| 1. |
- Petrén, Sofia, et al.
(författare)
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Early correction of posterior crossbite : a cost-minimization analysis
- 2013
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 35:1, s. 14-21
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 2. |
- Edman Tynelius, Gudrun, et al.
(författare)
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Five-year postretention outcomes of three retention methods : a randomized controlled trial
- 2015
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 37:4, s. 345-353
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Comparison of three different retention strategies 5 years or more postretention. Design, Setting, and Participants: Randomized, prospective, single-centre controlled trial. Forty-nine patients (33 girls and 16 boys) were randomly assigned to one of three retention methods during 2 years by picking a ballot shortly before start of retention treatment. Inclusion criteria were no previous orthodontics, permanent dentition, normal skeletal sagittal, vertical, and transversal relationships, Class I dental relationship, space deficiencies, treatment plan with extractions of four premolars followed by fixed straight-wire appliance. Maxillary and mandibular Little's irregularity index (LII), intercanine and intermolar width, arch length, and overbite/overjet were recorded in a blinded manner, altogether 10 measurements on each patient. Significant differences in means within groups assessed by t-test and between groups by one-way analysis of variance. Interventions: Retention methods: removable vacuum-formed retainer (VFR) covering the palate and the maxillary anterior teeth from canine-to-canine and bonded canine-to-canine retainer in the lower arch (group V-CTC); maxillary VFR combined with stripping of the lower anterior teeth (group V-S); and prefabricated positioner (group P). Results: Maxillary mean LII ranged from 1.8 to 2.6 mm, mean intercanine width 33.6-35.3 mm with a significant difference between groups V-S and P, mean intermolar width 46.8-47.4 mm and mean arch length 21.8-22.8 mm. Mandibular mean LII ranged from 2.0 to 3.4 mm with a significant difference between groups V-S and P, mean intercanine width from 25.4 to 26.6 mm, mean intermolar width from 40.8 to 40.9 mm and mean arch length from 16.9 to 17.3 mm. Mean overbite ranged from 1.8 to 2.7 mm and mean overjet from 3.7 to 4.1 mm. Limitations: A single centre study could be less generalizable. Conclusions: The three retention methods disclosed equally favourable clinical results.
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| 3. |
- Ganzer, Niels, et al.
(författare)
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A cost-effectiveness analysis of anchorage reinforcement with miniscrews and molar blocks in adolescents : a randomized controlled trial
- 2019
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 41:2, s. 180-187
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse cost-effectiveness of anchorage reinforcement with buccal miniscrews and with molar blocks. We hypothesized that anchorage with miniscrews is more cost-effective than anchorage with molar blocks. Trial design: A single-centre, two-arm parallel-group randomized controlled trial. Methods: Adolescents (age 11–19 years) in need of treatment with fixed appliance, premolar extractions, and en masse retraction were recruited from one Public Dental Health specialist centre. The intervention arm received anchorage reinforcement with buccal miniscrews during space closure. The active comparator received anchorage reinforcement with molar blocks during levelling/alignment and space closure. The primary outcome measure was societal costs defined as the sum of direct and indirect costs. Randomization was conducted as simple randomization stratified on gender. The patients, caregivers, and outcome assessors were not blinded. Results: Eighty patients were randomized into two groups. The trial is completed. All patients were included in the intention-to-treat analysis. The median societal costs for the miniscrew group were €4681 and for the molar block group were €3609. The median of the difference was €825 (95% confidence interval (CI) 431–1267). This difference was mainly caused by significantly higher direct costs consisting of material and chair time costs. Differences in chair time costs were related to longer treatment duration. No serious harms were detected, one screw fractured during insertion and three screws were lost during treatment. Generalizability and limitations: The monetary variables are calculated based on a number of local factors and assumptions and cannot necessarily be transferred to other countries. Variables such as chair time, number of appointments, and treatment duration are generalizable. Owing to the study protocol, the benefit of miniscrews as a stable anchorage has not been fully utilized. Conclusions: When only moderate anchorage reinforcement is needed, miniscrews are less cost-effective than molar blocks. The initial hypothesis was rejected. Miniscrews provide better anchorage reinforcement at a higher price. They should be used in cases where anchorage loss cannot be accepted. Trial registration: NCT02644811
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| 4. |
- Kallunki, Jenny, et al.
(författare)
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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.
- 2019
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Ingår i: European Journal of Orthodontics. - : Oxford Academic. - 0141-5387 .- 1460-2210. ; 41:2, s. 111-116
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 5. |
- Petrén, Sofia, et al.
(författare)
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A systematic review concerning early orthodontic treatment of unilateral posterior cross-bite
- 2003
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Ingår i: Angle orthodontist. - : Angle Society. - 0003-3219 .- 1945-7103. ; 73:5, s. 588-596
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Forskningsöversikt (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to assess the orthodontic treatment effects on unilateral posterior crossbite in the primary and early mixed dentition by systematically reviewing the literature. A literature search was performed by applying the Medline database (Entrez PubMed) and covering the period from January 1966 to October 2002. The inclusion criteria were primary and early mixed dentition with unilateral posterior crossbite, randomized controlled trials (RCT), prospective and retrospective studies with concurrent untreated as well as normal controls, and clinical trials comparing at least two treatment strategies without any untreated or normal group involved. Two reviewers extracted the data independently and also assessed the quality of the studies. The search strategy resulted in 1001 articles, and 12 met the inclusion criteria. Two RCTs of early treatment of crossbite have been performed, and these two studies support grinding as treatment in the primary dentition. There is no scientific evidence available to show which of the treatment modalities, grinding, Quad-helix, expansion plates, or rapid maxillary expansion, is the most effective. Most of the studies have serious problems of lack of power because of small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or lack of statistical methods. To obtain reliable scientific evidence, better-controlled RCTs with sufficient ample sizes are needed to determine which treatment is the most effective for early correction of unilateral posterior crossbite. Future studies should also include assessments of long-term stability as well as analysis of costs and side effects of the interventions.
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| 6. |
- Petrén, Sofia, et al.
(författare)
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Correction of unilateral posterior crossbite in the mixed dentition : a randomized controlled trial
- 2008
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Ingår i: American Journal of Orthodontics and Dentofacial Orthopedics. - : Elsevier BV. - 0889-5406 .- 1097-6752. ; 133:6, s. 7-13
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: From an evidence-based point of view, correction of posterior crossbite is not sufficiently evaluated. Thus, the aims of this study were to compare and evaluate the effectiveness of different treatment strategies to correct unilateral posterior crossbite in the mixed dentition by using the randomized clinical trial methodology with an untreated control group. METHODS: Sixty patients participated in the study. All met the following inclusion criteria: mixed dentition, unilateral posterior crossbite, no sucking habits, and no previous orthodontic treatment. The patients were randomized into 4 groups: quad-helix, expansion plate, composite onlay, and untreated control. The success rates, amounts of maxillary and mandibular expansion, and treatment times were registered. RESULTS: The quad-helix appliance was superior to the expansion plate in success rate and treatment time. Treatment with the expansion plate was unsuccessful in one third of the subjects. Crossbite correction with composite onlay in the mixed dentition was ineffective, and spontaneous correction in the mixed dentition did not occur. CONCLUSIONS: If unilateral posterior crossbite is planned to be corrected in the mixed dentition, this study clearly confirmed that treatment with the quad-helix is an appropriate and successful method.
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| 7. |
- Petrén, Sofia, et al.
(författare)
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Stability of unilateral posterior crossbite correction in the mixed dentition : a randomized clinical trial with a 3-year follow-up.
- 2011
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Ingår i: American Journal of Orthodontics and Dentofacial Orthopedics. - : Elsevier. - 0889-5406 .- 1097-6752. ; 139:1, s. e73-81
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: The long-term stability of posterior crossbite correction in the mixed dentition has not been sufficiently evaluated. Our aim was to compare long-term outcomes in patients with crossbite correction by using matched controls with normal occlusion.METHODS: After 35 patients were treated for crossbite with a quad-helix or an expansion plate, we used randomized controlled trial methodology to follow them for 3 years posttreatment. All had fulfilled our pretreatment criteria: mixed dentition, unilateral posterior crossbite, no sucking habits, and no previous orthodontic treatment. Transverse relationships, maxillary and mandibular widths, overbite, overjet, arch lengths, and midlines were registered on the study models immediately before and after treatment and at the follow-up 3 years after treatment. The matched control group comprised 20 subjects with normal occlusion and was compared with the first and last registrations for the treated groups.RESULTS: At follow-up, changes in the treatment groups were equal and stable. The changes were comparable with the control group. All other changes were minor and had no clinical implications. The long-term effect of crossbite correction on midline deviation was unpredictable.CONCLUSIONS: If crossbite is successfully corrected by the quad-helix appliance or the expansion plate, similar long-term stability is achieved. However, in treated patients, mean maxillary widths never reached those of normal control subjects.
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| 8. |
- Petrén, Sofia, et al.
(författare)
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Stability of Unilateral Posterior Crossbite Correction in the Mixed Dentition - a 3-year Follow-Up
- 2010
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Ingår i: Abstract book.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Stability of Unilateral Posterior Crossbite Correction in the Mixed Dentition - a 3-year Follow-Up. Aim: To compare and evaluate long-term stability of crossbite correction with Quad Helix or expansion plate in the mixed dentition. Methods: In this RCT-study 35 patients with unilateral posterior crossbite were randomized to be treated with either Quad Helix or expansion plate. The inclusion criteria were: mixed dentition, unilateral posterior crossbite, no sucking habits or previous orthodontic treatment. Stability was evaluated after 3 years by study cast measurements. Twenty subjects with normal occlusion were included as controls. Success rate, maxillary and mandibular transverse dimensions, overjet and overbite were registered. Results: Stability was equal for the two treatment methods. Small, albeit significant, differences between the groups were assessed with reference to transverse dimensions. No significant difference was seen for overjet and overbite. Conclusions: The long-term stability of posterior crossbite correction with Quad helix and expansion plate was equal.
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| 9. |
- Petrén, Sofia, et al.
(författare)
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Stability of Unilateral Posterior Crossbite Correction in the Mixed Dentition - a 3-year Follow-Up
- 2009
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Ingår i: Swedish Dental Journal. - : Swedish Dental Association. - 0347-9994. ; 33:4, s. 213-213
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To compare and evaluate long-term stability of crossbite correction with Quad Helix or expansion plate in the mixed dentition. Methods: In this RCT-study 35 patients with unilateral posterior crossbite were randomized to be treated with either Quad Helix or expansion plate. The inclusion criteria were: mixed dentition, unilateral posterior crossbite, no sucking habits or previous orthodontic treatment. Stability was evaluated after 3 years by study cast measurements. Twenty subjects with normal occlusion were included as controls. Success rate, maxillary and mandibular transverse dimensions, overjet and overbite were registered. Results: Stability was equal for the two treatment methods. Small, albeit significant, differences between the groups were assessed with reference to transverse dimensions. No significant difference was seen for overjet and overbite. Conclusions: The long-term stability of posterior crossbite correction with Quad helix and expansion plate was equal.
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| 10. |
- Sollenius, Ola, et al.
(författare)
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An RCT on clinical effectiveness and cost analysis of correction of unilateral posterior crossbite with functional shift in specialist and general dentistryd
- 2020
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 42:1, s. 44-51
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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