Growth Modifying Appliances (Headgear, Reverse Pull Face Mask)

Growth modifying appliances are usually recommended for:

• Children aged 6 years to 12 years of age.
• Patients with skeletal discrepancies, especially Class II and Class III skeletal malocclusions.
• Children with underdeveloped maxillas (Upper Jaw).
• Children with overdeveloped maxillas or retrognathic mandibles (Lower Jaw).
• Young patients prior to the pubertal growth spurt, which is the ideal time to achieve skeletal changes.

Early diagnosis with the tools of cephalometric analysis and clinical evaluation of growth is very important in determining if the child is a candidate for growth modification.

There are two primary types of devices used for growth modification:

1. Orthodontic Headgear

●     Primarily used with Class II cases.

●     Prevents forward growth of the maxilla.

●     Types include cervical pull, high-pull, and combination headgear.

2. Reverse Pull Facemask (Protraction Facemask)

●     Used with Class III malocclusion.

●     Promotes forward growth of the maxilla.

• Initial Consultation – Evaluation of growth determined on X-rays, photographs, and bite impressions.
• Treatment Planning – Determining which type of appliance will be used (headgear or facemask).
• Appliance construction – The device is made and fitted to the child by the orthodontist.
• Appliance Delivery – Instructing the child how to put on and care for the device.
• Wearing Schedule – Usually, the device is worn for approximately 12-14 hours a day (most at night).
• Regular check-ups for adjustments – Whenever required approximately every 4-6 weeks.
• Completion – The appliance is removed when the desired growth changes are completed.

• Early treatment can correct discrepancies in the jaws.
• Reduces chance of jaw surgery in the future.
• Improves facial profile & aesthetics.
• Aids in chewing and speech improvement.
• Any future teeth eruption and alignment is improved.
• Children will develop greater self-esteem and confidence.

• Less invasive than jaw surgery.
• Cost effective if treatment is completed early.
• Can modify the direction of growth but does not stop it.
• Greater compliance in children than in adults.
• Treatment can prevent or reduce the need for fixed braces.
• Unlike braces which only move teeth, growth modifying appliances will actually modify the development of bone in each jaw which is their value.

• The appliance itself can take 1-2 appointments to fit, and then the total wear-time is typically 12-14 hours/day.
• Total treatment time is usually 6 to 18 months.
• No surgical recovery is required; minor soreness may occur initially.
• Regular monitoring ensures timely adjustments and faster progress.

Cost of growth modifying appliances depends on the  type of appliance, clinic location, and complexity level:

1. Orthodontic headgear: ₹15,000 - ₹30,000.
2. Reverse pull face mask: ₹25,000 - ₹45,000.

Other factors that can add to the cost include follow-through visits, further appliances (for example, the RPE), and imaging for diagnostics. In India, government dental colleges or teaching hospitals may offer lower rates.

Possible complications include:

• Soreness or discomfort in teeth and jaws initially.
• Locally rashes, redness or irritation where the appliance contacts the face.
• Unsuccessful treatment due to poor compliance.
• Some speech issues during some of the first days of use.
• Tooth mobility, root resorption (these occurring quite rarely).

A good fitting, compliance from the patient, and allowing regular follow-up checks can keep any problems under control.

• Disadvantages of growth modifying appliances include:
• Require very high compliance from patients.
• Visible appliances may affect the child's self-confidence.
• Limited time frame for effectiveness (used up until puberty).
• Most patients will require further orthodontic treatment.

Alternatives are as follows:

• Fixed orthodontic treatment with braces.
• Surgical skeletal corrections when the patient reaches adulthood.
• Functional appliances like twin blocks or Herbst appliances (for select cases).
• Myofunctional therapy (when needing minor corrections).

Typically, all of the above will be scheduled for rectifying problems only when growth is arrested, therefore these treatments usually incorporate longer timelines and more invasive processes. 

Aftercare include:

• Wearing appliances for recommended hours daily.
• Cleaning the appliance regularly i.e. mild soap and soft brush.
• Avoiding rough play or incidental damage to the device.
• Scheduling and maintaining follow-up appointments.
• Ensuring good oral hygiene in order to prevent cavities, tooth decay and gum infection.