Headgear

What is the Headgear Appliance?

The components of the Headgear appliance include the facebow, neck strap and elastic modules. The facebow attaches to a tube on the band or ring that will be placed on the upper first molars. The elastic modules are attached to the neck strap are then attached to the external part of the headgear. Headgear is to be worn between 12-14h daily. The time worn does not have to be continuous. You do not have to wear headgear to school or activities with friends. We recommend wearing the headgear to bed but also when the patient is at home watching TV, doing homework or playing. Typical time to wear this appliance with braces is approximately 9-12 months. Most of the patients that we see are pretty good at wearing the appliance and can manipulate the facebow to insert and remove it themselves. We ask the patient to bring their headgear appliance at each orthodontic visit.

The headgear appliance may have a bad reputation as orthodontists once made their patients wear it to school. However, dental professionals and orthodontists know that this appliance, if worn well, is actually the gold standard of orthodontic care as it has so many benefits and little side effects. In fact, Dr. Virdee treats several patients who are children of dentists and in cases where the patient presents with a moderate to severe class II bite, most dentists will opt for headgear for their children.

How does headgear work?

Headgear works by minimizing the growth of the upper jaw and allowing the lower jaw to catch up with the upper. Therefore, it is a growth modification appliance. Headgear can also be used to drag the upper teeth back. This is especially useful in patients with teeth that are proclined forward ot stick out.

The headgear appliance is extremely beneficial in younger patients who have difficulty closing their lips around their teeth.

What if patients are not compliant with Headgear?

While headgear is the gold standard to help correct overjet, it requires patient compliance and not every patient is great at wearing it.

In cases where the appliance is not worn as instructed and there is still resulting overjet(i.e., the upper front teeth stick out), we will offer the patients elastics to wear, with the understanding that the potential for bone loss and gingival recession around the lower incisors increases. The chance of this occurring in patients with thin bone is greater than in those with thicker bone around the lower incisors. If Dr. Virdee finds the bone to be acceptable after initial alignment of the teeth, we may also recommend the Forsus appliance. There are ways to manipulate the appliance to help the upper molars move backwards and limit the force on the lower incisors. The last resort is interproximal reduction (filing of the upper front teeth to reduce their proclination) or extraction of permanent teeth in the upper jaw, again to help bring the upper front teeth back in order to reduce or idealize the overjet. Dr. Virdee would do a careful evaluation of the patient to determine the best course of action.