HEADGEARS

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 CONTENTS
 Introduction

 Definition

 History

 Classification of Headgear

 Components of Headgears

 Ideal Patients for Extra Oral devices

 Biomechanics of Headgear

 Types of Headgear

 Selection Criteria for Headgears

 Uses of Headgears

 Headgear combinations

 Assessment of patient compliance to determine HG wear

 Safety Precautions

 Conclusion
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INTRODUCTION:
To achieve a harmonious dento-facial relationship as a result of
orthodontic treatment, extra-oral devices using the neck or cranium as
anchorage have been employed.

These extra-oral appliances have been used to influence the maxillary

and mandibular growth patterns by inhibiting and/or redirecting their
normal growth potentials in children before and during maximal pubertal
growth.
Headgears are the most common among all the orthopedic appliances .

They are used to intercept the developing skeletal malocclusions in

growing children.

This family of appliance is typically used to restrict the downward and

forward growth of the maxilla.

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Understanding how to control the
direction and magnitude of the forces
produced by various headgear designs is
paramount in achieving desirable clinical
results.

Decreasing the patient's length of

treatment and improving the treatment
results would be only two of the benefits
derived from applying well-planned force
systems.

The use of headgear therapy is very

common in the treatment of Class II and
class III malocclusions as well as to
distalize the maxillary dentition.

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DEFINITION:

A class of appliances characterised by the extraoral

positions of activating elements and supporting structure
and having remotely located responsive force.

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The “Headcap” was
described by
Kingsley in 1866 and
Farrar in 1870’s. It’s
objective was limited
to retraction of upper
teeth.

Angle in 1888
HISTORY
described his extraoral
attachment for
maxillary dental
protrusion. It had a 6

long pin soldered onto

E arch at the midline
 Angle (1907) illustrated his occipital
headgear and traction bar, which he
replaced with “Baker’s anchorage”.

 Angle described the use of extra-oral

traction combined with extraction of
upper premolars.

HISTORY

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 In 1936 , Oppenheim
recognised that if a force
In 1921, Calvin Case
could be arranged so that
extended the
it passed through the
application of extraoral
center of rotation then a
therapy.
tooth, such as a molar
would move bodily.

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He placed molar bands and
dental bow all the way to the
molars and applied the headcap

Kloehn went on to combine

the dental bow and the face
bow in a soldered joint making
the center apparatus
removable.

Kloehn must be given the credit

for use of cervical traction in
treatment of class II and
maxillary anterior crowding.

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 In 1938, first cephalometric presentation of treated cases by
Brodie.

 In 1951, Jarabak introduced extraoral traction by attaching hooks

on the archwires with anteriors banded with neckstrap or straight
pull.

 In 1953, Buleah Nelson had shown posterior shift of pt A by 5mm.

 In 1954, Ricketts introduced expansion and contraction type

headgears.

 Jacobson in 1976 explained the mechanics associated with

headgear therapy.

In 1978, Teuscher used headgear with activators.

Subsequently in 1980's and 1990's many people employed headgear

with their appliances like with Clark’s twin block.
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CLASSIFICATION
OF HEADGEARS:
1. Headgears can be classified according
to the area of attachment into
• Cervical Headgear (Low pull)
• Occipital Headgear (High pull)
• Parietal Headgear (Vertical pull)
• Combination (Straight pull)

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2. According to the purpose of usage:
A. Growth modulators
B. For space regaining
C. Molar distalisation
D. Intrusion of maxilla

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 ACCORDING TO USE

TO PROTRACT MAXILLARY
TO DISTALIZE MAXILLARY
DENTITION
DENTITION
(FACEMASK/ REVERSE
(FACEBOW HEADGEAR)
PULL HEADGEAR)

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 ACCORDING TO ROOT
(1975) SUGGESTED
SIMPLIFIED
CLASSIFICATION

ATTACHED TO ARCH
ATTACHED TO TEETH WIRE- J- HOOK
HEADGEAR

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 ACCORDING TO
PULL

HIGH PULL LOW PULL

STRAIGHT PULL
OCCIPITAL/PARIETAL CERVICAL/KLOEHN

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 BASED ON WHERE
SOLDERED JOINT
B/W OUTER &
INNER BOW
PLACED

ASYMMETRIC SYMMETRIC
HEADGEAR HEADGEAR

FIXED TYPE SWIVEL TYPE

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COMPONENTS OF HEADGEAR

The principal components are:

• Force delivering unit

• Force generating unit

• Anchor unit

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FACEBOW:
 Metallic component that transmits extra oral forces on posterior teeth.
 Face bows are of two types
- Inner and outer bow type
- J-hook type
 Each J-hook consists of a 0.072" wire contoured so as to fit over a
small soldered stop on the arch wire, usually mesial to upper lateral
incisor.

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OUTER BOW

Made of 0.072” stiff round wire contoured to fit face.

Can be
– Short
– Medium
– Long

Distal end curved to form hook- gives attachment to

force element.

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 INNER BOW

 Madeof 0.045” or 0.051” round stainless steel wire contoured

around dental arch & molars.
 Inserted into max. 1st molar buccal tubes
 Stops placed mesial to molar tubes

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The methods used to make the inner bow stop mesial to the 1st molar
are :
 Bayonet Bends / Horizontal inset bends : which prevent the anterior
portion from impinging on brackets on teeth.
 Stopscrews : Cylindrical tubes with an internal diameter
corresponding to inner bow diameter.
 U’ loop : This is necessary when the upper molars are being moved
distally , in order to clear the bow from incisors

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 Trevor Johnson friction stops : with internal diameter of 0.045“
which can be soldered to inner bow to serve as stops.
 Preformed inner loops: serve as adjustable stops as well as shock
absorbers and are angulated for clearance. They also facilitate
necessary unilateral adjustments to keep the face bow comfortably
centered, increase face bow length as molars gradually move distally
& reduce face bow length as incisors are retracted.

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BUCCO-LINGUAL CONTROL

As a class II molar relationship is corrected, the relative

forwardmovement of the lower arch will produce a cross
bite tendency unless the upper arch width is expanded.
First Bucco-lingual force is controlled. If the bow is
inserted into one headgear tube, the other bow end should
be expanded approximately 5mm buccal to the opposite
tube.
This expansion bend is made near the anterior portion of
the inner bow.

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 SUPERO-INFERIOR CONTROL
 When the patient closes his mouth and relaxes his lips, the anterior
junction of the inner and outer bows should not be pushing either
lip in vertical direction.
 Thebow should be in a passive position between the lips. In order
to maintain this position , the posterior ends of the inner bow are
adjusted superiorly or inferiorly.

ANTERO-POSTERIOR CONTROL
 Antero-posterior adjustment: Inner-outer bow junction is just
anterior to the point where the lips seal. It may be necessary to
enlarge or constrict the loops in the inner bow to achieve this
position.
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JUNCTION

 Rigid joint b/w inner & outer bow.

 Can be soldered, wire wrapped or welded joint.

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MOLAR TUBES:

Maxillary molar buccal tubes can be either occlusal or gingival.

 GINGIVALLY –

• The tube is closer to the center of rotation of the molar, which reduces the molar
tipping effect and is advantageous in conditions where only molar movement is
desired.

 OCCLUSALLY –

• The patient finds it easier to insert the inner bows into the tubes.

• If omega loops are to be used, then these loops can block gingivally placed
headgear tubes.

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FORCE ELEMENT :

 Provides force to bring about

desired effect.
 Comprise of springs, elastics &
other stretchable materials.
 Connects face bow to head cap
or neck strap.

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HEAD CAP OR
CERVICAL STRAP:

 Takes anchorage from rigid

skull bones or back of neck.
 Selection based on pt.
needs.

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BIOMECHANICS OF HEADGEAR:

 Force systems a headgear can deliver depends on the magnitude,

direction, point of application and its line of action.

 Knowledge of the approximate location of the body’s center of

resistance is essential to choose the force system desired in treatment
mechanics.

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Stages Recommended force
values per side
Early mixed dentition 150-250 gms

Late mixed dentition 300-400 gms

Full permanent dentition 400-600 gms

Retention in permanent 150-400 gms.

dentition

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Duration:

 Forces of 12-16 hours duration applied as intermittent forces appear

to be the most effective for orthopedic changes. Because the
headgear is tooth borne, intermittent force minimizes tooth
movement while still providing for skeletal change. An intermittent
heavy force is less damaging to the periodontium and the teeth.

Force direction or vector:

 This depends on the location of the extra-oral attachment and the

location of the outer bow.

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 CENTRE OF RESISTANCE OF MAXILLA:

 The location of the center of resistance in the midface of the human skull
is between the first and second upper premolars anteroposteriorly, and
between the lower margin of orbitale and the distal apex of the first
molar vertically in the sagittal plane.
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 The Cres of the maxilla using holographic inferometry.
 They found that the Cres of the maxilla was located at the distal
contacts of the maxillary first molars, one half the distance from
the functional occlusal plane to the inferior border of the orbit.
 Hence the application of 500 gms per side of force applied 15 mm
above the occlusal plane and directed 20 0 downward from the
orbital plane produced pure translatory movement of maxilla.

• CLINICAL LOCATION OF THE CRES

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CENTRE OF ROTATION:
Point around which body will rotate or tip.
– Changes acc. to external force application
– If line of action of force (LOF) is above CR- centre of
rotation moves coronally & one gets counterclockwise
moment.
– Vice versa if LOF passes below CR

LINE OF ACTION :
Direction in which force acts.
Line connecting point of origin to point of attachment.

POINT OF ORIGIN OF FORCE :

Anchorage from occipital or cervical region.
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POINT OF ATTACHMENT OF FORCE :

Refers to hook present on distal end of outer bow to which

force element is attached.
 Direction of force can be altered by altering point of
attachment
Varying length of outer bow
Varying angle b/w outer & inner bow

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ZERO MOMENT LINE OF FORCE (LFO):

 LFO is a line that connects the center of resistance of the molar to the
point of force application on the cervical strap or the headgear strap
 The different moments and forces produced by the different
headgear depend on the situation of the outer bow in relation to the
LFO.

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TYPES OF HEADGEARS:

CERVICAL PULL
HEADGEARS:
 SILAS KLOEHN in 1947
 Component parts:
1. Molar tubes with headgear
tubes
2. Innerand outer bow soldered
together in the center
3. A neck strap

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These headgears obtain Anchorage
from the nape of the neck typically it
is used in growing patients with
decreased vertical dimension or low
mandibular plane angle as it causes
extrusion of the maxillary molars
leading to an increase in the lower
facial height.

They also moved the maxillary

dentition and the MaxIlla in a distal
direction thereby restricting the
growth of the Maxilla.

The vector of force is below the

occlusion plane producing both
extrusive and distilling effects.

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EFFECTS OF CERVICAL HEADGEAR:

To extrude the entire upper jaw

Tends to move the upper jaw distally

Steepen the occlusal plane.

Expansion of the upper arch.

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BIOMECHANICS

1. EFFECT OF DIFFERENT POSITIONS OF THE OUTER BOW ON

MAXILLA

A. OUTER BOW BENT LOW & SHORT:

• Equivalent force systems at unit cres has an extrusive and distal component
with large positive moment ( tends to steepen the occlusal plane).
• This force system is rarely used.

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43
B. OUTER BOW ADJUSTED SUCH THAT THE LINE OF ACTION OF
FORCE IS THROUGH THE Cres , has an extrusive and distal component
with no moment.

CERVICAL HEADGEAR SHOWING LINE OF ACTION OF FORCE

THROUGH Cres

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C. OUTER BOW ADJUSTED HIGH & LONG such that the line of action
of force passes to units Cres. Has a large extrusive component, a distal
component and large negative moment which flatten the occlusal plane.

CERVICAL HEADGEAR WITH LONG OUTER BOW BENT HIGH

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Advantages :

Direction of pull is advantageous in treatment of short face class II

maxillary protrusive cases with low MPA and deep bites.

Disadvantages:

It normally causes extrusion of the upper molars. This movement is

seldom desirable except in patients with reduced lower anterior facial
height. It is contraindicated in patients with steep mandibular planes

and in open bite cases.

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 OCCIPITAL PULL HEADGEAR

• These headgears derive Anchorage from the back or occiput of

the head. This type of headgear produces distally and superiorly
directed force on the maxillary teeth and the maxilla.

• Such forces are used in conditions where vertical control of the

molars is important.

• As growth guiding appliance, a high pull headgear can decrease

the vertical development of the maxilla thereby allowing for
autorotation of the mandible.

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A. SHORT OUTER BOW ANGULATED HIGH: In this the line of action
of force is far anterior to the unit’s Cres. A result of this force system
includes:

a. NEGATIVE MOMENT: Flattens the occlusal plane

b. Small distal and large intrusive force components

OCCIPITAL HEADGEAR WITH SHORT OUTER BOW ANGULATED

HIGH

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B. OUTER BOW PASSING THROUGH Cres : A result of the force system
includes :
a. No moment and therefore no change in the cant of the occlusal plane.
b. Distal and intrusive force components

OCCIPITAL HEADGEAR WITH OUTER BOW PASSING THROUGH Cres

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C. OUTER BOW LONG ENOUGH TO PASS POSTERIOR TO UNIT’S
Cres: A result of this force system includes:

a. Moment that tends to steepen the occlusal plane

b. A force with small intrusive and large distal components
c. Useful in Class II open bite patients

OCCIPITAL HEADGEAR WITH LONG OUTER BOW

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VERTICAL PULL HEADGEAR:

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• The main purpose of this headgear is to produce an intrusive direction
of force to the maxillary teeth with posteriorly directed forces.
• If the outer bow is hooked to the headcap so that the line of force is
perpendicular to the closure plane and through the centre of resistance
pure intrusion takes place.
• Due to the multiple notches in the head gap this headgear is also
versatile as the orientation of the line of action of force may be changed.
• BIOMECHANICS
• In the figure the head is divided into two compartments the anterior
component from the line of force and the posterior component behind
the line of force.
• If the outer bow is placed anywhere in the anterior component the
moment created will be counter clockwise and the forces produced will
be intrusive and posterior
• If the outer bow is placed anywhere in the posterior section the moment
will be clockwise and the vertical force will be intrusive but the
horizontal force will be forward

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 COMBI- PULL HEADGEAR:

 Straight Pull Headgear or Interlandi or Combination headgear

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• This style headgear is a combination of the high-pull and cervical
headgear, with the advantage of increased versatility.

• Depending on the force system desired, the orthodontist has the

opportunity to change the location of the LFO.

• The prime advantage of this headgear is its ability to produce an

essentially pure posterior translatory force.

• This is accomplished by placing the LFO through the center of

resistance, parallel to the occlusal plane. Clinically, this means
bending the outer bow to the same level as CR,
and hooking the elastic to a notch at the same vertical level. The
relation of the outer bow to the LFO dictates the direction and
magnitude of forces and moments. Placing the outer bow above the
LFO will produce a posterior force, counterclockwise rotation, and
most often an intrusive force.

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• If the outer bow is below the LFO, the force produced will be
posterior and superior, and the moment will be in a clockwise
direction.

• The straight-pull is the headgear of choice in a Class II malocclusion

with no vertical problems. It is also the headgear of preference when
the main thrust of headgear wear is to prevent anterior migration of
maxillary teeth, or possibly even translate them posteriorly

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 ASYMMETRIC HEADGEAR:

 Ifbuccal occlusion is asymmetric e.g. Class I on one side and class II on

the other side, without asymmetries either in molar axial inclinations or in
rotations, then it is most logical to achieve the correction with asymmetric
headgear.

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2. The diameter of wires can be increased for greater rigidity; it is
suggested that the arch wire be 0.055 inch and the face-bow 0.075 inch
(the 0.075 inch face-bow is approximately five times as stiff as the 0.50
inch one).

3. The arms of the face-bow should clear the cheeks so as not to

introduce more undesirable lateral forces.

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UNILATERAL FACE-BOWS:

Power-arm face-bow. In this design, one outer bow is longer

and/or wider than the other, with the longer or wider bow tip
located on the side anticipated to receive the greater distal force.

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SOLDERED-OFFSET FACE-BOW

 Here the outer bow is attached to the inner bow by a fixed soldered
joint placed on the side favored to receive the greater distal force.

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SWIVEL-OFFSET FACE-BOW

In this design the outer bow is attached to the inner bow

through a swivel joint located in an offset position on the side
favored to receive the greater distal force.

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SPRING-ATTACHMENT FACE-BOW

 Here an open coil of spring is wrapped around one of the inner-bow

terminals of a conventional bilateral face-bow. The coil is placed distal
to the stop on the side favored to receive the greater distal force.

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 The power arm face-bow is thought to be relatively
recommendable because it showed an acceptable asymmetric
effect.

 All asymmetric face-bows generate lateral forces as side effects as

long as the force delivery system with a combination of an
asymmetric face-bow and a neck strap or head cap is applied.

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 J PULL HEAD HEADGEAR:

 A line of pull through center of resistance

will produce distal movement of the
maxillary arch without undesirable rotational
effects.
 A more vertical direction of pull, mesial and
apical to center of resistance produces an
anti-clockwise moment and an intrusive
effect upon the incisor end of the arch wire.

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 REVERSE HEADGEAR OR PROTRACTION
HEADGEAR:

 Hickham claims he was the first to use a reverse head gear.

 This was made popular by Delaire around the same time.

 Headgears are generally used for the purpose of reinforcement

of anchorage or for maxillary distalization. However, when an
anterior protractory force is required, a protraction head gear is
used.
 A reverse pull head gear basically consists of a rigid extra-oral
framework which takes anchorage from the chin or forehead or
both for the anterior traction of the maxilla using extra-oral
elastics which generate large amounts of force.

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INDICATIONS:

• It can be used in a growing patient having a prognathic mandible and a

retrusive maxilla.
• It can also be used for selective rearrangement of the palatal shelves in
cleft patients.
• It can be used in correction of post surgical relapse after osteotomy.
• It can be used to treat certain accessory problems associated with nose
morphology such as lateral deviations.

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Sites of anchorage:
BIOMECHANICAL CONSIDERATIONS:
 Amount of force: The amount of force to bring about skeletal changes
is about 1 pound (500 gms) per side.
 Direction of force: Most authors recommend 15-20 degree downward
pull to the occlusal plane to produce a pure forward Translatory
motion of the maxilla.
 Durationof force- Low forces (250 gm/side) take 13 months to
produce desired results. However, very high force values like 1600-
3000 gms reduced treatment time to 4 – 21 days.
 Frequency of use: Most authors recommend 12-14 hrs of wear a day
 Sites
of anchorage-
– Anchorage from skull (forehead)
– Anchorage from chin
– Anchorage from chin & forehead

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 Partsof a reverse pull head gear
– Chin cup
– Forehead cap
– Intra-oral appliance
– Elastics
– Metal frame

 The principle of maxillary protraction is to apply tensile force on the

circumaxillary sutures and thereby stimulate bone apposition in the
suture areas; in doing so, the maxillary teeth become the point of force
application, and the face (forehead, chin, zygoma) or occipital area
becomes the anchorage source.

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Treatment effects of face mask:

 The maxilla moves downward and forward with a slight upward

movement in the anterior and downward movement in the posterior
palatal plane as the result of protraction force; at the same time posterior
teeth extrude somewhat.

 As a consequence, downward and backward rotation of the mandible

improves the maxillo-mandibular skeletal relationship in the sagittal
dimension but results in an increase in lower anterior facial height. This
rotation is a major contributing factor in establishing an anterior overjet
improvement.

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 Force application:

 Upward and forward rotation of the maxilla occurs when protraction

force on molars is applied parallel to the occlusal plane. This type of
maxillary rotation can be minimized when the force is applied in the
canine area, 20° to 30° below the occlusal plane.

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FACEMASK OF DELAIRE :
 This was popularized by Delaire in the 60's and also uses the chin and
forehead for support.
 Theappliance is made of a rigid framework which is squarish and kept
away from the face.
 It
has a forehead cap and a chin cup with a wire running in front of the
mouth used for elastic attachment.

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 TUBINGER MODEL:

 This is a modified type of Delaire face mask.

 It consists of a chin cup from which originates two rods that run in the
midline and is shaped to avoid the interference of nose.

 The superior ends of the two rods house a forehead cap from which
elastics encircle the head. In addition, a cross bar extends in front of the
mouth which can be used to engage elastics.

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 PETIT TYPE OF FACE MASK :

 This is also a modified form of Delaire face mask.

 Itconsists of a chin cup and a forehead cap with a single rod running in
the midline from forehead cap to chin cup.
 A cross bar at the level of the mouth is used to engage elastics.
 The advantage of this model is that the forehead cap, chin cup and the
cross bar can be adjusted to suit the patient.

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IDEAL PATIENTS FOR HEADGEAR:

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1.PATIENTS WITH MAXILLARY EXCESS:

Skeletal class II malocclusion with a component of excessive horizontal

or vertical growth of the maxilla

Some protrusion of maxillary teeth

Reasonably good mandibular dental and skeletal morphology as this

will be minimally affected.

Potential for continued mandibular growth

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2. PATIENTS WITH VERTICAL MAXILLARY EXCESS:

 High pull headgear for upper molars is given

 Interocclusal bite blocks can also aid in prevention of eruption of

posterior teeth.

E.x: High pull HG with functional appliances.

Ideal patients are

 Long face patients

 Skeletal open bite

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3.PATIENTS WITH HORIZONTAL MAXILLARY DEFICIENCY:

 Normally positioned or slightly retrusive but not protrusive

maxillary teeth

 Normal or short but not long anterior facial height

 Ideal age of 8 yrs

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TIMING OF HEADGEAR TREATMENT:

HG Treatment time SMI Stages

Most optimum treatment SMI 4 to 7
time

Most desirable treatment SMI 1 to 3

time

Least desirable treatment SMI 8 to 11

time

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SELECTION CRITERIA:
 Headgear anchorage location
 Age

 Based on MPA
 Based on occlusal plane requirements
 Differences between orthodontic and orthopedic forces

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1. Headgear anchorage location

a. High pull headgear: this applies a superior (intrusive) and distal

force to the maxilla and the maxillary dentition.

b. Cervical pull: this produces an inferior (extrusive) and

distalising force on the maxilla.

c. Combination headgear: no moment is produced and a

distalising force is applied to the maxilla.

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2. Age:

The treatment of skeletal malocclusions is usually done at the age of 8-9

yrs in girls and 10-11 yrs in boys depending on the developmental status.

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3. Based on MPA :

1. A low angle or normal growing (SN-MP< 37) case is suitable for

cervical headgear.

2. If SN-MP is between 37-41, a combination headgear is used.

3. If SN-MP>41, then a high pull HG is used.

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4. BASED ON OCCLUSAL PLANE REQUIREMENT

• Action desired headgear type

• 1.extrusion and steepening cervical HG; outer bow even or low

• 2. extrusion and flattening cervical HG; outer bow very high

• 3. intrusion and steepening high pull HG: outer bow posterior to

Cres

• 4. intrusion and flattening high pull HG; outer bow anterior to

Cres

• 5.distal force and flattening combination; outer bow above Cres

• 6.distal force and steepening combination; outer bow below Cres

• 7.distal force and no moment combination; outer bow at Cres

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USES OF HEADGEARS:

ANCHORAGE CONTROL

TOOTH MOVEMENT

ORTHOPEDIC CHANGES

CONTROLLING THE CANT OF

THE OCCLUSAL PLANE

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HEADGEARS WITH REMOVABLE APPLIANCES:
Margolis acrylic cervico occipital anchorage:
 Modified maxillary removable Hawley type appliance permits the use of
extra-oral forces against the maxillary dentition.
 Multiple ball end clasps and occlusal coverage can increase the
resistance to dislodgement by extraoral traction.
 Margolis used this appliance to hold the torque correction achieved with
fixed appliances.
 During 2nd phase during which space consolidation occurs, extraoral
forces help maintain anchorage posteriorly

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 MODIFICATION:

 Addition of 1 mm buccal tubes to the labial wire and soldering them

vertically at the canine-lateral incisor embrasure to receive the J-
hook extraoral force arms

 Inclined plane was added to eliminate functional retrusion and free

the mandible for all possible forward growth.

 The ACCO should be worn both day and night with a minimum of
12 hrs nocturnal headgear wear.

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 JACOBSON’S SPLINT
• The force magnitude for this type of removable appliance must not be
too great to prevent dislodgement of the appliance.

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HEADGEARS WITH FUNCTIONAL APPLIANCES:
Headgears with activator:
 Activatorcervical headgear therapy results in a simulation of normal
mandibular occlusal development and a redirection of maxillary
dentoalveolar development.

 Use cervical headgear, where necessary, for two reasons: (1) to extrude
maxillary molars, and (2) to apply orthopedic traction to the maxilla,
restrain maxillary growth, and cause selective eruption of teeth.

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 Primary treatment objective is to restrict developmental contributions
that tend to cause a skeletal Class II and at the same
time attempt to correct antero- posterior relation of jaws.
 Usage mainly limited to mixed dentition with force application of
250 gms/side.

 The activator:
 Prevents,intercepts ,corrects pernicious habits
 Acts as a space maintainer
 Expands if necessary
 Corrects individual positions of teeth
 Corrects Class II relationships

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 According to Teuscher extra-oral force should not exceed 400
gms / side.
 Pfeiffer and Grobety advocated force in the range of 300-400
gms.
 Cura et al . 1996 compared the effects of activator and activator
and HG therapy. A high pull headgear was used with a force of
400 gms/side for 17 hrs / day. They found greater improvement
in the sagittal base relationship in cases treated with combination
therapy than in patients who were treated with activator alone.

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HEADGEARS WITH HERBST APPLIANCE:

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 It is indicated only in cases of severe class II MO in early mixed
dentition.

 Forces in the magnitude of 500 to 1,000 gm of pressure on each side

were suggested

 When the total maxillary dental arch is used as anchorage, forces up to

1,500 gm on each side can be applied without discomfort to the
patient.

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HEADGEARS WITH BIONATOR:

 Dahan et al . In 1989 described the use of bioactivator with high pull

headgear for treatment of Class II Division 1 malocclusion cases.

 The headgear was worn every night (8 to 10 hours) during the first
year of treatment. They concluded that the combination of a
bimaxillary appliance with extraoral forces leads to rapid changes in
the correction of Class II, Division 1 skeletal conditions.

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 HEADGEARS AND TWIN BLOCK:

 THE CONCORDE FACE-BOW

The twin block technique uses a new method of applying intermaxillary
traction.
The Concorde facebow combines intermaxillary and extraoral traction by the
addition of a recurved labial hook to a conventional face-bow.
Intermaxillary traction is applied as a horizontal force from the labial hook to
the lower appliance, eliminating the unfavorable upward component of force
associated with conventional intermaxillary traction

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HEADGEARS AND TWIN BLOCK:

• The traction components are worn only at night to

reinforce the action of the occlusal inclined planes.
• If the patient fails to posture the mandible to the corrected
occlusal position , the intermaxillary traction force is
increased so that favourable intermaxillary forces are
applied continuously.

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ASSESSMENT OF PATIENT COMPLIANCE TO DETERMINE WEAR

1. Molar mobility,

2. Cleanliness of headgear tubes,

3. Cleanliness of headgear strap,

4. Ease of placement by patient,

5. Questioning patient,

6.Space creation between teeth,

7.Molar positioning comparing pretreatment models and/or cephalograms,

8.The position of the junction of the inner and outer bow of the headgear
compared with the previous appointment, and

9.Anchorage maintenance
 SAFETY MEASURES

 Check the fit of the locking facebow in a mirror, and confirm the lock
by lightly pulling forward on the facebow. Then attach the safety head
or neck strap at the prescribed tension (mark the appropriate holes)
while holding on to the facebow.

 Never wear the headgear while playing.

 Ifsomeone else grabs the headgear, take hold of it until the other
person lets go. Then take the headgear and facebow apart to make sure
nothing has been dislodged or broken.

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 If the headgear or facebow ever comes off at night, or if there are any
other problems, stop wearing it and schedule an appointment as soon
as possible.

 Always remove the head or neck strap before removing the facebow.

 An eye injury, however minor, see an ophthalmologist immediately.

Penetrating injuries may appear relatively asymptomatic, but
immediate antibiotic therapy is required to reduce the likelihood of
infection.

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 CONCLUSION:

 There are a number of ways to attempt the correction of class II

malocclusions. The method chosen depends on a series of factors that
must be carefully evaluated before each therapy. The right indication is
the formula for success.

 Only a careful and complete diagnosis and a continued diagnostic

monitoring during treatment enables the choice of the right appliance
for the individual case to assure optimal treatment.

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REFERENCES:
Contemporary orthodontics- William R. proffit (4 th edition).
Orthodontics : current principles and techniques- Graber &
Vanarsdall.
Text book of orthodontics – Dr. S. Gowri Shankar

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THANK YOU

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