3/30/2022

Extra-oral appliances
• Other names orthopedic A.-extra-
oral traction.
Orthodontic appliances
Extra-oral A

Extra-oral appliances
Uses
• increasing anchorage
• achieving tooth movement
–Distal -mesial
–Extrude- intrude the upper molar
Headgear
teeth
• Orthopaedic

Headgear Headgear

Components
• Force delivering unit-face bow, J
hook.
• Force generating unit.
• Anchor unit-head cap, neck strap.

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Headgear Headgear
Components Face bow
• Force delivering unit- face bow, J hook.
• Force generating unit.
• Anchor unit-head cap, neck strap.

Headgear Headgear
Face bow J hook
which slots into tubes (soldered to RA-
or in molar band FA)

Headgear Headgear

Force generating unit Force generating unit

by different sizes of extra-oral elastic
bands
Spring mechanisms
elastic strap

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Headgear Headgear
Occipital HG Cervical HG Treatment Effects
• Skeletal Effect
head cap
• compressing the sutures thus
restricting the normal downward and
forward growth of the maxilla
neck strap.

Headgear Headgear
Dental Effect Uses of Headgears
• Distalization of the maxillary molars. • To restrain and redirection maxillary
• Along with , extrusion or intrusion of growth.
the molar • Molar distalization: to correct the
Class II molar relationship or to gain
space for relief of crowding.

Headgear Headgear
Uses of Headgears types
• reinforce molar anchorage (worn for
at least 10 hr / day -300 gm)
• preventing mesial migration of
molars.
• Molar rotation by inner bow of the
headgear.

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Headgear Headgear

Types Cervical HG
• Cervical HG • Contraindications
• Occipital HG Open bite or tendency
to OB
• Combination pull
• High pull HG

Headgear Headgear

Occipital HG Combination pull

Headgear

High pull HG • safety

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Facemask
• by Delaire in 1970s (called mask
of Delaire)
• Also called reverse pull headgear.
Facemask

Facemask Facemask
Indications
1. Mild to moderate Class III skeletal
malocclusion ( maxillary retrusion).
2. Ideal patients for facemask should
have:
–Normal or retrusive (but not protrusive
↑teeth)
–Short or normal, but not long AFH
3. Correction of postsurgical relapse
after osteotomies.
4. For ttt of cleft patients.

Facemask
• Biomechanical Considerations
• The maxilla can be advanced 2-4
mm forward over a period of 8-12
months.
Facemask
Amount of force
• 300-500 gm of force per side in
the primary or mixed dentition.

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Facemask Facemask
Direction of force According to most
authors, a 15- 20°downward pull to the • Duration of force: on an average
occlusal plane is required. The line of at least 8-12 months of wear is
force passes below the center of
resistance of the maxilla producing a required
counter-clockwise moment on the
maxilla and dentition. Frequency of use 12-14 hrs/day
• However, in patients with increased
anterior facial height, downward pull is
contradicted.

Facemask Facemask

Facemask

Chin Cup

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Chin Cup Chin Cup

• an extraoral orthopedic device • to retard or redirect the growth

• is useful in the treatment of Class of the mandible in order to
III malocclusions that occurs due obtain a better anteroposterior
to a protrusive mandible but a relation between the two jaws
relatively normal maxilla.

Chin Cup Chin Cup

Philosophy of Chin Cup Therapy
• Mandible grows by apposition of bone at the
condyle and along its free posterior border.
• Condyle is not a growth center and condylar
growth is largely a response to translation of
surrounding tissues.
• So there is possibility for growth restraint of
the mandible, as with chin cup therapy.

Chin Cup Chin Cup

• Magnitude of Force most authors • Duration of Wear
recommend a force of 300-600 • A maximum of 12-14 hr/day of
gm/side.
chin cup wear is recommended.
• Initially a lower force level (about
150 gm) may be advised for the
patient to get used to the
appliance.

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Chin Cup Chin Cup

Types Occipital pull chin cup
1. Occipital pull chin cup
• the more commonly used.
• Derives anchorage from the
occipital region.
• This is used in Class III cases with
mild to moderate mandibular
protrusion , with short AFH.

Chin Cup
Chin Cup
Types Vertical pull chin cup
2. Vertical pull chin cup derives anchorage
from the parietal region.
• Called high pull chin cup
• It is indicated in high angle cases or long
face patients as it helps to close the
angle of the mandible and ↑PFH.

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