Orthodontic treatment, which aligns teeth and jaws to improve function and appearance, can be done in stages. Phase I (interceptive orthodontic treatment) is generally completed when baby teeth and adult teeth are both present. Phase II (comprehensive orthodontics) is done when all permanent teeth are present.
For patients who are still growing and have a difference between the position of the jaw bones, there may be treatment options that include more than braces. Your orthodontist can do a full evaluation to determine specific needs based on how the teeth come together as well as the position of the jaw bones, which also impact tooth position. Headgear is one option that can be used to modify the jaw bones to grow in a more favorable way.
Everyone grows differently. Some people’s top jaw grows more forward than the bottom jaw. This could be due to the growth of either jaw; this is called a Class II skeletal growth. Some people grow in the opposite way, where the bottom jaw is more forward than the top jaw, which is called Class III skeletal growth. There are different treatment options for each growth pattern.
Facemask
The treatment for Class III skeletal growth where the top jaw is small would be to move the top jaw forward. This is called a facemask, or reverse pull headgear. This treatment is best accomplished when a patient is around 8-10 years of age and can last for up to one year.
A facemask works with an appliance that is secured to the top teeth. The patient uses rubber bands from the appliance inside the mouth and attach to an external appliance that helps provide the traction to protract (move forward) the top jaw. The external part is removable. This appliance should be worn ideally 22 hours, but at least 12-16 hours, per day. Patients are not expected to wear a facemask or any headgear to school, parties or for physical contact activities. The appliance is not intended to make anyone feel self-conscious; it is intended to correct a difference or reduce a difference. Treatment is successful in about 75% of cases, while 25% of patients will grow out of treatment and require future interventions. Many patients will also benefit from braces later.
Headgear
When the upper jaw is more forward (Class II), headgear is used in an opposite way, restricting the top jaw and allowing the bottom jaw to grow forward. This technique also uses an appliance in the mouth with an external part that either attaches to the top of the head or near the back of the neck. Wear time recommendations are the same: at least 16 hours per day.
It has been found that using Class II headgear when baby teeth and adult teeth are present does not provide greater benefits than comprehensive treatment started later, if the child is still growing. Early treatment includes two phases and will take longer overall.
Patients with Class II headgear are little older than those with facemask treatment, closer to 11 or 12 years of age. This type of headgear, Class II correction, may not be used as commonly as a facemask.
While Class II and Class III headgear are intended to address a difference in the jaw bones, it is important to note that changes to the teeth also occur. Use of this type of therapy should be planned carefully with an orthodontist. Of course, success depends on the child following instructions and parents ensuring good oral hygiene.
Kaitrin Kramer DDS, MS, PhD is a craniofacial orthodontist at Nationwide Children’s Hospital’s Cleft Palate-Craniofacial Clinic. She received her doctorate in Dental Surgery from The University of Michigan, and then completed a research post-doctoral training and was an adjunct clinical assistant professor at the University of Michigan School of Dentistry before heading to The Ohio State University for her M.S. and Certificate in Orthodontics.
Henry Fields, DDS
Chief of Orthodontics
Henry W. Fields, DDS, MS, MSD, is Chief of Orthodontics at Nationwide Children's Hospital and a Professor of Orthodontics at The Ohio State University College of Dentistry.
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