Orthodontic headgear is a specialized external appliance used with braces to correct significant discrepancies in the alignment of the teeth and jaws. This device applies calculated forces to guide the growth of the jawbones, typically in children and adolescents whose skeletal structures are still developing. It is an effective treatment for severe bite problems, known as malocclusions, that cannot be fully corrected by fixed braces alone. The goal is to ensure the upper and lower jaws fit together harmoniously.
Defining Orthodontic Headgear and Its Purpose
Orthodontic headgear uses the head or neck as an anchor point to apply force directly to the teeth and jaw structure. The appliance consists of a metal framework, called a facebow, which connects to molar bands or specialized tubes inside the mouth. This inner structure extends to an outer bow, which attaches to an external anchorage system, such as a strap or cap worn around the head or neck.
The forces generated by the headgear are categorized as orthopedic forces, which are distinct from the purely dental forces used by braces. Braces apply lighter, continuous pressure primarily to move individual teeth within the bone. Headgear applies a heavier, interrupted force intended to modify the growth direction and position of the jawbones themselves, particularly the upper jaw (maxilla), during a patient’s growth phase.
The inner bow transfers the force from the external strap system to the back teeth, often the first permanent molars. This force can restrict the forward growth of the upper jaw or move the molars backward, creating space in the dental arch. By influencing the skeletal relationship between the upper and lower jaws, headgear helps correct severe overbites or underbites more effectively than tooth movement alone.
Different Types of Headgear
The type of headgear prescribed depends entirely on the specific direction of force needed to correct the malocclusion. Orthodontists select from three primary designs, each utilizing a different anchor point to achieve a unique vector of force.
Cervical Pull Headgear
Cervical pull headgear derives its anchorage from a strap that wraps around the back of the neck. The force applied is directed backward and slightly downward. This design is primarily used to move the upper molars backward and restrict the forward development of the upper jaw. It is commonly indicated for patients with an excessive horizontal overbite (overjet), where the upper teeth protrude significantly.
High-Pull Headgear
High-pull headgear uses a cap or strap that anchors high on the back of the head. The resulting vector of force is directed backward and upward. This upward pull inhibits the vertical growth of the upper jaw and prevents the upper molars from erupting too far downward. This type is frequently chosen for patients who exhibit a long facial height or need control over the vertical dimension of their bite.
Reverse-Pull Headgear (Facemask)
The reverse-pull headgear, often called a facemask, aims to pull the upper jaw forward rather than holding it back. This appliance consists of a vertical metal frame stabilized by a forehead pad and a chin cup. Elastic bands connect the frame to the braces or an expander inside the mouth, generating a forward-directed pull. It is the treatment of choice for an underbite (Class III malocclusion), where the lower jaw is positioned too far forward relative to the upper jaw.
Practicalities of Wearing and Caring for Headgear
The success of headgear therapy is directly tied to the patient’s consistent adherence to the wear schedule. The appliance typically requires 12 to 14 hours of wear per day, usually concentrated during evenings, nights, and weekends. If the prescribed force is not applied consistently, the progress achieved can quickly reverse, making compliance the most important factor in the treatment outcome.
Cleaning the appliance maintains hygiene and prevents damage. The metal facebow that enters the mouth should be brushed daily using a toothbrush and mild soap or toothpaste. Any accompanying head or neck straps should be hand-washed in cold water and allowed to air dry completely.
Safety guidelines must be followed rigorously to prevent accidental injury, especially to the face or eyes. The headgear must never be worn during physical activities, such as sports or rough play. During removal, always disconnect the external neck strap or head cap first, before attempting to detach the inner facebow from the teeth. This sequence prevents the risk of the facebow recoiling forcefully if the connection breaks.