BIOMECHANICS

OF
ORTHODONTIC
HEADGEAR

Presented by-
Dr.Lipika Mali
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 CONTENTS
1. Orthodontic Headgears

2. History of Headgears

3. Classification of Headgears

4. Components of Headgear

5. Principles in the use of Headgear

6. Biomechanics of Headgear
-Cervical
-Occipital
-Combee-pull
-Asymmetric

7. Determining the type of headgear required for treatment

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 ORTHODONTIC HEADGEARS

INTRODUCTION

A class of appliances characterised by the extra-oral positions of activating elements

and supporting structure and having remotely located responsive force.

These extra-oral appliances have been used to influence the maxillary and mandibular
growth patterns by inhibiting and/or redirecting their normal growth potentials in
children before and during maximal pubertal growth.

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 HISTORY
oIn 1866 Kingsley reported to have used occipital anchorage during
treatment.

oIn 1907, Angle referred to extra-oral anchorage and illustrated his

occipital headgear and traction bar.

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CLASSIFICATION

Area of
attachm
ent
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 Components of headgear

FORCE FORCE
DELIVERING GENERATING ANCHOR UNIT
UNIT UNIT

Headcap
Face-bow

Neck
J-Hook strap

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 FORCE DELIVERING UNIT
I. FACEBOW:

The force is delivered to the first molar by the face bow which is engaged in the buccal
tube. It can be attached via brackets or removable appliances .

2 types- a). Inner & Outer bow type

b). J-Hook type

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Parts of Inner & Outer bow type:

i. Junction*Situated in the midline

*Although can be shifted either right or left depending upon asymmetrical force needed.

ii. Inner bow *0.045 or 0.051 inch(dependent on the size of the headgear tubes on the first molars.
*Friction stops are placed in the bow, mesial to molar to the buccal tube of 1st molar to
prevent the inner bow from sliding too far distally through the buccal tube.
Junction

Inner Bow
Outer Bow

iii. The outer bow *Usually 0.072 inch

*Contoured to fit around the face.
*The length can be adjusted to produce the desired force vector/line of force.
*Distal ends are curved to form a hook that gives attachment to the force
generating unit. 8
*Can be short, medium or long.
 J Hook Type Face mask:

i. Each J-hook consists of a 0.072 inch wire

contoured so as to fit over a small soldered
stop on the arch wire.

ii. Site of attachment directly to the arch

wire usually in the incisor region.

iii. Therefore used along with maxillary fixed

appliance having a continuous arch wire.

iv. Used for retraction of maxillary anteriors

and have limited orthopaedic indications.

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 FORCE GENERATING UNIT

Produces heavy forces to effect skeletal changes.

It also connects the face bow to the anchor unit ( head cap or neck strap )
May be in the form of:
i) springs
ii) elastics
iii) other stretchable material

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 ANCHOR UNIT

Headgear appliance derives anchorage from extra oral sites using the rigid bones of
skull or back of the neck.
Two basic types of extra oral attachments are :

Occipital attachment / Head cap Cervical

attachment / Neck strap

*A combination of cervical & occipital attachments may also be

used to distribute the external forces over a wide surface area.
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Principles in the use of headgear
The following factors should be considered when planning the use of headgears:

Centre of Centre of
Resistance of resistance of
the Dentition maxilla

The point of
Point of the
origin of the
attachment
force

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I. Centre Of Resistance

Can be defined as the point on the body (tooth/maxilla) where a single force would produce
translation.
Centre of Resistance of a Tooth
 The centre of resistance of a tooth is dependent on the root length & morphology, the
number of roots & the level of alveolar bone.
The exact C res of a tooth cannot be identified easily, however analytic studies have determined
the Cres for single rooted teeth with normal alveolar bone level about 1/3rd to 1/4th distance
from the CEJ.

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Centre of Resistance of Maxilla

Experimental & analytic studies report the

Cres for maxilla slightly inferior to Orbitale &
6-8 mm over the apices of the upper 1st molars

Clinically can be determined- By dropping a line vertically

10 mm from outer canthus of eye & making a horizontal
from that point to meet the pupil line in front of the face.

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Centre of Resistance of Maxillary Dentition

Analytic studies report the Cres of maxillary dentition In between & above the root
apices of maxillary premolars.

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Centre of Resistance of Maxillary anteriors

For the maxillary anterior teeth, the Cres is situated  Distal to the lateral incisor roots.

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The point of origin of the force

Occipital headgears produce a superior and distal force on the teeth and maxilla

Cervical headgears produce an inferior and distal force on teeth and maxilla.

Thus an appropriate point of origin or site of anchorage should be selected based on what type of
tooth and maxillary movement would be beneficial for a given patient.

Occipital headgear Cervical headgear17

Point of attachment

It refers to the hook present on the distal end of the outer bow to
which the force generating unit is attached.

It is possible to alter the direction of force to the maxilla and the

dentition by altering the point of attachment.

2 ways of altering force system:

Changing the length of the outer bow on an inner-outer bow type
Bending the outer bow upwards/downwards.

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 BIOMECHANICS OF HEADGEAR
A force is a vector quantity, having both a magnitude and a direction.
A headgear can deliver only a net single, simple force.

It has a point of application. In addition, it has a line of action.

An important principle in analyzing the force system for a headgear is the relationship to the center of
resistance of maxilla or the first molar.

A force passing through the center of resistance causes pure translation in the direction of the line of the
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force. Any other force produces translation and a rotation with a moment.
 The magnitude of the moment produced by the headgear is calculated by multiplying the
PERPENDICULAR DISTANCE (P) from the LINE OF FORCE(LF) to the CENTRE OF
RESISTANCE(CR) by the magnitude of the force.

Thus, for a given force, the greater the distance from the CR that the force is applied, the greater
will be the moment.

M=FXD

C res

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CERVICAL HEADGEAR
Effects:
1. Always erupt teeth

2. To tend to move upper jaw distally

3. To steepen the plane of occlusion (positive movement)

5. Because of the elastic properties of the inner bow, an expansile force to the upper jaw

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Biomechanics

1.If the outer bow is placed above this line the moment produced by the force Counter clockwise direction.

2.If the outer bow adjusted below this line the moment created will be Clockwise.

3.If the outer bow is engaged with the neck strap(being below the Cres of maxilla Produces distal &
extrusive forces

•Shorter outer bow there is tendency to steepen the occlusal plane.

•Longer outer bow there is tendency to flatten the occlusal plane.

1. 2.

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3.
 HIGH PULL HEADGEAR
Effects :
1. Commonly used in class- II correction in which controlling anterior open bite tendencies is
part of problem.

2. Produces an intrusive and posterior direction of pull, due to the position of the head cap.

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Biomechanics
The direction of moment that is produced is dependent on the position of the outer bow.

1. If outer bow placed anterior to line of force (angulated > 45 to occlusal plane ) ,
moment produced Counter clockwise

2. Outer bow placed posterior Clockwise moment

3. Outer bow placed along the line of force Distal &

intrusive movement with no moment.
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Short outer bow when angulated high results in a force system
at the unit’s centre of resistance with a moment that tends to flatten
the occlusal plane
distal and intrusive forces.

With longer outer bowHeadgear’s line of action passes through

the unit’s centre of resistance
Steepens plane of occlusion
A force with intrusive and distal
components.
(Such system might be necessary for class-II open bite patients. )

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 STRAIGHT PULL / COMBEE-PULL HEADGEAR

Combination of the high-pull and cervical headgear, with

the advantage of increased versatility.
Depending on the force system desired, the orthodontist has
the opportunity to change the location of the LFO.

Advantage:
Produce an essentially pure posterior translatory force.

 This is accomplished by placing the LFO through the center of resistance, parallel
to the occlusal plane. Clinically, this means bending the outer bow to the same level as
CR, and hooking the elastic to a notch at the same vertical level.

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Biomechanics
1. Outerbow placed above Line of force  Produces posterior force, counter
clockwise rotation & mostly intrusive force

2. Outerbow placed below Clockwise moment produced

 Extrusive force

3. Force’s line of action passes through centre of resistance.

*No moment created
*Pure distal force passing through Centre of resistance

Combee-pull headgear is of choice mostly in cases of class II malocclusion with no

vertical problems.
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 ASYMMETRIC HEADGEAR

Asymmetric headgear is usually indicated when differential anchorage is required on

both sides.
They are usually cervical or the combee pull type.
The asymmetrical distal forces result from the different length in the outer bows on
the right & left side.

Distal forces exist on both sides , but they are 3 times greater on the longer bow side
than the shorter bow.

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 DETERMINING THE TYPE OF HEADGEAR REQUIRED FOR
TREATMENT

ACTION DESIRED HEADGEAR TYPE

•Extrusion of teeth & steepening of occlusal
plane
•Extrusion of teeth & flattening of occlusal
plane
•Intrusion of teeth & steepening of occlusal
plane
•Intrusion of teeth & flattening of occlusal
plane
•Good distal force & flattening of occlusal
plane
•Good distal force & no change in occlusal
plane
Cervical gear: Outer bow even or low
Cervical gear :Outer bow very high
Occipital gear: Outer bow post centre of
resistance.
Combee gear: Outer bow above centre of
resistance
Combee gear: Outer bow below centre of
resistance
Combee gear : Outer bow through centre of
resistance.

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 TIME REQUIREMENTS
NON EXTRACTION, Full Cusp class II
(Good Growth increment, forward growth rotation)  26 hours/day

Holding anchorage 18-20 hours

Precautionary Night use

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 CONCLUSION

Understanding how to control the direction and magnitude of the forces produced by various
orthopaedic appliances is paramount in achieving desirable clinical results.

Decreasing the patients length of treatment and improving the treatment results would be the two
benefits derived from applying well- planned force systems.

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 References

1. Michael Marcotte;Biomechanics in Orthodontics

2. R. Nanda; Biomechanics in Clinical orthodontics

3. Hocevar R: Understanding, planning, and managing tooth movement: Orthodontic force

system theory. AM J ORTHOD 80: 457- 477, 1981. 3. Christiansen

4. Christiansen RL, Burstone CJ: Centers of rotation within the periodontal space. AM J
ORTHOD 55: 353-368, 1969. 4. Nikolai RJ: Analytical mechanics and analysis of
orthodontic

5. The center of resistance of anterior teeth during intrusion using the laser reflection technique
and holographic interferometry . Marc M. Vanden Bulcke,Luc R. Dermaut,Rohit C. L.
Sachdeva,and Charles J. Burstone

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