For patients with an underbite, there are different orthodontic appliances that can be used to correct the bite. If interceptive orthodontic care is started before a child reaches puberty, reverse pull headgear (also known as a facemask) is an effective treatment option that can fix a patient’s bite and help avoid surgery in the future.
The headgear is worn on the face and it rests on the patient’s forehead and chin. The same rubber bands used to bring the upper jaw forward also provide the reciprocal force to hold the appliance against the face.
Reverse headgear is used in growing patients with underbites to move the jaw in the same direction that it was supposed to grow in the first place. More specifically, it is used when the upper jaw is underdeveloped, usually front to back or side to side, to pull it forward and assist in the growth of the upper jaw. I also will use this appliance sometimes if the lower jaw is a little overdeveloped and positioned forward.
Expanders are also often incorporated to increase vertical height a little bit, but mostly to bring an underdeveloped upper jaw forward.
If a child uses reverse headgear at an early age (as young as four or five years old), I can fix a significant underbite in three to four months when worn 18 hours a day, and even sooner if they keep it on 24 hours a day. I prefer to treat the patients when they are young enough that their baby teeth have plenty of long roots so we don’t have to compromise permanent molars. This treatment is ideal for children four years old up to puberty. After that, when children have a growth spurt, the reverse pull headgear has less of a jaw effect and just some tooth effect.
Treating patients with reverse pull headgear at a young age produces a more balanced face, a better profile (less concave) and a healthier bite.
