Preliminary tests of a new device to monitor orthodontic headgear use

The impact of force magnitude on the first and second maxillary molars in cervical headgear therapy

AIM

To study the effect of force magnitude on the maxillary first and second molars in cervical headgear (CHG) therapy.

MATERIAL AND METHODS

In this controlled clinical trial, patients (n = 40) were treated with CHG with a light (L, 300 g, n = 22) or a heavy force (H, 500 g, n = 18) magnitude. The subjects were asked to wear CHG for 10 hours a day for 10 months. The outer bow of the CHG facebow was lifted up for 10-20 degrees and the inner bow was expanded 3-4 mm. Adherence to instructions and force magnitude were monitored using an electronic module (Smartgear, Swissorthodontics, Switzerland). Panoramic and lateral radiographs before (T1) and after treatment (T2) were analysed using a Romexis Cephalometric module (Planmeca, Finland) focussing on the angular, sagittal, and vertical positions of the permanent first and second molars.

RESULTS

According to the cephalometric analysis of the maxillary first and second molars, distal tipping occurred during T1-T2 in the H group (P = 0.010 and 0.000, respectively), and the change was greater in the H group compared to the L group (P = 0.045 and 0.019, respectively). Based on the panoramic analysis, tipping occurred in the distal direction during therapy in the H group in the second molars compared to the midline or condylar line (P = 0.001 and 0.001; P = 0.008 and 0.003 on the right and left, respectively).

CONCLUSION

With heavy force magnitude, the maxillary first and second molars can tilt more easily in the distal direction even if the CHG was used less. Distal tipping of the molar can be considered to be a side effect of CHG therapy.

Adherence to instructions and fluctuation of force magnitude in cervical headgear therapy

OBJECTIVES

To investigate how patients adhere to instructions and how force magnitude fluctuates and influences the use of cervical headgear (CHG) therapy.

MATERIALS AND METHODS

In this controlled clinical trial, subjects (n = 40) were treated with CHG with light (L, 300 g) or heavy (H, 500 g) force. Patients were asked to wear CHG for 10 hours per day for 10 months (ie, during sleep), but the importance for treatment of wearing CHG also in the evening hours was emphasized. Adherence to instructions and force magnitude in CHG use were monitored by electronic module (Smartgear, Swissorthodontics, Switzerland).

RESULTS

Force magnitude can be set at a certain level, L or H, even if great individual variability is seen in all subjects (0-900 g). Children in the L group used CHG longer per day than those in the H group (9.3 hours ±1.5 hours and 7.8 hours ± 2.1 hours, respectively, P = .002). During evening hours, CHG was used more ( P = .02) in the L group than in the H group. In both groups, CHG was used less in the evening hours during school breaks than in the evening hours during school ( P < .001).

CONCLUSIONS

Children with lower force in CHG seem to adhere better to the instructions for CHG use. Daily rhythm also influences the time of appliance use regardless of force magnitude. The force can be set to a certain magnitude level, even though there is substantial individual variability.

Clinical and quantitative assessment of headgear compliance: A pilot study

INTRODUCTION

This study was undertaken to evaluate the compliance of patients using headgear with a timing device and to determine the efficiency of the electronic module timer as a patient motivator.

METHODS

Twenty-one patients (average age, 14 years 10 months) were selected from the orthodontic clinic of Federal University of Paraná on the basis of headgear wear for anchorage. The patients were instructed to wear their headgear 14 hours a day for a given number of days. The headgears were equipped with recorders (Compliance Science System and Affirm smart headgear modules, Ortho Kinetics, Vista, Calif). The patients were not told about the recorders, but they were instructed to keep track of their wear times. At the end of the test period (T1), the patients' reported wear times were compared with readings from the electronic modules. The patients were assigned a second period of headgear wear (T2) and told that their use would be monitored electronically. Again, the wear times reported by the patients were compared with the values from the electronic modules. Total time, number of hours accumulated between sessions, and quality time (uninterrupted use of headgear) were assessed.

RESULTS

Patients reported wearing their headgear an average of 13.6 hours per day; the electronic modules detected 5.6 hours per day in T1 and 6.7 hours per day in T2. Quality time was 1.8 hours per day in T1 and T2. The mean actual hours of daily wear relative to the provider's requirement was 56.7% in T1 and 62.7% in T2. Boys were more compliant than girls. After they learned of the electronic device, the girls' compliance improved. Younger patients were more compliant than older ones. The compliance rate of older patients improved slightly in T2.

CONCLUSIONS

Patients tend to overreport their headgear wear times. The mean actual hours of daily wear relative to the providers' requirement was 56.7%. This increased to 62.7% when patients knew a recording device was being used. A monitoring system can provide feedback to the patient, facilitate parental involvement, and motivate patients to comply with headgear wear.