Headgear

Editor in Chief: Berna Zorkun DMD [mailto:bernazorkun@gmail.com]

Headgear
Headgear is an appliance attached to dental braces that aid in correcting severe bite problems.

The most common treatment they are used for is correcting anteroposterior discrepancies - for instance the top teeth being too far forward relative to the lower teeth ("increased overjet".) The headgear is attached to the braces via metal hooks or a facebow and is anchored from the back of the head or neck with straps or a head-cap. Elastic bands are typically then used to apply pressure to the bow or hooks. Its purpose is to slow-down or stops the upper jaw from growing, hence preventing or correcting an overjet.

There is another type of headgear to treat reverse overjets (where the top jaw is not forward enough.) It is similar to a facemask, also attached to braces, and encourages forward growth of the upper jaw.

The headgear can also be used to make more space for teeth to come in. The headgear is then attached to the molars (via molar headgear bands & tubes), and helps to draw them backwards in the mouth, opening up space for the front teeth to be moved back using braces and bands.

Initially this can be embarrassing for children, however most doctors agree that children and adolescence adapt quickly to such changes and requirements. Parents should be aware that their child may be subject to mocking for wearing headgear although children and teenagers, friends and school peers normally get used to the new appliance after just a few weeks if full-time wear (i.e. 16 to 22 hours a day) is required. However, some orthodontists only require 12 hours per night.

They often must have multiple appliances and accessories to go along with their headgear, such as coil springs, plates or retainers and elastic bands.

The vast majority of patients receiving this type treatment are children and adolescence however adults sometimes are required to wear such appliances.

The need for headgear is a useful appliance for orthodontic specialists and it has increased somewhat as less and less orthodontists use temporary implants ("temporary anchorage devices") inside the patients mouth, to perform the same tooth movements.

Facemask
Facemask or Reverse-pull Headgear is an orthodontic appliance typically used in growing patients to correct under bites (known as a Class III orthodontic problem) by pulling forward and assisting the growth of the upper jaw (the maxillary), allowing the upper jaw (mandibular bone) to catch up.

Facemasks or Reverse-pull Headgear needs to be worn approximately 12 to 22 hrs to be truly effective in correcting the under bite, usually anywhere from 6 to 18 months depending on the severity of the bite and how much a patient is growing.

The appliance normally consists of a frame or a centre bars that are strapped to the patients head during a fitting appointment. The frame has a section which is positioned in-front of the patients mouth, which allows for the attachment of elastic or rubber bands directly into the mouth area. These elastics are then hooked onto the child's braces (brackets and bands) or appliance fitted in his or her mouth. This creates a forward 'pulling' force to pull the upper jaw forward.

Application
The orthodontic facemask will consist of three major components:


 * 1) Face frame: firstly the face-frame, is a metal and plastic structure which is adjusted to fit onto the patients face. The frame normally is stabilised on the child's face with the aid of a "chin cup" and a "forehead pad". These are padded to ensure patient comfort. The frame typically as a "mouth-yoke" which the orthodontist will adjust so it is positioned in-font of the patients mouth. The mouth yoke has a number of hooks (4 to 6 depending on type - see photo with 6 hooks) which allows the orthodontist to attach elastics or springs directly into the patients mouth. The frame allows the patient to move his or her head freely and to talk. All other oral activates are however restricted although drinking is recommended with a straw so as not to remove the whole appliance at night or in the day when thirsty.
 * 2) Head-cap: some facemasks and all reverse-pull headgear have a second part which consists of a head-cap, and is made up of a number of straps fitting around the patients head. In this case the head-cap is used to stabilise the face-frame described above and to ensure it is held correctly in position (see photo example of reverse-pull headgear with head-strap / cap).
 * 3) Attachment: the third and final component is the mouth attachment, typically using rubber bands, elastics or springs - joins the face-mask from the mouth-yoke, into the patients mouth. The elastics hook on the child's braces or other such suitable oral appliance. As the elastics are flexible up to six elastics may be used to provide various forward and sideways forces on the patients teeth and arch, while still allowing the patient to open and close his / her jaws.

In some cases it will be required to use surgery and a face-mask / reverse-pull headgear, although many parents and doctors recommend using early intervention (ages 7 to 13) using a facemask to avoid costly and painful surgical procedures later.

The appliance is very effective in correcting Class III orthodontic problems in younger or adolescent patients that are still growing however as parents, your orthodontist will provide you with all the information required for your child.

Initially it can be difficult for children to wear a mask or headgear, however most doctors and parents agree that children and adolescence adapt quickly to such changes and requirements. Parents should be aware that their child is often better-off wearing a facemask or headgear to avoid later surgery and the patient, friends and school peers normally get used to the new appliance after just a few weeks of full-time wear (i.e. 16 to 22 hours a day).