Orthodontic Headgear - Facemask and Reverse-pull Headgear

Facemask and Reverse-pull Headgear

Facemask or reverse-pull headgear is an orthodontic appliance typically used in growing patients to correct underbites (technically termed Class-III orthodontic problems) by pulling forward and assisting the growth of the upper jaw (maxilla), allowing it to catch up to the size of the lower jaw (mandible). Facemasks or reverse-pull headgear needs to be worn approximately 14 to 16 hours per day to be truly effective in correcting the underbite, usually anywhere from 12 to 18 months depending on the severity of the bite and how much a patient is growing.

The appliance normally consists of a frame or a center bars that are strapped to the patient's head during a fitting appointment. The frame has a section which is positioned in front of the patient's mouth, which allows for the attachment of elastic or rubber bands directly into the mouth area. These elastics are then hooked onto the patient's braces (brackets and bands) or appliance fitted in his or her mouth. This creates a forward pulling force to pull the upper jaw forward.

The orthodontic facemask consists of three major components:

1. Face frame: first, the face frame is a metal and plastic structure which is adjusted to fit onto the patient's face. The frame is normally stabilized on the child's face with the aid of a chin cup and a forehead pad. These are padded to ensure patient comfort. The frame typically has a mouth-yoke, which the orthodontist will adjust so it is positioned in font of the patient's mouth. The mouth yoke has a number of hooks (four to six depending on type – see photo with six hooks), which allows the orthodontist to attach elastics or springs directly into the patient's mouth. The frame allows the patient to move his or her head freely and to talk. All other oral activities are restricted, although drinking is recommended with a straw so as not to remove the whole appliance at night or in the day when thirsty.
2. Head cap: some facemasks and all reverse-pull headgear have a second part which consists of a head cap, and is made up of a number of straps fitting around the patient's head. In this case the head cap is used to stabilize the face-frame described above and to ensure it is held correctly in position (see photo example of reverse-pull headgear with head-strap/cap).
3. Attachment: the third and final component is the mouth attachment – typically using rubber bands – joins the facemask from the mouth-yoke into the patient's mouth. The elastics hook on the patient's braces or other such suitable oral appliance. As the elastics are flexible, up to six elastics may be used to provide various forward and sideways forces on the patients teeth and arch, while still allowing the patient to open and close his or her jaw.

In some cases surgery is required in conjunction with a facemask or reverse-pull headgear. Many parents and doctors recommend using early intervention (ages 7 to 13) by using a facemask to avoid costly and painful surgical procedures later.

The appliance is very effective in correcting Class III orthodontic problems in younger or adolescent patients that are still growing. Initially, it can be difficult for children to wear a mask or headgear, however most doctors and parents agree that children and adolescence adapt quickly to such changes and requirements. Parents should be aware that their child is often better-off wearing a facemask or headgear to avoid later surgery and the patient, friends and school peers normally get used to the new appliance after just a few weeks of wear.