Orthopaedic

Appliances
SNEHA TRESA BABLOO
FOURTH YEAR
PART 1 IR
Contents

 Introduction
 Basics of orthopaedic appliances
 Headgear
1.Components of headgear
2.Types of headgear
 Facemask / Reverse pull headgear
1.Parts of reverse pull headgear
2.Types of reverse pull headgear
• Chin cup

Parts and Types of chin cup

• Conclusion
• Reference
Introduction

Orthodontics

Orthodontic force Orthopaedic force

Movement of tooth Movement of skeletal

structures

Ranges from 5 to 10gms Range 400gms

 Basics of orthopaedic appliances

o Force applied to the teeth has the potential to radiate outwarads and
affect the nearby skeletal structures. For such skeletal changes to occur
the force applied should be above 400 gms
o Thus the orthopaedic appliances utilize the tooth as handles to transmit
the forces to the adjacent skeletal structures . In order to produce
skeletal changes consideration should be given to the amount and
duration of force
Amount of Force
Heavy forces of over 400 grams totally compresses the periodontal
ligament on the pressure side and causes hyalinisation that prevents the
tooth movement.These heavy forces are conducted to the skeletal
structures to produce an orthopedic effect .
Duration of Force
Intermittent forces ranging from 12 to 14 hours a day are believed to
cause minimum tooth movement but maximum
skeletal changes.Thus most orthopaedic appliances are worn 12
to 14 hours a day
Increase in duration of wear increases the dental effects.
There are Mainly three orthopaedic appliances they are :
1. Headgear 2. Facemask 3.Chin cup
 Headgear

• Head gears are the most commonly used

extraoral orthopaedic appliances
• They are used during the growth period to
intercept or correct certain skeletal
malocclussions as well as to distalize the
maxillary dentition or maxilla itself.
• Head gears also form one of the important adjuncts to control or gain
Anchorage.
• They derive Anchorage from cervical or cranial regions
• They are used to correct an excessive horizontal overbite or overjet in
children by holding back the growth of upper jaw
 Principles of headgear

Centre of resistance of maxilla Centre of resistance of dentition

Components of headgear
Head gear- facebow assembly has three main components
1. Facebow 2.The Force Element
3. The Head cap or cervical Strap
 Face Bow

There are two types of facebow

1. The inner –outer bow type
2. The j hook type
 Inner-outer bow type

• The face bow consists of outer bow ,inner bow, and the junction.
• Outer bow is made up of 1.5mm stiff round wire and is contoured to fit
around the face
• Outer bow can be short ,medium or long

1. Short – outer bow is lesser in length than inner bow

2. Medium ‐ outer bow length is equal to the inner bow
3. Long – outer bow is longer than inner bow
• The distal end of the outer bow is curved to form a hook that
gives attachment to the force element
• The innerbow is made of 1.25mm round wire and is contoured to
fit around the dental arch and molars.
• The junction is the rigid joint of inner and outer bow.
 The j hook type of face bow

• This type of facebow consists of two curved wires whose ends form hooks
that are contoured to fit over a small soldered stop on the anterior segment
of the maxillary arch wire
• Their normal site of attachment is between lateral incisor and the canine
• They are used for retraction of maxillary anterior and have limited
orthopaedic indications
 2. Force Element
• It is the part of the assembly which provides the force to bring about the
desired effect.
• The force element connects the facebow to the head cap or neck strap.
 3. Head cap or cervical strap

The appliance takes Anchorage from the rigid bones of the skull or from the
back of the neck by means of a head cap or neck strap or a combination of
the two.
It depends in the patient needs.
 Types of headgears

• Based on the site of anchorage ,headgears are of the following

type
1. Cervical headgear
2. Occipital headgear
3. Combination headgear
4. Vertical pull headgear
5. Asymmetrical headgear
 1. Cervical Headgear
• They obtain anchorage from the nape of the
neck
• Cause extrusion of maxillary molars leading to
an increase in lower facial height
• They also move maxillary dentition and maxilla
in a distal direction
• Generally indicated in low mandibular angle
cases
• It is used in patients who are growing
and who have decreased vertical
dimension. It can also be used to
restrain the growth of maxilla.

• The line of force application passes

below the occlusal plane and hence
has distalising effect as well as
extrusive effect can be seen.

• Depending on the point of force

application whether anterior or
posterior or above or below, the
tooth movement produced varies.
 2.Occipital Headgears
• They derive Anchorage from the back of the
head
• They produced a distal and superiority
directed force on the maxillary teeth and
maxilla.
• They are used in individuals In whom an
increase in vertical dimension is to be
avoided
• This headgear is responsible for dista
• In growth modification this appliance
• It can be used in patients with steep m
 3.Combination headgears

• Here occipital and cervical Anchorage is

combined
• When the forces extorted by both are
equal,a distal and a slight upward force is
exerted on the maxillary dentition and the
maxilla
 4.Vertical pull
• They derive Anchorage from the parietal region of
the cranium and hence produce a vertically directed
force on the maxilla and the maxillary dentition
• They can be used to produce intrusive forces on
maxilla
• It intrudes the maxillary molars and produce a
clockwise movement of the maxilla
• So it is used in anterior open bite patients
• This is a type of high pull
headgear in which the outer
bow is hooked to the head
cap in such a way that the
line of action is parallel to
occlusal plane and passes
through centre of resistance,
hence pure intrusion takes
place.
• It is not commonly used but
mostly used in cases of Class
I open bite cases.
 5.Asymmetrical Headgear

• Used when differential Anchorage is required on both sides of

the maxillary arch
• They are produced by altering the length of the outer bow on
each side and by variation of angle between the outer and inner
bow
• Molar relationship with
class1 on one side and class2
on other side without any
asymmetries in molar axial
inclination for asymmetrical
headgear.
 Uses of Headgears

1. Orthopaedic effect : Forces applied on to the maxilla can be used to

restrict its downward and forward growth. The distal force should be
applied through the centre of resistance of the maxilla.
2. Anchorage augmentation : Extraoral forces are used to reinforce
anchorage when those obtained from intraoral sources are insufficient.
• Distalization of molars : Distal movement of upper molars may be required for the
correction of molar relation or to gain space for correction of crowding or retraction of
anterior.
• Molar rotation: Correction is achieved by adjustment of the inner bow so that it
produces a rotational force on the molar.
• Space maintenance : A most effective method of maintaining arch length is by the use
of Extraoral forces.
 Face Mask
• A face mask is a type of
orthodontic headgear Used to treat underbite
and other malocclusions where the upper jaw is too far backwards
• Also called as revere pull headgear
• Used 12 to 14 hours per day
Parts of Reverse pull head gear
1. Forhead support
It is used to derive Anchorage from forhead
2. Chin cup
It is used to take Anchorage from the chin area usually connected
To the rest of the face mask by metal rods
3. Metal frame
It connects various components such as chin cup and forhead cap
4. Elastics
Used to apply a forward traction on the upper arch
5. Intraoral splint/device
For rapid maxillary expansion
 Types of Reverse pull Headgears

1. Protraction headgear by Hickahm

2. Facemask of Delaire
3. Tubinger model
4. Petite type facemask
 Protraction headgear by hickham

• This appliance uses the chin and top of the head

for Anchorage. The force distribution is as
follows15% head and 85% chin
• The headband and the chin cap are connected
with the arms Parallel to the mandibular bases
on both sides
• More aesthetically than any other type
 Delair type face mask

• It has a forhead cap and a chin

cap with a wire running in front
of the mouth used for elastic
attachment
• It also uses the chin and forehead
for support
 Tubinger model facemask

• It is a modified delaire type

• Consists of a chin cap From which
originates 2 rodes that runs in the
midline and is shaped to avoid the
interference with the nose
 Petite type facemask

• It is also a modified delaire type

• It consists of a chin cup and a forhead
cap with a single rod running in the
midline from forehead cap to chin cup.
• A crossbar at the level of the mouth is
used to engage elastics
 Chin cup
• Chin cup or chin cap is an Extraoral
orthopaedic appliance that covers the
chin and is connected to a headgear
• It is used to restrict the forward and
downward growth of the mandible
• The chin cup therapy is widely used for treating class 3
malocclusions
• It is the preferred appliance for growing children with
mandibular prognathism
• It is designed to suppress mandibular growth
• Patient is asked to wear the appliance for 12 to 14 hours a day
to achieve the desired results
 Types of chin cup
1. Occipital pull chin cup
• This type derives Anchorage from the
occipital region of the head.
• Most commonly used type
• Used in class 3 malocclusions associated with
mild to moderate mandibular prognathism
• They are very successful in patients who can bring their incisors
close to an edge to edge position at centric relation
• They are also indicated in patients with slightly protrussive lower
incisor as they invariably produce lingual tipping of the lower
incisors
 2. Vertical pull chin cup
• They derive anchorage from the parietal region of the
head.
• It is indicated in patients with strep mandibular plane
angle,excessive anterior facial height and open bite
which can accompany class 3 malocclusion or certain
type of class 1 malocclusion.
 Conclusion

Fundamental principle of orofacial orthopaedics is to aim at

optimizing the development of structures that is to remove
restrictions or retardation in the accomplishment of growth
patterns. Orthopaedic therapy is aimed at the correction of
skeletal imbalance with the correction of any dento alveolar
malocclusion being of less importance in which little or no tooth
movement is desired
 Reference

• Orthodontics – The art and science - S I Bhalajhi (7th edition)

Thankyou