{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:07:26Z","timestamp":1780067246727,"version":"3.54.0"},"reference-count":64,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,3]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives:<\/jats:title>\n To investigate how patients adhere to instructions and how force magnitude fluctuates and influences the use of cervical headgear (CHG) therapy.<\/jats:p>\n <\/jats:sec>\n \n Materials and Methods:<\/jats:title>\n 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).<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Force magnitude can be set at a certain level, L or H, even if great individual variability is seen in all subjects (0\u2013900 g). Children in the L group used CHG longer per day than those in the H group (9.3 hours \u00b11.5 hours and 7.8 hours \u00b1 2.1 hours, respectively,\n P<\/jats:italic>\n = .002). During evening hours, CHG was used more (\n P<\/jats:italic>\n = .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 (\n P<\/jats:italic>\n < .001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.2319\/030718-188.1","type":"journal-article","created":{"date-parts":[[2018,11,19]],"date-time":"2018-11-19T10:18:27Z","timestamp":1542622707000},"page":"268-274","source":"Crossref","is-referenced-by-count":9,"title":["Adherence to instructions and fluctuation of force magnitude in cervical headgear therapy"],"prefix":"10.2319","volume":"89","author":[{"given":"Tuula","family":"Talvitie","sequence":"first","affiliation":[{"name":"Instructor, Tampere University Hospital, Oral and Maxillofacial Unit, Tampere, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mika","family":"Helminen","sequence":"additional","affiliation":[{"name":"Biostatistician, Science Center, Pirkanmaa Hospital District and Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susanna","family":"Karsila","sequence":"additional","affiliation":[{"name":"Research Scientist, Turku Municipal Health Care Services, Dental Teaching Unit, Turku, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reeta","family":"Varho","sequence":"additional","affiliation":[{"name":"Graduate student, Turku Municipal Health Care Services, Dental Teaching Unit, Turku, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Signorelli","sequence":"additional","affiliation":[{"name":"Specialist in Orthodontics, Department of Orthodontics and Pediatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timo","family":"Peltom\u00e4ki","sequence":"additional","affiliation":[{"name":"Professor, Faculty of Medicine and Life Sciences, University of Tampere, Finland, and Institute of Dentistry, University of Eastern Finland, Kuopio, Finland."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i0003-3219-89-2-268-b01","series-title":"Int J Dent","first-page":"945074","article-title":"Trends in Finnish public orthodontic care from the professionals' perspective","volume":"2009","author":"Pietil\u00e4 \n I,","year":"2009","unstructured":"Pietil\u00e4 \n I, \n \n \n Pietil\u00e4 \n T, \n \n \n Varrela \n J, \n \n \n Pirttiniemi \n P, \n \n \n Alanen \n P. \n \n \n Trends in Finnish public orthodontic care from the professionals' perspective. Int J Dent. 2009;2009:945074."},{"key":"i0003-3219-89-2-268-b02","series-title":"Angle Orthod","first-page":"584","article-title":"Current trends in headgear use for the treatment of Class II malocclusions","volume":"86","author":"T\u00fcfek\u00e7i \n E,","year":"2016","unstructured":"T\u00fcfek\u00e7i \n E, \n \n \n Allen \n SB, \n \n \n Best \n AM, \n \n \n Lindauer \n SJ. \n \n \n Current trends in headgear use for the treatment of Class II malocclusions. Angle Orthod. 2016;86:584\u2013589."},{"key":"i0003-3219-89-2-268-b03","series-title":"Dent Press J Orthod","first-page":"76","article-title":"Effects of cervical headgear appliance: a systematic review","volume":"20","author":"Henriques \n FP,","year":"2015","unstructured":"Henriques \n FP, \n \n \n Janson \n G, \n \n \n Henriques \n JF, \n \n \n Pupulim \n DC. \n \n \n Effects of cervical headgear appliance: a systematic review. 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Eur J Orthod. 2004;26:59\u201364."},{"key":"i0003-3219-89-2-268-b07","series-title":"Angle Orthod","first-page":"42","article-title":"Effects of cervical headgear on overbite against the background of existing growth patterns: a retrospective analysis of study casts","volume":"77","author":"Godt \n A,","year":"2007","unstructured":"Godt \n A, \n \n \n Kalwitzki \n M, \n \n \n G\u00f6z \n G. \n \n \n Effects of cervical headgear on overbite against the background of existing growth patterns: a retrospective analysis of study casts. Angle Orthod. 2007;77:42\u201346."},{"key":"i0003-3219-89-2-268-b08","series-title":"Angle Orthod","first-page":"960","article-title":"Facial profile changes in early Class II correction with cervical headgear","volume":"77","author":"Kirjavainen \n M,","year":"2007","unstructured":"Kirjavainen \n M, \n \n \n Hurmerinta \n K, \n \n \n Kirjavainen \n T. \n \n \n Facial profile changes in early Class II correction with cervical headgear. 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Am J Orthod Dentofacial Orthop. 1992;102:197\u2013205."},{"key":"i0003-3219-89-2-268-b13","series-title":"Eur J Orthod","first-page":"263","article-title":"The role of psycho-social factors in headgear compliance","volume":"27","author":"A\u011far \n U,","year":"2005","unstructured":"A\u011far \n U, \n \n \n Doruk \n C, \n \n \n Bi\u00e7ak\u00e7i \n AA, \n \n \n B\u00fck\u00fcso\u011flu \n N. \n \n \n The role of psycho-social factors in headgear compliance. Eur J Orthod. 2005;27:263\u2013267."},{"key":"i0003-3219-89-2-268-b14","series-title":"Eur J Orthod","first-page":"429","article-title":"The effects of early headgear treatment on dental arches and craniofacial morphology: an 8 year report of a randomized study","volume":"27","author":"Pirttiniemi \n P,","year":"2005","unstructured":"Pirttiniemi \n P, \n \n \n Kantomaa \n T, \n \n \n M\u00e4ntysaari \n R, \n \n et al. \n The effects of early headgear treatment on dental arches and craniofacial morphology: an 8 year report of a randomized study. Eur J Orthod. 2005;27:429\u2013436."},{"key":"i0003-3219-89-2-268-b15","series-title":"Am J Orthod","first-page":"217","article-title":"Controlling the magnitude, direction, and duration of extraoral force","volume":"59","author":"Armstrong \n M.","year":"1971","unstructured":"Armstrong \n M. \n \n \n Controlling the magnitude, direction, and duration of extraoral force. 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Eur J Orthod. 2007;29:614\u2013621."},{"key":"i0003-3219-89-2-268-b18","series-title":"Eur J Orthod","first-page":"438","article-title":"Reliability of patient reports on compliance","volume":"12","author":"Sahm \n G,","year":"1990","unstructured":"Sahm \n G, \n \n \n Bartsch \n A, \n \n \n Witt \n E. \n \n \n Reliability of patient reports on compliance. Eur J Orthod. 1990;12:438\u2013446."},{"key":"i0003-3219-89-2-268-b19","series-title":"Am J Orthod Dentofacial Orthop","first-page":"419","article-title":"Accuracy of patient reporting as an indication of headgear compliance","volume":"121","author":"Cole \n WA.","year":"2002","unstructured":"Cole \n WA. \n \n \n Accuracy of patient reporting as an indication of headgear compliance. Am J Orthod Dentofacial Orthop. 2002;121:419\u2013423."},{"key":"i0003-3219-89-2-268-b20","series-title":"Angle Orthod","first-page":"1002","article-title":"Effects of wear time recording on the patient's compliance","volume":"83","author":"Pauls \n A,","year":"2013","unstructured":"Pauls \n A, \n \n \n Nienkemper \n M, \n \n \n Panayotidis \n A, \n \n \n Wilmes \n B, \n \n \n Drescher \n D. \n \n \n Effects of wear time recording on the patient's compliance. Angle Orthod. 2013;83:1002\u20131008."},{"key":"i0003-3219-89-2-268-b21","series-title":"J Clin Orthod","first-page":"94","article-title":"Effects of head posture on headgear force application","volume":"33","author":"Johnson \n PD,","year":"1999","unstructured":"Johnson \n PD, \n \n \n Bar-Zion \n Y, \n \n \n Taylor \n M, \n \n \n Wheeler \n TT. \n \n \n Effects of head posture on headgear force application. 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