Orthodontic headgear is a specialized extra-oral appliance used by orthodontists, typically with braces or other devices inside the mouth. It applies carefully controlled force to the teeth and jaws, a force that internal appliances alone cannot generate. The main purpose of this device is to fix significant alignment problems, often referred to as malocclusion or a “bad bite.”
This appliance is most often recommended for children and adolescents because their growing jawbones are more responsive to directed pressure. Headgear connects to the teeth, usually through bands on the back molars, and anchors the force using the head or neck as a stable point. By influencing the growth and position of the upper jaw, headgear helps ensure the upper and lower teeth meet correctly, promoting proper bite function and facial harmony.
Addressing Specific Bite and Jaw Growth Problems
The primary function of orthodontic headgear is to create skeletal and dental changes that correct major discrepancies between the upper and lower jaws. The device achieves this by generating an orthopedic effect, modifying the underlying bone structure rather than just moving individual teeth. This is particularly effective in growing patients whose facial bones have not yet fully fused.
One of the most common applications is correcting a Class II malocclusion, characterized by the upper jaw and teeth protruding too far past the lower jaw (overjet or overbite). In these cases, the headgear applies a restraining force to the upper jaw (maxilla). This pressure restricts the forward growth of the maxilla, allowing the lower jaw (mandible) to align properly as it continues its natural growth pattern.
Headgear can also create dental changes, primarily by moving the upper back molars backward, a process called distalization. This backward movement creates space in the dental arch for crowded front teeth to be properly aligned by braces. Creating space this way can sometimes help the orthodontist avoid extracting permanent teeth for crowding relief.
Conversely, for a Class III malocclusion (underbite), the goal is to encourage forward growth of the upper jaw. This is necessary when the lower jaw is too far forward or the upper jaw is underdeveloped. The headgear applies a forward-directed pull on the maxilla, stimulating its development so that the upper teeth can correctly overlap the lower teeth. This skeletal guidance is most successful when treatment begins early, while the growth plates of the face are still highly active.
Understanding the Main Types of Headgear
The various types of orthodontic headgear are distinguished by the direction of the force they apply, which dictates the specific problem they are designed to correct. The force is delivered from an external anchor point to an internal component, usually a metal facebow that connects to the molar bands. The design of the strap and its attachment point determines the vector of the pressure.
Cervical Pull Headgear
Cervical Pull Headgear is used for Class II correction when restricting forward upper jaw growth is desired alongside a downward and backward force. This appliance uses a strap that wraps around the back of the neck, providing a low-pull anchorage. The resulting force vector helps move the upper molars backward and slightly downward, which benefits patients who have a lower angle of jaw growth.
High-Pull Headgear
High-Pull Headgear is also used for Class II correction, but it applies an upward and backward force. The straps anchor to a headcap that sits over the back and top of the head. This vertical component is useful for patients who need control over the vertical dimension of their face or those with an open bite, as the upward force prevents the upper molars from erupting further.
Reverse-Pull Headgear (Facemask)
The Reverse-Pull Headgear, often called a Facemask, is structurally different and treats Class III malocclusion (underbite). It consists of a vertical metal frame with two cushioned pads that rest against the forehead and the chin. Elastics or wires connect the frame to the upper teeth, pulling the entire upper jaw forward to stimulate the forward growth of the maxilla.
Essential Guidelines for Wearing and Care
The success of headgear treatment depends entirely on consistent compliance with the orthodontist’s instructions. The required wearing time is typically 10 to 14 hours per day, concentrated during the evening and overnight hours. Since bone remodeling and tooth movement require continuous, gentle pressure, consistent use is far more effective than intermittent use.
Patients must remove the headgear for all sports, rough play, and while eating. This safety precaution is necessary because a sudden blow to the appliance while it is worn could cause serious injury to the lips, cheeks, or teeth. Due to the external nature of the appliance, it must be treated with caution and stored safely in its case whenever it is not being worn.
Maintaining the appliance requires simple, regular cleaning to ensure proper hygiene and function. The metal facebow, which goes into the mouth, should be brushed daily with a toothbrush and water, similar to cleaning a retainer. Fabric straps or headcaps should be hand-washed in cold water and air-dried to prevent damage. It is important to inspect the headgear regularly for damage or distortion and to inform the orthodontist immediately if any part becomes loose or bent, as this alters the direction of the therapeutic force.