Headgear
The headgear (literally: head device) is an orthodontic appliance for extraoral support.
construction
The headgear basically consists of a metal bracket and a head cap or neck strap. The metal bracket has an inner and an outer arch. The inner arch is attached to the rear molars in tubes or to a removable appliance. The outer arch is outside the mouth. The ends of the outer bow are provided with hooks, on which the head cap or the neck band can be attached by means of tensioners. Since the arch is also visible from the outside, it is often referred to as an outer clasp. The headgear is one of the removable devices. Note: The metal bow is called the "facebow" in Anglo-Saxon literature. This is not to be confused with the face bow that is common in German usage and is an aid in dental technology .
indication
Headgear is used when molars are to be shifted backwards (distalized) or kept in their position. In addition, molars can be rotated or the dental arch can be expanded slightly. This requires support outside the mouth.
Depending on the desired effect or the applied direction of pull, a distinction is made:
- Highpull Headgear (head cap)
- Straightpull Headgear (head cap and neck strap)
- Lowpull headgear (neck strap)
The daily wearing time is approx. 14-16 hours, i. H. the headgear does not usually have to be worn to school or work. In the case of regular afternoon classes, however, it is also advisable to wear it during school hours. It is imperative that the headgear is worn regularly and consistently in order to ensure successful treatment. Headgear is generally not worn when eating or exercising. Its use was widespread in the 1980s, and alternative treatment methods were increasingly used in the 1990s, although these turned out to be less efficient, but are usually perceived as more pleasant. In addition, their costs are not covered by the health insurance companies. In the interest of a short treatment duration, headgear is now being used more frequently again. There are also regional differences in use; in the Netherlands, for example, headgear is used more frequently than in Germany and Austria . At the same time, headgear is very often worn during school lessons in the Netherlands.
At the beginning of treatment with the headgear, you may experience severe pain when wearing it, and the head cap is sometimes removed while sleeping. During the first few weeks of treatment, painkillers can make it easier to bear the pain. It is also advisable to wear the headgear all day during this time, so that the patient can get used to the external braces and the forces acting on them. However, there is no need to wear it all day.
disadvantage
The main disadvantage of the headgear is that the success of the treatment depends on the patient's cooperation . Irregular wearing means that the treatment goal is either significantly delayed or - in extreme cases - not achieved at all. After wearing it for about three months, the first results should at least be visible to the practitioner.
However, the fact that some orthodontists fix the headgear when they discover insufficient cooperation from the patient so that it cannot be removed by the patient is an old wives' tale that often appears on the Internet. Because of its conspicuousness, the headgear is perceived as unaesthetic by some patients, parents or practitioners. Individual orthodontists categorically reject the use of the headgear.
Alternatives
As an alternative to headgear, depending on the bite defect and indication, u. U. are used:
- Mini screws
- Orthodontic implants
- Pendulum apparatus
- Bondemarkare
swell
- F. Angelieri, RR de Almeida, G. Janson, JF Castanha Henriques, A. Pinzan: Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment. In: Eur J Orthod. 30 (6), Dec 2008, pp. 572-579.
- EH Lai, CC Yao, JZ Chang, I. Chen, YJ Chen: Three-dimensional dental model analysis of treatment outcomes for protrusive maxillary dentition: comparison of headgear, miniscrew, and miniplate skeletal anchorage. In: Am J Orthod Dentofacial Orthop. 134 (5), Nov 2008, pp. 636-645.
- A. Rawji, L. Parker, P. Deb, D. Woodside, B. Tompson, CM Shapiro: Impact of orthodontic appliances on sleep quality. In: Am J Orthod Dentofacial Orthop. 134 (5), Nov 2008, pp. 606-614.
- SK Varlik, HN Iscan: The effects of cervical headgear with an expanded inner bow in the permanent dentition. In: Eur J Orthod. 30 (4), Aug 2008, pp. 425-430.
