High-pull Headgear Research Articles

Cephalometric changes after headgear anchored to the deciduous second molars in the early mixed dentition.

The present study aimed to evaluate the cephalometric effects of a headgear anchored to the deciduous second molars in the early mixed dentition. Study design: The study followed a retrospective longitudinal design and enrolled 31 consecutive patients (17 females and 14 males) treated with high pull (HP) headgear anchored to the deciduous second molars, average age 8y 5m± 5m at pre-treatment time (T0) and 9y 8m± 6m at post-treatment time (T1). All the patients wore the headgear for approximately 8-10 hours at night, with a force of 250 g per side. The active phase of treatment ended once patients obtained a distal step on permanent molars of at least 2 mm. Lateral cephalograms at T0 and T1 were taken; 10 angular measurements were chosen as variables of the study. The paired sample t-test was employed to assess the significance of the differences of each variable between T0 and T1. In this group of Class II patients, HP headgear anchored to the deciduous second molars in the early mixed dentition produced: significant reduction of SNA angle, significant increase of SN/NL angle with no significant change in SN/ML angle, significant labial flaring of upper incisors. As clinically evaluated, the correction of the Class II occlusal relationship and the anterior crowding of maxillary arch were also accomplished.

Change in the vertical dimension of Class II Division 1 patients after use of cervical or high-pull headgear.

The goals of this study were to compare the effects thatcervical and high-pull headgear have on the vertical dimensions in Class II Division 1 patients during phase 1 treatment and to compare these effects with untreated predicted growth for the sample population. Pretreatment and posttreatment cephalometric radiographs of children who had undergone Class II Division 1 correction with cervical (n=22) or high-pull headgear (n=19) were analyzed for the measurements that describe the changes in the vertical component of growth and mandibular position. The groups were matched for age (mean, 9±2.5years), treatment time (mean, 14months), malocclusion, and similar skeletal features. The groups were compared with each other and also with an untreated growth model. Treatment with cervicalheadgear resulted in smaller increases in measurements that describe the vertical dimension than with high-pull headgear. Cervical headgear showed more favorable changes in mandibular growth that were statistically significant when compared with the untreated growth models. In this study, the cervical headgear showed more control over the vertical dimension and produced more favorable changes in mandibular position by normalizing the occlusal plane. Compared with the untreated growth model, cervical headgear worked synergistically with growth to produce more optimal changes in mandibular position.

Correction of Skeletal Sagittal Dysplasia using Twin Block Traction Technique

ABSTRACTThe primary concern of the patient as well as their parent seeking orthodontic treatment is the sagittal relationship of the dentition and jaws. Twin block is the most common functional appliance used successfully in correction of growing patient with skeletal class II malocclusion. However, the method of using extraoral traction in combination with twin block appliance (twin block traction technique) is to reinforce the functional component for correction of a class II sagittal relationship. A 12-year-old male patient reported to the Department of Orthodontics with a chief complaint of forwardly placed upper front teeth. With the help of clinical examination, cephalometrics, and diagnostic records, the diagnosis of the patient was confirmed as skeletal class II maxillomandibular relationship with prognathic maxilla and retrognathic mandible with a vertical growth pattern. The patient was treated with twin block appliance along with headgear. The appliance design and postfunctional results are demonstrated in the following case report. Although twin block with high-pull headgear is known to produce favorable results in mixed dentition, the same was observed in permanent dentition during growth phase. Combination of twin block appliance with high pull headgear gave the desired results.How to cite this articleDaga PN, Karandikar GR, Ravindranath VK, Doshi S. Correction of Skeletal Sagittal Dysplasia using Twin Block Traction Technique. J Contemp Dent 2016;6(1): 75-79.

AÇIK KAPANIŞLA BERABER SINIF II ANOMALİYE SAHİP HASTANIN TEDAVİSİ VE 8 SENELİK TAKİBİ – OLGU SUNUMU

Aim: The aim of this case report is to present the treatment and its 8-year follow-up of a patient who has Class II skeletal malocclusion with mild open bite. Case and Method: An 11-year-old female patient’s chief complaint was crowding. According to the intraoral examination, the patient had Class II canine and molar relationships on both sides. Overjet and overbite were found to be 4 mm and -2 mm respectively. According to cephalometric analysis she had normal vertical growth pattern, skeletal Class II relationship due to the small mandible, with proclined upper and lower incisors. In order to distalize the upper molars cervical headgear was used, and to prevent extrusion of molars high-pull headgear was combined. After achieving Class I molar relationship, fixed treatment was initiated. After leveling and aligning, reverse curve archwire was placed in the lower arch and anterior elastics were used. At the end of the treatment fixed retainers were bonded and the patient was instructed to use positioner for the night time. In order to observe the long term results of the treatment, patient was re-called after eight years and records were renewed. Results: Occlusion was improved both functionally and esthetically. Class I dental relationship and ideal overjet/overbite were achieved. Dental relationships and the amount of overjet were maintained after eight years whereas, a decrease was observed in overbite. Conclusion: Attainment of proper overjet, overbite and interdigitation makes a big contribution to longterm clinical success. However, more care is required for stability and retention in patients with openbite tendency

Perawatan Ortodontik Gigitan Terbuka Anterior

Perawatan gigitan terbuka anterior telah lama dianggap sebagai tantangan bagi ortodontis. Prevalensi gigitan terbuka anterior antara 3,5% hingga 11% terdapat pada berbagai usia dan kelompok etnis, serta ada sekitar 17% pasien ortodonti memiliki gigitan terbuka. Stabilitas hasil perawatan gigitan terbuka anterior sangat sulit, karena adanya kombinasi diskrepansi anteroposterior dengan gigitan terbuka skeletal sehingga dibutuhkan tingkat keterampilan diagnosis dan klinis yang tinggi. Etiologi gigitan terbuka anterior sangat kompleks karena dapat melibatkan skeletal, dental, dan faktor-faktor habitual. Eliminasi faktor etiologi merupakan hal yang penting dalam perawatan gigitan terbuka anterior. Berbagai cara perawatan untuk koreksi gigitan terbuka anterior diantaranya bedah ortognatik dan perawatan ortodontik kamuflase, seperti high-pull headgear, chincup, bite blocks, alatfungsional, pencabutan gigi, multi-loop edgewise archwires dan mini implan. Stabilitas hasil perawatan adalah kriteria yang paling penting dalam menentukan cara perawatan gigitan terbuka anterior.Orthodontic Treatment of Anterior Open Bite. An anterior open bite therapy has long been considered a challenge to orthodontist. The prevalence of anterior openbite range from 3,5 % to 11% among various age and ethnic groups and it has been shown that approximately 17% of orthodontic patients have open bite. Stability of treatment result of anterior open bite with well-maintained results is difficult, because the combination of anteroposteriorly discrepancy with skeletal open bite requires the highest degree of diagnostic and clinical skill. The etiology is complex, potentially involving skeletal, dental and habitual factors. The importance of an anterior open bite therapy is to eliminate the cause of the open bite. Various treatment modalities for the correction of an anterior open bite have been proposed, orthognatic surgery and orthodontic camouflage treatment such as high-pull headgear, chin cup, bite blocks, functional appliances, extractions, multi-loop edgewise arch wires and mini implant. The stability is the most important criterion in deciding the treatment method for anterior open bite malocclusion.

Temporary skeletal anchorage devices: The case for miniscrews

5 According to Newton's Third Law, for every action, there is an equal and opposite reaction. Orthodontists must acknowledge this law every time they try to move teeth. Simply stated, every desired tooth movement has the potential to simultaneously create an undesired tooth movement. Orthodontic anchorage is defined as the resistance to such undesired tooth movement and can be achieved by more or less predictable methods. For space closure, 3 anchorage situations are traditionally defined by the ratio of incisor retraction to molar protraction. Maximum anchorage describes space closure mostly by incisor retraction and, to a lesser degree, by molar protraction (ratio of 2:1). Moderate anchorage comes with equal parts of incisor retraction and molar protraction (ratio of 1:1), whereas minimal anchorage allows spaces to close mostly by molar protraction and less by incisor retraction (ratio of 1:2). Traditionally, this type of anchorage control relies heavily on other appliances that add to the anchorage segment, such as compliance-dependent headgear or the noncompliance-dependent Nance appliance or, for instance, on elastic wear, which again depends on compliance. Although headgear incorporates skeletal structures into the anchorage segment (eg, high-pull headgear uses the occipital bone), elastics incorporate only other teeth into the anchorage segment, and this carries the potential for further side effects in the opposing dental arch. The philosophy behind skeletal anchorage is that if the reactive forces can be absorbed by skeletal structures, tooth movement can be limited to the desired therapeutic movements, and the undesirable reactive side effects can be prevented entirely. Such a situation can nowadays be created by temporarily implanting small devices into the patient's jawbone and using

Camouflage Treatment of a Severe Open Bite Case

Skeletal open bite is a complex and multifactorial anomaly. There are many reasons for the occurrence of open bite, including skeletal abnormal growth pattern; dental, respiratory, neurologic, and habitual factors; and tongue posture and function. Anterior open bite is one of the most difficult problems to treat in orthodontics. Various treatment modalities for the correction of an anterior open bite have been proposed such as extrusion of anterior teeth using intermaxillary elastics, multiloop edgewise archwire technique developed by Kim, inhibition of molar eruption using bite blocks and high-pull headgear during growth, and extraction therapy. The most effective treatment option in adult patients is the repositioning of both the maxilla and mandible through a surgical correction. Although satisfactory results can be achieved with orthognathic surgery, the complexity, risks and costs of surgery are disadvantages of the surgical treatment. With the advent of skeletal anchorage, a number of studies were released to introduce the treatment of anterior open bite by intrusion of maxillary posterior teeth. This report presents the treatment and long-term stability of an adult case of a severe anterior open bite treated by means of extraction of the 4 first molars.

Orthodontic treatment of anterior open bite: a review article—is surgery always necessary?

Anterior open bite cases are very difficult to treat satisfactorily because of their multifactorial aetiology and their very high relapse rate. Dependent on the origin of the anterior open bite malocclusion and the patient's age, there are several treatment possibilities ranging from deterrent appliances, high-pull headgear, fixed appliances with and without extractions to orthognathic surgery, and skeletal anchorage with miniplates or miniscrews. The gold standard treatment of skeletal anterior open bite cases is the combined approach of orthodontic treatment with fixed appliances and orthognathic surgery. In recent years, temporary anchorage devices (TAD) have been developed to correct anterior open bites orthodontically. With the introduction of TAD as an effective treatment modality, orthognathic surgery may be avoidable in selected anterior open bite cases. This is a relatively new technique and to date there remains a lack of evidence of long-term stability of anterior open bite closure with TAD.

Midpalatal miniscrews and high-pull headgear for anteroposterior and vertical anchorage control: Cephalometric comparisons of treatment changes

Our aim was to evaluate which anchorage system is better suited for both anteroposterior and vertical anchorage control of maxillary posterior teeth. Fifty-one subjects requiring maximum anchorage were divided into 2 groups according to maxillary posterior anchorage reinforcement: high-pull headgear, conventional transpalatal arch, and interarch elastics (n= 28); or modified transpalatal arch supported by 2 midpalatal miniscrews (n= 23). Bilateral maxillary first premolars were extracted in all patients. Pretreatment and posttreatment lateral cephalometric radiographs were superimposed to compare skeletal and dental changes between the groups. (1) The miniscrew group had less mesial movement of the maxillary first molars (0.85 vs 3.63 mm) and greater maxillary incisor retraction (6.87 vs 4.50 mm) than did the headgear group with the same treatment duration. (2) The maxillary molars were significantly intruded in the miniscrew group (1.30 mm), whereas they were extruded in the headgear group (0.71 mm). In the miniscrew group, intrusion of the maxillary molars resulted in a statistically significant decrease in the mandibular plane angle (0.80°). Patients using high-pull headgear showed no significant decrease in these measurements. In both the anteroposterior and vertical directions, a modified transpalatal arch supported by 2 midpalatal miniscrews provided more stable anchorage.

Class II malocclusion treatment using high-pull headgear with a splint: a systematic review

To systematically review the scientific evidence regarding the effectiveness of high-pull headgear in growing Class II subjects. A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH). Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects with 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the anteroposterior relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials.

Combined treatment with headgear and the Frog appliance for maxillary molar distalization: a randomized controlled trial

ObjectiveTo evaluate the efficiency of the Frog appliance (FA) alone or in combination with headgear for distalizing the maxillary molars.MethodsFifty patients (25 males and 25 females) aged 12.6 - 16.7 years who received treatment for Class II malocclusion at the Orthodontic Clinic of Al-Baath University were selected for this study and randomly divided into 2 equal groups. Maxillary molar distalization was achieved using the FA alone (group 1) or a combination of the FA with high-pull headgear worn at night (group 2). Lateral cephalograms were obtained before and after treatment.ResultsThe maxillary molars moved distally by 5.51 and 5.93 mm in groups 1 and 2, respectively. Distal movements were associated with axial tipping by 4.96° and 1.25°, and with loss of anchorage by mesial movement of the second maxillary premolars by 2.70 and 0.90 mm in groups 1 and 2, respectively. The combined use of the FA and nighttime high-pull headgear decreased the distalization time and improved the ratio of maxillary molar distalization movement relative to the overall opening space between the first maxillary molars and second premolars.ConclusionsThe FA can effectively distalize the maxillary molars, this distalization associates with some unfavorable changes. Nighttime use of high-pull headgear combined with the FA can reduce these unfavorable changes and improve treatment outcomes.

Orthodontic treatment in the severely compromised periodontal patient

We describe the diagnosis and treatment of a class II division 1 malocclusion complicated by severe periodontal disease, tooth loss, dentoalveolar protrusion associated with tipping and extrusion of the maxillary incisors, and a traumatic occlusion. Treatment involved the use of a modified palatal arch to intrude and retract the maxillary incisors and high-pull headgear to enhance anchorage and correct the Class II relationship. After active treatment for 19 months, a good anterior occlusion was achieved, with 17° of lingual retroclination and 3 mm of intrusion at the apex of the maxillary incisors. An acceptable occlusion and periodontal status was maintained over a retention period of 2 years. With the patient's cooperation, a successful outcome was achieved with this approach.

Extraction of the lateral incisors to treat maxillary protrusion: Quantitative evaluation of the stomatognathic functions

To treat morphological abnormalities, impaction, and severe malposition of the teeth, the lateral incisors are sometimes extracted, followed by orthodontic space closure. This procedure often requires special consideration, not only with regard to esthetics but also for functional issues. However, thus far, few reports that have performed a functional evaluation in such cases. The purpose of this article is to report the successful treatment of an adult patient with a Class II division 1 malocclusion who was treated with extraction of the upper lateral incisors. The female patient, aged 23 years and 6 months, had a chief complaint of maxillary incisal protrusion and crooked teeth. In this patient, the upper lateral incisors were extracted to fulfill the patient's strong request, followed by orthodontic treatment using edgewise appliances. A high-pull J-hook headgear on the lower dental arch was used to prevent further labial inclination of the lower incisors. The total active treatment period was 37 months. The resulting occlusion and a satisfactory facial profile were maintained during a 4-year retention period. Additionally, this treatment did not affect the stomatognathic functions as assessed by the following criteria: range of the incisal path or condylar motion during maximal open-close movement, protrusive excursion, lateral excursion, and the chewing test. In conclusion, extraction of the upper lateral incisors can be an effective treatment choice when the upper lateral incisors are dwarfed, are nonvital, or demonstrate severe malposition.

Two-phase treatment of skeletal Class II malocclusion with the combination of the Twin-block appliance and high-pull headgear

The patient was a boy with a Class II skeletal and dental relationship, a large overjet, an impinging overbite, and a steep mandibular plane angle. Treatment started with the Twin-block appliance combined with high-pull headgear to promote growth of the mandible, restrain the maxilla in the anteroposterior and vertical planes, and improve his profile. This was followed by extraction of the maxillary second premolars and the mandibular first premolars. Then fixed appliances were used to align and level the dentition. Pretreatment and posttreatment records are shown, and the treatment results are stable 2 years after debonding.

Esthetic orthodontic treatment with a double J retractor and temporary anchorage devices

This clinical article reports an esthetic treatment option for managing a Class II malocclusion in an adult. The patient, a woman aged 24 years 2 months, had crowding and a convex profile. She was treated with maxillary first premolar extractions, a double J retractor, and temporary skeletal anchorage devices in the maxillary arch. Posttreatment records after 2 years showed excellent results with good occlusion and long-term stability.

Is traditional treatment a good option for an adult with a Class II deepbite malocclusion?

The Tweed-Merrifield directional force technique is a useful treatment approach for a patient with a Class II malocclusion with dentoalveolar protrusion. The purpose of this case report was to present the diagnosis and treatment descriptions of a patient with an Angle Class II malocclusion complicated by tooth losses, severe dentoalveolar protrusion, and skeletal discrepancy. Treatment involved extraction of the maxillary first premolars, high-pull headgear to enhance anchorage, and high-pull J-hook headgear to retract and intrude the maxillary anterior segments. A successful outcome was achieved with traditional orthodontic treatment in this borderline surgical case.

Minimally invasive midface distraction for maxillary hypoplasia during growth

The treatment of skeletal anterior open-bite malocclusion requires complex orthodontic planning that considers its multifactorial etiology, treatment limitations, and high relapse rates. This case report illustrates a successful treatment approach for a skeletal high-angle Class II malocclusion in an adult with a severe open bite. The treatment consisted of a high-pull headgear therapy after mini-implants failure during fixed orthodontic therapy. Adequate esthetics and function were achieved. Despite its low probability, the unexpected event of mini-implant loosening during complex treatments should be considered. Therefore, classic orthodontic mechanics should be established, especially when treating patients for whom invasive procedures such as miniplates or orthognathic surgery are not available options.

Treatment strategies for patients with hyperdivergent Class II Division 1 malocclusion: Is vertical dimension affected?

The dilemma of extraction vs nonextraction treatment, along with the uncertain potential of orthodontic treatment to control vertical dimensions, still remains among the most controversial issues in orthodontics. The aim of this study was to evaluate 2 contradictory treatment protocols for hyperdivergent Class II Division 1 malocclusion regarding their effectiveness in controlling vertical dimensions. The subjects were retrospectively selected from 2 orthodontic offices that used contrasting treatment protocols. The patients had similar hyperdivergent skeletal patterns, malocclusion patterns, skeletal ages, and sexes. Group A (29 patients) was treated with 4 first premolar extractions and "intrusive" mechanics (eg, high-pull headgear), whereas group B (28 patients) was treated nonextraction with no regard to vertical control (eg, cervical headgear, Class II elastics). Twenty-seven landmarks were digitized on lateral cephalometric radiographs before and after treatment, and 14 measurements were assessed. Geometric morphometric methods were also implemented to evaluate size and shape differences. As expected, the maxillary and mandibular molars translated mesially and the mandibular incisors uprighted in group A but remained approximately unchanged in group B. The vertical positions of the molars and the incisors were similar between groups before and after treatment, although they were altered by treatment or growth. No significant differences were observed in the posttreatment skeletal measurements between the 2 groups, including vertical variables, which remained unaltered. Permutation tests on Procrustes distances between skeletal shapes confirmed these results. This study demonstrated the limitations of conventional orthodontics to significantly alter skeletal vertical dimensions. More important factors are probably responsible for the development and establishment of the vertical skeletal pattern, such as neuromuscular balance and function.

Dentoskeletal effects of functional appliances vs bimaxillary surgery in hyperdivergent Class II patients

To compare treatment outcomes of growing and nongrowing Class II patients characterized by mandibular retrusion and increased vertical dimension. Seventeen patients (mean age 9 years 5 months) were treated with a Bionator fabricated with posterior bite block and high-pull headgear, while 15 patients (mean age 23 years 6 months) received Le Fort I osteotomy for maxillary impaction and mandibular advancement. These groups were compared with 17 nontreated control subjects from the Bolton and Michigan growth studies. Lateral cephalograms taken for the functional group at T1 (initial records), T2 (completion of functional appliance treatment), and T3 (completion of comprehensive treatment) were compared with radiographs taken at T1 (initial records), T2 (immediate post surgery), and T3 (1 year post surgery) for the surgical patients. A null hypothesis of no difference in treatment outcomes between the functional and surgical groups was proposed. A mixed-design analysis of variance was used to compare changes within and between groups. Significance was set at P ≤ .002. In the functional appliance group, the mandible showed a more favorable growth direction and rotation. Both groups had stable results over time and finished treatment with similar cephalometric measurements. Both the functional appliances and orthognathic surgery resulted in similar dentoskeletal treatment changes. The control groups did not self correct either in the anteroposterior or vertical dimensions.

Brodie bite with an extracted mandibular first molar in a young adult: A case report

Total buccal crossbites are rare, but, when they occur, they can be extremely difficult to correct, even with surgery and orthodontics. In most patients with in-locking crossbites, the maxillary teeth erupt past their mandibular antagonists, creating severe occlusal difficulties. This article presents an adult patient with scissors-bite or partial telescoping bite bilaterally in the posterior region and an extracted mandibular first molar on the right side. She was treated with expansion of the mandibular arch, and the subsequent open bite was closed with the help of masticatory muscle exercises and high-pull headgear. The second and third molars were uprighted and moved mesially to close the extraction spaces.