The headgear

THE HEADGEAR
www.indiandentalacademy.com

CONTENTS
 INTRODUCTION
 HISTORY
 TYPES OF HEADGEAR
 USES OF HEADGEAR
 HEADGEAR ASSEMBLY
 SELECTION OF CASES
 CLINICAL PROCEDURES
 BIOMECHANICS & FORCE PRESCRIPTION
 HEAD GEARS IN COMBINATION THERAPY
 CONCLUSION

HISTORY
Kingsley – late 1800’s

HISTORY Ball joint
Angle’s E- arch appliance, Early-1900’swww.indiandentalacademy.com

EFFECT OF CLASS II ELASTICS

HISTORY
Silas Kloehn, after World War II

PRESENT DAY

HEADGEAR ASSEMBLY
Head cap
Cervical strap
Face bow components
Outer bow (.051” or .062”)
Inner bow (.045” or .052”)
Molar bands and headgear tubes
Force element

HEAD CAP

NECK STRAP

MOLAR BAND

MOLAR TUBE -OCCLUSAL

MOLAR TUBE GINGIVAL

TRACTION RELEASE FORCE
MODULES

TYPE OF OUTER BOW

FACE BOW JUNCTIONS (Dougherty and
Beazley AJO, Nov 1976)
Brazed / soldered joints

FACE BOW JUNCTIONS
Parallel pin-and-tube
attachment

FACE BOW JUNCTIONS
Tongue- and-groove
attachment

FACE BOW JUNCTIONS
Key-and-slot
design

MODE OF ATTACHMENT TO
DENTITION
 Headgear tubes on 1st
molars
 Maxillary splint
 Functional appliance
 J- hooks attached to archwire

INDICATIONS
 Growing individuals
 Class II Div 1 malocclusion

TYPES OF HEADGEAR
 Occipital / High pull head gear
 Cervical / Low pull head gear
 Vertical pull headgear
 Combined Occipital & Cervical / Straight pull
headgear
 Interlandi / Variable pull headgear

KLOHEN FACEBOW

RAMPTON FACE BOW

ROOT HIGH PULL FACE BOW

Occipital / High pull headgear

Cervical / Low pull Headgear

Combination / Straight pull

Vertical pull headgear

Interlandi / Variable pull headgear

HIGH PULL HEADGEAR WITH J HOOK
J

HORIZONTAL PULL HEADGEAR

 PROTACTION HEAD GEAR
 REVERSE PULL HEAD GEAR- FOR
TREATMENT OF CLASS III

ASSYMETRIC HEAD GEAR

TYPES OF FACE BOWS (Hershey,
AJO-DO Mar 1981)
 Bilaterally symmetrical face bow
 Power-arm unilateral face bow
 Soldered offset or fixed union unilateral face
bow
 Swivel offset or swivel union unilateral face
bow
 Spring attachment unilateral face bow

BILATERALLY SYMMETRICAL
FACE BOW

POWER-ARM UNILATERAL FACE
BOW

SOLDERED OFFSET OR FIXED
UNION UNILATERAL FACE BOW

SWIVEL OFFSET OR SWIVEL UNION
UNILATERAL FACE BOW

SPRING ATTACHMENT UNILATERAL
FACE BOW

USES OF HEADGEAR
Growth modification
Anchorage augmentation
Space maintenance
Molar distalization

APPLICATIONS OF HEADGEAR
 ORTHOPAEDIC
 Restriction of maxilla
 Distalization of maxilla
 Intrusion of maxilla

GROWTH MODIFICATION
 TREATMENT OF CLASS II
 RANDOMISED CLINICAL TRIALS OF 1990s
DATA Shows that functional appliance and
headgear both shows small but significant
improvement in jaw relationship than controls
Similar decrease in ANB

 IN Case of 2 phase treatment headgear is
compatible with fixed appliance

SHORT FACE (SKELETAL DEEP BITE )
CLASS II
 The additional goals are
-block eruption of incisor teeth
-control eruption of upper posterior teeth
-facilitate eruption of lower posterior teeth
This pattern of change is produced most
effectively with a functional appliance

 Cervical headgear are used in deep bite
cases ,it differentially allow eruption of upper
first molar rather than lower
 Activator and bionator are useful in such
type of cases
 Fixed functional appliance of the Herbst type
tend to depress upper molars ,usually they
are not recommended for short face patients

Class II CHILDEREN WITH NORMAL
FACE HIEGHT
 Either headgear or any type of functional
appliance is acceptable
 Straight pull or high pull headgear is
preffered over cervical headgear ,to reduce
elongation of maxillary molars and better
control of mandibular plane

 Functional appliance that minimize tooth
movement are preffered to obtain maximum
skeletal effect

Long face (skeletal open bite class II)
 Major diagonostic criteria
- Short ramus
- Rotation of the palatal plane up posteriorly
- Excessive maxillary posterior growth than
anteriorly
- Downward and backward rotation of
mandible
- Excessive eruption of maxillary and
mandibular teeth www.indiandentalacademy.com

 Keys to successful growth modification would
be restraining vertical development and
encouraging anterioposterior mandibular
growth,while controlling eruption of teeth in
both jaw

HIERECHERY OF EFFECTIVENESS IN
LONG FACE CLASS II TREATMENT
 HP headgear to functional bite blocks
 Bite blocks on functional appliance
 High pull headgear to maxillary splint
 High pull headgear to molars

HIGHPULL TO
M.I.S

EFFECT ON MAXILLA
 It should be worn 12-14 hrs day
 Current recommendation of force -12-16
ounce side (350-450gm side day

Force prescription
 Force of 500 -1000 gm total
 Force direction slightly above the occlusal p
lane –through the centre of resistance of
molar teeth
 Force duration – at least 12 hours from early
evening until next morning
 Typical treatment duration -12 -18 months

Correction of molar relationship
 To change end –to – end molar relation to
class I
 More the child wear the headgear is better
 14- 16 hrs day
 100 gm side
 Tooth movement 1mm month
 3 mm movement in 3 months

For anchorage reinforcement
 Ratio of pdl between anchorage unit and
tooth moving unit is
2:1 without friction
4:1 with friction
Head gear apply backward force on upper arch
The reaction force is disspiated against the
bones of cranial vault
Problem
– intermittent force

 ANCHORAGE AUGMENTATION (with intraoral
mechanics)
Closure of 1st
premolar Xn
space

By pass arch for levelling by intrusion
 High pull headgear to the upper molars can
be added with any of bypass arch systems to
improve upper posterior anchorage

Canine retraction
 Avoid strain on posterior teeth
 Disadvantage-
heavy and intermittent force
more friction may cause assymetric
response

 CAN BE USED FOR DISTALIZATION OF
FIRST MOLAR AFTER SECOND MOLAR
EXTRACTION
 STRAIGHT PULL OR HIGH PULL
HEADGEAR IS INDICATED
 FORCE -300 gm side

Retention after class II MOLAR
CORRECTION
 OVER CORRECTION OF OCCLUSAL
RELATIONSHIP
 CONTINUE NIGHT TIME WEAR OF
HEADGEAR WITH RETAINER
 USE OF ACTIVATOR – BIONATOR TYPE
OF FUNCTIONAL APPLIANCE

 TOOTH MOVEMENTS
 Molar distalization
• Bilateral
• Unilateral
 Distal molar crown tipping
 Distal molar root tipping
 Molar intrusion
 Canine retraction
 Retraction of maxillary anteriors
 Flattening occlusal plane

 SPACE MAINTANENCE
 SPACE REGAINER

SELECTION OF CASES
 3 major decisions
 LOCATION OF THE HEADGEAR

FORCE PRESCRIPTION
 RESTRICTION OF MAXILLA
 250-500 grams/side
 Worn atleast 12 hrs/day
 Early in the evening till next morning
 12-18 monthsdepending on growth and
patient compliance

 END TO END MOLARS -> CLASS I
 100 grams/side
 Moderate intensity, longer duration
 14-16 hrs/day
 1 mm movement/month

 FIRST MOLAR DITALIZATION FOLLOWING
7 Xn
 300 grams/side
 Full time wear

 CANINE RETRACTION
 200 grams/side

HIGH PULL
Longer bow bent up or short
outer bow bent down will
produce same line of action

CERVICAL PULL

COMBI-PULL

CLINICAL PROCEDURES
 MOLAR BANDING
WITH TUBES
 PREFORMED FACE
BOWS WITH
ADJUSTMENT LOOPS
IN INNER BOW
 CHECK THE SIZE
USING PRE Rx CAST

CLINICAL PROCEDURES
 PLACE IT INTO ONE
TUBE AND EXAMINE
ITS RELATION TO
THE OTHER TUBE
 KEEP IT 3-4 mm
AWAY FROM THE
TEETH

CLINICAL PROCEDURES
 INNER BOW MUST BE
PASSIVE IN THE MOLAR
TUBE
 END SHOULD BE FLUSH
WITH TUBE OR NOT
MORE THAN 1 mm
 Jn OF I.B. & O.B. MUST
PASSIVELY REST
BETWEEN THE LIPS

 AS MANDIBULAR
ADVANCEMENT
TAKES PLACE THE
I.B. SHOULD BE
EXPANDED
 EXPANSION OF 2MM

 O.B. SHOULD BE
KEPT AWAY FROM
CHEEKS
 CUT TO PROPER
LENGTH AND HOOKS
FORMED

 SELECTION OF HEADCAP AND/OR
NECKSTRAP
 LOW FORCE LEVELS TO START WITH
 RECHECK BOW POSITION
 MAKE CHILD MANIPULATE UNDER
SUPERVISION
 PATIENT INSTRUCTIONS

BIOMECHANICS
 Definition of terms
 FORCE
A force is that which changes or tends to
change the position of rest of a body or its
uniform motion in straight line .

 CENTER OF MASS
A FREE BODY IN SPACE HAS A SINGLE
POINT WHERE ALL ITS MASS IS
CENTERED. WHEN A FORCE IS APPLIED
THROUGH THE C.O.M. IT CAUSES ALL
POINTS IN THE BODY TO MOVE THE
SAME AMOUNT IN THE SAME DIRECTION
AS THE LINE OF FORCE (TRANSLATION)

 CENTER OF RESISTANCE
THE ANALOGOUS CENTER OF MASS OF A
RESTRAINED BODY e.g. A TOOTH
SUPPORTED BY ALVEOLAR BONE IS
CALLED CENTER OF RESISTANCE.

 Or
 Is that point through which the resultant of
constraining forces acting upon it may be
considered to act
 Or a point at which resistance to movement
can be concentrated for mathematical
analysis

CENTER (C
Res) OF
RESISTANCE
OF MAXILLARY
MOLAR

CENTER OF
RESISTANCE www.indiandentalacademy.com

CENTER OR
RESISTANCE
(C Res) OF
MAXILLA

 CENTER OF ROTATION
It is an arbitary point about which a body
appears to have rotated as determined from
its initial and final position. The center of
rotation is located at variable points
depending on how far the force is applied.

MOMENT OF A FORCE
Defined as the product of force times the
perpendicular distance from the point of force
application to the center of resistance.
Tendency to rotate resulting from a force NOT
acting at the center of resistance is called
MOMENT OF A FORCE.

MOMENT = FORCE X PERENDICULAR DISTENCE

TOOTH MOVEMENTS RESULTING FROM FORCES
NOT ACTING THROUGH THE CRes IS A
COMBINATION OF ROTATION AND TRANSLATION

 COUPLE
Two non-collinear forces equal in magnitude
and opposite in direction.
Application of a couple causes pure rotation

 MOMENT OF A COUPLE
Tendency to rotate when a couple is applied.
Moment of couple= one of the forces of couple
X perendicular distance
between two parallel forces of coule

LINE OF ACTION
 Line of action of a force is that line
connecting the point of origin of force ( head
cap or neck) to the point of attachment
( hook on outer bow.
 The resultant force acting on banded molar
tooth is the relationship of line of action to
centre of resitance of tooth

 The line of action depend on the point of
attachment (hook on the outer bow)

Teeth can be moved in 3 planes
 Sagittal plane
 Coronal plane
 Transverse plane

Sagittal plane
 point of attachment (outer bow hook)can
be anywhere on the line a-p axis ,V-Vi
axis in the saggital rectangle

AP
V
V i

Shape of outer bow is of no
consequence

Point of attachment can be varied by
 Varying the length of outer bow
 Varying the angle between inner and outer
bow
 combination

Cervical headgear for bodily
movement

Location of point of attachment

Distal force component
 Distal force is maximum when line of action
is horizontal,rather than inclined, and passes
through centre of resistance.

Minimal inclined line of action

Steep line of action

Coronal plane
 The magnitude of the intrusive or extrusive
vertical component is dependent upon the
inclination or steepness of line of action
 Steeper the line of action more extrusive or
intrusive vertical component
 Horizontal forces neither extrude or intrude

 Since line of action passes bucally during
intrusion or extrusion these teeth will tend to
roll.
 Buccal crown movement during intrusion and
palatal crown movement during extrusion
 The moment or rotation effect is depend
upon molar tube height from centre of
resistence
 Soldering a palatal bar can solve this
problem www.indiandentalacademy.com

Palatal bar for bodily intrusion

Transverse plane
 Tooth can be moved distally and medially or
laterally
 expansion or contraction of inner arch of
face bow will be translate the crown of molar
medially or laterally

Lateral forces on molar during
extraoral force application
 Lateral forces in case of
symmetrical face bow

Offset joint in face bow
16 16
18 14
70

 This difference is due to flexibility of arm and
not due to offset joint
 If outer bow is rigid force will be same
 the rationale of unequal force distribution to
molars relates to the distance of outer bow to
the mid sagittal plane

Symmetrical soldered outerbow with
different arm length

 In clinical practice lengthening one arm or
bending it out will create more distal force on
that side
 A mild expansion of inner bow wil counteract
the lateral force on lengthen side

Swivel type of unilateral extraoral face
bow
 Most suitable without
any lateral force

HEADGEARS IN COMBINATION
THERAPY
 FUNCTIONAL APPLIANCE
 EXTRAORAL FORCE
 CLASS II DIV I CASES WITH
 More excessive vertical growth pattern
 Excessive lower anterior facial height

 ACTIVATOR WITH HEADGEAR
 Hasund (1969)
 Stockfisch (1977)
 Stockli (1982)
 Pfeiffer (1984)
 Grobety (1984)

PFEIFFER-GROBETY TECHNIQUE

STOCKLI-TEUSCHER APPLIANCE

HEADGEAR WITH BIONATOR

 FRANKEL APPLIANCE
WITH HEADGEAR

The headgear

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The headgear