Orthodontic Headgear Effects on Jaw Growth
Cervical headgear restricts maxillary growth, occipital headgear restricts maxillary growth with different vertical effects, and reverse headgear (facemask) promotes maxillary growth while potentially restricting mandibular growth.
Cervical Headgear (Maxillary Restriction)
Primary Effect: Restricts forward maxillary growth and development
- Significantly restricts anterior maxillary displacement and reduces maxillary length growth, correcting Class II malocclusion primarily through maxillary forward growth restriction 1, 2
- Creates a downward and backward force vector on the maxilla due to the low cervical attachment point 1
- Produces maxillary dentoalveolar effects including retrusion of maxillary incisors and distal movement of maxillary molars 1
- Does not significantly affect mandibular growth - mandibular development proceeds normally during cervical headgear treatment 1, 2
- Results in improved maxillomandibular relationship through maxillary restriction rather than mandibular promotion 2
Occipital Headgear (Maxillary Restriction with Different Vector)
Primary Effect: Restricts maxillary growth with more horizontal force direction
- Provides higher attachment point than cervical headgear, creating a more horizontal or slightly upward force vector on the maxilla
- Restricts forward maxillary growth similar to cervical headgear but with less tendency to increase vertical facial dimension
- Preferred when vertical facial growth control is needed alongside maxillary restriction
- Does not promote mandibular growth - mandibular development continues independently 1
Reverse Headgear/Facemask (Maxillary Promotion, Mandibular Restriction)
Primary Effect: Promotes forward maxillary growth and may restrict mandibular growth
- Promotes anterior maxillary displacement and increases midfacial length when combined with rapid maxillary expansion (RME) 3
- Creates forward and downward traction on the maxilla through the facemask attachment 3
- May produce mandibular growth restriction effects - studies show significantly smaller increases in mandibular length and posterior positioning of the chin compared to untreated controls 3
- Results in greater maxillary dentoalveolar effects including proclination of upper incisors and retroclination of lower incisors 3
- Does not cause significant trabecular changes in mandibular bone structure, suggesting effects are primarily growth modification rather than bone remodeling 4
Mandibular Cervical Headgear (Mandibular Restriction)
Primary Effect: Restricts mandibular growth and repositions mandible
- Produces posterior and anterior rotation of the mandible with distalization of mandibular molars 5
- Restricts mandibular length growth - shows significantly smaller increases in mandibular length and sagittal chin position compared to maxillary protraction 3
- Effective for Class III malocclusion with mandibular prognathism rather than maxillary deficiency 3, 5
- Does not affect maxillary growth - maxillary development proceeds normally 3
Clinical Decision Algorithm
For Class II malocclusion (mandibular deficiency/maxillary excess):
- Use cervical or occipital headgear to restrict maxillary growth 1, 2
- Choose cervical if vertical dimension is acceptable 1
- Choose occipital if vertical control is needed
For Class III malocclusion:
- If maxillary deficiency predominates: use reverse headgear/facemask with RME to promote maxillary growth 3
- If mandibular prognathism predominates: use mandibular cervical headgear to restrict mandibular growth 3, 5
Critical Caveats
- Timing is essential - all headgear appliances work through growth modification and must be used during active growth periods 1, 2, 3
- Skeletal effects are limited - much of the correction comes from dentoalveolar changes rather than pure skeletal modification 1
- Compliance-dependent - extraoral appliances require excellent patient cooperation for effectiveness 1, 2