This document provides information on headgear used in orthodontic treatment. It discusses the mechanism of action, classification, components, uses, factors influencing effectiveness, and problems associated with headgear use. It also outlines instructions that should be provided to patients wearing headgear for orthodontic treatment.

1. HEADGEAR
RESOURCE FACULTIES
DR PRABHAT RANJAN
POKHAREL
ASSOCIATED PROFESSOR
DR RAJESH GYAWALI
ASSISTANT PROFESSOR
DR JAMAL GIRI
ASSISTANT PROFESSOR
DEPARTMENT OF
ORTHODONTICS
PRESENTED BY
SANTOSH PANDIT
ROLL NO:502
BATCH 2011
bless288maniac@gmail.com

2. CONTENTS
• INTRODUCTION
• MECHANISM OF ACTION
• CLASSIFICATION
• COMPONENTS
• USES
• FACTORS INFLUENCING EFFECT
• PROBLEMS WITH HEAD GEAR
• INSTRUCTIONS

3. INTRODUCTION
Introduced in late 1800s
Abandoned as it was thought that intra- oral
elastics would be as effective
Reintroduced in 1940s after cephalometric
developed
Means of applying posterior directed forces to
teeth and skeletal structures from an extra oral
source

4. MECHANISM OF ACTION
Growth modification by
changing the pattern of bone
apposition at the sutures
CL II correction is obtained as
the mandible grows forward
normally while maxillary
growth is restrained
Favorable mandibular growth
is a must for CL II correction
with HG use

5. Force is generated by head
cap or neck strap through ;
a)springs
b)Elastic bands

6. Force is delivered to the
teeth by ;
a)Face bow
b)J Hooks

7. CLASSIFICATION
Distalising HG: direction of elastic traction has a distal component
Types : Occipital directed ( high) pull
Combination pull
Cervical directed (low) pull
Asymmetric HG
Vertical pull HG

8. OCCIPITAL(HIGH PULL)HEADGEAR
DERIVES ANCHORAGE FROM BACK OF HEAD
PRODUCE DISTAL AND SUPERIORLY DIRECTED
FORCE ON MAXILLA AND ITS DENTITION
PRODUCE MORE VERTICALLY DIRECTED FORCE SO
USED IN INDIVIDUAL IN WHOM AN INCRESE IN
VERTICAL DIMENSION IS TO BE AVOIDED
INDICATED IN LONG FACE CLASS II PATIENT WITH
TENDENCY OF OPEN BITE

9. HIGH PULL HEADGEAR

10. COMBINATION(STRAIGHT PULL)HEAD GEAR
OCCIPITAL AND CERVICAL ANCHORAGE IS
COMBINED
WHEN FORCE EXERTED ARE EQUAL DISTAL
AND SLIGHT UPWARD FORCE IS EXERTED
ON MAXILLA AND ITS DENTITION
FORCE DIRECTION CAN BE ALTERED BY
ALTERING FORCE DERIVED FROM HEAD
CAP AND NECK STRAP

11. COMBINATION PULL HEADGEAR

12. CERVICAL(LOW
PULL)HEADGEAR
DERIVES ANCHORAGE FROM
NAPE OF NECK
CAUSE EXTRUSION OF MAXILLARY
MOLAR LEADING TO INCREASE IN
LOWER FACIAL HEIGHT
INDICATED IN LOWER
MANDIBULAR ANGLE

13. LOW PULL HEADGEAR

14. ASYMMETRICAL
HEADGEARS
USED WHEN DIFFERENTIAL ANCHORAGE IS
REQUIRED ON BOTH SIDE OF MAXILLARY
ARCH
DIFFERENTIAL VALUE ARE PRODUCED BY
ALTERING LENGTH OF OUTER BOW AND
ANGLE BETWEEN AOTER AND INNER BOW
EG:USED IN CLASS II IN ONE SIDE AND
CLASS II ON OTHER SIDE

16. VERTICAL PULL
HEADGEAR
DERIVES ANCHORAGE FROM PARIETAL
REGION
PRODUCE VERTICALLY DIRECTED FORCE
ON MAXILLA AND ITS DENTITION
USED TO PRODUCE INTRUSIVE FORCE
ON ANTERIOR REGION OF MAXILLA
USED TO TREAT VERTICAL MAXILLARY
EXCESS AND GUMMY SMILE

17. COMPONENTS
FACE BOW
THE FORCE ELEMENT
THE HEAD CAP OR
CERVICAL STRAP

18. FACE BOW
TWO
TYPES
• HAS METALLIC COMPONENT IN TRANSMITTING
EXTRAORAL FORCE ONTO POSTERIOR TEETH
• CONSISTS-
• OUTER BOW
• INNER BOW
• JUNCTION
A)INNER-
OUTER
BOW TYPE

19. OUTER BOW AND
ITS TYPES
SHORT
OUTER
BOW IS
LESSER IN
LENGTH
THAN
INNER BOW
MEDIUM
OUTER
BOW
LENGTH IS
EQUAL TO
INNER BOW
LONG
OUTER
BOW IS
LONGER
THAN
INNER BOW

20. J HOOK TYPE OF FACE
BOW
CONSISTS OF TWO 0.072 INCH
CURVED WIRES WHOSE ENDS
FORM HOOKS
NORMAL SITE OF ATTACHMENT IS
BETWEEN THE LATERAL INCISOR
AND CANINE
USED FOR RETRACTION OF
MAXILLARY ANTERIORS AND HAVE
LIMITED ORTHOPEDIC INDCATIONS

21. FORCE ELEMENT
PROVIDES FORCE TO
BRING ABOUT
DESIRED EFFECT
COMPRISE-
SPRINGS,ELASTICS
AND OTHER
STRETCHABLE
MATERIALS
CONNECTS FACE
BOW TO THE HEAD
CAP OR NECK STRAP

22. HEAD CAP OR
CERVICAL STRAP
TAKES ANCHORAGE FROM RIGID
BONES OF SKULL OR FROM BACK OF
THE NECK BY MEANS OF HEAD CAP
OR NECK STRAP OR COMBINATION
SELECTION DEPENDS ON
INDIVIDUAL PATIENTS NEEDS

23. USES-DENTAL
Anchorage
Distalisation – single or blocks of teeth
Intrusion -- single or blocks of teeth
Extrusion
Asymmetric movement

24. USES-SKELETAL
growth modification
maxilla --- suppression which is permanent even after
treatment has ceased
mandible --- suppression, retrusion of the chin during chin
cap treatment.however catch-up mandibular growth may
occur during or after pubertal growth period

25. Factors
influencing effect
Direction of force
Duration of force
Magnitude of force
Centers of rotation

26. Duration and
magnitude of force
Orthopedic effect
Principle: higher forces for comparatively
smaller duration
12 ---16 oz or 350-----450 gm / side
10 ---12 hrs

27. Duration and
magnitude of
force
Tooth movement
Principle : smaller forces for longer duration
100 --- 200 gm / side
14 --- 16 hrs
Anchorage
250 --- 300 gm / side
10 hrs min

28. Magnitude of force is
determined by a Strain-
gauge
Spring loaded assembly
comes with a built-in
force indicator

29. FORCE
MEASURING
DEVICE

30. Centers of rotation
Single rooted teeth -----
centroid
6_ ----- trifurcation
Maxilla ----- b/w roots of
4&5

31. Resolution of
forces:horizontall
y
Force through center of resistance
----- bodily movement
Force above center of resistance --
--- distal root tipping
Force below center of resistance --
--- mesial root tipping

32. Resolution of forces:
Vertically
Above occlusal plane
----- intrudes teeth
Below occlusal plane -
---- extrudes teeth

33. Problems with HG
Tooth- related
Unwanted tooth movement
Tipping
Extrusion of 6_ may cause clockwise
rotation of mand. Pt. Becomes more CLII
Buccal rolling of 6_ with high pull HG

34. Cross bite on side of movement with
asymmetric HG
Lingual tipping of lower incisors,
clockwise rotation of mand. & increased
LAFH with chin cup therapy
Root resorption possibly with J hook HG

35. Problems with HG
Patient related
Co-operation
biological variability
growth may be unfavorable
Extra / intra-oral injuries
Pain
Difficulty with insertion

36. Assessment of patient compliance at
every visit
Check for signs of use intra orally as well
as extra orally
Hand out Time-sheets for record of wear
Offer reward

37. Extra oral injuries include injuries to eyes
, eyelids, nose etc.
Most common are eye injuries
Catapult type of injury very common
while playing
Disengagement of face bow during sleep

38. Safety
No single safety HG is best
Should use safety face bow and release mechanism
together
Written instructions must be given to patient
Risks involved should be explained
told to seek medical advice if any problem arises

39. INSTRUCTIONS
Wear HG a minimum of 12-14 hours every day. HG
does not have to be worn a consecutive 14 hours. It
can be worn a minimum of 1 hour at a time, as long
at it equals 12-14 per day.
Do not wear HG during rough play or sports. This
could result in injury to you.
Some temporary discomfort may be experienced
during the first night or two. Molar teeth may
become tender and even a little loose. This is
normal

40. When not wearing your HG, please keep
it in the case . If the facebow of your HG
becomes lost or bent,contact dentist.
Never try to pull the HG off without first
un-hooking the safety strap.
Please place and remove the HG the same
way advised

41. DON’T SIT AROUND MOPING AN
WAITING
FOR YOUR LUCK TO COME BACK
GO OUT AND FIGHT FOR
IT
IT WILL SOON BE BACK