Orthodontic Headgear UK

What is orthodontic headgear?

Orthodontic headgear is a category of extra-oral appliances that connect to intraoral components — typically to tubes on molar bands or to hooks on fixed braces — and extend outside the mouth to attach to a strap that wraps around the head or neck. The external anchorage point provides a fixed structure to push against, allowing forces to be applied to the teeth or jaws that could not be generated by intraoral mechanics alone. Headgear can restrain jaw growth, move teeth distally (backward), or stimulate forward growth of the upper jaw, depending on the type and the direction of force applied.

Cervical-pull headgear

Cervical-pull headgear consists of a facebow — a U-shaped metal bar with an inner bow that inserts into molar tubes and an outer bow that extends to the sides of the face — attached to a strap that passes around the back of the neck. The cervical strap applies a backward and slightly downward force to the upper molars and, when worn during growth, can restrain forward development of the upper jaw. It has historically been used for Class II malocclusion — where the upper teeth protrude relative to the lower — by holding the upper arch back while the lower jaw continues to grow. Compliance of 12 to 14 hours per day is required. Cervical-pull headgear is considerably less commonly prescribed today following the development of alternatives, particularly temporary anchorage devices (TADs), which can achieve molar distalisation without extra-oral anchorage.

High-pull headgear

High-pull headgear attaches to the outer bow of a facebow via straps that run over the top of the head rather than around the neck. The more vertical direction of pull allows the orthodontist to control vertical growth as well as the horizontal — making it appropriate for patients with a steep jaw angle (high angle Class II cases) where a cervical-pull would risk worsening the vertical dimension. By directing the force upward and backward, high-pull headgear can restrict downward growth of the upper jaw and prevent the molars from erupting further vertically. Like cervical-pull headgear, high-pull requires many hours of daily wear and is now largely supplemented by TADs in UK specialist practice.

Reverse-pull facemask

The reverse-pull facemask — also known as a protraction facemask — works in the opposite direction. It consists of a chin cup that rests under the chin, a forehead pad that rests on the forehead, and a rigid vertical bar connecting them. Elastics run from hooks on the upper arch (usually on a removable appliance or fixed braces) forward and slightly downward to attach to the bar of the facemask, pulling the upper jaw forward. This is the main treatment for skeletal Class III malocclusion in growing children — where the upper jaw is underdeveloped relative to the lower. It is most effective before the age of 10, when the sutures between the facial bones are still relatively mobile and the upper jaw can genuinely be stimulated to grow forward. After growth is complete, forward movement of the upper jaw requires surgical intervention. Compliance is demanding — 14 or more hours per day — and the facemask is visually conspicuous. Despite these challenges, it remains the primary non-surgical intervention for genuine skeletal Class III in young children and has no comparable intraoral alternative for achieving maxillary protraction.

Modern alternatives to headgear

For tooth-borne anchorage — the need to push molars backward to create space for the front teeth — temporary anchorage devices (TADs) have largely replaced conventional cervical and high-pull headgear in specialist UK orthodontic practice. TADs are small titanium miniscrews placed into the jawbone between the roots of the teeth under local anaesthetic. They act as a fixed anchorage point intraorally, allowing the orthodontist to apply the same distalising forces without the compliance burden of extra-oral wear. For Class III protraction, however, no equivalent intraoral replacement for the reverse-pull facemask has achieved the same clinical evidence base, and it remains in common use at hospital orthodontic departments.

NHS availability

Orthodontic headgear is available on the NHS. However, because the cases requiring headgear are often more complex, NHS treatment involving headgear is typically delivered at a hospital orthodontic department or a specialist practice with an NHS contract, rather than by a general dental practitioner. Waiting times for hospital orthodontics on the NHS can be considerable, and early referral is advisable for young Class III patients who may be candidates for reverse-pull facemask treatment, as timing relative to the growth phase is critical.

Safety features of modern headgear

All modern orthodontic headgear is manufactured with safety release mechanisms to prevent injury if the appliance is pulled sharply. Earlier designs without these features were associated with serious eye injuries when the facebow snapped out under tension. Current facebow designs incorporate safety locks that release the outer bow from the inner bow if sufficient force is applied — for example if a child grabs the facebow or rolls onto it during sleep. Parents and patients should always check that the safety mechanism is engaged before wearing headgear, and should follow the fitting instructions provided by the orthodontist precisely.

Useful related pages

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.