Orthodontics Blog - Dr. Albert Fontaine

A Primer On Headgear Alternatives

SPRING HILL, FLORIDA— Headgear is one of those orthodontic appliances patients frequently see as a torture device instead of appreciating its true orthodontic benefit.

Since even the likes of Dakota Fanning- prescribed headgear by an orthodontist- and Katy Perry- who donned it for a music video- are unable to increase its “cool” factor, we’re sharing some headgear alternatives with you, in the event you’re a patient or parent of a patient who may need this Palm Harbor orthodontic treatment in the future. Dr. Albert Fontaine has a great deal of knowledge regarding these appliances, because he has used them all at some point.

First, an explanation of headgear’s purpose: it helps correct an overbite, and it also is used to control jaw growth. It can hinder upper jaw growth and give the lower jaw an opportunity to grow forward.

Herbst Appliance The Herbst is not patient-friendly, but it certainly is the most effective, says Dr. Fontaine. The Herbst takes more time to install however, and is sometimes difficult to remove.

This Spring Hill orthodontist’s opinion is: “You will not win any friends with this one. Patients and parents will hate you for prescribing it.”

That’s because it requires a lot of chair time at the orthodontist’s office, it requires impressions and has to be sent to the lab. That means more costs.

MARA The MARA- short for mandibular anterior repositioning appliance- uses cemented crowns over the molars like the Herbst, but it offers a bit more lateral freedom for your lower jaw.

“The Herbst and MARA are both heavy, hard-core appliances, in my mind,” Dr. Fontaine says. “They work, and they give more predictable results, but I don’t use them due to the discomfort, chair time involved, cost and potential joint problems.”

Jasper Jumper

The Jasper Jumper is like a rubber-covered spring that attaches from the top arch to the bottom. This doesn’t require fitted crowns over the molars. Instead, we just use your regular braces setup. This reduces cost and chair time, since no impressions and lab costs are involved, Dr. Fontaine says. Because the spring is covered by soft material, patients do not get the cheek irritation that is prevalent with other appliances.

“However, I find that these are flexible and will break more often,” he says. “You also get more tooth movement and less jaw movement.”

Our goal in using these types of appliances is achieving skeletal or jaw movement, so an argument can be made that this appliance doesn’t give the desired result.


The Forsus appliance is attached to regular braces, so costs and chair time are reduced, says the Dunedin and Spring Hill overbite correction expert. It uses a piston on each side that is attached to the braces. It is metal and rigid, so it is more solid and durable than the Jasper Jumper. It doesn’t have the Jasper Jumper’s lateral movement freedom, but it has more freedom than the MARA or Herbst.

It appears to be a middle ground between the two appliance styles. One negative to the Forsus is that it can come apart, but we teach patients to put it back together because doing so is simple.

“Currently, I use Forsus most often,” Dr. Fontaine says. “It works pretty well and is not super uncomfortable to the patient.”

Twin Force Bite Corrector

This is a new appliance that is getting some good reviews. It is like the Forsus in many ways, but it doesn’t come apart, Dr. Fontaine says. It attaches directly to braces, meaning there is no need for impressions and lab cost.

“All of the fixed bite correctors I have discussed remove most, if not all, the patient compliance factor,” he says. “This is the number one problem for Clearwater orthodontists when trying to correct malocclusion.”

A Word About Headgear

There is no mistaking that good old headgear still does the job. But its success relies upon the patient wearing it nightly, plus a few hours a day.

“I liked the headgear since it was inexpensive, easy to place and did not appear to adversely affect the temporomandibular joint,” Dr. Fontaine says. “The headgear placed pressure on the maxilla only.”

Headgear allows free lower jaw movement and works by holding back the maxilla and allowing the lower jaw to basically catch up. It does not displace the mandible like all of the above bite correctors.

“The bite correctors push the mandible forward, and I have concerns about pulling the lower jaw out of the socket even though I haven’t seen any problems to date,” Dr. Fontaine says. “I guess this is just an orthodontist’s worry.”

In any event, Dr. Fontaine routinely takes X-rays to evaluate the jaw joints before and after the bite correction. Not all orthodontists do this, but he views it as prudent.

Dr. Fontaine cautions patients not to get too caught up in which appliance to use. They all work, and it is more important to use something that works in the orthodontist’s hands. Ask questions and see what is available, but remember it is the orthodontist’s decision, ultimately.

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