Headgear is an appliance that is used to correct a Class II malocclusion (upper jaw or teeth ahead of lower jaw or teeth). It consists of two bands that fit around the upper first molars and a metal appliance that fits partially inside the mouth and partially outside of the face that is usually worn to sleep. Headgear can distalize the upper molar teeth and can also guide the growth of the face and jaw. The main disadvantage to headgear is that it requires compliance… that is you need to remember to put it on every night for it to work efficiently! It works great for a compliant patient! Because it works with the growth of the jaws, it is usually worn for 12 to 18 months. Good compliance can shorten the duration; poor or moderate compliance can lengthen the time it is worn.
The Herbst Appliance is an excellent way to correct a severe Class II malocclusion (upper jaw considerably ahead of the lower jaw). It is frequently used in cases where the growth of the lower jaw hasn’t kept pace with the upper jaw and the lower jaw appears small or retrognathic.
This functional appliance is used in growing patients. It repositions the lower jaw forward stimulating increased growth and places the jaw structures in balance with each other and with the rest of the face.
It can protect severely protrusive maxillary incisors by bringing the lower jaw and teeth in line with the upper teeth. It can also be used to correct midline asymmetries, severe deep bites, and to distalize maxillary posterior teeth. It is cemented in place acting continuously to give optimal skeletal change.
Pendulum / Pendex
In many Class II cases (upper teeth ahead of lower teeth – protrusive maxillary teeth), getting the molars in the upper arch distalized to fit into the correct relationship with the lower teeth is our biggest and most time consuming challenge.
The pendulum appliance is inserted prior to placing braces. Because the appliance is cemented, it distalizes the maxillary 1st molars with light continuous forces.
In a four to six month period, the molars are distalized into a “super-corrected” relationship. A smaller fixed appliance (the nance) is used to hold the molars in their newly corrected relationship. The upper bicuspids and cuspids drift or erupt into a more distalized relationship following the molars.
This can dramatically shorten the treatment time that is needed in braces and reduce compliance issues.
The Quadhelix is a cemented expander that widens and develops the upper arch. it corrects anterior and posterior crossbites (upper teeth inside of the lower teeth). It also makes room for eruption of the maxillary permanent teeth eliminating the need for unnecessary extraction of permanent teeth. Frequently developing the upper arch allows for spontaneous development of the lower arch elimination the need for a lower expander.
Adults with a severe underbite (lower jaw has out grown upper jaw significantly) frequently require surgery, in addition to braces, to put the upper and lower jaw bones in balance.
In growing patients we can often times keep the upper jaw growing in pace with the lower jaw by using a protraction headgear or face mask. This is usually worn to sleep in and is used in conjunction with an upper expander to protract or move the upper jaw and teeth forward. Early orthodontic intervention can sometimes eliminate the need for more invasive and costly surgical procedures.
Children frequently put their thumbs and fingers into their mouths. Finger and thumb sucking put orthodontic like forces on the teeth and growing jaws causing a number of negative oral developments. Open bites (front teeth that don’t touch when the patient is biting down), constricted and V-shaped upper jaws, and protruding front teeth and jaws are frequently seen with long term thumb and finger habits. Tongue thrust habits also frequently accompany thumb and finger habits can put long term negative forces which on the teeth even after the habit has stopped and the patient has started comprehensive orthodontic treatment.
Frequently children want to stop these habits but are unable to do so on their own. A simple appliance that is shaped like a football is inserted perpendicular to the roof of the mouth and acts as a deterrent. The appliance is usually cemented to the molar teeth using orthodontic bands and is left in place until the patient is habit-free for three months. Often times spontaneous close of a significant open bite will occur without further orthodontic interception. The same appliance can be used as an aid in alleviating a tongue thrust or to improve resting and swallowing tongue posture.
Space Maintaining Appliance
Premature loss of baby teeth (long before the anticipated eruption of the permanent tooth) can cause loss of arch length and can lead to unnecessary extraction of permanent teeth or to orthodontic treatment that would have otherwise been unnecessary. A simple appliance that uses bands usually cemented to molars and simple soldered wires can maintain the space until the permanent tooth erupts.