Orthodontic headgear is an extraoral appliance that uses a strap or cap around the head or neck to apply force to the teeth and jaws. This contrasts sharply with fixed braces inside the mouth. While often associated with older movies, many wonder if this traditional treatment method is still used in modern dental care. This article clarifies whether headgear remains a tool in the orthodontist’s repertoire today.
The Current Role of Traditional Orthodontic Headgear
Orthodontic headgear is still utilized, but its use is much less common, reserved for specific, severe cases of jaw misalignment in growing patients. It applies extraoral force, using the head or neck as an anchor point, to achieve skeletal correction. This modification of jaw bone growth is necessary because braces alone cannot accomplish it. The appliance is prescribed during childhood or early adolescence when jaw bones are actively growing and can be guided.
Types of Headgear
A high-pull headgear, anchored to the top and back of the head, restricts the forward growth of the upper jaw (maxilla). This corrects a severe overbite or Class II malocclusion. Conversely, a reverse-pull headgear, or facemask, uses a forehead and chin cup to gently pull the upper jaw forward. This corrects an underbite (Class III malocclusion).
Modern Alternatives for Skeletal Correction
The decline in headgear usage is due to the development of fixed and less conspicuous alternatives that achieve similar skeletal movements. Fixed functional appliances, such as the Herbst appliance, are cemented onto the back teeth. They continuously hold the lower jaw in a forward position, encouraging growth into a corrected relationship without external straps.
Temporary Anchorage Devices (TADs) are small, temporary screws placed into the jaw bone. TADs provide a stable internal anchor point, allowing the orthodontist to apply precise, strong forces to move teeth or restrain a jaw segment. This creates a 24-hour “headgear effect” internally. Modern clear aligner therapy, using specialized attachments and powerful elastics, can also achieve mild to moderate skeletal correction. These internal and fixed devices offer a more aesthetic and predictable treatment experience.
Patient Compliance and Treatment Success
The success of traditional headgear is heavily dependent upon high patient compliance, often requiring 12 to 14 or more hours of wear daily. This high demand for cooperation outside of the orthodontist’s supervision is the primary reason many practitioners shifted to fixed alternatives. Studies using electronic timers show that patients frequently struggle to meet the prescribed wearing time.
When required hours are not met, treatment is less effective, leading to slower progress or incomplete skeletal correction. The shift toward fixed appliances, such as the Herbst, removes the patient compliance variable entirely. This ensures a more consistent application of force and drives the move toward more predictable and timely treatment outcomes.