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Jaw Discrepancies and Orthopedic Treatment: Growth Modification

As children grow, their facial and jaw bones develop simultaneously with their height. However, genetic factors or habits like thumb sucking and mouth breathing can disrupt this development. This leads to discrepancies where the jaws are positioned too far forward or backward relative to each other or the facial structures (Class II and Class III malocclusions). The method used to correct these skeletal discrepancies at the bone level in growing children is called Growth Modification (Orthopedic Treatment). Removable functional appliances and extraoral orthopedic appliances play the most significant role in this treatment.

When such bone discrepancies are diagnosed in adults who have completed their growth, treatment options become limited, and orthognathic surgery is often required. However, in children, bones are still young and highly adaptable. Orthodontists utilize this window of opportunity to guide the jaw bones into their correct direction, using the child's own natural growth energy as a leverage.

1. Removable Functional Appliances: These devices are custom-made removable appliances primarily preferred in cases where the lower jaw is underdeveloped (Class II) to position it forward. When a child with an underdeveloped lower jaw wears the appliance, the mouth is forced to close in a more forward position. Over time, muscles and joints adapt to this correct position, guiding growth in that direction. The Twin Block and Activator systems, commonly used in our clinic, are the most successful examples of this group.

2. Extraoral Orthopedic Appliances: These are powerful systems that apply heavier forces and receive support from outside the mouth (forehead, chin, or neck/head area) to directly change the direction and amount of jaw bone growth, going beyond simple tooth movement. The first of these, the Face Mask, is used in cases where the upper jaw is backward (Class III). It supports itself from the forehead and chin to mechanically pull the upper jaw forward and is usually worn at night and in the home environment. The second system, the Headgear, is preferred when upper jaw development is too far forward. It takes support from the neck or back of the head to restrain the forward growth of the upper jaw, allowing the lower jaw to catch up and achieve balance.

Critical Factors for Success: Functional treatments for lower jaw deficiency and Headgear applications show maximum effectiveness during the pubertal growth spurt (usually between ages 9-14). However, the most ideal and efficient age for the face mask treatment used for upper jaw deficiency is between 6-8 years old. In this early period, the upper jaw sutures are not yet fully fused, making it much easier to guide the upper jaw forward.

Success depends entirely on the child's compliance. For optimal results, these appliances must be worn continuously for at least 14-16 hours a day. Since growth hormone is secreted most intensely during the evening and sleeping hours, starting to wear the devices in the early evening (while doing homework, watching TV, etc.) rather than right before bed maximizes their effects.                         

Assist. Prof. Dr. Aslıhan KUĞUOĞLU

Yozgat Bozok University

Faculty of Dentistry

Department of Orthodontics