Cervical headgear effectiveness in distalizing molars in relation to patient compliance.

OBJECTIVES: The purpose of this study was to measure the effectiveness of the cervical headgear for distalizing first permanent maxillary molars in relation to hours of use. METHODS: This was a one-centre, prospective, clinical study conducted at the Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece. Participants (N = 26; 17 females, 9 males) were patients with no history of orthodontic treatment, no syndromes or clefts, and Angle's Class II malocclusion, where the treatment plan included a cervical headgear. They were instructed to wear the appliance for at least 12 h per day. A TheraMon® microsensor was embedded in the headgear's strap to objectively measure wear-time. To measure tooth movement, pre- and post-treatment digital models were superimposed, using the palate as a reference area; translation and rotation were measured along three axes. Superimposition and movement measurements were made with the Viewbox 4 software. RESULTS: Average treatment time and headgear wear were 130 days and 55 days, respectively, i.e. 10.1 h/day. During this period, distal movement averaged 1.75 mm with high variability (min 0.2 mm, max 4.5 mm). Distal tipping and rotation had an average of approximately 5 °C. Cumulative headgear wear was significantly correlated with distal movement (r2 = 0.32, P < .002), distal tipping (r2 = 0.27, P < .01), and distal rotation around the long axis of the tooth (r2 = 0.20, P < .05). CONCLUSION: Compliance is critical for having a successful clinical outcome. Distalization of the molar with a cervical headgear is correlated with the cumulative hours of appliance use, with hours per day being a weaker predictor.

Cervical headgear therapy and sleep-related attributes.

INTRODUCTION: The study aimed to assess (1) the effect of the treatment with cervical headgear on patients' sleep-related attributes and well-being and (2) whether these sleep-related parameters (ie, sleep quality and quantity) were associated with patients' compliance during the orthodontic treatment. METHODS: The study protocol was based on a prospective longitudinal quasi-experimental design. Participants (n = 26; 9 males; mean age, 12.4 ± 1.68 years) were patients in the Postgraduate Orthodontic Clinic, National and Kapodistrian University of Athens. All patients received treatment with a cervical headgear having an embedded TheraMon microsensor. Sleep was assessed by wrist-worn actigraphy for 59 ± 19 days. The Epworth Sleepiness Scale was used to assess average daytime sleepiness, whereas we used the Athens Insomnia Scale for insomnia symptoms. Oral health-related quality of life (OHRQOL) was assessed by the Oral Health Impact Profile (OHIP-14). RESULTS: Patients slept on average 7.35 ± 0.42 h/d. Compared with the lowest sleep duration recommended for their age group, patients had an average chronic sleep deficit of 1.40 ± 0.49 h/d. Patients wore the headgear 90.9% of the days for 10.40 ± 4.17 h/d. However, only 7 (28%) patients reached or exceeded the wear-time recommendation of 12 h/d. In contrast, 2 (8%) patients wore headgear <5 h/d, 11 (44%) 5-10 h/d, and 12 (48%) patients wore headgear >10 h/d. Aggregated by participants, the median Epworth Sleepiness Scale score during the study was 3.40 (interquartile range [IQR], 4.85; range, 0.2-13.6), the median Athens Insomnia Scale score was 3.00 (IQR, 4.25; range, 0-7), and the median Oral Health Impact Profile score was 1.40 (IQR, 4.17; range, 0.0-20.8). Compared with patients who wore the orthodontic appliance >7.8 h/d, patients who wore it <7.8 h/d had worse average daytime sleepiness (P = 0.050) and worse OHRQOL (P = 0.019). CONCLUSIONS: Orthodontic treatment with cervical headgear has no substantive negative effect on sleep attributes (quantity and quality), average daytime sleepiness and OHRQOL. However, poor compliance with orthodontic treatment seems to be associated with higher levels of daytime sleepiness.