University of Oulu

Johanna Julku, Kirsi Pirilä-Parkkinen, Mimmi Tolvanen, Pertti Pirttiniemi, Comparison of effects of cervical headgear treatment on skeletal facial changes when the treatment time is altered: a randomized controlled trial, European Journal of Orthodontics, Volume 41, Issue 6, December 2019, Pages 631–640,

Comparison of effects of cervical headgear treatment on skeletal facial changes when the treatment time is altered : a randomized controlled trial

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Author: Julku, Johanna1,2,3; Pirilä-Parkkinen, Kirsi1,3; Tolvanen, Mimmi4,5;
Organizations: 1Oral and Maxillofacial Department, Oulu University Hospital
2Department of Oral Development and Orthodontics, Research Unit of Oral Health Sciences, University of Oulu
3MRC Oulu, Oulu University Hospital and University of Oulu
4Department of Community Dentistry, Institute of Dentistry, University of Turku
5Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.5 MB)
Persistent link:
Language: English
Published: Oxford University Press, 2019
Publish Date: 2020-08-01


Background: There is a lack of evidence based on longitudinal information in the field of Class II malocclusion management with cervical headgear (CH), especially in a randomized setting.

Objectives: The main objective of this study was to evaluate skeletal facial changes, particularly in vertical dimensions, after Kloehn-type CH treatment in children when the timing of treatment is altered.

Trial design: Prospective, parallel-group, randomized controlled trial.

Methods: Screened children with Class II malocclusion were randomized in 1:1 ratio to two groups of equal size by sealed-envelope randomization: the early group (EG), where active CH treatment was started at the age of 7.8 years, and the late group (LG), where CH treatment was started at the age of 9.5 years. The active treatment was continued until normal Class I occlusion on first molars was achieved. Cephalograms were taken at three different time points. Changes in cephalometric measurements were compared between groups and genders. Blinding was applicable for outcome evaluation.

Results: Of 67 randomized children, 56 completed the study. Upper face height increased during the CH treatment phase, as the parameter N–ANS increased significantly during the active treatments of EG (P < 0.05) and LG (P < 0.05). Also, the parameter NSL–PL increased significantly during the treatment of EG (P < 0.01) and during the treatment of LG (P < 0.01). The Gonial angle decreased significantly in the early CH treatment group compared to the later treatment group (T₀–T₂: P < 0.01). CH improved the antero-posterior jaw relationship. No harms were encountered.

Conclusions: Although the upper face height increased, the mandible showed anterior rotation after CH treatment. The Gonial angle was significantly decreased in the EG compared to the LG. There were gender-specific differences in both sagittal and vertical dimensions when examining interrelations in dimensional changes. The differences found between the early and later treatment groups were not clinically important when the cephalometric results are considered.

Clinical registration: (NCT02010346).

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Series: European journal of orthodontics
ISSN: 0141-5387
ISSN-E: 1460-2210
ISSN-L: 0141-5387
Volume: 41
Issue: 6
Pages: 631 - 640
DOI: 10.1093/ejo/cjz053
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This work was supported by the Kerttu Saalasti Foundation.
Copyright information: © The Author(s) 2019. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( This is a pre-copyedited, author-produced version of an article accepted for publication in European Journal of Orthodontics following peer review. The version of record is available online at: