Orthodontic headgear is a specialized appliance used in conjunction with braces or as a standalone treatment to address specific dental and jaw alignment issues. It works by applying precise forces to guide jaw growth and move teeth into their proper positions. While traditional braces primarily focus on tooth alignment, headgear offers a unique capability to influence the development of facial structures and correct more complex bite problems.
Understanding Orthodontic Headgear
Orthodontic headgear is an external device that applies controlled forces to the teeth and jaws. It consists of several key components. A U-shaped metal facebow or J-hooks insert into tubes attached to the molars inside the mouth. This internal component extends outside the mouth, connecting to an external strap system.
The external straps (e.g., head cap, neck strap) provide anchorage for the forces. Elastic bands or springs connect the facebow to these straps, generating pressure to guide tooth movement or jaw growth. These components work together to exert gentle, continuous pressure, guiding tooth movement or jaw growth to correct malocclusions.
Specific Bite Issues Corrected by Headgear
Headgear is often recommended for specific orthodontic problems, particularly jaw misalignment. A common issue is Class II malocclusion, a severe overbite or protruding upper front teeth (“buck teeth”). In these cases, headgear restricts forward growth of the upper jaw or moves upper molars backward to create space and improve the bite. Cervical pull headgear (anchoring around the neck) and high-pull headgear (anchoring over the head) are often used.
Conversely, headgear addresses Class III malocclusion (underbite), where the lower jaw protrudes beyond the upper. A reverse-pull facemask is typically employed. This headgear uses forehead and chin pads, connected by a frame, with elastics pulling the upper jaw forward to encourage growth and alignment. It can also create space for crowded teeth by moving molars backward, preventing extractions.
How Headgear Achieves Orthodontic Correction
Headgear achieves its corrective effects through the application of specific forces that influence both tooth movement and jaw growth. Orthodontists differentiate between “orthodontic” forces, which primarily move teeth within the bone, and “orthopedic” forces, which guide the growth and remodeling of jaw bones. Headgear is particularly effective at applying these orthopedic forces, especially in growing patients.
The continuous, gentle pressure exerted by headgear causes biological responses in the surrounding tissues. This pressure leads to bone remodeling, a natural process where bone is reabsorbed on one side and deposited on the other, allowing teeth to move through the bone. The direction and magnitude of the force, determined by the headgear’s design and adjustment, dictate the type of movement or growth modification achieved. For instance, specific headgear designs can produce distalizing forces to move molars backward or intrusive forces to prevent them from erupting excessively.
Factors Guiding Headgear Recommendation
An orthodontist considers several factors when determining if headgear is an appropriate treatment option. The patient’s age and growth stage are among the most important considerations. Headgear is most effective during periods of active growth, typically in children and teenagers, because their jawbones are still developing and can be influenced more readily. For adults, headgear is less commonly used for jaw growth modification, but it can still be effective for tooth movement, such as maintaining space after extractions.
The severity and specific type of malocclusion also play a significant role in the recommendation. Headgear is typically reserved for more complex bite problems that cannot be fully corrected with braces alone, such as severe overbites or underbites. Patient compliance is also a practical consideration, as headgear requires consistent wear, often for 12 to 14 hours a day, to achieve the desired results. The orthodontist will assess these factors to develop a personalized treatment plan.