Orthodontic headgear is an external appliance used in conjunction with braces or other oral devices to correct significant alignment issues of the teeth and jaws. This device is typically recommended during a patient’s growth phase when an orthodontist needs to influence the development of the facial bones. Headgear is designed to apply a controlled, directional pressure that is strong enough to modify skeletal growth patterns or move teeth that internal appliances alone cannot manage. The appliance works by leveraging external structures like the neck or the back of the head to serve as stable anchor points for the necessary force.
Understanding the Force Applied
Headgear applies extraoral force (force originating outside the mouth) to an internal dental component. This force is transferred via a U-shaped wire, known as a facebow, which connects the external straps or pads to bands placed on the back molars. The head or neck acts as a stationary anchor point, allowing the elastic straps to generate a steady push or pull on the jaw structure.
The forces delivered by headgear are categorized as having either an orthopedic or an orthodontic effect. Orthopedic force is heavier and aims to modify the growth and position of the jaw bones, which is most effective in growing patients. Orthodontic force, which is lighter, focuses more on moving individual teeth, such as retracting the upper molars backward. Orthodontists adjust the angle and magnitude of the force to achieve a precise effect on the patient’s dentition and skeletal structure.
Specific Malocclusions Treated By Headgear
The specific design of the headgear determines the direction of the force and the type of malocclusion it corrects.
Cervical-Pull Headgear
The Cervical-Pull headgear (Low-Pull) uses a strap that wraps around the back of the neck to apply a backward and slightly downward force. This design treats Class II malocclusions, which involve an overjet or overbite where the upper teeth protrude excessively. The downward vector helps move the upper molars backward and promotes a downward rotation of the upper jaw.
High-Pull Headgear
The High-Pull headgear is also used for Class II correction, utilizing straps that anchor at the back and top of the head. This setup directs the force backward and upward, restraining the vertical growth of the upper jaw. It is used in patients with a tendency toward excessive vertical facial growth, preventing the upper molars from erupting further. The upward force helps retract the upper dental arch while controlling the vertical dimension of the face.
Reverse-Pull Headgear (Facemask)
The Reverse-Pull headgear, or Facemask, addresses the opposite problem: Class III malocclusion (underbite). This appliance consists of a vertical frame with pads that rest on the forehead and chin, connected by elastics to the patient’s upper teeth. The Facemask applies a forward-directed force to the upper jaw, encouraging the maxilla to grow forward in relation to the lower jaw. This protraction stimulates the forward growth of an underdeveloped upper jaw bone.
Wear Time and Maintenance
The success of headgear treatment depends heavily on patient compliance, as the appliance is removable and only works when worn. Orthodontists typically prescribe a wear time of 10 to 14 hours per day, sometimes up to 16 hours, to achieve the necessary skeletal or dental change. This extended time is often accumulated during after-school hours and throughout the night while the patient is sleeping.
Consistency is paramount, as the teeth and jaws can quickly relapse if the appliance is not worn for the required duration. If a patient misses time, they are usually instructed to make it up on the following day to prevent treatment delays. Headgear must be removed during meals and active sports to prevent damage and minimize injury risk. Maintenance involves cleaning the facebow and internal components with a toothbrush to ensure hygiene.