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Hansson S, Josefsson E, Lund H, Miranda-Bazargani S, Magnuson A, Lindsten R, Bazargani F. Skeletal effects of posterior crossbite treatment with either quad helix or rapid maxillary expansion: a randomized controlled trial with 1-year follow-up. Angle Orthod 2024; 94:512-521. [PMID: 39230018 PMCID: PMC11363985 DOI: 10.2319/010424-9.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 03/01/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVES To assess skeletal and dental effects and evaluate possible side effects of maxillary expansion with two different appliances, directly after expansion and 1 year postexpansion. MATERIALS AND METHODS Forty-two patients with unilateral posterior crossbite (mean 9.5 ± 0.9 years) were randomized to either rapid maxillary expansion (RME) banded on the deciduous second molars and bonded to the primary canines or slow expansion with quad helix (QH) on the permanent first molars. Cone-beam computed tomography records were taken at baseline, directly after correction of the posterior crossbite and at follow-up 1 year after expansion. RESULTS All patients were analyzed. RME opened the midpalatal suture more anteriorly and inferiorly (mean 4.1 mm) and less posteriorly and superiorly (mean 1.0 mm). No effect on midpalatal suture could be shown in the QH group after expansion, P < .001. Buccal bone width had significantly decreased (P < .001) in the QH group compared with the RME group. Buccal fenestrations and root resorption on the left first molar had a higher prevalence directly after expansion finished in the QH group (P = .0086, P = .013) but were not significant at 1-year follow-up (P = .11, P = .22). CONCLUSIONS Opening of the suture with RME was more anterior and inferior, and the QH did not open the midpalatal suture at all. More buccal bone loss and fenestrations were seen on the permanent first molar in patients treated with conventional QH than RME anchored to deciduous teeth.
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Affiliation(s)
| | | | | | | | | | | | - Farhan Bazargani
- Corresponding author: Dr Farhan Bazargani, Department of Orthodontics, Sahlgrenska Academy, Gothenburg University, PO Box 450, SE-405 30 Gothenburg, Sweden. (e-mail: )
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Johansson K, Matilainen LB, Wiaderny M, Berlin H, Klingberg G, Ghiasi H, Brechter A, Paulsson L. Self-reported pain during different phases of orthodontic treatment with fixed appliance: A multi-centre randomized controlled trial in adolescents with crowding. Orthod Craniofac Res 2024; 27:560-571. [PMID: 38389292 DOI: 10.1111/ocr.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVES To compare self-reported pain levels across various treatment phases using passive self-ligating (Damon) and conventional (Victory) standardized fixed appliance systems. MATERIALS AND METHODS Adolescents (12-17 years old) with crowding and displaced teeth, planned for non-extraction treatment, were recruited from four orthodontic clinics. They were randomized into stratified blocks (1:1 ratio) using concealed allocation to receive Damon Q™ (34 boys, 28 girls) or Victory™ (39 boys, 31 girls). Pain and analgesic intake were assessed on seven different occasions with validated self-report questionnaires using a 10-grade scale. RESULTS Of the 132 patients included, six were lost to follow up. Clinically relevant mean pain scores (≥4) were registered in both groups after bonding upper and lower arches and after insertion of 0.019 × 0.025 stainless steel archwire. The highest mean scores were reported on day two after bonding the upper arch (Damon 5.96, Victory 7.18, P = .011). In both groups, at least 40% reported taking analgesics during various treatment phases. The Damon group reported a lower intake of analgesics on days one and two (P = .042 and .037) after treatment initiation. In the entire sample, boys reported significantly higher mean pain scores than girls on the second and third days after bonding (P = .008 and .026, respectively). CONCLUSIONS Lower pain levels were reported from the Damon group after bonding. In general, boys reported higher pain than girls did. Clinicians and adolescents need to be aware that clinically relevant pain levels can be expected not only after bonding but also in later phases.
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Affiliation(s)
- Kristina Johansson
- Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Orthodontics, Östersund Hospital, Östersund, Sweden
| | | | - Michal Wiaderny
- Department of Orthodontics, Folktandvården Dalarna, Falun, Sweden
| | - Henrik Berlin
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | | | - Houda Ghiasi
- Private Orthodontic Practice, Bernhold Ortodonti, Helsingborg, Sweden
| | - Anna Brechter
- Private Orthodontic Practice, Bernhold Ortodonti, Helsingborg, Sweden
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Hansson S, Johansson N, Lindsten R, Petrén S, Bazargani F. Posterior crossbite corrections in the early mixed dentition with quad helix or rapid maxillary expander: a cost-effectiveness analysis of a randomized controlled trial. Eur J Orthod 2024; 46:cjae028. [PMID: 38808562 PMCID: PMC11134208 DOI: 10.1093/ejo/cjae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Unilateral posterior crossbite is a common malocclusion, and early treatment is recommended to enable normal growth. There are several possibilities regarding choice of appliances used for correcting this malocclusion; however, when treatment is financed by public funds the decision needs to be based not only on the effects but also on the effect in relation to the costs. OBJECTIVES The aim was to perform a cost-effectiveness analysis comparing quad helix (QH) and rapid maxillary expanders (RME; hyrax-type) in children in the early mixed dentition. MATERIAL AND METHODS Seventy-two patients were randomized to treatment with either QH or RME, at two different centres. Data were collected from the patient's medical records regarding success rate, number of visits, total treatment time, emergency visits, and so forth, together with answers from patient questionnaires concerning absence from school and use of analgesics. A cost-effectiveness analysis with both an intention-to-treat (ITT) and a per-protocol approach was performed, as well as a deterministic sensitivity analysis. RESULTS The success rate, one year after the completion of the expansion, was equal between groups according to the ITT approach. From a healthcare perspective, the mean cost difference between RME and QH was €32.05 in favour of QH (P = 0.583; NS). From a societal perspective, the mean cost difference was €32.61 in favour of QH (P = 0.742; NS). The total appliance cost alone was higher in the RME group €202.67 resp. €155.58 in the QH group (P = 0.001). The probability of RME having a higher cost was 71% from a healthcare perspective and 62.7% from a societal perspective. The total treatment time was 97 days longer in the QH group. In the deterministic sensitivity analysis, when using a higher valuation of the children's educational loss, the QH becomes €58 more costly than the RME. There was a statistically significant difference in chair time and visits between centres (P < 0.001). CONCLUSION The difference in costs between RME and QH is not statistically significant, however, there is a slightly higher probability that RME is more expensive than QH with a mean cost of an additional €32 per patient from a healthcare perspective. Different work procedures at different centres indicate that logistics around the patient's treatment is a more important aspect than appliance used to decrease the number of visits and save chair time and thereby also costs.
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Affiliation(s)
- Stina Hansson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, 701 82 Örebro, Sweden
- Department of Orthodontics, Postgraduate Dental Education Center, 701 15 Örebro, Sweden
| | - Naimi Johansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 701 82 Örebro, Sweden
- Department of Clinical Science and Education, Stockholm South General Hospital, Karolinska Institute, 118 83 Stockholm, Sweden
| | - Rune Lindsten
- Department of Orthodontics, The Institute for Postgraduate Dental Education, 551 11 Jönköping, Sweden
- School of Health and Welfare, Jönköping University, 553 18 Jönköping, Sweden
| | - Sofia Petrén
- Department of Orthodontics, Malmo University, 214 21 Malmo, Sweden
| | - Farhan Bazargani
- Sahlgrenska Academy, Department of Orthodontics, University of Gothenburg, 405 30 Gothenburg, Sweden
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Hua F. DENTAL PATIENT-REPORTED OUTCOMES UPDATE 2023. J Evid Based Dent Pract 2024; 24:101968. [PMID: 38401950 DOI: 10.1016/j.jebdp.2023.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 12/26/2023] [Indexed: 02/26/2024]
Abstract
The emergence and rapid development of disruptive innovations are quickly turning our profession into personalized dentistry, built upon evidence-based, data-oriented, and patient-centered research. In order to help improve the quality and quantity of patient-centered evidence in dentistry, further promote the wide and standard use of dental patient-reported outcomes (dPROs) and dental patient-reported outcome measures (dPROMs), the Journal of Evidence-Based Dental Practice has put together this special issue, the third of a series entitled Dental Patient-Reported Outcomes Update. A total of 7 solicited articles are collected in this issue. To put them into a broader perspective, this review provides a concise summary of key, selected PRO and dPRO articles published during 2023. A brief introduction to those articles included in this Special Issue follows. Four main domains are covered in this Special Issue: (1) dPROs and digital dentistry, (2) standardization of dPRO-related methodology, (3) current usage of dPROs and dPROMs in published research, and (iv) the significance and relevance of dPRO usage.
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Affiliation(s)
- Fang Hua
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Evidence-Based Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Center for Orthodontics and Pediatric Dentistry at Optics Valley Branch, School and Hospital of Stomatology, Wuhan University, Wuhan, China; Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
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Lu L, Zhang L, Li C, Yi F, Lei L, Lu Y. Treatment effects after maxillary expansion using invisalign first system vs. acrylic splint expander in mixed dentition: a prospective cohort study. BMC Oral Health 2023; 23:598. [PMID: 37635237 PMCID: PMC10463527 DOI: 10.1186/s12903-023-03312-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Invisalign First System (First) is a new type of orthodontic appliance for maxillary arch expansion in mixed dentition children. Till now, few studies have evaluated the expansion effects of First versus other appliances. What's more, most studies of arch expansion did not include a natural group to rule out growth effects. This prospective cohort study aimed to evaluate the dental and dentoalveolar effects using First or acrylic splint rapid maxillary expander (RME) in adolescents excluding growth factors. MATERIALS AND METHODS After screening by strict inclusion criteria and propensity score matching (PSM), fifty-one patients were included: First group (n = 17), RME group (n = 17), and natural growth (NG) group (n = 17). Nine indicators including dental arch width, dentoalveolar arch width, and inclination of the molars were measured on digital dental casts at baseline (T0) and six-month follow-up (T1). Paired t-tests were used for intra-group results, and two-sample independent t-tests were used for inter-group comparisons. RESULTS There was no significant increase in all indicators within six months in the NG group (p > 0.05). In the First group and RME group, all width indicators were significantly increased after treatment (p < 0.05). The RME group exhibited greater expansion than the First group in intercanine width, first interpremolar width, second interdeciduous molar width, first intermolar width, arch perimeter, intercanine dentoalveolar width, intermolar dentoalveolar width, and inclination of the molars (p < 0.05). Whereas, there was no significant difference in arch depth between the two treated groups. CONCLUSIONS Both First and RME can expand the maxillary arch in mixed dentition. In case of mild to moderate maxillary transverse deficiency (MTD), Invisalign First System could be a reasonable option. RME shows significant better efficiency of dental arch expansion than First, recommended for patients with severe MTD. TRIAL REGISTRATION This prospective study was registered on ClinicalTrials.gov (01/02/2022, registration number: ChiCTR2200056220). The trial was approved by the Ethical Committee of the Hunan Xiangya Stomatological Hospital Central South University (20,200,088), and informed consent was obtained from all subjects and their legal guardian(s).
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Affiliation(s)
- Lanxin Lu
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China
- Hunan Key Laboratory of Oral Health Research, Changsha, China
- Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha, China
| | - Lingling Zhang
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China
- Hunan Key Laboratory of Oral Health Research, Changsha, China
- Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha, China
- The Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China
| | - Chengri Li
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China
- Hunan Key Laboratory of Oral Health Research, Changsha, China
- Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha, China
| | - Fang Yi
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China
- Hunan Key Laboratory of Oral Health Research, Changsha, China
- Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha, China
| | - Lei Lei
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China
- Hunan Key Laboratory of Oral Health Research, Changsha, China
- Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha, China
| | - Yanqin Lu
- Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China.
- Hunan Key Laboratory of Oral Health Research, Changsha, China.
- Hunan Clinical Research Center of Oral Major Diseases and Oral Health, Changsha, China.
- Department of Orthodontics, Hunan Key Laboratory of Oral Health Research & Hunan Clinical Research Center of Oral Major Diseases and Oral Health & Xiangya Stomatological Hospital, Xiangya School of Stomatology, Central South University, 410008, Changsha, Hunan, China.
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