Cervical headgear usage and the bioprogressive orthodontic philosophy

During the past 125 years, a variety of headgear appliances have been used as adjuncts during orthodontic therapy. At the outset, a headgear was usually used in combination with the extraction of the upper first bicuspid teeth which created the space required to retract protruding upper anterior teeth. It did not take long for clinicians to understand that some form of extraoral support was required to augment the somewhat-limited anchor-age provided by the maxillary bicuspid and molar teeth during incisor retraction. Thus, the headgear became the treatment auxiliary of choice during the retraction of the anterior segment of teeth. Used in this manner, the appliance became known as occipital, or headgear anchorage. After the introduction of cephalometric radiography, it became evident that headgear appliances could be used not only to move teeth, but also as orthopedic appliances to modify the development of the jaws of growing children. With time and development, headgears lost some of their early complexity and they evolved into appliances that closely resembled modern cervical headgears. The cervical pull headgear soon became involved in a controversy when some clinicians claimed that the use of a high pull, or occipital pull headgear resulted in more optimal treatment results than the cervical pull headgear. The Bioprogressive philosophy of orthodontic therapy recommends the use of cervical headgears in the unequivocal belief that, when correctly used, they produce the most advantageous and predictable orthopedic changes in growing faces.