup and by 3.3 mm. for the intermittent group during this
S-week posttreatment period. Likewise, the underjet at the canine showed an arer-
age reduction of 3.0 mm. for the continuous group and 1.5 mm. for t,he intermit-
tent group. The amount of intramasillary dental change measured from the
canine was within it range of 0 to 1.5 mm. Car all animals, ant1 no tlistinrtion was
noted between the intermittent and continuous groups.
FXIAI, SKELETOS. Ihring the T,-T, period, a rcvclrsal in the direction 01
changes was noted. Th(~ mitlfac:iaI ~~mr~~lcs rotatctl in a c.omlterclockmisc~
dircetion, and the cranial vilult ant1 calvnria rotated iI1 iI clockwise tlirection
with a clcpression at lamb&~. There was ;I ~bountl of thr premaxilla toward its
initial position as displayed by a cuunterclockwisc rotation of’ the premasilla and
nasomasillary bones, intlepc~ndent from the maxilla. The amount and rate of
skeletal trha,nge were greater clurillg the: T-T, period for the animals that were
 C’o?ltiwous z!ersus i?lterneittent extraoral trnctio?l 615

\ I \

Fig. 6. Occlusion tracings of animals of the intermittent group at the end of active treat.
ment (T,) (left) and 6 months posttreatment (T,) (right).
 Ant. J. Orthod.
616 Brousseax md Kubisch June 1977

mm.
(CRANIAL BASE - MAXILLA)

Fig. 7. Maxillary skeletal change is represented by the resorption and apposition that oc-
curred at the facial sutures, measured from the cranial base implants to the maxillary
implants. During active treatment (TO-T,) the animals subjected to a continuous force show
more than twice the amount of skeletal retraction when compared with animals sub-
jected to an intermittent force. The immediate posttreatment response (T,-T,) shows slightly
more skeletal change for the animals of the continuous group. However, over a 6-month
posttreatment period (T,-Ts), apposition of the facial sutures and forward movement of the
maxilla per se were comparable for both groups.

subjected to a continuous force (Fig. 7). The skeletal change for the continuous
group represented an average increase in interimplant distance of 2.6 mm.
(range, 2.5 to 2.7 mm.) and, for the intermittent group, an average increase of
1.95 mm. (range, I.8 to 2.1 mm.).
Xix modhs posttreatment (TI-TQ) Table III.
DENTITION. At the end of the 6-month posttreatment period (T,), each of the
three animals in the continuous group had a full Class III malocclusion as illus-
trated in E’igs. 3 and 5, with the maxillary canine and permanent molars used
as points of reference. Three monkeys in the intermittent group also presented
Class III malocclusion, but to a lesser degree (Figs. 4 and 6). One animal, I-50,
of this group had an occlusion that was closer to a Class I. The anteroposterior re-
lationship of the maxillary posterior teeth and mandibular teeth achieved at the
end of active treatment (T,) was closely maintained 6 months posttreatment (T,)
in three monkeys of the intermittent group (Fig. 6). In animals submitted to a
continuous force, the occlusion achieved at the end of active treatment (T,)
was not maintained as well after treatment (T,-T,) . These animals showed change
in the interocclusal relationship at a decreasing rate for 15 weeks posttreatment,
and from that, point on the occlusal relationship was stable.
FACIAL SKELETON. Throughout the posttreatment period (T1-TR), a gradual
decrease in the rate of change in distance between the maxillary implants and
 Continuous versus intermittent extraoral traction 617

Table III. Changes that occurred during the 6-month posttreatment phase

Posttreatment
changes (6 months) c-39 c-40 C-80 1-64 I-06 1-74 I-50
Maxillary implant-
Maxillary central (mm.) 5.5 4.8 4.1 3.9 6.2 4.3 6.5
Cranial base-
Maxillary central (mm.) 12.7 II.7 I I.3 II.4 12.7 II.7 12.0
Maxillary implant-
Maxillary canine (mm.) 2.5 I.4 1.2 I.0 1.3 2.0 3.5
Cranial base-
Maxillary canine (mm.) 9.6 8.3 8.0 8.4 1.5 9.5 9.0
Cranial base-Maxillary
implants (mm.) 1.2 6.9 1.2 7.4 6.5 1.5 5.5
Occlusal plane counterclock-
wise rotation (degrees) 16.0 10.0 10.0 II.0 8.0 4.0 22.0
Mandibular plane counter-
clockwise rotation (degrees) 3.0 2.0 2.5 0.0 2.5 0.0 2.0
Reduction of underjet
Maxillary central-Man-
dibular central (mm.) 7.0 9.5 7.0 4.0 4.0 4.0 8.0
Reduction of underjet
Maxillary canine-Man-
dibular central (mm.) 4.0 6.0 4.0 I.0 0.0 2.0 5.0

the upper incisors was noted. The average increase in distance (TX-T3) from
the maxillary implant to the maxillary central incisors was 5.1 mm., as contrasted
to a similar measurement of 1.8 mm. from the maxillary implant to the maxillary
canine. The absolute amount of skeletal change seen in the maxilla was not
distinguishable between intermittent and continuous groups over a period of 6
months (T,-T,) , All animals exhibited counterclockwise rotation of the maxilla
reflected in occlusal plane change over a range of 4 to 22 degrees and the rota-
tion obtained during treatment relapsed during the posttreatment observation
period (Tables II and III). The mandibular plane rotated counterclockwise in a
range of 0 to 3 degrees.

Discussion

At the end of active treatment (T,), the Class III malocclusion created in
the animals subjected to a continuous application of force (24 hours per day)
was significantly greater than the one created in animals subjected to an intermit-
tent force application (12 hours per day). Since there was no distinction between
groups with regard to intramaxillary dental change, the intergroup difference is
attributed to skeletal response; animals in the continuous group experienced 2.4
times more sutural resorption than the ones in the intermittent group.
Posttreatment (T1-T3), all seven animals responded in a similar pattern :
(1) dental tipping and skeletal rotation that occurred during active treatment
had reverted, (2) linear measurements between cranial base implants and maxil-
lary implants show that the maxilla had moved forward a comparable linear
amount for all animals.
Therefore, the net difference at the end of 6 months posttreatment can be
 explained only by growth inhibition and sutural resorption that occurred during
the active treatment phase. The more nonrotational retraction of the maxilla that
was achier-ed during treatment, the more net retract,ion was maintained post-
treatment.
It is possible to create diff’ercnt occlusal relationships within a given animal l)y
rotating the maxilla while interimplant distances measured linearly to a reference
point, such as the cranial base, remain the same. A vlockwisc rotation of the
maxilla has been reported previously when extraoral traction ~-as applied to tht
maxrilla.5, 7. 3, 12 The skeletal rotation that was protl~m~l in the midfacial com-
plex during active treatment rcverscd when traction was discontinued as mea-
sured b,v occlusal planr changes. This observation intlicatcs a lack of stability
in mechanically produced skclctal rotation. Evaluation of’ the occlusal relation-
ships (Figs. 3 to 6) shows that the continuous group had more maxillary dental
retraction and more occlusa I rclapsc than did the intermittent group. Il;ren
though the two groups cannot be statistically distinguished on the basis of range
of change in the occlusal plant, subjecti\c comparison of mean values for Mach
group shows a tendency for the continuous group to have more rotat’ion of the
maxilla. (Animal J-50 was not, included because of an instable splint.) Other sub-
jective cvidencc also lends support to this theory. I+‘014c~samplo, t)litJ opcnitlg of
the prcmaxillon~axillar~ suture at the superior aspect (T,) in three animals of
the intermittent group and none of thosr in the continuous gronp may bc a result
of vertical masillary growth, as seen in untreated animals, during inactive trac-
tion. Also, the two animals of the intermittent group that showed the least change
in occlusal plane (l-06 and I-74)) as SWII ill Tahlc TI, snbsequcntl!- showc~l the
least change in tlental occlusion during the course’ of the posttreatment period
(Fig. 6).
In an evaluation of immediate posttrcatment changes IT,-T,) , the continuous
group illust~ratetl a greater rate of skeletal change when compared with the intcr-
mittent group. Although it is impossibl~~ to differentiate brtwccn growth ant1 1*0-
lapse, it is likely that the relapse at the sutures was clxprcssctl by a minimal
amount, of catch-up growth at the sutures, which occurred early after remora1 of
the traction force.
Yamamoto’” studied the application of extraoral traction to the maxillas of
monkeys for 18 hours per day and confirmed remodeling of facial sutures, both
histologically and cephalometric~ally. One of the conclusions he reached was that
extraoral traction to the maxilla had less retraction effect as his subjects in-
creased in age.
Elder and Tuenge5 found more dental c*ontribution and less skeletal contribu-
tion to the over-all treatment change than was observed in the continuous group of
the present study. In addition, more midfacial skeletal rotation was produced in
the present investigation. It is likely that these disparities arc, in part, attrib-
utablc to the inabilit,y to completely distinguish between dental tipping and
skeletal rotation, as well as to differcnrcs in suljject age level and appliance dr-
sign. Mandibular plane rotational change during maxillary traction has been
c*lockwisc in previous studies,‘, !I, 1~’with one exception.” The present studp con-
firms earlier investigations and did not demonstrate the counterclockwise rotation
during the actirc treatment phase that was reported by Elder and Tueng~.
 Clo~tinuous versus intermittent estr,aaoral trrrctio?a 619

During a posttreatment observation period of 26 days, Henry” noted move-

ment of the affected bones toward their original positions at a rate that was much
higher than could be attributed to normal growth over a similar time period. In
contrast, Tuenge and Elde? reported that dental changes were seen immediately
but that skeletal changes were insignificant during the early posttreatment phase
and were consistent with what would be expected during normal growth. Our
findings indicate that tipped teeth are inherently unstable, as reported by Tuenge
and Elder, and add support to Henry’s” finding regarding early posttreatment
skeletal changes. All studies agree that headgear traction accomplished only a
temporary redirection of the maxillary growth pattern.
Comparisons with untreated subjects (Fig, 2) illustrate that, over a compara-
ble development period, there is possibly less eruption of the maxillary dentition
in the animals receiving extraoral high-pull traction, indicating that the traction
retarded vertical development of the dentition and alveolus.
It is important to differentiate between maxillary and premaxillary response.
Macaque monkeys at this stage of development have a patent premaxillomaxillary
suture,8 and independent movement of the premaxilla has been shown in normal
development as well as in experimental study. I1 This study confirms indepen-
dent movement of the premaxilla when viewed on maxillary superimpositions.
Also, during the posttreatment phase (T1-T3), there was a greater increase in
the distance from the maxillary implant to the maxillary central incisor than
from the implant to the maxillary canine. Previous studies of extraoral traction
hare made no mention of independent premaxillary movement; however, they
involved older subjects. The opening at the superior aspect of the premaxillo-
maxillary suture in combination with loosening of the occipital anchor plugs in
the intermittent group but not in the continuous group during active treatment
may be due to the intermittent application of force. This phenomenon is visual-
ized as a mechanical “pumping” effect occurring with the activation and deactiva-
tion of the traction force. Further investigation of a histologic nature might
contribute to the understanding of this observation.
With regard to possible clinical implications of this study, it is critical to dis-
tinguish morphologically between monkeys and human subjects37 4 and to consider
that monkeys are altered from a normal dental and skeletal relationship to a
malocclusion, while with human beings the opposite takes place. In order to achieve
a maximal skeletal retraction effect, extraoral traction should be used in conjunc-
tion with an appliance that splints the teeth together. A recent clinical study1
reported minimal skeletal effect when continuous extraoral traction was applied
to only the maxillary first permanent molars. The maxillary molars also demon-
strated a. strong tendency to recover to their original position and inclination
relative to their base. Another study2 showed a relatively greater effect of extra-
oral traction on maxillary position when premolars were splinted to the molars,
even when the force application was intermittent. Comparison of the present re-
sults with previous studies leads to the conclusion that young patients present the
most. favorable prognosis for skeletal retraction of the maxilla. In addition, it
appears that minimal retention would be required if the patient were subjected
to an intermittent traction force that would deliver nonrotational skeletal re-
traction of the maxilla.
 Am. J. Orthod.
620 Brousseau and Kubisch June 1977

Summary and conclusions

The comparative treatment and posttreatment effects of intermittent and con-

tinuous extraoral traction applied to the maxillas of eight Macaca nemestrina
monkeys was studied. Two groups of four subjects each were prepared in iden-
tical fashion, with one group receiving 12 hours per day of active traction (12
hours inactive) and the other group receiving continuous traction (24 hours per
day). The force level was 400 Gm. per side and was applied to face-bows attached
to cast maxillary splints and stabilized by bony extraoral anchorage. The traction
was applied for an average of 83 days, and then posttreatment observation was
carried out for a minimum of 6 months. Both phases were documented by serial
cephalometric radiographs.
1. Intermittent application of extraoral traction to the maxilla of Macaca
nemestrina produces significant retraction of the midfacial complex.
2. Maca.ca ~aemestrina monkeys subjected to continuously applied extraoral
maxillary traction exhibit a greater than proportional maxillary skeletal retrac-
tion than the ones on an intermittent application schedule.
3. Whatever clockwise maxillary skeletal rotation and distal dental tipping
are achieved with extraoral traction prove to be unstable posttreatment in young
growing monkeys.
4. The more nonrotat,ional retraction of the maxilla achieved during treat-
ment, the more net retraction is maintained posttreatment.

The authors would like to thank R. William McNeil1 and Benjamin C. Moffett for their
help in the preparation of this manuscript. We also thank Andree Brousseau for her technical
assistance.

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3. Enlow, D. H.: A comparative study of facial growth in Homo and Macaca, Am. J. Phys.
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9. Henry, H. L.: Craniofacial changes induced by orthopedic forces in the Xacaca rhesus
monkey, M.S.C. thesis, University of Manitoba, 1973.
10. McNamara, J. A., Jr.: Neuromuscular and skeletal adaptations to altered orofacial func-
tion, Monograph No. 1, Craniofacial Growth Series, Ann Arbor, 1972, Center for Human
Growth and Development, University of Michigan.
 Continuous versus idermittent extraoral traction 621

11. Moore, G. J.: A longitudinal study of thumb-sucking and open-bite in the ~acacn mulatta,
M.S.D. thesis, University of Washington, 1970.
12. Sproule, TV. R.: Dentofacial changes produced by extraoral cervical traction to the maxilla
of the Xncaca mulatta, M.S.D. thesis, University of Washington, 1968.
13. Tuenge, R. H., and Elder, J. R.: Posttreatment changes following extraoral high-pull trac-
tion to the maxilla of .Uucuca mulatla, AM. J. ORTHOD. 66: 618-644, 1974.
14. Van Ness, A. L.: Cranial base implants for nonhuman primates, Personal communication,
1975.
15. Van Ness, A. L., Merrill, 0. M., and Hansel, J. R.: Cephalometric roentgenography for non-
human primates utilizing a surgically implanted head-positioner, Am. J. Phys. Anthropol.
43: 141-148, 1975.
16. Yamamoto, J.: Effects of extraoral forces in the dentofacial complex of Xucaca irus,
orthodontic thesis, Osaka Dental University, Japan, 1975.

Dr. Browseazl: 3639 Sozcrces Rd. (H9B lY4)

Dr. Kubisch: 5611 119th Ave. (98006)

THE JOURNAL 60 YEARS AGO

June,1917

The great need of the dental and the medical professions today is the pathmaker; the
man who will walk through the untrodden field and leave a trail. Original thinking and
doing is hard work, and man inherently is a lazy animal. Most men prefer to loiter along
the beaten highway, content to pick here and there a berry or a flower that has been
overlooked by the travelers who have passed on before, rather than take chart and
compass, explore the trackless wild, make a new path, derive all the pleasure and profit
that belongs to the pioneer, and leave a trail. (Martin Dewey: Editorial-The Pathmaker
in Dentistry and Medicine, International Journal of Orthodontia, predecessor of The
American Journal of Orthodontics, 3:369, 1917.)