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Pain and discomfort during the first week of maxillary expansion using two different expanders: patient-reported outcomes in a randomized controlled trial
Örebro University, School of Medical Sciences. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.ORCID iD: 0000-0002-8700-9715
Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Department of Orthodontics, The Institute for Postgraduate Dental Education, Jönköping, Sweden; School of Health and Welfare, Jönköping University, Jönköping, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
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2023 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 45, no 3, p. 271-280Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Quad Helix (QH) is the appliance most preferred by orthodontists to correct unilateral posterior crossbite in the early mixed dentition while other orthodontists suggest rapid maxillary expansion (RME) on deciduous teeth in these patients.

OBJECTIVES: To evaluate and compare perceived pain intensity, discomfort, functional jaw impairment, and analgesic consumption during the first week of treatment with either RME or QH appliances.

TRIAL DESIGN: Two-arm parallel group, two-centre, randomized controlled trial.

MATERIAL AND METHODS: Seventy-two patients, mean age 9.5 (SD ±0.8) years, with unilateral posterior crossbite requiring maxillary expansion were randomly allocated to either the RME (22 boys, 14 girls) or QH (22 boys, 14 girls) group. Validated questionnaires were used to assess pain intensity, discomfort, jaw function impairment, and analgesic consumption, on the first, fourth, and seventh days after appliance insertion and activation.

BLINDING: Due to clinical limitations, only the outcome assessors were blinded to the groups to which the patients were allocated.

RESULTS: Seventy patients completed the questionnaires. Pain from the tongue and chafe from the appliance were significantly higher in the QH group on the first day of treatment (P = 0.003 and P = 0.000, respectively). On the fourth day, the chafe from the appliance was still significantly higher in the QH group (P = 0.007). Speech was affected in both groups on day 1; this impairment continued and was significantly higher in the RME group days 4 and 7. No significant difference in analgesic consumption was found between the groups at any time. The analgesic consumption was highest at day 1 of treatment.

HARMS: No harm was observed in any patient.

LIMITATIONS: Double blinding was not possible due to the clinical limitations.

CONCLUSION: During the initial 4 days of treatment, pain from the tongue and chafe from the appliance caused the most reported inconvenience in the patients in the QH group. A majority of reported visual analogue scale values were in the lower mid-range, suggesting low to moderate pain and discomfort in both groups.

CLINICAL TRIAL REGISTRATION: NCT04458506.

Place, publisher, year, edition, pages
Oxford University Press, 2023. Vol. 45, no 3, p. 271-280
National Category
Orthopaedics
Identifiers
URN: urn:nbn:se:oru:diva-102155DOI: 10.1093/ejo/cjac067ISI: 000878758100001PubMedID: 36331513Scopus ID: 2-s2.0-85160873791OAI: oai:DiVA.org:oru-102155DiVA, id: diva2:1710736
Note

Funding agency:

Regional Research Council

Available from: 2022-11-14 Created: 2022-11-14 Last updated: 2024-10-30Bibliographically approved
In thesis
1. Posterior crossbite treatments in the early mixed dentition: Patients’ experiences, treatment effects and health economics
Open this publication in new window or tab >>Posterior crossbite treatments in the early mixed dentition: Patients’ experiences, treatment effects and health economics
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Posterior crossbite is one of the most common malocclusions in children and requires treatment to support normal growth. Various appliances can be used for correction. The overall aim of this thesis was to compare patients' experiences, treatment outcomes, and health impacts between two different appliances.

Materials and Methods: Two fixed appliances were compared in a randomized controlled trial (RCT). Slow expansion using a quad helix (QH) on the first permanent molars was compared to rapid palatal expansion (RME) with a Hyrax-type expander anchored on the deciduous second molar and canine in children with early mixed dentition. A total of 72 patients were randomized across two different centres.

Results: Both treatments were equally successful in achieving normal transverse relationships at follow-up. QH patients reported more initial pain, while RME patients experienced more speech difficulties during the first week. In the RME group, the midpalatal suture opened in a triangular fashion, widest anteriorly and inferiorly, whereas no suture opening was observed in the QH group. Side effects, such as buccal bone loss and fenestrations, were more common in the QH group. Palatal volume and areas were normalized in both treatment groups compared to a control group with normal occlusion. A health economic evaluation showed a minor societal cost differenceof €32, with the QH being less expensive, though this difference was not statistically significant. The treatment duration in the RME group was nearly 100 days shorter than in the QH group.

Conclusion: Both appliances were equally effective in normalizing the palate, but the RME had fewer side effects, a shorter treatment time, and no significant difference in overall costs.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2024. p. 108
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 305
Keywords
Posterior crossbite, Children, Patient experiences, Skeletal effects, 3D technique, Health economics
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-115757 (URN)978-91-7529-604-3 (ISBN)978-91-7529-605-0 (ISBN)
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Available from: 2024-09-03 Created: 2024-09-03 Last updated: 2024-11-01Bibliographically approved

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Hansson, StinaBazargani, Farhan

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