Class II malocclusion treatment using high-pull headgear with a splint: a systematic review.

OBJECTIVE To systematically review the scientific evidence regarding the effectiveness of high-pull headgear in growing Class II subjects. METHODS A literature survey was performed by electronic database search. The survey covered the period from January 1966 to December 2008 and used Medical Subject Headings (MeSH). Articles were initially selected based on their titles and abstracts; the full articles were then retrieved. The inclusion criteria included growing subjects with 8 to 15 years of age, Class II malocclusion treatment with high-pull headgear, and a control group with Class II malocclusion. References from selected articles were hand-searched for additional publications. Selected studies were evaluated methodologically. RESULTS Four articles were selected; none were randomized controlled trials. All of the articles clearly formulated their objectives and used appropriate measures. The studies showed that high-pull headgear treatment improves skeletal and dental relationship, distal displacement of the maxilla, vertical eruption control and upper molars distalization. One of the studies showed a slight clockwise rotation of the palatal plane; the others showed no significant treatment effect. The mandible was not affected by the treatment. CONCLUSIONS While there is still a lack of strong evidence demonstrating the effects of high-pull headgear with a splint, other studies indicate that the anteroposterior relations improve due to distalization of the maxilla and upper molars, with little or no treatment effects in the mandible. Greater attention to the design should be given to improve the quality of such trials.