University of Oulu

Matti Hannula, Mimmi Tolvanen, Pertti Pirttiniemi, Kirsi Pirilä-Parkkinen, Johanna Julku, Effects of headgear timing on dental arch changes from 7 to 18 years of age: a follow-up study, European Journal of Orthodontics, Volume 45, Issue 5, October 2023, Pages 496–504,

Effects of headgear timing on dental arch changes from 7 to 18 years of age : a follow-up study

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Author: Hannula, Matti1,2; Tolvanen, Mimmi3; Pirttiniemi, Pertti1,2,4;
Organizations: 1Research Unit of Population Health, Faculty of Medicine, University of Oulu, PO Box 5000, FIN-90014 Oulu, Finland
2Medical Research Center, Oulu University Hospital, University of Oulu, PO Box 8000, FI-90014 Oulu, Finland
3Faculty of Medicine, University of Oulu, PO Box 8000, FI-90014 Oulu, Finland
4Oral and Maxillofacial Department, Oulu University Hospital, PO Box 10, FI-90029 OYS, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 2.8 MB)
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Language: English
Published: Oxford University Press, 2023
Publish Date: 2023-09-19


Background: Dental arch effects after cervical headgear (CHG) treatment have been researched from several different perspectives. However, the long-term effects of CHG timing are still unknown.

Objectives: To analyse the long-term effects of CHG timing on dental arches.

Material and methods: A total of 67 children with Angle Class II malocclusion comprised the study group in this trial. The participants were randomized into two equal-sized groups. In the early group (EG, n = 33), treatment was started after the eruption of the first upper molars. In the later-timed group (LG, n = 34), treatment was started 18 months later compared with the early group. Long-term effects were measured from dental casts taken at five time points between 7 and 18 years of age.

Results: The total maxillary dental arch length was achieved earlier, the gained length persisted better in the long term, and significantly more space was achieved in EG compared with LG (P = .048). The intermolar width in the maxillary dental arch was more stable and was reached earlier in EG compared with LG (P = .002). The results showed that in terms of total mandibular arch length increases, EG males benefited the most and LG females the least from CHG treatment (P = .031).

Conclusions: Both genders benefited from earlier CHG treatment. The maxillary dental arches remained longer, and the final width was gained earlier in EG compared with LG.

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Series: European journal of orthodontics
ISSN: 0141-5387
ISSN-E: 1460-2210
ISSN-L: 0141-5387
Volume: 45
Issue: 5
Pages: 496 - 504
DOI: 10.1093/ejo/cjad045
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This work was supported by The Finnish Dental Society Apollonia (No. 20210043), The Finnish Cultural Foundation (No. 60212354), and Selma and Maja-Lisa Selander’s Fund for Research in Odontology (2021).
Copyright information: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Orthodontic Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.