British Journal of Orthodontics

ISSN: 0301-228X (Print) (Online) Journal homepage: http://www.tandfonline.com/loi/yjor19

Theoretical Considerations of Headgear Therapy: A

Literature Review

D. E. J. Bowden M.D.S., F.D.S.(Edin.), D.D.O.R.C.P.S.(G)

To cite this article: D. E. J. Bowden M.D.S., F.D.S.(Edin.), D.D.O.R.C.P.S.(G) (1978) Theoretical

Considerations of Headgear Therapy: A Literature Review, British Journal of Orthodontics, 5:3,
145-152, DOI: 10.1179/bjo.5.3.145

To link to this article: http://dx.doi.org/10.1179/bjo.5.3.145

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 British Journal of Orthodontics/Vol 5/1978/145-152 Printed in Great Britain ©

Theoretical Considerations of
Headgear Therapy: A Literature
Review
D. E. J. Bowden, M.D.S., F.D.S.(Edin.), D.D.O.R.C.P.S.(G)
Orthodontic Department, Dental School, Heath, Cardiff CF4 4XY

Abstract. The literature of headgear therapy is reviewed and used to explain some of the theoretical mechanical
~rinciples of tooth movement and anchorage control achieved by this method. Part I, Mechanical Principles,
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ISa review of force directions, centres of rotation, force magnitude and duration. In Part 2, Clinical Response
and Usage, the clinical uses of different directions of force are examined. Some of the clinical research into
the changes produced by different headgears is described. An attempt is made to draw conclusions from the
theoretical concepts discussed which may be of aid to the clinician.

Part 1 Mechanical Principles
The response of an individual tooth to a single
force to its crown is generally one of tilting, the
root apex moving in the opposite direction to the
crown. The clinician, who applies force through
arch wire and bracket to a tooth's crown employs
a more complex system of forces in the form of a
couple, creating a suitable ratio between force and
~oment system in order to produce pure transla-
tton. In the same way headgear forces are applied
at molar tube or bracket level. Tipping of teeth
readily occurs and pure translation is difficult to
achieve unless a number of mechanical principles
are observed. Additionally, it is claimed that
orthopaedic forces may produce changes in the
Position of the maxilla, whilst other writers have
de!llonstrated unwanted reactions to headgears,
PTimarily those associated with maxillary molar
extrusion and mandibular rotation. It is thus
essential that the orthodontist understands fully the
mechanical principles involved in headgear therapy.
Worms et al. (1973) discussed four factors in the
~ffective employment of extra-oral force systems.
hese are centres of rotation, the direction, the
magnitude and the duration of the force.
Centres of Rotation
Face bow to maxillary molars
~outd (1957) and Oosthuizen et al. (1973) discuss
he mechanical principles involved in the use of the
face bow and cervical traction, whilst Kuhn (1968)
and Worms et al. {1973) additionally consider the
effect of differing directions of pull to maxillary
molars.
Gould (1957) cites the example of a body that
revolves around a fixed centre of rotation such as a
fly wheel on a shaft. The body may only rotate,
no translational movement is possible. Figure la
shows a force vector which does not pass through
the centre of rotation. The body responds by
rotating in the direction of the force applied. This
rotational effect depends upon the creation of a
moment arm (lever arm) which is the perpendicular
distance between the force vector and the centre
of rotation. !n Figure le the force is applied in a
clockwise direction, a moment arm is created and
the flywheel rotates clockwise. In Figure I b the
force vector passes directly through the centre of
rotation and there being no moment arm created,
there is no rotation.
However, a free body without a fixed centre of
rotation will behave differently, for both transla-
tional and rotational movements are possible. A
free body will resist a force, the resistance being
equal and opposite to the force applied (Newton's
third law of motion) and may be reduced to one
point described as the centre of resistance. A force
which passes through the centre of resistance will
produce pure translation of a free body. However,
once again, if the force vector does not pass through
the centre of resistance, a moment arm is created,

145
 D. E. J. Bowden
APPLIED
FORCE
F
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Fig. 1. Body with fixed axis of rotation. From Gould, I. E.
American Journal of Orthodontics, 43, p. 325, Fig. 8, 1957.
Fig. 2. 'M', the centre of resistance of the banded
maxillary arch. From Poulton, D. R. Angle Orthodontist,
29, p. 248, Fig. 14, 1959.
rotation resulting. Whilst the body rotates, the
centre of resistance will also move in the direction
of the force applied. The degree of rotation or
translation depends upon the centre of rotation
146
c
Fig. 3. The shortest perpendicular distance between
the headgear force vector and the centre of resistance
(e) determines the moment arm and hence the centre
of rotation (X). From Worms, F. W. et al. Angle
Orthodontist, 43, p. 394, Fig. 11, 1973.
which has been created, its position being inversely
proportional to the length of the moment arm. Thus
the greater the perpendicular distance from th~
force vector to the centre of resistance, the closer
to it is the created centre of rotation and the greater
the rotational force component. Compare the fly
wheel where the two centres coincide. The shorter
the perpendicular distance between the force
vector and the centre of resistance, the further
away is the created centre of rotation and the less
rotation occurs. When the force vector passes
through the centre of resistance, the created
centre of rotation is at infinity and pure translatory
movement occurs (Fig. 3).
Mechanically, a tooth in bone will respond to
forces placed upon its crown as a free body. Unless
a headgear's line of force passes through the centre
 Theoretical Considerations of Headgear Therapy: A Literature Review
of resistance, rotation occurs following the princi-
ples described. The exact centre of resistance is
unknown, but is generally assumed to be in the
region of the middle to apical third of the root.
Worms et al. ( 1973) clinically determined the
centre of resistance of maxillary first molars to be
at the trifurcation of the roots. Poulton ( 1959)
designated the geometric centre of the maxillary
dental roots and alveolar process as the centre of
resistance of a fully banded maxillary arch. This
point he called 'M' and states that it lies between
the premolar roots (Fig. 2). Barton (1972) quotes
Poulton, but states that the centre of resistance of
a banded maxillary arch will vary according to the
number of teeth banded and the size of the roots
of the banded teeth.
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Following these principles, the effect of various
lines of force applied to a maxillary molar by
means of a face bow may be examined, using a
diagram by Worms et al. (1973). Figure 3a shows
a line of force passing through the centre of resis-
tance so that translation occurs. Figure 3b shows a
line of force apical to the centre of resistance
creating a perpendicular moment arm. The created
centre of rotation approaches the crown edge and
tipping of the root occurs in a distal direction. In
Figure 3c the line of force passes further apically
to the centre of resistance. The created centre of
rotation approaches the centre of resistance and
greater distal root tipping results.
Whether a face bow, 'J' hooks to the arch wire
or to individual teeth is used, a line of force may
be chosen to relate to the particular centre of
resistance. The direction and moment created will
depend upon the shortest perpendicular distance
from the force vector to the centre of resistance.
This perpendicular distance may of course alter
as the tooth moves and rotates. Thus, in the case
of the face bow, a suitable line of force may be
achieved by angulating the outer arms upwards
and arranging a line of pull along their long axes
through the centre of resistance, to the headgear.
Alternatively, a suitable force vector may be
created by choosing an appropriate line and direc-
tion of elastic traction to the headgear whilst the
face bow outer arms remain at the same level as
the molar tubes. The appropriate direction of pull
of 'J' hook traction to an arch wire or to individual
teeth may be achieved by choosing the most
suitable headgear or point of attachment upon a
variable pull headgear.
The position of the face bow outer arms relative
to the centre of resistance of the maxillary molar,
will affect the position of the centre of rotation in
a number of ways (Kuhn, 1968). The first factor is
their position in the antero-posterior plane i.e.,
the outer arms are made to end mesial or distal to
the centre of resistance of the tooth. Exceedingly
long or short outer arms may take the force vector
further away from the centre of resistance and
consequently excessive rotation of the tooth results.
Moreover, the antero-posterior position of the
outer arms may determine whether the line of force
passes mesial or distal to the centre of resistance
and hence decides the direction of the rotation.
The second factor is the position of the outer
arms in the vertical plane i.e., the bow is made to
lie apical or occlusal to the centre of resistance of
the tooth, for this also determines the direction in
which the tooth rotates. A distal force vector
passing apically to the centre of resistance will
tip the maxillary molar roots distally. A distal
force passing occlusally to the centre of resistance
will tip the roots mesially. For example, cervical
traction to a long face bow, outer arms bent
upwards, apical to the centre of resistance within
the maxillary molar root, will produce a distally
directed line of force and a moment which tips the
molar roots distally. However, short outer face
bow arms to cervical traction may produce a line
of force which is occlusal and mesial to the centre
of resistance and which consequently tips the root
mesially. These points are briefly summarized with
regard to cervical and high pull in Figure 4. A
more detailed analysis of the effect of face bow
outer arm antero-posterior and vertical position in
regard to cervical, straight and high pull, has been
made in diagrammatic form by Greenspan (1970).
Thirdly, in the coronal plane, the face bow inner
and outer arms may induce compressive or expan-
sive forces upon the maxillary molars.
J-Hook headgear to arch wire
Examination (Fig. 2) of force vectors relative to the
maxillary centre of resistance 'M' (Poulton, 1959)
indicates the direction of the moment system
formed, assuming the arch wire is stiff enough to
make the maxillary arch behave as a single unit.
Clearly a line of pull attached to the incisor region
of the arch wire and passing occlusally to 'M' will
place a distally directed force upon the maxillary
teeth. but will also tip the occlusal plane down-
wards at the incisor end of the arch. A line of pull
through 'M' will produce distal movement of the
maxillary arch without undesirable rotational
effects. A more vertical direction of pull, mesial and
apical to 'M' produces an anti-clockwise moment
and an intrusive effect upon the incisor end of the
147
 D. E. J. Bowden

various directions of headgear pull are well des-

cribed by Kuhn (1968). Adaptation of his diagrams
shows a number of different directions of pull
A \f (Fig. 5) whilst Figure 6 shows the resultant linear
force vectors. Kuhn's diagrams are self-explana-
tory; however, in his analysis of straight pull to
the maxillary molar, he suggests a small intrusive
CLHVlCAL Pl.iLL
effect. The vertical component here will be very
variable and indeed Baumrind's (1973) clinical
work suggests a small extrusive component of
[)
force.
It is clear that each direction of pull has hori-
c ,.... zontal and vertical force components shown in
dotted lines. A solid line indicates the resolution of
these forces. Thus, to a greater or lesser extent,
each direction of pull illustrated has a vertical
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component which may extrude or intrude a tooth

OCCIPITAL Pt:LL
or arch, whilst producing the desired movement in
the antero-posterior plane.
Fig. 4. Direction of force and moment systems. (A) Long
arm, resultant line of force passes distal and apical to Vertical force components
centre of resistance- distal root tipping. (B) Short arm,
resultant line of force passes mesial and occlusal to
A direction of headgear pull to the maxillary arch
centre of resistance- mesial root tipping. (C) Long arm, upwards and backwards from the occlusal plane
resultant line of force passes distal and occlusal to will intrude the teeth closest to the attachment of
centre of resistance- mesial root tipping. (D) Short arm, the headgear. A direction of pull downwards and
resultant line of force passes mesial and apical to centre backwards from the occlusal plane will cause
of resistance- distal root tipping.
extrusion. The occlusal plane may also be rotated.
The greater the vertical component of force, the
greater the intrusive or extrusive effect. The extru-
arch wire. Figure 6(1) shows four different lines
sion of maxillary posterior teeth is generally
of force relative to the centre of resistance within a
undesirable and the large extrusive component
maxillary incisor, each effecting a different moment present when cervical traction is used (Fig. 6(2))
system. may make this form of headgear traction unsuit-
able in certain cases (to be discussed in Part 2).
J-Hooks to individual teeth
Figure 6(5) shows the small distal component of
If the centre of resistance of a single rooted tooth force produced by high occipital pull and it would
coincides with the centroid (Burstone, 1962) the appear to have little use for producing distal
line of force of a J-hook headgear intended to movement. The large intrusive component has led
produce upright bodily movement of a~ individual to its use to attempt the intrusion of posterior
tooth should ideally pass through th1s centre of teeth in the reduction of anterior open bite. High
resistance. Thus, most authorities suggest an pull to the incisor region of the arch wire, Figures
occipitally directed line of force to move maxillary 5 and 6(1) produces an intrusive force upon the
canines distally. It is difficult to obey these theore- upper incisors and also a smaller distal one.
tical concepts when moving mandibular canines
distally and straight pull is usually suggested Lateral force components
(Berman, 1976). Sliding jigs may be employed to Expansion or contraction of the face bow inner
apply a more suitably directed force to molar teeth. arms relative to the first molar tubes will produce
consequent changes in the position of the first
Direction of the Force molars in the coronal plane. Less easily under-
Antero-posterior force components stood are the effects of bending outwards one outer
The clinical usage of directional forces has been face bow arm in the coronal plane or an alteration
described by Merrifield and Cross (1970), Arm- in the length of these arms relative to each other.
strong (1971), Hickham (1974) and Berman (1976). Vector analysis of the force lines in the coronal
The linear force vectors and moments delivered by plane is complex. These are diagrammatically

148
 Theoretical Considerations of Headgear Therapy: A Literature Review

of force (traction) to the midline axis are bilaterally

DlHJ;CTION OF PULL
equal. Changes in the angulation of the traction on
one side will produce changes in the distal and
1. High lateral force components. If the angulation of the
2. Cervical
line of traction to the midline on one side be in-
3. Straight
creased, a greater distal, but also palatally directed
4. Low Occipital
lateral force will be exerted on the molar of the
5. High Occipital
same side. Thus, Figure 7 shows that as the angle
6. Cervical
{3 increases, so s increases and the reactive force at
Q. This has been achieved by alterations in the
relative length of the arms of the outer bow. A
greater force will be delivered unilaterally by
lengthening the outer bow of the side where the
Fig. 5. Directions of force. Adapted from Kuhn, R. J. greater distal movement is required.
Angle Orthodontist, 38, p. 345, Fig. 8, 1968. Two additional methods claiming to produce
unilateral movement have been suggested, although
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Oosthuizen et al. (1973) suggest that both methods

~---~ are ineffective. Bending one outer arm outwards,
effects only slight changes in the angulation of the
~=---~ line of traction. The distal force component is not
0 increased, but a dangerous palatally directed force
is applied to the molar on the same side and a
buccally directed force to the molar on the opposite
0
---· I
side of the arch. Similarly, off-setting the soldered
joint between inner and outer arms of the face
bow does not affect the force distribution system.

I z
I
I
--- _____ .:1

!------{lJ
l.o..---- - ~
0
-------~

1. High
4. Low Occipital
2. Cervical
5. High Occipital
3. Straight
6. Cervical
Fig. 6. Relative horizontal and vertical force components.
Adapted from Kuhn, R. J. Angle Orthodontist, 38, p. 348,
Fig. 11, 1968.

described and well explained by Oosthuizen et al.

(1973) in regard to the cervical strap. T~ose w?o
wish mathematical proof of the followmg bnef
summary are referred to Oosthuizen's paper.
Symmetrical force delivery to right and left m~xil­
lary molars requires that the angulation of the hoes
Fig. 7. Increasing angle fJ will increases and also the
reactive force at Q. From Oosthuizen, L. et al. Angle
Orthodontist, 43, p. 230, Fig. 16, 1973.

149
 D. E. J. Bowden
Duration of the Force
There is little in the literature in regard to the use of
continuous headgear forces, whether heavy or
light. Armstrong (1971) demonstrated rapid tooth
movement and claimed retarded maxillary growth
by the use of 44 oz of force each side applied
continuously day and night. However, he feels
that such co-operation is uncommon even from
children in the early permanent dentition. Poulton
(1959, 1964) and Kloehn (1953, 1961) demonstrated
improvement in arch relationships by means of
occipital and cervical traction respectively, worn
for 12 to 14 hours per 24 hours. Ricketts (1960)
and Klein ( 1957) suggest that cervical traction
worn for a similar period of time will move maxil-
lary molars distally whilst altering the position of
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the maxillary complex in the growing child. It is
possible that shorter periods of wear will produce
tooth movement, for Northcutt (1975) on intro-
ducing a headgear capable of recording the hours
of wear, found that the great bulk of his patients
wore their headgears for only 35 to 50 hours per
week. However, knowledge that the period of wear
was being recorded by the headgear caused the
patients to raise their wearing rate to I 00 hours per
week, with a consequent reduction of treatment
time.
Magnitude of the Force
Reitan (1969) suggests that the single most impor-
tant factor in the causation of root resorption is
the magnitude of the force. He also feels that a
force greater than I lb or 450 g surpasses the
tooth moving threshold. Force magnitude would
thus appear to be critical and yet a huge range of
forces is certainly used. The force component is
notoriously difficult to measure. Elastic bands and
straps are subject to 'creep' and continual force
reduction. A continuous neck strap may be subject
to friction and apply uneven pressure to each side
of the face bow arms. The headgear force required
will depend upon the number of teeth banded,
the reaction to anterior tooth movement and
whether distal arch movement or merely anchorage
is required. Thus, authors seldom quote the forces
they use. Kloehn (1961) and Jakobsson (1967)
are guided by patient comfort. Berman (1976) uses
450 g (I Ib) each side to his combination cervical
and occipital headgear. Clinical experience would
suggest a force of 340 to 450 g ( 12 to 16 oz) each
side transmitted to maxillary molars by means of a
face bow will move them distally, but that patient
comfort and clinical response remain the best
150
guide. It is suggested that forces applied by 'J'
hooks to the arch wire or when directly applied to
individual teeth should be in the region of 170
to 226 g (6 to 8 ozs) at least initially, though the
pressure may be increased depending upon the
clinical response. Berman (1976) suggests 450 g
(lib) of pressure may be employed to each canine.
Greater forces are necessary to produce the
'orthopaedic' changes in the position of the maxilla
as described by. Klein ( 1957), Poulton (1959),
Moore (1959), R1cketts (1960), Weislander (1963)
and Sandusky (1965). Graber (1969) suggests that
450 to 900 g (I to 2 lb) of pre.>sure on each side
of cervical traction to the maxillary teeth, retards
maxillary growth. Arm strong (1971 ), using about
I± to 2! kg (3 to ~I b) of force continuously,
demonstrated both d1stal movement of maxillary
teeth and distal displacement of the maxilla. Haas
(1970) used about I± to 2! kg (3 to 5 lb) each
side to produce orthopaedic change. It should be
remembered that these larger forces are distributed
widely and as evenly as possible to the teeth of the
maxillary dentition, thus reducing the pressure
upon any one tooth. Gianelly and Valentini (1976)
in discussing the relative importance of ortho-
paedic and orthodontic movement, come to the
conclusion that 'high' pressures probably produce
both types of change. They show two cases in
which extra oral forces of approximately 900 g
(2 lb) of force each side, worn for approximately
14 hours a day, attached to the incisal portion of a
removable appliance, produced a net change in the
molar relationship of 4 to 5 mm. They comment
that the principle mode of correction was tooth
movement.
An important factor, affecting even patients in
whom the headgear force applied is of sufficient
magnitude and duration, is the dental age of the
patient. Armstrong (1971) suggests that in the
vast majority of patients of the same dental age,
the dento-alveolar response is fairly uniform to the
application of a given force and direction, 24 hours
per day. Quoting Dewel (1967) and Haas (1970)
he points to an observed faster rate of tooth
movement in patients in the mixed dentition to
those in the adult dentition. Moo re ( 1959), San-
dusky ( 1965) and Armstrong (1971) suggest that
greater orthopaedic change in the naso-maxillary
complex may be achieved by commencing headgear
therapy in the early mixed dentition. Gianelly and
Valentini (1976) in agreeing with Armstrong's
observations, comment that the skeletal system of
the younger patient is apparently more dynamic,
possessing a greater capacity to re-model.
 Theoretical Considerations of Headgear Therapy: A Literature Review
Intra-oral Forces
It is, of course, unlikely that a biological system of
tooth and bone will always respond in exactly the
same manner as the theoretical models described.
Moreover, headgear forces may be augmented,
modified or completely negated by forces produced
by archwires, intra-oral elalitics or the presence of
abutment teeth.
Unerupted second molars rarely create resistance
to the distal movement of the first molar tooth.
Indeed they move distally in response to the
moving first molar, as do other unerupted tooth
germs, (Poulton, 1959; Worms et al., 1973).
However, a fully erupted second mol~r creates a
resistance which will affect the magmtude of the
force and the moment system exerted on the first
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molar (Worms et al., 1973). If a headge~r force is
applied distally through the centre of res1s!ance of
the first molar, it should produce translatiOn, but
the resistance produced by the erupted second
molar crown enforces a rotational moment. The
first molar tilts distally with root ahead of crown.
A force acting apically to the centre of resistance
will have an increased distal root tipping effect. A
force acting occlusally to the centre of resistance
will have an increased mesial root tipping effect.
Although first permanent molars may on occasions
be moved distally in the presence of an erupted
second permanent molar, Armstrong (1971) sug-
gests that this movement should be completed
before the eruption of the second permanent
molar; alternatively, the latter's extraction. will
facilitate distal movement of the first max11lary
molar.-
The direction and moment system of headgear
forces will be affected by the presence of an arch
wire. For example, should a tip back bend be
incorporated mesial to the terminal molar, particu-
larly if the arch wire is tied back to the mol~r
crown, then mesial tipping of the molar root w1ll
occur. If upright distal movement of that molar
is required, a greater compensation by headgear
distal root rotational forces will be necessary.
However, if the face bow is being used for anchor-
age purposes only •. especially if some ~pace closure
from behind is demed at a later stage m treatment,
the headgear may be used to augment mesial
movement of molar roots preparatory to later
mesial movement of the crown.
Intra-maxillary elastics tend to tip the molar
crown mesially. This may be resisted by tip back
bends in the arch wire and if applicable the face
bow may be activated to assist in root control as
suggested above. A high pull headgear to 'J' hooks
in the maxillary incisor region may be used to
resist the extrusive forces produced by Class 11
inter-maxillary elastics. Similarly, maxillary molars
may be supported against the vertical pull of
Class Ill inter-maxillary elastics by use of a high
pull face bow headgear.
Only by strict attention to the antero-posterior,
vertical and lateral force vectors and moment
system of the headgear and of the force vectors of
the intra-oral forces being employed, can efficient
molar control be attained; and as importantly,
the unfortunate sequelae of unwanted side reac-
tions be avoided.
Face Bows and Molar Tube Position
The theoretical considerations discussed have
assumed a rigid face bow. The use of a rigid face
bow will reproduce these mechanics more accura-
tely and allow less adverse reaction, especially the
rotational forces introduced by a 'springy' face
bow. In practice, Root (1975) feels that a face bow
with a 1·15 mm (0·045 in.) round inner bow and a
1·57 mm (0·062 in.) outer bow, will be suitable,
provided the inner bow is strengthened from the
front, back to about two-thirds of the way to the
molar tubes. If it proves difficult to place the face
bow into the molar tubes because the molar is
tipped or rotated, angle the inner arms to achieve a
fit, 'straightening' them progressively to de-rotate
the molars; alternatively, use an appropriate palatal
arch (Orton, 1965) or a free sliding buccal arch
(Hasund, 1972) to establish tube alignment first,
rather than increase the flexibility of the face bow.
There has been argument about the position of
the face bow tube relative to the arch wire tube
upon the molar band. Worms et al. (1973) put
the problem in perspective (Fig. 8). Given two
identical face bows, the more gingivally placed
tube will raise the level of the outer bow hook
relative to the centre of resistance. Thus, the
perpendicular distance of face bow A, B, C to the
centre of resistance is greater than that of face
bow A1-B1-C 1 - and consquently more tipping
will result. However, the outer face bow arm may
be adjusted to the centre of resistance, independent
of any position of the face bow molar tube. It is,
therefore, suggested that the tube is positioned for
convenience and is generally placed occlusal to the
arch wire tube.
Summary
I. The direction of the moment produced in a tooth
depends upon the relationship of the line of
151
 D. E. J. Bowden

upon the length of the shortest perpendicular

drawn from the line of force to the centre of
resistance. The greater the perpendicular dis-
----- ............. __
tance, the closer does the created centre of
rotation approach the centre of resistance and
-- _ the larger the rotational moment.
....
---- ...................
-, I
3. The antero-posterior, vertical and lateral posi-
tion of the outer face bow hooks relative to the
_______
__ .,...
.::-.;;.~a
I centre of resistance will determine the direction
I and moment system produced by the headgear.
~~~~--------~~~----~~~·~ 4. The centre of resistance in the maxillary molars
approximates to the trifurcation of the roots·
that of a single rooted tooth is in the region of
the middle to apical third of the root; that of
the banded maxillary arch is thought to lie
between the maxillary premolar roots.
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5. An antero-posterior directed line of force which

does not pass directly along the occlusal plane
Fig. 8. Tube position variability with constant face bow will have a force component in the vertical plane.
design. From Worms, F. W. et al. Angle Orthodontist, A line of force passing upwards from the
43, p. 394, Fig. 12, 1973.
occlusal plane will have an intrusive effect upon
teeth in the maxillary arch, whilst one which
force to the centre of resistance. A distally passes downwards will have an extrusive effect.
directed force passing apically to the centre of 6. All types of headgear have been shown to
resistance of a maxillary tooth will tip the root produce satisfactory tooth movement if worn
apex distally. A line of force which passes for 12 to 14 hours per 24 hours.
occlusally to the centre of resistance of a maxil- 7. A wide range of forces will produce tooth
lary tooth will tip the root mesially. A line of movement. A force of 350 to 450 g (12 to 16
force passing directly through the centre of ozs) to molar teeth, or perhaps a lesser force
resistance will produce pure translational move- directly applied through 'J' hooks to individual
ment. Similar rotational changes will be pro- single rooted teeth or directly to the arch wire
duced in the fully banded upper arch, assuming will result in satisfactory tooth movement. Th~
that it is a rigid unit; depending upon the rela- best guide will be the clinical response. Larger
tionship of the line of force to the centre of forces to produce orthopaedic type changes in
resistance of the arch. the maxillary complex must be distributed widely
2. The extent of the moment of rotation depends and evenly to the teeth of the maxillary arch.

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