A cost-minimization analysis of large overjet reduction with two removable functional appliances based on a randomized controlled trial.

Objective: The purpose of this study was to assess and relate the societal costs of reducing large overjet with a prefabricated functional appliance (PFA), or a slightly modified Andresen activator (AA), using a cost-minimization analysis (CMA). Design, settings, and participants: A multicentre, prospective, randomized clinical trial was conducted with patients from 12 general dental practices. Ninety-seven patients with an Angle Class II, division 1 malocclusion, and an overjet of ≥6 mm were randomly allocated by lottery to treatment with either a PFA or an AA. The PFA and AA groups consisted of 57 and 40 subjects, respectively. Blinding was not performed. Duration of treatment, number of scheduled/unscheduled appointments, and retreatment were registered. Direct and indirect costs were analysed with reference to intention-to-treat (ITT), successful (S), and unsuccessful (US) outcomes. Societal costs were described as the total of direct and indirect costs, not including retreatments. Interventions: Treatment with a PFA or an AA. Results: The direct and societal costs were significantly lower for the PFA than for the AA group. The number of visits was lower in the PFA group, when ITT was considered, and for the US cases as well. No difference in retreatment rate could be seen between the groups. Limitations: Costs depend on local factors and thus should not be generalized to other settings. Harms: No harms were detected during the study. Conclusion: The success rate of the both appliances was low. However, the PFA was the preferred approach for reduction of a large overjet in mixed dentition, since it minimized costs and there were no difference in clinical outcomes between PFA and AA. Registration: This trial was registered at 'FoU i Sverige' (http://www.fou.nu/is/sverige), registration number: 97131. Protocol: The protocol was not published before trial commencement.

Success rate, costs and long-term stability of treatment with activator/headgear combinations.

The aims of this study were to evaluate treatment outcome with activator-headgear combinations carried out by general dental practitioners, overall costs, long-term stability and patients' satisfaction with treatment outcome. Patients who were recommended to start treatment in 2006 were included in this study (n = 97). Inclusion criteria were: Class II Division 1 with at least half a cusp width distal molar relationship, overjet ≥ 6 mm and presence of dental records. Data were collected, pre-treatment, post-treatment and 3 years after treatment for those with favorable outcome. Patients at follow-up completed a questionnaire about satisfaction with treatment outcome, perceived pain and discomfort during treatment, and subjective need for additional treatment. Eighty-five patients were analyzed, 52 boys and 33 girls (mean age 11.2 years SD 1.39). Thirty-five patients had successful treatment outcome, 15 partially successful and 35 had an unsuccessful outcome. Total costs for all 85 patients amounted to SEK 1 405 000 including both direct and indirect costs. Thirty-eight patients participated in the 3-year follow-up. Treatment outcomes were then categorized as successful in 28 patients, partially successful in 9 patients and 1 patient was judged as unsuccessful. Median values on VAS (0-100) for overall satisfaction with treatment and treatment outcome were high, 78 and 84 respectively. Median value for perceived pain and discomfort during treatment was 42. Just over half of the patients had a favorable treatment outcome. Patients with favorable outcome were stable over time and satisfied with treatment.

Early correction of posterior crossbite--a cost-minimization analysis.

There are few cost evaluation studies of orthodontic treatment. The aim of this study was to determine the costs of correcting posterior crossbites with Quad Helix (QH) or expansion plates (EPs) and to relate the costs to the effects. To determine which alternative has the lower cost, a cost-minimization analysis was undertaken, based on that the outcome of the treatment alternatives is identical. The study comprised 40 subjects in the mixed dentition, who had undergone treatment for unilateral posterior crossbite: 20 with QH and 20 with EPs. Duration of treatment, number of appointments, broken appointments, and cancellations were registered. Direct costs (for the premises, staff salaries, material and laboratory costs) and indirect costs (loss of income due to parent's assumed absence from work) were calculated and evaluated for successful treatment alone, for successful and unsuccessful treatment and re-treatment when required. The QH had significantly lower direct and indirect costs, with fewer failures requiring re-treatment. Even the costs for successful cases only were significantly lower in the QH than in the EP group. The results clearly show that in terms of cost-minimization, QH is the preferred method for correcting posterior crossbite in the mixed dentition.

[Orthodontic appliance made from silicone elastomer, evaluated clinically and from patient opinions after treatment for malocclusion]. / Aparat ortodontyczny z elastomeru silikonowego w ocenie klinicznej i opinii pacjentów po leczeniu niektórych wad zgryzu.

Elastodontics is a new branch of orthodontics dealing with orthodontic appliances made with silicone elastomer. The appliances are simple in construction and function, easy to use, and safe. One of the simplest is the elasto-aligner used in some forms of malocclusion. The purpose of this work was: 1) to evaluate the results of treatment of malocclusion with this type of appliance in relation to age of patient and duration of treatment; 2) to gather the opinions of patients; 3) to assess the costs and duration of treatment. 70 patients were examined clinically and asked to fill in a questionnaire (Tab. 1, 3). The elasto-aligner was especially useful when applied in malocclusion after treatment with a fixed appliance. The silicone appliance is recommended for the youngest of patients and should be worn for at least 12 hours per day (Tab. 2). Adaptation to the silicone appliance was long and the most uncomfortable symptoms were toothache, excessive salivation, and dry lips in elderly patients (Fig. 1). The time needed to make the elasto-aligner was up to 20 hours and the cost of materials varied between an acrylic activator and a fixed appliance.

Assessing the costs of activator treatments in general practice.

From a register of patients with malocclusion, 1688 patients were selected, of which 208 (12.3 per cent) had received activator treatment in general practice. Fifteen patients having moved from the area, the remaining 193 patients were selected for the study. From the patients' records, activator treatment time, and the costs of activator and additional orthodontic treatment were estimated. The results of activator treatment were graded according to a three-grade scale. Most activator treatments (83 per cent) had a duration of 2 years or less. Approximately half (48 per cent) of the patients were estimated to have good or excellent results. There was great variation in activator treatment costs and these did not appear to be associated with treatment results. There were also extreme variations between patients in number of visits to the clinic as well as in chairside-time. Additional orthodontic treatments were performed by the GDPs in 55 per cent of the patients and 12 per cent of the patients were referred to orthodontic specialist clinics for treatment.

A clinical comparison of the quadhelix appliance and the nickel titanium (tandem loop) palatal expander: a preliminary, prospective investigation.

Maxillary expansion using either a quadhelix appliance (Qx) or a nickel titanium palatal expander (Nt) was prospectively compared in 28 consecutive new patients (19 female, nine male) presenting with posterior buccal segment crossbites. Study models taken at each activation were measured to determine the mean maxillary expansion efficacy (Emax) and the mean expansion rate (m(max)) across the first molars and first premolars. Patient discomfort was assessed using visual analogue scores, and cost-effectiveness was also considered. Neither Emax nor m(max) differed significantly between Qx and Nt across either the first molars or the first premolars. However, both Emax and m(max) were significantly greater across the first molars than across the first premolars only with Qx (Emax: 8.4 +/- 0.7 mm versus 5.1 +/- 0.6 mm, P = 0.001; m(max): 0.09 +/- 0.005 mm/day versus 0.05 +/- 0.006 mm/day, P = 0.0001). In addition, greater variance was apparent in m(max) with Nt than with Qx across both the first molars and the first premolars. Overall, Qx and Nt elicited similar discomfort. However, significantly less was reported with Nt on days 6 (P = 0.04) and 7 (P= 0.03) following the second 'activation'. These preliminary results suggest that Qx and Nt are equally efficacious maxillary expanders. However, Qx expansion appeared significantly more controlled, as well as more individually predictable in expansion rate. Overall, Qx and Nt probably elicit similar discomfort, but significantly less discomfort may be seen with Nt following the second activation. Finally, because more than one appliance is invariably required with Nt, Qx expansion is potentially less costly.

Generalización del uso del bloqueador lingual en la confección del aparato de ortodoncia Hawley durante 5 años / Generalization of the use of the lingual blockers in the confection Hawley Ortodoncy appliance during 5 years

Este trabajo se realizó en el Departamento de Ortodoncia de la Clínica Estomatológica “13 de Marzo” del municipio de Cárdenas, incentivado por la necesidad de suplir la carencia de alambre 0.028 mm y de 0.032 mm. Esta situación nos motivó a buscar una nueva forma de ahorrar al máximo el alambre de que disponíamos y aumentar así el rendimiento de los recursos. Esto se logró con la sustitución de la rejilla alámbrica por un bloqueador lingual de acrílico, de modo que el alambre que utilizamos en la rejilla podría usarse en otros aparatos removibles. Se comenzaron a confeccionar estas placas de Hawley con bloqueador lingual en el año 2000, siendo instalados 811 hasta el 1er. semestre del año 2005, no construyéndose hasta la fecha el anterior Hawley con rejilla. En encuestas a pacientes y ortodoncistas éstos expresaron que el uso de estos aparatos ofrece más comodidad, menos roturas y cumple mejor con su función de eliminar el hábito de protracción lingual y succión digital...(AU)