EXTRAORAL ORTHOPAEDIC APPLIANCE(HEADGEAR)MUHAMMAD SHARIQ SOHAILFINAL YEAR BDSDEPARTMENT OF ORTHODONTICSZIAUDDIN UNIVERSITY

CORRECTION OF CLASS 2 SKELETAL PROBLEMS Orthopaedic restraint of maxillar y growth(headgear).

Enhancement of mandibular growth in aldolescent (Functional appliance)

Orthognathic surgery in adults.

DEFINITION:

Headgear is an extraoral orthopaedic appliance use to restrain the downward and forward growth of maxilla.

COMPONENTS OF HEADGEAR

Force delivering unitFacebow/J hook (they Transmit forces)

Force Generating Unit Springs/Elastics

Anchor Unit Headcap/ Neck Strap (they direct forces above or below occlusal plane)

TYPES/CLASSIFICATION:

Highpull/Occipital Headgear

Lowpull/Cervical Headgear

Combipull/Straight Headgear

HIGH PULL/OCCIPITAL HEADGEAR

Headcap is attached to back of head in occipital region or junction or parietal & occipital.

Exerts Superior and Distal force to maxilla and maxillary dentition Force on maxillary molars Distal and Intrusive. Line of force Pass through C.O.R Bodily movement

Pass above C.O.R Distal Root tip Pass below C.O.ODistal Crown tip

Outer Bow is Short and Bent Upward (superior Vector Force) INDICATIONS: High mandibular angle cases

Excessive vertical Maxillary Growth Open Bite.

LOW PULL/CERVICAL HEADGEAR

Derives its anchorage from Nape of the Neck. Exerts Inferior and Distal force to Maxilla. Force on Maxillary Molars Distal and Extrusive. Line of Force Pass through C.O.R Bodily movement

Pass Above C.O.R Distal Root tip Pass below C.O.R Distal Crown tip

Outerbow is Long and Bent Downward (Inferior Force Vector) INDICATIONS: Low Madibular plane angle.

Decrease Vertical Growth Deep bite.

COMBIPULL/STRAIGHT HEADGEAR

It has both occipital and cervical strap. Exerts Distal and Slight upward Force on Maxilla and Maxillary

teeth. INDICATIONS: In Normal/average Manibular plane angle.

Vertical Maxillary excess.

SELECTION OF HEADGEAR

It Depends upon: Selection of required movement bodily or tipping movement Headgear anchorage location High or low angle cases. Headgear dentition attachment points Tubes of maxillary

molars(facebow) Maxillary splint(on Premolar teeth) Functional appliance.

MAGNITUDE OF FORCE AND DURATION

1)MAGNITUDE: a)SKELETAL: 350-450 gms/side b)DENTAL: 100-200 gms/side (*by anchorage)

2)TYPE OF FORCE: Intermittent forces

3)DURATION OF WEAR: 12-16 hours/day night time wear8pm-1am (GH release high)

LIMITATIONS OF HEADGEAR USE

Pateint compliance Slower tooth movement with intermittent force Delayed eruption of max second molars or impactions.

ENDOGENOUS FUNCTIONAL APPLIANCE EFFECT:

Mandibular growth in AP direction is necessary part of response to headgear use.There is some evidence of increased mandibular growth during treatment of headgear. Headgear doeas appear both maxillary and mandibular effect.

JUDGEMENT OF PATIENT(APPLIANCE WEARING OR NOT)

Tell patient to wear appliance in front of you Slight mobility of first premanent molar Marks of appliance wear. Calculus deposits around appliance.

USES OF HEADGEAR ORTHOPAEDIC: 350-450gms/side ; 10-12 hours wear ; 12-18 months

ANCHORAGE: Reinforcement of anchorage during fixed appliance 250-350gms/side ; 10-2 hours/day.

DISTALIZATION OF MAX 1ST MOLAR: To correct molar relationship 300gms/side. if unilateral class 2asymmetric headgear

SPACE MAINTENANCE & REGAINING: space maintenanceasymmetric headgear space regainingdur to premature loss of decidous teeth.

INTRUSION OF MOLARS AND INCISORS: By using High pull headgear and Maxillary splint.

EXPANSION OR CONTRACTION OF ARCH: By adjusting inner bow

UPRIGHTING OF MOLARS: mesially tipped molars can be upright

After removal of headgear downward and forward rotation of maxilla was observed. Relapse was limited to teeth and not to nasomaxillary complex, suggesting that the skeletal effect is permanent. Class 2 correction was maintained through a more pronounced growth in mandible and not necessarily from molar correction.

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