What Happened to Orthodontic Headgear? Why Braces Headgear Disappeared and What Replaced It

What Happened to Orthodontic Headgear? Why Kids No Longer Wear It

For generations of children, orthodontic headgear was practically a rite of passage. The bulky metal appliance, connected to braces and secured around the head or neck, was once a familiar sight in orthodontist offices. Today, however, many children finish orthodontic treatment without ever wearing one.

So what happened to headgear? Did orthodontists discover that it did not work, or did advances in dental technology make the uncomfortable appliance unnecessary? The answer is more complicated than simply replacing an outdated piece of equipment. Research found that traditional headgear could effectively correct certain jaw alignment problems, but getting children to wear it for the required number of hours was a major challenge. Newer orthodontic treatments also gave doctors additional ways to correct bite problems without relying on an external device.

An examination of the research, including findings discussed by orthodontist Dr. Ben Winters, helps explain why headgear became less common, what replaced it and why some versions of the appliance are still used today.

What Was Orthodontic Headgear Designed to Do?

Orthodontic headgear was primarily designed to correct problems involving the relationship between the upper and lower jaws, particularly in growing children with an overbite. An overbite-related condition known as Class II malocclusion occurs when the upper teeth or jaw sit too far forward in relation to the lower teeth or jaw. In certain growing patients, orthodontists used headgear to apply controlled pressure to the upper back molars and help guide the development of the bite.

The traditional appliance consisted of a metal facebow that connected to small tubes attached to the upper back molars. The facebow was connected to an external strap worn around the head or neck. Depending on its design, the appliance could apply different directions of force. Cervical-pull headgear used a strap around the neck, while high-pull headgear used support around the back of the head.

The goal was to influence the position of the upper jaw and upper molars while the child’s face and jaws were still developing. This gave the lower jaw an opportunity to catch up as growth continued. Although headgear may seem like a relatively modern orthodontic invention, versions of extraoral dental appliances date back to the 1800s. Early orthodontists experimented with external devices to influence jaw positioning and tooth movement long before today’s braces and treatment technologies became widely available.

Why Was Headgear So Popular in the 1980s?

Headgear was once a routine part of orthodontic treatment for many children. A 1986 survey published in the Journal of Clinical Orthodontics found that approximately 41% of responding orthodontists routinely used Kloehn facebow headgear. Another 36% reported using it occasionally. That means more than three-quarters of the orthodontists surveyed used the appliance at least occasionally.

At the time, headgear was an established option for treating certain bite problems and managing the position of the upper molars. However, the appliance came with one major requirement: Patients had to wear it consistently. Orthodontists commonly prescribed 12 to 14 hours of daily wear, depending on the treatment plan. That meant children often had to put it on after school, wear it while doing homework and keep it on overnight. For many families, maintaining that schedule was difficult.

The Biggest Problem Was Getting Kids to Wear It

Headgear could only deliver its intended treatment effects if patients actually wore it. Children were often embarrassed by the appliance, especially when it was visible outside the mouth. Unlike traditional braces, which remained attached throughout the day, headgear required patients to make a conscious decision to put it on and keep it in place. Research eventually provided a way to measure how much children were actually wearing their appliances.

A 2019 prospective clinical study published in the European Journal of Orthodontics examined 20 children between the ages of 8 and 12 who were prescribed cervical headgear for 12 hours daily. Researchers installed electronic monitoring devices that recorded temperature and force to determine actual wear time. The findings revealed a significant difference between the prescribed schedule and actual use.

Children averaged just 6.4 hours of daily wear when days without any use were included. That represented approximately 54% compliance with the prescribed 12-hour schedule. The study also found that headgear use dropped considerably during July and August, suggesting that summer vacation made consistent treatment even more difficult. The appliance was primarily worn at night, with very little daytime use. The findings highlighted a central problem with traditional headgear: The treatment depended on patient cooperation, and many children simply did not wear it enough.

Did Research Find That Starting Headgear Earlier Was Better?

Another important question was whether children benefited from beginning orthodontic treatment earlier rather than waiting until adolescence. Researchers examined this question through clinical trials involving children with Class II malocclusion. The trials compared two approaches. One group received early orthodontic treatment with headgear while their permanent teeth were still developing, followed by additional treatment during adolescence when necessary. The other group waited until adolescence to receive a single course of orthodontic treatment. The results were revealing.

A 2018 Cochrane systematic review examined evidence from multiple clinical trials and found that early headgear treatment did not produce significantly better final bite measurements than waiting until adolescence. By the end of treatment, the groups had similar results in important measurements involving overjet, the horizontal distance between the upper and lower front teeth, and jaw relationships. However, early treatment did have one important advantage: It reduced the risk of injuries to the upper front teeth.

In the headgear trials included in the review, 24 of 117 children who received early treatment experienced new incisor trauma, compared with 44 of 120 children who received later treatment. That translates to approximately 21% versus 37%. The findings suggest that early treatment can protect vulnerable front teeth in some children, but it does not necessarily eliminate the need for later orthodontic treatment. The research also found that starting earlier generally meant spending more time in orthodontic treatment overall.

Safety Concerns Also Changed How Headgear Was Designed

Another factor in headgear’s history involved safety. Although serious injuries were uncommon, medical literature documented cases involving metal facebows that became dislodged during use. A 1985 study published in Archives of Ophthalmology documented severe eye injuries involving orthodontic headgear. The report described penetrating injuries affecting three eyes in two patients, with serious consequences for vision.

These incidents raised concerns about how external orthodontic appliances were secured and how they could behave if accidentally pulled away from the mouth. Modern headgear designs incorporated safety improvements, including breakaway straps and locking mechanisms designed to reduce the risk of the metal facebow coming loose unexpectedly. These safety features were important developments, but they did not eliminate the larger problem of patient compliance. Even with improvements to the appliance, children still had to wear it consistently for treatment to work.

What Replaced Traditional Orthodontic Headgear?

Traditional headgear did not disappear overnight. Instead, orthodontists gained access to several alternatives that could address similar bite problems without requiring children to wear a large external appliance. For generations of children, orthodontic headgear was practically a rite of passage. The bulky metal appliance, connected to braces and secured around the head or neck, was once a familiar sight in orthodontist offices. Today, however, many children finish orthodontic treatment without ever wearing one.

So what happened to headgear? Did orthodontists discover that it did not work, or did advances in dental technology make the uncomfortable appliance unnecessary? The answer is more complicated than simply replacing an outdated piece of equipment. Research found that traditional headgear could effectively correct certain jaw alignment problems, but getting children to wear it for the required number of hours was a major challenge. Newer orthodontic treatments also gave doctors additional ways to correct bite problems without relying on an external device.

An examination of the research, including findings discussed by orthodontist Dr. Ben Winters, helps explain why headgear became less common, what replaced it and why some versions of the appliance are still used today.

What Was Orthodontic Headgear Designed to Do?

Orthodontic headgear was primarily designed to correct problems involving the relationship between the upper and lower jaws, particularly in growing children with an overbite. An overbite-related condition known as Class II malocclusion occurs when the upper teeth or jaw sit too far forward in relation to the lower teeth or jaw. In certain growing patients, orthodontists used headgear to apply controlled pressure to the upper back molars and help guide the development of the bite.

The traditional appliance consisted of a metal facebow that connected to small tubes attached to the upper back molars. The facebow was connected to an external strap worn around the head or neck. Depending on its design, the appliance could apply different directions of force. Cervical-pull headgear used a strap around the neck, while high-pull headgear used support around the back of the head. The goal was to influence the position of the upper jaw and upper molars while the child’s face and jaws were still developing. This gave the lower jaw an opportunity to catch up as growth continued.

Although headgear may seem like a relatively modern orthodontic invention, versions of extraoral dental appliances date back to the 1800s. Early orthodontists experimented with external devices to influence jaw positioning and tooth movement long before today’s braces and treatment technologies became widely available.

Why Was Headgear So Popular in the 1980s?

Headgear was once a routine part of orthodontic treatment for many children. A 1986 survey published in the Journal of Clinical Orthodontics found that approximately 41% of responding orthodontists routinely used Kloehn facebow headgear. Another 36% reported using it occasionally. That means more than three-quarters of the orthodontists surveyed used the appliance at least occasionally.

At the time, headgear was an established option for treating certain bite problems and managing the position of the upper molars. However, the appliance came with one major requirement: Patients had to wear it consistently. Orthodontists commonly prescribed 12 to 14 hours of daily wear, depending on the treatment plan. That meant children often had to put it on after school, wear it while doing homework and keep it on overnight. For many families, maintaining that schedule was difficult.

The Biggest Problem Was Getting Kids to Wear It

Headgear could only deliver its intended treatment effects if patients actually wore it. Children were often embarrassed by the appliance, especially when it was visible outside the mouth. Unlike traditional braces, which remained attached throughout the day, headgear required patients to make a conscious decision to put it on and keep it in place. Research eventually provided a way to measure how much children were actually wearing their appliances.

A 2019 prospective clinical study published in the European Journal of Orthodontics examined 20 children between the ages of 8 and 12 who were prescribed cervical headgear for 12 hours daily. Researchers installed electronic monitoring devices that recorded temperature and force to determine actual wear time. The findings revealed a significant difference between the prescribed schedule and actual use.

Children averaged just 6.4 hours of daily wear when days without any use were included. That represented approximately 54% compliance with the prescribed 12-hour schedule. The study also found that headgear use dropped considerably during July and August, suggesting that summer vacation made consistent treatment even more difficult. The appliance was primarily worn at night, with very little daytime use. The findings highlighted a central problem with traditional headgear: The treatment depended on patient cooperation, and many children simply did not wear it enough.

Did Research Find That Starting Headgear Earlier Was Better?

Another important question was whether children benefited from beginning orthodontic treatment earlier rather than waiting until adolescence. Researchers examined this question through clinical trials involving children with Class II malocclusion. The trials compared two approaches. One group received early orthodontic treatment with headgear while their permanent teeth were still developing, followed by additional treatment during adolescence when necessary. The other group waited until adolescence to receive a single course of orthodontic treatment. The results were revealing.

A 2018 Cochrane systematic review examined evidence from multiple clinical trials and found that early headgear treatment did not produce significantly better final bite measurements than waiting until adolescence. By the end of treatment, the groups had similar results in important measurements involving overjet, the horizontal distance between the upper and lower front teeth, and jaw relationships. However, early treatment did have one important advantage: It reduced the risk of injuries to the upper front teeth.

In the headgear trials included in the review, 24 of 117 children who received early treatment experienced new incisor trauma, compared with 44 of 120 children who received later treatment. That translates to approximately 21% versus 37%. The findings suggest that early treatment can protect vulnerable front teeth in some children, but it does not necessarily eliminate the need for later orthodontic treatment. The research also found that starting earlier generally meant spending more time in orthodontic treatment overall.

Safety Concerns Also Changed How Headgear Was Designed

Another factor in headgear’s history involved safety. Although serious injuries were uncommon, medical literature documented cases involving metal facebows that became dislodged during use. A 1985 study published in Archives of Ophthalmology documented severe eye injuries involving orthodontic headgear. The report described penetrating injuries affecting three eyes in two patients, with serious consequences for vision.

These incidents raised concerns about how external orthodontic appliances were secured and how they could behave if accidentally pulled away from the mouth. Modern headgear designs incorporated safety improvements, including breakaway straps and locking mechanisms designed to reduce the risk of the metal facebow coming loose unexpectedly. These safety features were important developments, but they did not eliminate the larger problem of patient compliance. Even with improvements to the appliance, children still had to wear it consistently for treatment to work.

What Replaced Traditional Orthodontic Headgear?

Traditional headgear did not disappear overnight. Instead, orthodontists gained access to several alternatives that could address similar bite problems without requiring children to wear a large external appliance.

Rubber Bands

One of the most recognizable alternatives is orthodontic elastics, commonly called rubber bands. These small elastic bands connect brackets on the upper and lower teeth to apply pressure and help correct the relationship between the two dental arches.

Patients typically attach and remove them themselves, following their orthodontist’s instructions. Rubber bands are easier to carry, less noticeable than traditional headgear and can be incorporated into everyday routines. However, they also require cooperation. Patients must wear them as prescribed to achieve the desired results.

Herbst Appliances

The Herbst appliance is another option for treating certain Class II bite problems. Unlike traditional headgear, the Herbst appliance is attached inside the mouth and connects the upper and lower dental arches with metal mechanisms.

It helps position the lower jaw forward and can be used while a child is growing. Because it is fixed in place, patients do not have to remember to put it on every night. This makes it a useful option when orthodontists want to reduce dependence on daily patient compliance.

Forsus Springs

Forsus appliances use spring mechanisms attached to braces to apply continuous force between the upper and lower dental arches. The appliance is installed inside the mouth and helps address certain overbite-related problems. Like the Herbst appliance, it does not require children to attach and remove an external device every day.

Temporary Anchorage Devices

Temporary anchorage devices, commonly called TADs, are small orthodontic screws temporarily placed in the jawbone to provide additional support during tooth movement. They give orthodontists another way to apply controlled forces without relying entirely on neighboring teeth for support.

TADs can be useful in more complex orthodontic cases, although they are not a universal replacement for headgear. The important development is that orthodontists now have several tools available to address different bite problems, allowing treatment to be tailored to the patient’s age, jaw development and specific orthodontic needs.

Why the Reverse-Pull Facemask Is Still Used

Instead of pulling the upper jaw backward, the reverse-pull facemask applies forward-directed force to help encourage the development of the upper jaw. It is typically used during childhood, when the facial bones are still developing.

Research from the United Kingdom has demonstrated why this treatment can be important for selected patients. A 2016 randomized clinical trial followed children who received early facemask treatment and compared them with children who did not receive early treatment. The study involved 73 children between the ages of 7 and 9 and followed their outcomes over six years.

Researchers found that approximately 36% of children who received early facemask treatment were considered likely to need corrective jaw surgery later in life. Among children who did not receive early treatment, that figure was approximately 66%. The findings suggested that early facemask treatment could substantially reduce the likelihood of requiring orthognathic surgery, which involves surgically correcting the position of the jaws. However, the study also showed that early treatment did not eliminate the possibility of surgery. Some children still required additional intervention as they grew.

Did Headgear Actually Stop Working?

No. The decline of traditional orthodontic headgear does not mean the appliance became ineffective. Headgear remains a useful treatment option in certain cases, particularly when orthodontists need to control the position of the upper molars or influence jaw development in a growing patient. What changed was the availability of other treatment methods.

Research also demonstrated that prescribing an appliance and getting a child to use it consistently are two very different things. With traditional headgear, the effectiveness of treatment depended heavily on daily wear time. Newer fixed appliances offered orthodontists additional options that did not require the same level of daily cooperation. That does not mean every modern appliance is better for every patient. Rubber bands still require consistent use, and fixed appliances come with their own limitations. Instead, orthodontists can now select from a wider range of treatments based on the individual patient’s needs.

The Bottom Line: Why Kids Rarely Wear Headgear Anymore

The familiar metal headgear that once defined childhood orthodontics has become far less common, but it has not disappeared completely. Its decline reflects a combination of research findings, patient compliance challenges, safety improvements and advances in orthodontic technology.

Studies found that children frequently wore headgear for substantially fewer hours than prescribed. Research also showed that starting treatment early did not necessarily produce better final bite results, although it could reduce the risk of front-tooth injuries.

Today, rubber bands, Herbst appliances, Forsus springs and temporary anchorage devices give orthodontists additional ways to correct bite problems. And for children with certain underbites, reverse-pull facemasks remain an important early treatment option. Ultimately, headgear did not become obsolete because it stopped working. Orthodontics evolved, giving doctors more ways to achieve similar treatment goals without relying on an appliance that many children struggled to wear.