Bill HangDental Practitioner, Lecturer at OrthO2Health

The Case Against Headgear - William M. Hang DDS MSD

30 Dec 2012 · 2 min

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1:45

In this segment, William M. Hang cites a 31‑year‑old study by James McNamara, PhD, that examined Class II malocclusion in 8‑ to 10‑year‑old children. The study found that only a small minority of cases showed true maxillary skeletal protrusion; most children had a neutral or even retruded maxilla relative to the cranial base, and the most common skeletal pattern was a combined maxillary‑mandibular retrusion. Hang argues that these findings undermine treatment approaches that aim to restrict maxillary growth (e.g., headgear) and instead support strategies that advance both the maxilla and mandible to correct the malocclusion. He challenges the interpretation of the data, questioning whether the proper conclusion should be to develop the maxilla forward before advancing the mandible.

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James McNamara, PhD, teaching at the University of Michigan right here, 31 years ago talks about components of Class II malocclusion in 8 to 10-year-old children. And he concludes, looking at a large group of them using his criteria, Only a small percentage of the cases in this study exhibited maxillary skeletal protrusion relative to cranial and cranial base structures. On the average, the maxilla was in a neutral position. It was more often in a retruded than protruded position. In other words, the upper jaw is really not sticking out. Matter of fact, it's too far back in many cases. I can tell you right now, based on the criteria that we use, it's too far back in every case. Next thing he concluded is maybe we ought to— he said maxillary mandibular skeletal retrusion was the most common single characteristic. Really? And finally, he then concludes maxillary skeletal protrusion is not a common finding. In fact, more cases of maxillary retrusion were observed. Thus, it appears that in designing the ideal treatment regime, those approaches which might alter the amount and direction of mandibular growth. could be more appropriate in many cases than those which restrict maxillary development. Let's develop the lower jaw forward. What might he really conclude from this if he were really to get accurate? He might suggest first that we want to develop the maxilla forward. Am I correct? And then develop the mandible forward.