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MUHAMMAD SHARIQ SOHAIL
FINAL YEAR BDS
DEPARTMENT OF ORTHODONTICS
ZIAUDDIN UNIVERSITY
CORRECTION OF CLASS 2 SKELETAL PROBLEMS
 Orthopaedic restraint of maxillar y growth(headgear).
 Enhancement of mandibular growth in aldolescent (Functional appliance)
 Orthognathic surgery in adults.
DEFINITION:
Headgear is an extraoral orthopaedic appliance use to restrain the
downward and forward growth of maxilla.
COMPONENTS OF HEADGEAR
 Force delivering unitFacebow/J hook (they Transmit forces)
 Force Generating Unit Springs/Elastics
 Anchor Unit Headcap/ Neck Strap (they direct forces above or below occlusal
plane)
TYPES/CLASSIFICATION:
 Highpull/Occipital Headgear
 Lowpull/Cervical Headgear
 Combipull/Straight Headgear
HIGH PULL/OCCIPITAL HEADGEAR
 Headcap is attached to back of head in occipital region or junction or parietal &
occipital.
 Exerts Superior and Distal force to maxilla and maxillary dentition
 Force on maxillary molars  Distal and Intrusive.
 Line of force Pass through C.O.R Bodily movement
Pass above C.O.R Distal Root tip
Pass below C.O.ODistal Crown tip
 Outer Bow is Short and Bent Upward (superior Vector Force)
 INDICATIONS: High mandibular angle cases
Excessive vertical Maxillary Growth
Open Bite.
LOW PULL/CERVICAL HEADGEAR
 Derives its anchorage from Nape of the Neck.
 Exerts Inferior and Distal force to Maxilla.
 Force on Maxillary Molars  Distal and Extrusive.
 Line of Force Pass through C.O.R Bodily movement
Pass Above C.O.R Distal Root tip
Pass below C.O.R Distal Crown tip
 Outerbow is Long and Bent Downward (Inferior Force Vector)
 INDICATIONS: Low Madibular plane angle.
Decrease Vertical Growth
Deep bite.
COMBIPULL/STRAIGHT HEADGEAR
 It has both occipital and cervical strap.
 Exerts Distal and Slight upward Force on Maxilla and Maxillary teeth.
 INDICATIONS: In Normal/average Manibular plane angle.
Vertical Maxillary excess.
SELECTION OF HEADGEAR
It Depends upon:
 Selection of required movement bodily or tipping movement
 Headgear anchorage location  High or low angle cases.
 Headgear dentition attachment points  Tubes of maxillary molars(facebow)
Maxillary splint(on Premolar teeth)
 Functional appliance.
MAGNITUDE OF FORCE AND DURATION
1)MAGNITUDE:
a)SKELETAL: 350-450 gms/side
b)DENTAL: 100-200 gms/side (*by anchorage)
2)TYPE OF FORCE: Intermittent forces
3)DURATION OF WEAR: 12-16 hours/day
night time wear8pm-1am
(GH release high)
LIMITATIONS OF HEADGEAR USE
 Pateint compliance
 Slower tooth movement with intermittent force
 Delayed eruption of max second molars or impactions.
ENDOGENOUS FUNCTIONAL APPLIANCE EFFECT:
Mandibular growth in AP direction is necessary part of response to headgear
use.There is some evidence of increased mandibular growth during treatment
of headgear. Headgear doeas appear both maxillary and mandibular effect.
JUDGEMENT OF PATIENT(APPLIANCE WEARING OR NOT)
 Tell patient to wear appliance in front of you
 Slight mobility of first premanent molar
 Marks of appliance wear.
 Calculus deposits around appliance.
USES OF HEADGEAR
 ORTHOPAEDIC: 350-450gms/side ; 10-12 hours wear ; 12-18 months
 ANCHORAGE: Reinforcement of anchorage during fixed appliance
250-350gms/side ; 10-2 hours/day.
 DISTALIZATION OF MAX 1ST MOLAR: To correct molar relationship 300gms/side.
if unilateral class 2asymmetric headgear
 SPACE MAINTENANCE & REGAINING: space maintenanceasymmetric headgear
space regainingdur to premature loss of
decidous teeth.
 INTRUSION OF MOLARS AND INCISORS: By using High pull headgear and
Maxillary splint.
 EXPANSION OR CONTRACTION OF ARCH: By adjusting inner bow
 UPRIGHTING OF MOLARS: mesially tipped molars can be upright
After removal of headgear downward and forward rotation
of maxilla was observed. Relapse was limited to teeth and
not to nasomaxillary complex, suggesting that the skeletal
effect is permanent. Class 2 correction was maintained
through a more pronounced growth in mandible and not
necessarily from molar correction.
THANKYOU
ANY QUESTIONS???

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Extraoral orthopaedic appliance(headgear)

  • 1. MUHAMMAD SHARIQ SOHAIL FINAL YEAR BDS DEPARTMENT OF ORTHODONTICS ZIAUDDIN UNIVERSITY
  • 2. CORRECTION OF CLASS 2 SKELETAL PROBLEMS  Orthopaedic restraint of maxillar y growth(headgear).  Enhancement of mandibular growth in aldolescent (Functional appliance)  Orthognathic surgery in adults.
  • 3. DEFINITION: Headgear is an extraoral orthopaedic appliance use to restrain the downward and forward growth of maxilla.
  • 4. COMPONENTS OF HEADGEAR  Force delivering unitFacebow/J hook (they Transmit forces)  Force Generating Unit Springs/Elastics  Anchor Unit Headcap/ Neck Strap (they direct forces above or below occlusal plane)
  • 5. TYPES/CLASSIFICATION:  Highpull/Occipital Headgear  Lowpull/Cervical Headgear  Combipull/Straight Headgear
  • 6. HIGH PULL/OCCIPITAL HEADGEAR  Headcap is attached to back of head in occipital region or junction or parietal & occipital.  Exerts Superior and Distal force to maxilla and maxillary dentition  Force on maxillary molars  Distal and Intrusive.  Line of force Pass through C.O.R Bodily movement Pass above C.O.R Distal Root tip Pass below C.O.ODistal Crown tip  Outer Bow is Short and Bent Upward (superior Vector Force)  INDICATIONS: High mandibular angle cases Excessive vertical Maxillary Growth Open Bite.
  • 7. LOW PULL/CERVICAL HEADGEAR  Derives its anchorage from Nape of the Neck.  Exerts Inferior and Distal force to Maxilla.  Force on Maxillary Molars  Distal and Extrusive.  Line of Force Pass through C.O.R Bodily movement Pass Above C.O.R Distal Root tip Pass below C.O.R Distal Crown tip  Outerbow is Long and Bent Downward (Inferior Force Vector)  INDICATIONS: Low Madibular plane angle. Decrease Vertical Growth Deep bite.
  • 8. COMBIPULL/STRAIGHT HEADGEAR  It has both occipital and cervical strap.  Exerts Distal and Slight upward Force on Maxilla and Maxillary teeth.  INDICATIONS: In Normal/average Manibular plane angle. Vertical Maxillary excess.
  • 9. SELECTION OF HEADGEAR It Depends upon:  Selection of required movement bodily or tipping movement  Headgear anchorage location  High or low angle cases.  Headgear dentition attachment points  Tubes of maxillary molars(facebow) Maxillary splint(on Premolar teeth)  Functional appliance.
  • 10. MAGNITUDE OF FORCE AND DURATION 1)MAGNITUDE: a)SKELETAL: 350-450 gms/side b)DENTAL: 100-200 gms/side (*by anchorage) 2)TYPE OF FORCE: Intermittent forces 3)DURATION OF WEAR: 12-16 hours/day night time wear8pm-1am (GH release high)
  • 11. LIMITATIONS OF HEADGEAR USE  Pateint compliance  Slower tooth movement with intermittent force  Delayed eruption of max second molars or impactions.
  • 12. ENDOGENOUS FUNCTIONAL APPLIANCE EFFECT: Mandibular growth in AP direction is necessary part of response to headgear use.There is some evidence of increased mandibular growth during treatment of headgear. Headgear doeas appear both maxillary and mandibular effect.
  • 13. JUDGEMENT OF PATIENT(APPLIANCE WEARING OR NOT)  Tell patient to wear appliance in front of you  Slight mobility of first premanent molar  Marks of appliance wear.  Calculus deposits around appliance.
  • 14. USES OF HEADGEAR  ORTHOPAEDIC: 350-450gms/side ; 10-12 hours wear ; 12-18 months  ANCHORAGE: Reinforcement of anchorage during fixed appliance 250-350gms/side ; 10-2 hours/day.  DISTALIZATION OF MAX 1ST MOLAR: To correct molar relationship 300gms/side. if unilateral class 2asymmetric headgear  SPACE MAINTENANCE & REGAINING: space maintenanceasymmetric headgear space regainingdur to premature loss of decidous teeth.  INTRUSION OF MOLARS AND INCISORS: By using High pull headgear and Maxillary splint.  EXPANSION OR CONTRACTION OF ARCH: By adjusting inner bow  UPRIGHTING OF MOLARS: mesially tipped molars can be upright
  • 15. After removal of headgear downward and forward rotation of maxilla was observed. Relapse was limited to teeth and not to nasomaxillary complex, suggesting that the skeletal effect is permanent. Class 2 correction was maintained through a more pronounced growth in mandible and not necessarily from molar correction.

Editor's Notes

  1. Facebow headgear: 1)retraction of teeth 2)Restriction of mesial drift associated with growth 3)Restriction of meial drift associated with early loss of decidous teeth 4)reduction of slippage of posterior teeth in extraction 5)increase of vertical anchorage 5)restraints upperjaw 6)Reduction of teeth eruption 7)protraction of teeth
  2. Class 2 division 2 cases
  3. Timing of treatment: prealdsolesecnt: cvm 2 or 3 if maxillar cvm 3 if mandible early aldolescent: before transition complete growth leeway space: decidous molars are larger mesiodistally than permanent molars 0.5-1mm space is time poe dete headgear
  4. Rale effect: opposite to endogenous functional appliance effect.