Headgear and its

mechanics
Submitted by: S.Dharani, Ist year PG
Synopsis :
1. Components of headgear
2. Effects of headgear on maxilla
3. Selection of headgear type
4. Types of headgear
5. Cervical head gear
6. High pull headgear
7. Determining the type of headgear for treatment

Components of headgear :
 Facebow
 Neck strap/ headcap
Facebow: applied to permenant first molars but can be applied
through splints and functional appliances.
Headcap/neckstrap: it is the anchorage component responsible for
direction of force, either above the occlusal plane or below the
occlusal plane
Effects of headgear on maxilla :
Headgear force can decrease the amount of forward/downward
growth of maxilla by changing the pattern of apposition of bone at the
sutures . class II correction is obtained as the mandible grows
downward and forward normally while similar forward growth of
maxilla is restrained, so mandible growth is a necessary part of
treatment response to headgear.

In a growing patient, headgear can be regularly for atleast 10-12 hours

per day to be effective in controlling growth, with a force of 350-
450gm per side.

Selection of headgear type :

The headgear anchorage location must be chosen to provide a
preferred vertical component of force to the skeletal and dental
structures.
A high pull headcap will place a superior and distal force whereas
a cervical neckstrap will place an inferior and distal force on teeth
and skeletal structures.
The initial choice of headgear is based on original face pattern: the
more signs of a vertically excessive growth pattern, higher the
direction of pull and vice versa.
The second decision is how the headgear is to be attached to the
dentition, the usual arrangement is a facebow to the large headgear
tubes on the permenant molars.
Finally, a decision is made whether a bodily movement of tipping
movement is desired.
Force vectors above the center of resistance of the molar should
cause distal root movement , through the center of resistance should
cause bodily movement, below this point should cause distal crown
tipping
(Center of resistance of the molars lie in the midroot region of the
furcation, while for maxillary dentition , it lies in between the roots
of premolars within the maxillary sinus, for maxilla, it lies in the
posterior superior aspect of the frontozygomatic suture)
Types of headgear:
 Cervical headgear
 Occipital headgear
 Highpull headgear
 Reverse pull headgear
 Combination or straight pull headgear

Cervical headgear :
The effects of a cervical
headgear is to
1. Erupt the entire jaw
2. Moves the upper jaw
distally
3. Steepens the plane of
occlusion
4. An expansile force on
the upper arch
A class II can be corrected
using a headgear by distal
movement of upper jaw with
forward growth of lower jaw
Steepening the plane of occlusion where the force from the headgear
tends to erupt the upper teeth which ‘hinges’ the mandible open. The
positive moment steepens the plane of occlusion indicated by a
gummy smile
How can the positive moment be eliminated ?
Outerbows of the facebow bent outward
Bring the outerbow to the line of action: this puts a negative moment
on the upper arch flattening the occlusal plane and an extrusive force
Bring the outerbow to the neckstrap: when outer bow is brought
below the center of resistance, it puts a positive moment on the
maxilla, a distal force and an extrusive force
Adding the positive and negative moment effects, the moments tend
to cancel each other out leaving a distal force and an excessively
greater extrusive force resulting in hinging of the mandible and a
toothier gummier smile.
In patients with significant forward growth rotations, the
intermaxillary growth space wedges distally, so significant eruption
can occur without ultimately hinging the mandible open.

Thus to summarize:
 Two moments are produced that tend to cancel each other out
 There is a distal force to the upper teeth
 Increased eruptive force to the buccal segments
 Good for individuals with good forward growth rotations

Outerbows bent downward :

When the outer bow is brought up to the line of action of the neck
strap, a positive moment is placed on the upper jaw that tends to
steepen the plane of occlusion as well as an intrusive force.
Since the line of action of the headgear is below the center of
resistance, it will already produce a positive moment and an extrusive
force.
When both the force systems are combined, the resultant force is a
very large positive moment, a distal force and an extrusive force.
Outerbow is shorter or longer than inner bow:
When the outer bow is very short, there is a greater tendency to
steepen the occlusal plane, making the straps engaged, that is, the pull
of the headgear is further forward from the center of resistance,
making the positive moment greater.
If the outerbow is longer, there is a tendency to flatten the occlusal
plane.

(Picture showing angulation outerbow from its orginal position; high

pull: 60 degree; cervical pull: 15 degree downwards)
High pull headgear:
The occipital headgear has different designs to the harness
1. One that goes around the ears. The headgear straps are arranged
in a particular manners that the pull of the elastic straps is
parellal to the plane of occlusion .
2. High occipital: easiest and most effective for deep bite
corrections. Usually positioned on the crown of the head and
extended to the outerbow hooks- a shorter outer bow that lies
anterior to the center of resistance.
3. True occipital:
a. Occipital type: this harness is placed around the ear and
can be fabricated such that the pull of the elastic straps is
parellal to the plane of occlusion.
b. Interlandi type: it consists of an occipitocervical
combination strap along with a small C shaped with
notches. The level of force is determined by which of the
notches is used to connect the elastic to the outer bow.
c. Combee type: they have both occipital and cervical
traction springs.
THE BIOMECHANICS OF HIGH PULL HEADGEAR:
Incase of distal traction:
A distal force straight through the center of resistance

Negating the side effects of intrusion of anterior segment:

The undesirable side effects of eruption and rotation of upper buccal

segments is prevented by giving an upper and backward force anterior
to the center of resistance of the buccal segments. This is done using a
short outer bow bent up or a longer bow bent down and occipital pull.

Shorter the outer bow, greater the negative moment

Force posterior to the center of resistance:

This type of headgear will steepen the plane of occlusion. The outer
bow is made to lie distal to the center of resistance.
The main difference between this and a cervical head gear is the
intrusive type of force to upper jaw. A positive rotation of the upper
jaw is indicated in open bite cases woth intrusion of upper molars and
eruption of anterior segment.

DETERMINING THE TYPE OF HEADGEAR FOR

TREATMENT:
1. The anchorage requirements, vertically and horizontally,
determine the kind of headgear, treatment plan tracing and
occlusogram tracing should show treatment objectives.

2. Occlusal plane requirements:

Extrusion of teeth and Cervical gear: OB even or low

steepening of OP
Extrusion of teeth and Cervical gear: OB very high
flattening of OP
Intrusion of teeth and Occipital gear: OB post center of
steepening of OP resistance
Intrusion of teeth and Occipital gear: OB ant to Cres
flattening of OP
Distal force and flattening Combee gear: OB above Cres
of OP
Distal force and steepening Combee gear: OB below Cres
of OP
Distal force and no change Combee gear: OB through Cres
of OP

3.Time requirements :

Non extraction, class II, forward 24h/day

growth rotation
Holding anchorage in Group A arch 18-20h/day

Precautionary Night

References:
 Contemporary orthodontics, 6th edition; Profitt
 Biomechanics in orthodontics ; Marcotte
 Biomechanics in clinical considerations; Burstone
 Theoretical Considerations of Headgear Therapy: A Literature Review 2.
Clinical response and usage; D. E. J. Bowden M.D.S., F.D.S.(Ed.),
D.D.O.R.C.P.S.
 Dental and orthopaedic effects of high-pull headgear in treatment of Class
II, Division I malocclusion, Maurice Firouz, DDS," Joseph Zernik, BDS,
PhD, b and Ravindra Nanda, BDS, MDS, PhD, c