An RCT on clinical effectiveness and cost analysis of correction of unilateral posterior crossbite with functional shift in specialist and general dentistry.

OBJECTIVES: To evaluate the costs of quad-helix (QH) and removable expansion plate (EP) treatments performed either in specialist or general dentistry for the correction of unilateral posterior crossbite with functional shift in the mixed dentition. TRIAL DESIGN: Four-arm parallel group multicentre randomized controlled trial. MATERIALS AND METHODS: One hundred and ten patients with unilateral posterior crossbite with functional shift were recruited. The patients were randomized by an independent person not involved in the trial. The randomization used blocks of 20 and into the following four groups: QH treatments in specialist orthodontic clinics (QHS), QH treatments in general dentistry (QHG), EP treatments in specialist orthodontic clinics (EPS), and EP treatments in general dentistry (EPG). Blinding was accomplished of the outcome assessor and data analyst. A cost analysis was performed with reference to intention-to-treat (ITT), regarding direct costs, indirect costs, and societal costs (the sum of direct and indirect costs) for calculations of successful treatments alone and for retreatments when required. To determine which alternative has the lower cost, a cost-minimization analysis was undertaken, based on that the outcome of the treatment alternatives were broadly equivalent, so the difference between them reduces to a comparison of costs. RESULTS: In the QHS group, 28 of 28 patients were successfully corrected compared to 23 of 27 in the QHG group. Treatment with expansion plate was less successful: 18 of 27 patients in the EPS group and 18 of 28 in the EPG group. QH treatment performed in specialist orthodontic clinics had significantly lower costs than QH or EP treatment accomplished in general dentistry as well as EP treatments in specialist orthodontic clinics. LIMITATIONS: Costs depend on local factors and should not be directly extrapolated to other locations. CONCLUSION: Treatment of unilateral posterior crossbite in the mixed dentition is recommended to be performed by a specialist orthodontist using the QH appliance. TRIAL REGISTRATION: The trial was not registered.

Three-dimensional evaluation of forced unilateral posterior crossbite correction in the mixed dentition: a randomized controlled trial.

OBJECTIVES: The objectives of this study were to assess the three-dimensional (3D) treatment changes (palatal surface area and volume) of forced unilateral posterior crossbite correction using either quad-helix or removable expansion plate appliances in the mixed dentition, and to compare the treatment changes with the three-dimensional changes occurring in age-matched untreated unilateral posterior crossbite patients as well as in subjects with normal occlusion and with no or mild orthodontic treatment need. TRIAL DESIGN: Six-arm parallel group multicentre randomized controlled trial. MATERIALS AND METHODS: One-hundred and thirty-five patients with unilateral posterior crossbite with functional shift were recruited. The patients were randomized by an independent person not involved in the trial. The randomization used blocks of 25, and the patients were randomized into the following five groups: quad-helix treatments in specialist orthodontic clinics (QHS), quad-helix treatments in general dentistry (QHG), removable expansion plate treatments in specialist orthodontic clinics (EPS), removable expansion plate treatments in general dentistry (EPG), and untreated crossbite (UC). Twenty-five patients with normal occlusion who served as normal controls were also included in the trial. Blinding of the outcome assessor and data analyst was accomplished. Data on all children were evaluated on an intention-to-treat basis, regarding 3D palatal surface area, palatal projection area, and palatal shell volume; two-dimensional linear measurements were registered at the same time. RESULTS: After treatment, the surface and projection area and shell volume increased in the four treatment groups (QHS, QHG, EPS, and EPG). QHS increased significantly more than EPG for the surface and projection area. The QHS and EPS had significantly higher mean difference for shell volume. LIMITATIONS: The trial considers a short-term evaluation. CONCLUSION: After treatment, there were no significant differences between the four treatment groups and the normal group, which implies that the surface and projection area together with the shell volume for the four treatment groups and the normal group were equivalent. TRIAL REGISTRATION: The trial was registered with https://www.researchweb.org/is/sverige, registration number: 220751.

Oral health-related quality of life among children with excessive overjet or unilateral posterior crossbite with functional shift compared to children with no or mild orthodontic treatment need.

OBJECTIVES: To compare Oral health-related quality of life (OHRQoL) among 9-year-old children with excessive overjet (EO) to children with unilateral posterior crossbite (UPC) and children with normal occlusion (NO). MATERIALS AND METHODS: The study sample sourced from 19 Public Dental Service Clinics in Sweden. Reported are baseline data originating from two controlled trials, one regarding UPC and the other focusing on EO. The NO children derive from the same trials. The UPC group comprised 93 children (45 boys and 48 girls), the EO group 71 children (36 boys and 35 girls), and the NO group 65 children (32 boys and 33 girls). In conjunction to a clinical examination, all children completed the Child Perceptions Questionnaire (CPQ8-10) for evaluation of OHRQoL. The CPQ8-10 comprises 25 questions grouped into four domains: oral symptoms, functional limitations, emotional, and social well-being. Validated questions about pain in the jaws and face were also included. RESULTS: The total mean CPQ score was 5.1 for the UPC, 7.4 for the EO, and 4.4 for the NO group, showing a significant difference between the UPC and EO (P = 0.048) and between EO and NO group (P = 0.012). These differences remained when adjusted for the confounders' caries, trauma, enamel defects, and headache. No difference between UPC and NO was found. The EO children also reported significantly higher scores in the domains emotional and social well-being (P = 0.039 and P = 0.012). LIMITATIONS: The study would be strengthened if a longitudinal design had been performed. CONCLUSION: Children with EO reported significantly lower OHRQoL compared to children with UPC or NO. The children generally reported low CPQ scores that imply an overall fairly good OHRQoL.

Health economic evaluations in orthodontics: a systematic review.

BACKGROUND: Economic evaluation is assuming increasing importance as an integral component of health services research. AIM: To conduct a systematic review of the literature and assess the evidence from studies presenting orthodontic treatment outcomes and the related costs. MATERIALS/METHODS: The literature review was conducted in four steps, according to Goodman's model, in order to identify all studies evaluating economic aspects of orthodontic interventions. The search covered the databases Medline, Cinahl, Cochrane, Embase, Google Scholar, National Health Service Economic Evaluation Database, and SCOPUS, for the period from 1966 to September 2014. The inclusion criteria were as follows: randomized controlled trials or controlled clinical trials comparing at least two different orthodontic interventions, evaluation of both economic and orthodontic outcomes, and study populations of all ages. The quality of each included study was assessed as limited, moderate, or high. The overall evidence was assessed according to the GRADE system (The Grading of Recommendations Assessment, Development and Evaluation). RESULTS: The applied terms for searches yielded 1838 studies, of which 989 were excluded as duplicates. Application of the inclusion and exclusion criteria identified 26 eligible studies for which the full-text versions were retrieved and scrutinized. At the final analysis, eight studies remained. Three studies were based on cost-effectiveness analyses and the other five on cost-minimization analysis. Two of the cost-minimization studies included a societal perspective, i.e. the sum of direct and indirect costs. The aims of most of the studies varied widely and of studies comparing equivalent treatment methods, few were of sufficiently high study quality. Thus, the literature to date provides an inadequate evidence base for economic aspects of orthodontic treatment. CONCLUSION: This systematic review disclosed that few orthodontic studies have presented both economic and clinical outcomes. There is currently insufficient evidence available about the health economics of orthodontic interventions. Further investigation is warranted.

Effect of fluoridated milk on enamel demineralization adjacent to fixed orthodontic appliances.

OBJECTIVE: To investigate the effect of daily intake of fluoridated milk on enamel demineralization adjacent to fixed orthodontic brackets assessed with quantitative light-induced fluorescence (QLF). MATERIALS AND METHODS: Sixty-four healthy adolescents (13-18 years) undergoing orthodontic treatment with fixed appliances were enrolled and randomly allocated to a randomized controlled trial with two parallel groups. The intervention group was instructed to drink one glass of milk (≈ 200 ml) supplemented with fluoride (5 ppm) once daily and the subjects of the control group to drink the same amount of milk without fluoride. The intervention period was 12 weeks and the end-point was mineral gain or loss in enamel, assessed by QLF on two selected sites from each individual. The attrition rate was 12.5% and 112 sites were included in the final evaluation. RESULTS: There was no statistically significant difference between the groups concerning fluorescence (ΔF) values and lesion area (A mm(2)) at baseline. After 12 weeks, a significant decrease (p < 0.05) in ΔF was registered in the fluoridated milk group and a significant increase in the non-fluoride control group (p < 0.05). The mean reduction in the test group was somewhat lower (14%) than the increase in the control group (18%), but individual variations were evident. Only minor alterations of lesion area were recorded over the 12-week period and no statistically significant differences compared with baseline were found in any of the groups. CONCLUSION: Daily intake of fluoridated milk may aid remineralization of white spot lesions adjacent to fixed orthodontic appliances.

Effect of topical applications of a novel chlorhexidine-thymol varnish formula on mutans streptococci and caries development in occlusal fissures of permanent molars.

OBJECTIVE: To evaluate the effect of a new formula of a chlorhexidine-thymol varnish on mutans streptococci (MS) colonization and fissure caries development. METHODS: The study group consisted of 58 healthy adolescents (12-17 years old) undergoing orthodontic treatment with fixed appliances. A double-blind split-mouth design was applied, and 116 pairs of molar teeth were randomly assigned to topical varnish applications with either the new Cervitec Plus or its predecessor Cervitec. Both varnishes contained 1% CHX and 1% thymol (CHX/T) as active ingredients, but differed with respect to adhesive properties. The varnishes were applied in the fissures at baseline, and then every sixth week throughout the 48-week study period. Endpoints were MS colonization (CRT test) and occlusal laser fluorescence (LF, DIAGNOdent) recordings carried out regularly during follow-up. RESULTS: A significant reduction in the levels of MS in the fissures after the initial treatment was displayed with both varnishes (p < 0.05), and the levels remained consistently suppressed throughout the follow-up period. A non-significant but clear tendency was noted in favor of the new formula after six and 12 weeks, with fewer teeth harboring high counts (> or = 10(5) CFU) of MS (6w:12% vs. 24%, 12w:16% vs. 26%). No new lesions were registered in any subject, and the mean LF recordings did not change significantly over time in the groups. CONCLUSION: There were no statistically significant differences between the CHX/T varnishes in terms of bacterial growth and caries prevention. For MS suppression, a tendency towards an initially superior effect was displayed with the new formula.

Transverse displacement of the proximal segment after bilateral sagittal osteotomy: a comparison of lag screw fixation versus miniplates with monocortical screw technique.

PURPOSE: The purpose of the present study was to compare lag screw fixation versus miniplates with monocortical screw technique with respect to the amount of transverse displacement of the proximal segment after bilateral sagittal osteotomy (BSO) for mandibular advancement surgery. PATIENTS AND METHODS: We conducted a multicenter, retrospective investigation of 82 patients who underwent a mandibular advancement with BSO and rigid internal fixation. Forty-five patients from Denmark and Sweden, the miniplate fixation group, received a rigid fixation consisting of miniplates with monocortical screws. Thirty-seven patients from the Mayo Clinic, the lag screw fixation group, received a rigid fixation with lag screw fixation of the mandible. The transverse displacement and angulation of the proximal segments were measured on posterior-anterior cephalometric radiographs, using the best-fit method. RESULTS: After BSO, 44 of 45 patients in the miniplate fixation group showed an increased transverse intergonion distance with a mean of 5.0 mm and an increase transverse interramus width with a mean of 2.4 mm. Thirty-six of 37 patients in the lag screw fixation group had an increased intergonial width with a mean of 5.6 mm, and 35 of 37 patients showed an increased transverse interramus width with a mean of 3.3 mm. t tests showed that there were no significant differences between the 2 groups with respect to these 2 variables. CONCLUSIONS: Our results indicate that transverse displacements of the proximal segments occur after BSO surgery with both miniplate or lag screw fixation technique. Attention and future studies should focus on possible complications that transverse displacement of the proximal segment may cause.