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Vertical skeletal excess can be managed using either extraoral or intraoral force. Extraoral force is delivered via a high-pull headgear, which consists of:
The headgear applies force in a superior and distal direction through the maxillary first molars, inhibiting vertical maxillary development and posterior tooth eruption. Since no force is exerted on the mandibular teeth, they may erupt freely, potentially compensating for the restricted maxillary growth. In some cases, this compensatory eruption can negate the headgear's benefits, leading to downward and backward mandibular rotation instead of the desired forward projection.
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