An evidence-based comparison of headgear and functional appliance therapy for the correction of Class II malocclusions

The purpose of this literature review is to compare the effects of headgears and functional appliances in treating children with distoclusions. The comparisons are made as a series of key questions addressing short-term effects, outcomes following fixed appliance treatment, and post-retention effects. Headgears and functional appliances are equally effective in correcting Class II malocclusions in children (before comprehensive treatment). Short-term skeletal effects include a small restriction in forward maxillary growth with headgear and a small forward positioning of B point with functional appliances, leading to an ANB improvement in Class II patients of about 1° with either appliance. A significant portion of the Class II correction is distal maxillary molar movement with headgears and mesial mandibular molar movement (plus mandibular incisor proclination) with functional appliances. Higher levels of evidence, to answer the question of whether the effects of headgears and functional appliances are equal following fixed appliances, are lacking and needs to be addressed.