Improving headgear wear: why force level and direction of traction matter

BACKGROUND: Empiric data on headgear wear are scarce. The aim was to examine a possible discrepancy between the duration of wearing and force application, and whether such a difference is influenced by force level or direction of traction. MATERIALS AND METHODS: In this retrospective analysis, 122 consecutive patients were included. All were treated with headgear (three subgroups: high-pull headgear [n = 60], cervical-pull headgear [n = 32], and high-pull headgear in combination with an activator [n = 30]) and were monitored for three successive months using an electronic module. The device recorded chronographically the measured force magnitude and temperature, allowing to differentiate between the duration of headgear wear (recorded body temperature) and actual force application (recorded force). RESULTS: For all subgroups, the average recorded force application was lower than wear time (mean inactivity during wear: 15.9 +/- 22.8 minutes/night). The direction of traction significantly influenced the extent and length of wear time without force application (P < 0.001): patients with cervical-pull headgear were more prone to inactive wear time (27.7 minutes/night) than patients with high-pull headgear (13.7 minutes/night) or with headgear-activator (7.8 minutes/night). The observed inter-individual variability of inactive wear time was considerable (0-134 minutes/night). The mean applied force was highly significantly associated with inactive wear time (correlation coefficient: -0.575; P < 0.001), and force levels below 250 g seem particularly related to episodes of inactivity. CONCLUSIONS: There is a clear incongruity between the duration of headgear wear and the duration of force application. Inactive wear time is influenced by the direction of traction and force level applied. Clinicians should be aware of the likelihood of periods of inactive wear time and researchers should search for options to reduce or even eliminate these periods.