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Introduction
In orthodontic practice ,forces employed are basically of two types
-Orthodontic force (that moves the teeth efficiently ):applied using wires
and other active components of fixed and removable or fixed appliances
Force produced by this appliances are light and range from 50-100 grams
-Forces applied to the teeth have the potential to radiate outwards and affect
the nearby skeletal structures.
-For such skeletal changes to occur, the forces employed should be over 400
grams.
-Thus the orthopedic appliances utilize the teeth as handles to transmit the
forces to the adjacent skeletal structures.
DURATION OF FORCE
A . HEAD GEAR
B . FACE MASK
C . CHIN CUP
Head gears
HEAD GEAR
HEAD GEAR
Most commonly used extra oral orthopedic appliance
Used during the growth period to intercept or correct certain skeletal
malocclusions as well as to distalize the maxillary dentition or maxilla
itself.
Also form one of the important adjuncts to control or gain anchorage.
They derive anchorage from the cervical or the cranial regions.
Inner bow is made up of 1.25mm round stainless steel wire and contoured
around the dental arch and molars .The inner bow is inserted in to the buccal
tubes fixed on the maxillary first molars. Stops are placed on the inner bow from
sliding too far through the tubes
The junction is the rigid joint of inner and outer bow it can be
a. Simple soldered
b. Wrapped soldered or
c. Welded joint
It is placed at the midline of the bows in case of symmetric forces required
it can be shifted from midline when asymmetric forces are needed
junction
-by varying the angle between the inner and outer bow
Types of headgears
Based on the site of anchorage headgears can be :
1 . Cervical headgears
2 . Occipital headgears
3 . Combination headgears
5 . Asymmetrical headgear
Cervical headgears
These headgears obtain anchorage from nape of the neck . Cervical headgears
causes extrusion of the maxillary molars leading to an increase in the lower
facial height .They also move the maxillary dentition and the maxilla in a distal
direction .These headgears are generally indicated in low mandibular angle cases ,
as in increase in lower facial height would be beneficial in such patients
consideration
Relation of line of force to the centre of resistance is to be considered as if line
of force is passing below the centre of resistance we can expect a clockwise
rotation of maxilla
Cervical pull headgear
Occipital headgears
These headgears derive anchorage from the back of the head . This type of
headgear produces a distal and superiorly directed force on the maxillary teeth
and the maxilla . These high pull Headgears produce a more vertically directed
force and there for is used in individuals in whom an increase in vertical dimension
is to be avoided . They decrease the vertical development of maxilla and there
for indicated in long face class 2 patients and in patients with open bite tendencies
Combination headgears
In this type of headgear ,occipital and cervical anchorage is combined . When the
forces exerted by both are equal , a distal and slightly upward force is exerted on
the maxillary dentition and the maxilla . By varying the proportions of the total
force derived from the head cap and the neck strap the resultant force direction
can be altered
Occipital headgear Combination headgear
Vertical pull headgear
They are headgears that derive anchorage from the
parietal region of the cranium and there for Produce
a vertically directed force on maxilla and the
maxillary dentition these headgears can be used to
produce intrusive forces on the anterior region of
the maxilla and there by producing a Counter-
clockwise movement of maxilla . This is beneficial
in the treatment of vertical maxillary excess and
gummy smiles . Intrusive forces on the posterior
aspect of maxilla can be of benefit in anterior open
bite patients as it intrude the maxillary molars and
therefore produces a clockwise movement of
maxilla
Asymmetrical headgears
They are used when differential anchorage is required on both sides of the
maxillary arch. For Example a patient with class 2 molar relation on one
side and a class 1 molar relation on the other side can be given an asymmetric
headgear . The different force values are produced by Altering the length of
outer bow on each side and by variation of the angle between the outer And inner
bows
Uses of headgears
A . Orthopaedic effect : Forces applied onto the maxilla can be used to restrict
its downward and forward Growth . The distal force in such a case should be
applied through the centre of resistance of the maxilla . The suggested range
of force is 350-450 gms on each side for a minimum of 12-14 hrs /days are
required Orthopeadic effects from extraoral forces are best tapped in pre
adolescent years
Hickham (1972) claims he was the first to use reverse headgear. However this modality
was made popular by Delaire around the same time .
A reverse pull headgear basically consists of a rigid extraoral framework , which takes
Anchorage from chin or forehead or both for the anterior traction of the maxilla using extraoral
Elastics that generate large amount of force up to 1 kg or more
Indications
1 . In a growing patient having a prognathic mandible and a retrusive maxilla . It aids in
pulling the Maxillary structures forward and pushing mandibular structures backward
2 . It can be used for bending the condylar neck for stimulating temporo-mandibular joint
adaptation to posterior displacement of chin
3 . It can also be used for selective rearrangement of the palatal shelves in cleft patients
Anchorage from chin :This type of protraction head gear is commonly used
in Britain ,chin cup with posts are employed . As the anchorage is obtained
solely from the chin ,the force is transmitted to the condylar cartilage and thereby
has a disadvantage of altering the growth of the mandible
Anchorage from chin & forehead Anchorage from forehead (skull)
Anchorage from skull :Certain form of reverse pull head gears obtain anchorage
only from forehead .The disadvantage include patient discomfort while sleeping , cost
and time required in fabrication and fixing
Anchorage from chin & forehead : This face mask makes use of anchorage from
both chin and forehead .Anchorage is spread over a larger area . Thus no excessive
force is exerted onto the growth cartilage . However the disadvantage with this
appliance are difficulty in speech and compromise in esthetics and Comfort due to
size
Biomechanical considerations
Amount of force : The amount of force required to bring about skeletal changes
is about 1 pound(or 450gms) per side
Chin cup: Most protraction headgears obtain anchorage from chin as well as the
forehead . The chin cup is used to take anchorage from the chin area . It is usually
connected to the rest of the face mask assembly by means of metal rods . The chin
cup can the ready-made or can be fabricated from an impression from the patient’s
genial region .
Forehead cap : The forehead support or cap or strap is used to derive anchorage
from the forehead
Forehead cap
Metal frame
Chin cup
Elastics : Elastic force is used to apply a forward traction on the upper arch .
Vertical posts of chin cup are used to attach the elastics on to the molars or
hooks soldered on the arch wire . This sort of traction is purely for tooth
movement
Metal frame
Elastics
Intraoral appliance
Types of reverse pull head gears
Long arm
Face mask of Delaire :this was popularized by Delaire in the 60’s and also
uses the chin and Forehead for support . The appliance is made up of a rigid
wire framework which is squarish and kept away from the face . It has a
forehead cap and a chin cup with a wire running in front of the mouth used
for elastic attachment
Forehead cap
framework
Chin cup
Petit type of face mask : this is also a modified
type of Delaire face mask. It consist of a chin
Cup and a forehead cap with a single rod
running in the midline from forehead cap to
chin cup . A cross bar at the level of the mouth
is used to engage elastics . The advantage of this
model is that the forehead cap ,chin cup and the
cross bar can be adjusted to suit the patient
Chin cup
Introduction
The chin cup or thin cap as it is sometimes referred to is an extraoral
orthopaedic device that covers The chin and is connected to a headgear .
It is used to restrict the forward and downward growth of the mandible .
The chin cup – face bow assembly consist 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
Chin cups are of two types . They are the occipital pull chin cup and the vertical
pull chin cup
Occipital pull chin cup: This type of chin cup derives anchorage from the
occipital region of the head . This is the most commonly used type of chin
cup . It is used in class 3 malocclusions associated with mild to moderate
mandibular prognathism .they are very successful in patients who can bring
their incisors close to a edge-to-edge position at centric relation . They are
also indicated in patients with slightly protrusive lower incisors as they
invariably produce lingual tipping of the lower incisors
Vertical pull chin cup : this type of chin cup derives anchorage from the parietal
region of the head . It is indicated In patients with steep mandibular plane angle and
excessive anterior facial height . These Patients usually exhibit an anterior open bite