Activator versus cervical headgear: superimpositional cephalometric comparison

Clinical trials comparing activator and headgear treatment have shown comparable effectiveness in the total result achieved, but the mechanism of correction is still uncertain. Most studies have used conventional cephalometric methods to evaluate treatment effects, and this might be a factor for the inconclusive results. The aim of this retrospective investigation was to compare the effects of activator and cervical headgear treatment with a superimpositional cephalometric method that could discern between vertical and horizontal effects as well as skeletal, dental, and rotational treatment results. The sample consisted of 2 groups of Class II Division 1 patients, treated without extraction by the same clinician (22 patients were treated with a modified activator-type functional appliance, and 30 patients were treated with a combination of cervical headgear and fixed edgewise appliances). Lateral cephalometric radiographs taken at the beginning of treatment and after Class II molar correction were evaluated conventionally and with a superimpositional method. Regarding the conventional cephalometric measurements, the only difference in the anteroposterior dimension between the 2 treatment modalities was the significantly reduced SNA angle in the headgear group. Both appliances appeared to produce minimal changes in FMA and GoGn-SN angles, and there were no statistically significant differences between the treatment groups. Regional superimpositions showed differences in the movement of molars: the maxillary molar was found to move more posteriorly and inferiorly in the headgear group. Conversely, the mandibular molar was found to move toward the occlusal plane more in the activator group. Assessment of mandibular skeletal changes showed that the mandible moved anteriorly by approximately 1 mm more in the activator than in the headgear group. The overall effect of the 2 appliances was found to be clinically comparable. However, the individual components of change showed differences characteristic of each appliance.