Transcript HEAD GEAR
HEAD GEAR
DR. ABDUL JABBAR 1
Means of applying posterior directed forces to teeth and skeletal structures from an extra oral source 2
Headgear Introduced in late 1800s Abandoned as it was thought that intra oral elastics would be as effective Reintroduced in 1940s after cephalometric developed 3
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Mechanism of action
Growth modification by changing the pattern of bone apposition at the sutures CL II correction is obtained as the mandible grows forward normally while maxillary growth is restrained Favorable mandibular growth is a must for CL II correction with HG use 6
Force is generated by head cap or neck strap through ; springs Elastic bands 7
Force is delivered to the teeth by ; Face bow J Hooks 8
classification
Distalising HG
: direction of elastic traction has a distal component Types : Occipital directed ( high) pull Combination pull Cervical directed (low) pull J-hook HG Asymmetric HG HG to mandible 9
High Pull Headgear
Skeletal Class II with prognathic maxilla High Angle case Growing ages
Straight Pull Headgear
Skeletal Class II with prognathic maxilla normal Angle case Growing ages
Cervical Pull Headgear
Skeletal Class II with prognathic maxilla Low Angle case Growing ages
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High pull HG
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Combination pull HG
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Low pull HG
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J Hook HG
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A. Single pull to maxillary dentition B. Attachment of the J hooks to both maxillary and mandibular dental arches.
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Asymmetric HG
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Components
Head cap / neck strap Elastics Face bow (Inner bow, outer bow and U loop) 17
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Uses: dental
Anchorage Distalisation – single or blocks of teeth Intrusion -- single or blocks of teeth Extrusion Asymmetric movement 25
Uses: skeletal
growth modification maxilla --- suppression which is permanent even after treatment has ceased mandible --- suppression, retrusion of the chin during chin cap treatment.however catch-up mandibular growth may occur during or after pubertal growth period 26
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Factors influencing effect
Direction of force Duration of force Magnitude of force Centers of rotation 28
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Duration and magnitude of force
Orthopedic effect Principle: higher forces for comparatively smaller duration 12 ---16 oz or 350-----450 gm / side 10 ---12 hrs 33
Duration and magnitude of force
Tooth movement Principle : smaller forces for longer duration 100 --- 200 gm / side 14 --- 16 hrs Anchorage 250 --- 300 gm / side 10 hrs min.
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Magnitude of force is determined by a Strain-gauge Spring loaded assembly comes with a built in force indicator 35
FORCE MEASURING DEVICE
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Centers of rotation
Single rooted teeth ----- centroid 6_ ----- trifurcation Maxilla ----- b/w roots of 4&5 38
Resolution of forces:horizontally
Force thru center of resistance ----- bodily movement Force above center of resistance ----- distal root tipping Force below center of resistance ----- mesial root tipping 39
Resolution of forces: Vertically
Above occlusal plane ----- intrudes teeth Below occlusal plane ----- extrudes teeth 40
Problems with HG Tooth- related
Unwanted tooth movement Tipping Extrusion of 6_ may cause clockwise rotation of mand. Pt. Becomes more CLII Buccal rolling of 6_ with high pull HG Cross bite on side of movement with asymmetric HG Lingual tipping of lower incisors, clockwise rotation of mand. & increased LAFH with chin cup therapy Root resorption possibly with J hook HG 41
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Problems with HG Patient related
Co-operation biological variability growth may be unfavorable Extra / intra-oral injuries Pain Difficulty with insertion 44
Assessment of patient compliance at every visit Check for signs of use intra orally as well as extra orally Hand out Time-sheets for record of wear Offer reward 45
Extra oral injuries include injuries to eyes , eyelids, nose etc.
Most common are eye injuries Catapult type of injury very common while playing Disengagement of face bow during sleep 46
Safety
No single safety HG is best Should use safety face bow and release mechanism together Written instructions must be given to patient Risks involved should be explained told to seek medical advice if any problem arises 47
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THANK YOU
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