HEADGEARS

 INTRODUCTION
 HISTORY
 TYPES
 BASIC DESIGN

CONTENTS  PRINCIPLES OF FORCE APPLICATION

 BIOMECHANICS
 TREATMENT EFFECTS
 CEPHALOMETRIC GUIDELINES
 TIMING OF TREATMENT
 SELECTION OF HEADGEAR
 CLINICAL STEPS
 RETENTION
 COMPARISON WITH FUNCTIONAL APPLIANCES
 COMPLICATIONS AND SAFETY MEASURES
 INSTRUCTIONS TO PATIENTS
 CONCLUSION
 REFERENCES
 “
INTRODUCTION
A CLASS OF APPLIANCES CHARACTERISED BY THE EXTRAORAL
POSITIONS OF ACTIVATING ELEMENTS AND SUPPORTING
STRUCTURE AND HAVING REMOTELY LOCATED RESPONSIVE
FORCE
 HISTORY
KINGSLEY 1866

EDWARD H ANGLE 1888

CALVIN CASE 1907

ALBIN OPPENHEIM 1911- center of rotation of a tooth as the

point around which a tooth would rotate when a force was
applied to the crown. Oppenheim also recognised that if a force
could be arranged so that it passed through the center of rotation
then a tooth, such as a molar would move bodily

OPPENHEIM 1936
HISTORY

SILAS KLOEHN AFTER

WORLD WAR II
INTRODUCED THE
CERVICAL HEADGEAR
 GRABER - 1955 - “EXTRA ORAL FORCE – FACTS & FALLACIES”

1) There is no evidence that maxillary growth , per se is affected.

2) Bodily distal movement of molars can be accomplished, but in most cases it is
merely restrained from coming forward in its normal path or tipped distally.
3) It is possible to impact 2nd molars temporarily by excessive distal tipping of first
molars.
 TYPES OF HEADGEARS

ACCORDING TO THE MEANS OF ATTACHMENT TO TEETH

• USING FACEBOW

• USING J HOOK
 ACCORDING TO FORCE ELEMENT

• ELASTIC STRAP OR ELASTIC BANDS

• SPRING LOADED
ACCORDING TO DIRECTION OF PULL
APPLIANCE DESIGN- BASIC ELEMENTS

Force delivering unit i.e. Force generating unit

Face bow, 'J' hooks. i.e. Elastics, Springs.

Anchor Unit i.e. Head

cap, Neck pad
 FORCE DELIVERING UNIT

A. OUTER FACE BOW/

WHISKER BOW
C

B. INNER BOW
A
B
C. JUNCTION OR
JOINT
 OUTER FACE BOW

SHORT
MEDIUM
LONG
INNER BOW
J HOOK
 Springs : Calibrated tension springs are available.
• These have the advantage that the applied force can be varied.
 Elastics : Serve as force elements
 Safety pads : for elastic bands
 Friction Release Systems : They provide case of assembly and include an inner
steel coil to provide a consistent traction force.

MISCELLANEOUS COMPONENTS
HEADGEARS CERVICAL PULL HEADGEAR
TYPES OF

 Dr. Silas J. Kloehn first described it on 1947.

 It is also known as the Kloehn Headgear.
 This was to become the most widely used form of an extraoral traction appliance to be used in
contemporary orthodontics.
 HIGH PULL HEADGEAR

 TREATMENT EFFECTS OF THE HIGH-PULL HEADGEAR include intrusion and distalization of maxillary models, Anti-
clockwise mandibular rotation, decreased lower facial height, retrusion of incisors etc.
 COMBINATION FACEBOW

 Advocated by Armstrong (1971) and Berman (1976)

 J-HOOK HEADGEAR

 Armstrong (1971) , Hickham (1974) and Vaden et al (1986) have used 4 J hooks with the interlandii headgear to
simultaneously retract maxillary & mandibular canines.
 Hickham (1974) also suggested use of diagonally set J hooks for reciprocal correction of maxillary & mandibular
centre lines.
 In Tweed-Merrifield non extraction treatment, Jhook headgear is also attached to mandibular anterior teeth to
prevent mandibular incisor proclination during the resolution of lower incisor crowding and the preparation of
mandibular anchorage.
 ASHER FACE BOW

 Demonstrated by Roth
 Advantages: – Comfortable to wear. – Conserves anchorage – Simultaneous retraction of both arches. Helps in
intrusion of incisors
 DISTALIZING PLATE OF MARGOLIS &
CETLIN

 Commonly called as ACCO appliance.

 AC – Acrylic
 CO – Cervical Occipital Anchorage.
 HEADGEAR WITH
ACTIVATOR

 Reported by Stockli + Teuscher (1964) wherein a cervical HG was attached to upper molars.
 Pfeiffer attached the HG directly to the activator and applied occipital traction to achieve better vertical and rotational
control during Class II treatment.
 Bass modified the appliance and used a 'J' hook headgear
ASYMMETRIC/UNILATERAL HEADGEARS
BIOMECHANICS
PRINCIPLES OF ORTHODONTIC TOOTH
MOVEMENT

FORCE

CENTER OF RESISTANCE

CENTER OF RESISTANCE OF MAXILLA

CENTER OF ROTATION

MOMENT
 FORCE

 Clinically, the determination of horizontal , vertical and transverse components of a force

improves the understanding of the direction of tooth movement that might be expected.
 RESOLVING A FORCE INTO COMPONENTS

 It is often useful to divide a single force into components at right angles to each
other.
 Usually, the objective is to determine how much force is being delivered
perpendicular and parallel to the
• Occlusal plane
• Frankfort horizontal
• The long axis of the tooth
 CENTER OF RESISTANCE

 A free body can be considered to have a single point within it where all of its mass is centered.
 Single tooth, units of teeth, complete dental arches and the jaws themselves each have center of
resistance.
 In other words the center of resistance is the point on the body where a single force would
produce translation i.e ., all points moving in parallel, straight lines
 LOCATION OF CENTER OF RESISTANCE

Maxillary dental arch

• Between the roots of 1st & 2nd premolars.
Maxilla/Nasomaxillary complex
• Nanda & Goldin (1980) reported it to be in central part of zygoma
• According to Billet et al (2001) it is same as maxillary arch.
• Tanne et al (1995) – At pterygo-maxillary fissure.
For maxillary incisors
• According to Melsen et al(1990) it is within roots of central & lateral incisors.
• Pedersen et al (1991) & Vanden et al (1986) reported it to be more distally.
Maxillary six anterior teeth
• Melsen et al(1990) estimated it to be in centroid of triangle linking centers of resistance of central,
lateral incisors & canines.
• Vanden et al (1986) reported it to be distal to 2nd premolar root.
• Pedersen et al (1991) – Between canine & 1st premolar roots.
Maxillary first molar
• Situated at trifurcation of the roots.
• Worms et al(1973) reported that distalization of maxillary first molars led to occlusal & distal movement
of erupting 2nd molars .
• Due to resistance offered by erupting 2nd molars, centre of resistance of 1st molars move from root
trifurcation towards crown

LOCATION OF CENTER OF RESISTANCE

 CENTER OF RESISTANCE OF MAXILLA

 Miki (1979) , 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 the
lower margin of orbitale and and the distal apex of the first molar
vertically in the sagittal plane.
 Lee (1997) determined the Cres of the maxilla using holographic
inferometry. They found that the Cres of the maxilla was located at
the distal contacts of the maxillary first molars, one half the distance
from the functional occlusal plane to the inferior border orbit.
 CENTER OF ROTATION

 When a force is applied to a tooth and its line of action does not pass through center of rotation,
then tipping will occur around a center of rotation which may be located anywhere between the
center of resistance of the tooth and infinity
 MOMENT OF FORCE

 Awareness of moment of force is required to develop effective and efficient appliance designs.
 Two variables determine the moment of force
the magnitude of the force
the distance.
 Either one can be manipulated by the clinician to achieve the desired force systems.
 MOMENT OF A COUPLE

 This is another method of achieving rotational movements.

 A couple is two parallel forces of equal magnitude acting in opposite directions and separated by
a distance.
 BIOMECHANICS OF HEADGEAR

 In 1971 Armstrong demonstrated the importance of the precise control of magnitude, direction,
and duration of extraoral force to increase its efficiency and effectiveness in treating
malocclusions in the late mixed dentition.
 Gould has shown how changes in the inclination of the facebow affect the direction of the force
and ultimately the direction of tooth movement.
EFFECTS OF VARIOUS
HEADGEARS
 CERVICAL PULL HEADGEAR

 The cervical headgear is applied in early treatment of Class II malocclusion to inhibit forward
displacement of the maxilla or maxillary teeth, while the rest of the dentofacial structures
continue their normal growth.
 The main disadvantage to the use of the cervical headgear is that it normally will cause extrusion
of the upper molars.
 This movement is seldom desirable except in treatment of patients with short lower facial
heights.
outer bow is short -- steepen the occlusal plane
outer bow is long -- flatten the occlusal plane
 HIGH PULL HEADGEAR

This style headgear always produces an intrusive and posterior direction of pull, due to the position
of the headcap.
 COMBINATION HEADGEAR

• This style headgear is a combination of the high-pull

and cervical headgear, with the advantage of
increased versatility.
• Depending on the force system desired, the
orthodontist has the opportunity to change the
location of the LFO.
 VERTICAL PULL HEADGEAR

The main purpose of this

headgear is to produce an
intrusive direction of force
to maxillary teeth, with
posteriorly directed
forces.
 ASYMMETRIC HEADGEAR

If buccal occlusion is
asymmetric e.g. Class I on one
side and class II on the other
side, without asymmetries
either in molar axial
inclinations or in rotations
 CEPHALOMETRIC GUIDELINES FOR HEADGEAR TREATMENT

Direction of growth
 Broad mandibular base and ascending ramus together with a very marked, thick symphysis
suggest a change in direction toward horizontal growth.
 Narrow mandible and thin symphysis – vertical growth.
Growth potential
 If the mandible is too small in class II in a growing individual, growth may be expected to be quite
considerable.
 A well developed mandible in a posterior position must be considered to offer poor prospects
for successful correction of class II malocclusion, except in cases with translation.
 TIMING OF HEADGEAR TREATMENT

 The most optimum treatment time is between maturational stages SMI 4 to 7, a very high
velocity period of growth.
 The next most desirable time to treat is during the accelerating velocity period between stages
SMI 1 to 3 the least desirable time is during the decelerating velocity period between
maturational stages SMI 8 to 11.
 SELECTION OF HEADGEAR TYPE

 If the Sn –mp angle is 35 degrees or less; class II skeletal patterns can be treated with a cervical
facebow.
 If the sn-mp angle is 36 _41 degrees; vertical dimension is best treated with the use of
combination head gear (occipital and cervical straps).
 If the sn-mp angle is 42 degrees or greater; we need to prevent further vertical growth of the
maxilla .A high pull face bow is described for the patient with high angle skeletal class II.
 CLINICAL STEPS
Braun et al, 1999
• Holding amalgam plugger in the maxillary vestibular region while
the teeth are in occlusion and soft tissues and lips are relaxed.
 Then facing buccally amalgam plugger is positioned at one half
of the distance from inferior border of the orbit to the
functional occlusal plane and corresponding to the distal
contact of maxillary first molar.
• A mark is made on the skin and checked for asymmetry.
• Force measured with the help of Dontrix gauge or Corex Gauge
• Maximum of 450 gm each side
RETENTION FOLLOWING HEADGEAR TREATMENT

• For patients treated with headgear, the headgear itself may be the best

form of retention until such time that fixed appliances can be used.
• An appliance routinely used to hold the retracted maxillary molars is the
Nance holding
• A modified Nance holding appliance, the vertical holding appliance (VHA),
may be more successful in such instances since the force exerted by the
tongue is vertical and directed to the posterior.
COMPARISON WITH FUNCTIONAL APPLIANCES AND RELATED CONTROVERSIES

 Stephen D. Keeling. Anteroposterior skeletal and dental changes after early Class II
treatment with bionators and headgear (Am J Orthod Dentofacial Orthop 1998).
 J. Ghafari,F. S. Shofer, U. Jacobsson Hunt, D. L. Markowitz, and L. L. Laster. Headgear
versus function regulator in the early treatment of Class II, Division 1 malocclusion: A
randomized clinical trial. (Am J Orthod Dentofacial Orthop 1998)
 Tulloch JF, Proffit WR, Phillips C. Outcomes in a 2-phase randomized clinical trial of early
Class II treatment. (Am J Orthod Dentofacial Orthop. 2004)
 Although skeletal change without dental movement is usually desired when using the
headgear for orthopedic purposes, it is not possible for a tooth-borne appliance to
selectively alter skeletal relationships without dental change
COMPLICATIONS

Damage to
Teeth
Oral mucosa
Soft tissues of face
Eyes
Pressure alopecia
 COMPLICATIONS

OCULAR INJURIES
Seel 1980
Booth-Mason and Birnie, 1988
Bery, 1992
Chouraqui and Aouizerate, 1990
De Leo and Bertele, 1992
 COMPLICATIONS
DISCOMFORT DURING WEAR
Marzo et al, 2016- european journal of paediatric dentistry
 COMPLICATIONS
PRESSURE INDUCED ALOPECIA
Sridhar Premkumar, 2013 – The journal of contemporary dental
practice
 COMPLICATIONS
PRESSURE INDUCED ALOPECIA
Rosalia Leonardi, 2008 - American Journal of Orthodontics and
Dentofacial Orthopedics
 SAFETY MEASURES
SAFETY KLOEHN BOW WITH
SAFETY KLOEHN NITOMLOOP LOCKING SYSTEM
BOW

PLASTIC COATED SAMUEL’S

FACEBOW LOCKING
 INSTRUCTIONS TO PATIENT
 Patients should be advised never to wear their headgear during playful activity.
 Should another individual grab their facebow, the patient should also take hold of it until the other person has released their
hold. They should then dismantle the headcap and/or neckstrap, and facebow to check that nothing has been broken.
 Always fit the locking facebow first. Once the facebow is in position then the self-releasing headcap/neckstrap may be fitted,
whilst holding on to the facebow, to the prescribed tension .
 If the head cap/neck strap /facebow ever comes off at night or there are any other problems, the patient should stop wearing
the appliance, and return to see the clinician as soon as possible.
 If the patient experiences a problem unlocking or removing the face bow, excessive force should not be used to remove it.
 Before removing the facebow the patient must first remove the head cap/neck strap.
 The patient and parent should also be advised that, if in the rare and unlikely event, they suspect that part of the head
cap/neck strap/face bow might have caused injury to the eye, then the eye should be examined without delay.
CONCLUSION
THANK YOU
 REFERENCES

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