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HEADGEARS
 CLASSIFICATION
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ACCORDING TO:
1) Origin or direction or location of the active force:

 Cervical pull
 Straight pull
 Occipital pull
 Reverse pull

2) Location of force delivery

 Maxillary arch .
 Mandibular arch
 Both
 Chin
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3) According to Marcotte, headgear classification is based on the

area of attachment 2:

 Cervical area of the neck (cervical strap)

 Occipital area of the head (occipital strap)
 The chin (chin cup)
 Frontal
 Combination of cervical & occipital (straight pull)
 Very high pull headgear (parietal).
 COMPONENTS OF HEADGEAR 3, 19
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1. The force activators

2. The anchorage force distributors ( HEAD STRAPS )
3. A face bow or a pair of ‘J’ hooks
 Two types of face bows :
 Inner & outer bow type:
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 Inner bow is available in 0.0455” (1.1mm) or 0.051” (1.3mm) inch

depending on the size of the headgear tube on first molar bands.

 Outer bow size is 0.072”.

 J-hook type: Each J hook consists of a 0.072” wire contoured so

as to fit over a small soldered stop on the archwire usually
between lateral incisors and canines;
 FACEBOWS 2,18
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 BIOMECHANICS OF HEADGEAR2, 7, 10, 20
7 The prescription in orthodontics is the force application.

The mechanical influence of the appliance produces a reaction in the

biologic system under stress, and local response can be evaluated in the
affected tissue areas and during growth period.
However, the quantity of force can be controlled and growth dynamics
may also be modified .

To effectively employ extra-oral force systems of head gear, it is

necessary to consider four essentials. They are :

 Centre of resistance and rotation

 Direction
 Force magnitude
 Duration .
A.) CENTRE OF RESISTANCE
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 Centre of resistance (COR) of a body is the point of greatest resistance,

through which the resultant of the applied forces acting upon it may be
considered to act.

 The COR is a fixed point and it can not be changed by extra-oral force
application.

 The centre of resistance of a single rooted tooth with a parabolic shape is

at a point 0.4times the distance from the alveolar crest to the apex.

 In upper first molar, the COR is at the middle third of root near the
junction of cervical third or approximately at trifurcation of roots.

 Applying a simple force, through the COR will lead to a pure

translatory (bodily) movement along the force. vector and no
rotation.
Center of resistance of maxilla:

 Miki 1979 and Hirato

1984 reported that the
location of the center of
resistance in the midface of
the human skull is between
the first and second upper
premolars
anteroposteriorly, and
between the lower margin
of orbitale and the distal
apex of the first molar
vertically in the sagittal
plane.
 B.) LINE OF ACTION OR DIRECTION
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 Line of action is usually represented by arrow and is a direction

in which the force acts. The direction of head gear force system
can be adjusted for extrusion, intrusion or distal movement.

C.) FORCE MAGNITUDE

For orthopedic correction,

Acc to Profit, lighter force i.e 250 g per side is used to
decrease the growth of maxilla.
heavier force upto 500g per side can be used. To bring
maxilla forward.

 Acc. To Graber & Swain,

Force on each side may range upto: 1400g without causing
pain.
 According to Marcotte force values of 200 gms per
side in mixed dentition and 500 gms per side in
permanent dentition
 Graber advocates force application of more than 400
gms.
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D.) DURATION

Acc to Profit,
The duration of force orthopedic correction, 12 hours/day with
emphasis on wearing from early evening to next morning.
The duration of treatment should be 12- 18 months.

Acc. To Graber & Swain,

light to moderate forces can be applied for 16-24 hrs.
heavy forces can be applied for 12-14 hrs/ day
 1. CERVICAL HEADGEAR 2, 7, 24
Introduced by Silas Kloehn, 1947.
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It consists of 3 parts:
 1) Molar bands and tubes
 2) Inner bow and outer bow soldered together near the middle
of the two bows
 3) Neck strap that is placed around the back of the neck to
provide traction to the denture.

 Effects of cervical headgear:

 To erupt the entire upper jaw
 Tends to move the upper jaw distally
 Steepen the occlusal plane.
 Expansion of the upper arch
Effect of different positions of the outer bow: when the outer
bow is bent upwards:
When the outer bow is bent downwards:
Kloehn headgear can be used to
 Distalize the entire maxillary segment

 Anchorage reinforcement

 Retraction of upper incisors

 Correction of class II molar relationship

 Correction of crossbites.

 Cervical headgear is used early in the treatment of

class II malocclusions to inhibit forward displacement of
maxilla or maxillary teeth, while rest of the dentofacial
structures continues their normal growth.
Advantages
 Direction of pull is advantageous in treatment of
short face class II maxillary protrusive cases with
low MPA and deep bites.
Disadvantages:
 It normally causes extrusion of the upper molars.
This movement is seldom desirable except in
patients with reduced lower anterior facial height. It
is contraindicated in patients with steep mandibular
planes and in open bite cases.
HIGH PULL HEADGEAR

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Occipital pull with short outer bow (force anterior to Cres)
 This results in a force system at the unit’s Cres with a moment that
tends to flatten the occlusal plane and creates distalising and
intrusive components.
Occipital pull with force passing through Cres
 In this configuration, there is no moment that is created and hence
there is no change in the cant of the occlusal plane. Intrusive and
distal components of force are produced.
Occipital pull with long outer bow( force posterior to Cres)
 The force system at the unit’s Cres has a moment that tends to
steepen the occlusal plane. Intrusive and distalising forces are
produced. This system might be required in class II open bite
patients.
Advantages:
 These headgears can be used in patients with steep

mandibular planes and in cases wherein mandibular

growth is more vertical than horizontal.
 They can also be used in certain open bite cases

caused due to excessive eruption of buccal teeth.

COMBINATION HEADGEAR:
 J’ HOOK HEADGEAR TO THE ARCH WIRES

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 This headgear consists of two separate curved hooks which

are attached directly onto the maxillary archwire in the
anterior region.
 This type of headgear is most commonly used for the
retraction of the canines and incisors rather than for
orthopedic purposes. J-hook HG is limited in use only with a
maxillary fixed appliance and a continuous arch wire.
 It is preferable if all the teeth are included in the archwire.
The intraoral point of attachment is directly to the maxillary
archwire, distal to the lateral incisors.
 This HG is mainly used to retract and intrude the maxillary
incisor teeth and to prevent or correct ‘gummy smiles’.
 DELAIRE’S FACE MASK 1, 2, 14
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 In late 1970’s Delaire showed that forward positioning of the skeletal

maxilla can be achieved.
 Anchorage sites are chin and forehead, and the appliance exerts force
on the maxilla with elastics that attach to the hooks placed near the
COR of maxilla.
Mesial force of 500 g is applied.
 By adjusting the height of outer bow, presence of the lips in
controlling the level of mesial force can be controlled.
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 Time of treatment: Best suited for 6-8 years old patients

 Ideal patients for treatment:. Normal positioned or retrusive maxillary teeth.

FACE MASK

When an anterior protractory force is required, a protraction headgear is used.

 This appliance was popularized by Delaire around 1970 and later modified
by Hickham in 1972.
 A reverse pull headgear consists of a rigid extra-oral framework which

takes anchorage from the chin or forehead or both, for the anterior traction
of the maxilla using extra oral elastics which generate large amount of force
upto 300 g of force.

 PRINCIPLE: It works on the principle of pull force on the circum-maxillary

sutures with reciprocal push force on the forehead or chin through facial
anchorage .
 BIOMECHANICAL CONSIDERATIONS 13

Force application
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 If a patient has normal overbite and normal vertical proportion,

protraction without any moment is indicated.
 If the patient has an anterior open bite, in addition to the maxillary
deficiency, a clockwise moment should be used.
 If the patient has a deep bite, a counter clockwise moment should be
chosen.
 The moment is determined by design of the headgear and the
placement of the protraction force.
 The length of the face mask should be adjusted so the chin cup and
forehead pad fit comfortably. The height of the elastic attachment bar
is then set to produce the appropriate moment on maxilla.
 CHIN CUP1, 2
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It is an extra-oral orthopedic device that covers the chin and is connected

to the headgear.
It is used to restrict the downward and forward growth of mandible.
Parts of Chin cup- Headgear assembly:
The chin cup face bow assembly consists of a chin cup that covers the
chin, a head cap and an adjustable elastic strap that connects the
chin cup with the head cap.
Types of Chin Cups:
Occipital Pull Chin Cup: It derives anchorage from occipital region of
head.
It is used in Class III malocclusions, patients who can bring their incisors
edge to edge at centric position and in patients with slightly
protrusive lower incisors.
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Vertical Pull Chin Cup: It derives anchorage from parietal region.

It is used in patients with steep mandibular plane angle and increased
anterior facial height.
These patients generally have open bite.

Force Magnitude : In the beginning, 150-300g per side.

After 2 months, 450-700g per side.

Duration of wear: 12- 14 hrs/ day.