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HEADGEAR
RESOURCE FACULTIES
DR PRABHAT RANJAN
POKHAREL
ASSOCIATED PROFESSOR
DR RAJESH GYAWALI
ASSISTANT PROFESSOR
DR JAMAL...
CONTENTS
• INTRODUCTION
• MECHANISM OF ACTION
• CLASSIFICATION
• COMPONENTS
• USES
• FACTORS INFLUENCING EFFECT
• PROBLEMS...
INTRODUCTION
Introduced in late 1800s
Abandoned as it was thought that intra- oral
elastics would be as effective
Reintrod...
MECHANISM OF ACTION
Growth modification by
changing the pattern of bone
apposition at the sutures
CL II correction is obta...
Force is generated by head
cap or neck strap through ;
a)springs
b)Elastic bands
Force is delivered to the
teeth by ;
a)Face bow
b)J Hooks
CLASSIFICATION
Distalising HG: direction of elastic traction has a distal component
Types : Occipital directed ( high) pul...
OCCIPITAL(HIGH PULL)HEADGEAR
DERIVES ANCHORAGE FROM BACK OF HEAD
PRODUCE DISTAL AND SUPERIORLY DIRECTED
FORCE ON MAXILLA A...
HIGH PULL HEADGEAR
COMBINATION(STRAIGHT PULL)HEAD GEAR
OCCIPITAL AND CERVICAL ANCHORAGE IS
COMBINED
WHEN FORCE EXERTED ARE EQUAL DISTAL
AND S...
COMBINATION PULL HEADGEAR
CERVICAL(LOW
PULL)HEADGEAR
DERIVES ANCHORAGE FROM
NAPE OF NECK
CAUSE EXTRUSION OF MAXILLARY
MOLAR LEADING TO INCREASE IN
L...
LOW PULL HEADGEAR
ASYMMETRICAL
HEADGEARS
USED WHEN DIFFERENTIAL ANCHORAGE IS
REQUIRED ON BOTH SIDE OF MAXILLARY
ARCH
DIFFERENTIAL VALUE ARE ...
VERTICAL PULL
HEADGEAR
DERIVES ANCHORAGE FROM PARIETAL
REGION
PRODUCE VERTICALLY DIRECTED FORCE
ON MAXILLA AND ITS DENTITI...
COMPONENTS
FACE BOW
THE FORCE ELEMENT
THE HEAD CAP OR
CERVICAL STRAP
FACE BOW
TWO
TYPES
• HAS METALLIC COMPONENT IN TRANSMITTING
EXTRAORAL FORCE ONTO POSTERIOR TEETH
• CONSISTS-
• OUTER BOW
•...
OUTER BOW AND
ITS TYPES
SHORT
OUTER
BOW IS
LESSER IN
LENGTH
THAN
INNER BOW
MEDIUM
OUTER
BOW
LENGTH IS
EQUAL TO
INNER BOW
L...
J HOOK TYPE OF FACE
BOW
CONSISTS OF TWO 0.072 INCH
CURVED WIRES WHOSE ENDS
FORM HOOKS
NORMAL SITE OF ATTACHMENT IS
BETWEEN...
FORCE ELEMENT
PROVIDES FORCE TO
BRING ABOUT
DESIRED EFFECT
COMPRISE-
SPRINGS,ELASTICS
AND OTHER
STRETCHABLE
MATERIALS
CONN...
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...
USES-DENTAL
Anchorage
Distalisation – single or blocks of teeth
Intrusion -- single or blocks of teeth
Extrusion
Asymmetri...
USES-SKELETAL
growth modification
maxilla --- suppression which is permanent even after
treatment has ceased
mandible --- ...
Factors
influencing effect
Direction of force
Duration of force
Magnitude of force
Centers of rotation
Duration and
magnitude of force
Orthopedic effect
Principle: higher forces for comparatively
smaller duration
12 ---16 oz ...
Duration and
magnitude of
force
Tooth movement
Principle : smaller forces for longer duration
100 --- 200 gm / side
14 ---...
Magnitude of force is
determined by a Strain-
gauge
Spring loaded assembly
comes with a built-in
force indicator
FORCE
MEASURING
DEVICE
Centers of rotation
Single rooted teeth -----
centroid
6_ ----- trifurcation
Maxilla ----- b/w roots of
4&5
Resolution of
forces:horizontall
y
Force through center of resistance
----- bodily movement
Force above center of resistan...
Resolution of forces:
Vertically
Above occlusal plane
----- intrudes teeth
Below occlusal plane -
---- extrudes teeth
Problems with HG
Tooth- related
Unwanted tooth movement
Tipping
Extrusion of 6_ may cause clockwise
rotation of mand. Pt. ...
Cross bite on side of movement with
asymmetric HG
Lingual tipping of lower incisors,
clockwise rotation of mand. & increas...
Problems with HG
Patient related
Co-operation
biological variability
growth may be unfavorable
Extra / intra-oral injuries...
Assessment of patient compliance at
every visit
Check for signs of use intra orally as well
as extra orally
Hand out Time-...
Extra oral injuries include injuries to eyes
, eyelids, nose etc.
Most common are eye injuries
Catapult type of injury ver...
Safety
No single safety HG is best
Should use safety face bow and release mechanism
together
Written instructions must be ...
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 wor...
When not wearing your HG, please keep
it in the case . If the facebow of your HG
becomes lost or bent,contact dentist.
Nev...
DON’T SIT AROUND MOPING AN
WAITING
FOR YOUR LUCK TO COME BACK
GO OUT AND FIGHT FOR
IT
IT WILL SOON BE BACK
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headgear....

  1. 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. 2. CONTENTS • INTRODUCTION • MECHANISM OF ACTION • CLASSIFICATION • COMPONENTS • USES • FACTORS INFLUENCING EFFECT • PROBLEMS WITH HEAD GEAR • INSTRUCTIONS
  3. 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. 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. 5. Force is generated by head cap or neck strap through ; a)springs b)Elastic bands
  6. 6. Force is delivered to the teeth by ; a)Face bow b)J Hooks
  7. 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. 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. 9. HIGH PULL HEADGEAR
  10. 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. 11. COMBINATION PULL HEADGEAR
  12. 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. 13. LOW PULL HEADGEAR
  14. 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
  15. 15. 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
  16. 16. COMPONENTS FACE BOW THE FORCE ELEMENT THE HEAD CAP OR CERVICAL STRAP
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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
  22. 22. USES-DENTAL Anchorage Distalisation – single or blocks of teeth Intrusion -- single or blocks of teeth Extrusion Asymmetric movement
  23. 23. 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
  24. 24. Factors influencing effect Direction of force Duration of force Magnitude of force Centers of rotation
  25. 25. 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
  26. 26. 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
  27. 27. Magnitude of force is determined by a Strain- gauge Spring loaded assembly comes with a built-in force indicator
  28. 28. FORCE MEASURING DEVICE
  29. 29. Centers of rotation Single rooted teeth ----- centroid 6_ ----- trifurcation Maxilla ----- b/w roots of 4&5
  30. 30. 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
  31. 31. Resolution of forces: Vertically Above occlusal plane ----- intrudes teeth Below occlusal plane - ---- extrudes teeth
  32. 32. 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
  33. 33. 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
  34. 34. Problems with HG Patient related Co-operation biological variability growth may be unfavorable Extra / intra-oral injuries Pain Difficulty with insertion
  35. 35. 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
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. DON’T SIT AROUND MOPING AN WAITING FOR YOUR LUCK TO COME BACK GO OUT AND FIGHT FOR IT IT WILL SOON BE BACK

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