Bone Anchored Traction [BAT]
There are children whose facial development may lag behind for a variety of reasons. The upper jaw may not keep pace with the lower jaw and the child develops an underbite.
Orthodontists for decades have come up with various ways of correcting this early underbite by using orthodontic appliances to apply external forces to the upper jaw bone as the child is going through his or her growth spurt. The extra 'pull' by a face mask or head gear as the child is growing may work but many children have found it difficult to wear and the amount of time asked can be exhaustive and the appliance cumbersome.
In contrast, by putting the traction force directly on the bone by special plates [Bollard or DeClerk] is more efficient as the problem is in the bones and not in the teeth. The elastics attach to special plates with hooks inside the mouth that have been surgically attached to the upper jaw and the lower jaw. Additionally the children have found wearing internal dental elastics more comfortable compared to external head gear. The internal traction can work for 24 hours a day and without interfering with the child's ability to go to school, sports or eating.
This is a SURGICAL PROCEDURE and needs to be done in a HOSPITAL. This treatment is suitable for ages 11-13 years old. For older children, conventional jaw surgery known as orthognathic surgery is more appropriate.
Downsides: Failure of the plates and screws. This depends on the quality of the bone.