The role of cervical headgear and lower utility arch in the control of the vertical dimension

Introduction: This study was carried out to evaluate the treatment changes in skeletal and dental parameters in growing patients. Methods: The sample consisted of 24 subjects with Class II Division 1 malocclusion. Half of the patients were treated with cervical headgear alone (group C, n = 12), and the other half received a combination of cervical headgear and lower utility arch (group CU, n = 12). The treatment groups were compared with a matched untreated control group (n = 12). The mean ages of the subjects at the beginning of the study were 8.85 ± 1.19 years in group C, 9.23 ± 0.76 years in group CU, and 8.62 ± 0.78 years in the control group. The cervical headgear was used with an expanded inner bow and a 15° to 20° upward bend of the longer outer bow, worn 12 to 14 hours a day, with a force of 450 to 500 g per side. The lower utility arch was designed as described in the bioprogressive technique. Treatment changes were assessed on lateral cephalometric radiographs. Results: The cervical headgear produced Class II correction through maxillary orthopedic and orthodontic changes. Anterior face height increased more in the treatment groups than in the control group. The treatment groups also displayed statistically significant increases in ramus height. Due to these effects, mandibular plane orientation stayed relatively unchanged. There was no opening rotation of the mandible in the treatment groups. The lower utility arch produced intrusion and lingual tipping of the mandibular incisors and distal tipping without extrusion of the mandibular molars. The treatment groups showed significant anterior descents of the palatal plane. Maxillary molar total extrusion produced by cervical headgear treatment was an average of no more than 1 mm as compared with the control group. The utility arch did not appear to influence mandibular rotational response.