| 1. |
- Abdulraheem, Salem, et al.
(författare)
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Do fixed orthodontic appliances cause halitosis? A systematic review
- 2019
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Ingår i: BMC Oral Health. - : BioMed Central. - 1472-6831. ; 19:1
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Forskningsöversikt (refereegranskat)abstract
- Objective: To examine: (I) the current evidence of the impact of fixed orthodontic appliances on the development of halitosis in patients undergoing orthodontic treatment, and (II) the influence of different orthodontic bracket systems on halitosis. Material and methods: Three electronic databases (PubMed, Scopus, and Cochrane Library) were searched prior to March 15, 2018. The review was systematically conducted and reported according to the Cochrane Handbook and the PRISMA statement. Only Randomised Clinical Trials (RCTs) were considered. Selected full-text papers were independently assessed by four investigators and any disagreements were resolved by consensus. The Cochrane Handbook was used to grade the risk of bias and the quality of evidence was rated according to GRADE. Results: Out of 363 identified studies, three RCTs on halitosis and fixed orthodontic appliances met the inclusion criteria. The risk of bias in the three studies was rated as high and the quality of evidence was rated as very low. Conclusions/clinical implications: There is a lack of scientific evidence that subjects with fixed orthodontic appliances develop halitosis during treatment. Additional well-conducted RCTs with extended periods of assessment are needed as well as consensus concerning cut-off values for the diagnosis of halitosis.
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| 2. |
- Edman Tynelius, Gudrun, et al.
(författare)
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A cost-minimization analysis of an RCT of three retention methods
- 2014
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 36:4, s. 436-441
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Tidskriftsartikel (refereegranskat)abstract
- SUMMARY BACKGROUND: There are few cost evaluation studies of orthodontic retention treatment. The aim of this study was to compare the costs in a randomized controlled trial of three retention methods during 2 years of retention treatment. MATERIALS/METHODS: To determine which alternative has the lower cost, a cost-minimization analysis (CMA) was undertaken, based on that the outcome of the treatment alternatives was equivalent. The study comprised 75 patients in 3 groups consisting of 25 each. The first group had a vacuum-formed retainer (VFR) in the maxilla and a cuspid retainer in the mandible (group V-CTC), the second group had a VFR in the maxilla combined with stripping of the incisors and cuspids in the mandible (group V-S), and the third group had a prefabricated positioner (group P). Direct cost (premises, staff salaries, material and laboratory costs) and indirect costs (loss of time at school) were calculated. Societal costs were defined as the sum of direct and indirect costs. RESULTS: The societal costs/patient for scheduled appointments for 2 years of retention treatment in group V-CTC were €497, group V-S €451 and group P €420. Societal costs for unscheduled appointments in group V-CTC were €807 and in group V-S €303. In group P, there were no unscheduled appointments. CONCLUSIONS/IMPLICATIONS: After 2 years of retention in compliant patients, the cuspid retainer was the least cost-effective retention appliance. The CMA showed that for a clinically similar result, there were differences in societal costs, but treatment decisions should always be performed on an individual basis.
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| 3. |
- 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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| 4. |
- 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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| 5. |
- Ghiasi, Peyman, et al.
(författare)
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Comparative cost analysis of different prosthetic rehabilitations for the edentulous maxilla : early results from a randomized clinical pilot study
- 2022
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Ingår i: BDJ Open. - : Springer Nature. - 2056-807X. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives/aim To analyze and compare costs of different prosthetic rehabilitations for the edentulous maxilla. Materials and methods Patients with edentulous maxillae were rehabilitated with either of three implant-supported prosthetic protocols; removable overdenture supported by 2 implants (ISOD 2), fixed dental prostheses supported by 4 (ISFAFDP 4) or 6 (ISFAFDP 6) implants. Cost of treatment and costs during follow-up were registered and compared. Results Twenty-four patients were included: six patients received ISOD 2 treatment, eight patients received ISFADP 4 treatment and ten patients received ISFADP 6 treatment. Initial costs for ISFAFDP 6 were higher than costs for ISFAFDP 4 and ISOD 2, but there were no differences in cost for maintenance i.e., the ISOD treatment remained the least costly treatment alternative after 1-year follow-up. Discussion The lack of difference in cost for maintenance and repair over the first year suggests that implant-supported overdentures will remain the least costly treatment option for the edentulous maxilla, at least in a short-term perspective. Conclusions Removable maxillary overdentures supported by 2 implants may be a valid low cost treatment option.
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| 6. |
- Ghiasi, Peyman
(författare)
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Studies on maxillary overdentures : implant- and prosthesis survival, cost analysis and patient-reported outcomes
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Edentulism is a debilitating condition which may negatively affect quality of life, particularly in relation to nutritional and social health, speech, and poor facial appearance. Prosthetic options available range from conventional complete dentures to implant-supported overdentures (ISODs) and implant-supported full arch fixed partial dentures (ISFAFDPs). The choice of treatment is connected to the patient's general health, oral status, preferences and financial means. From the point of view of the treatment provider, there is a lack of evidence to support choice of treatment, as information from randomised clinical trials is sparse. This is particularly true when it comes to cost analysis and patient-reported outcome measures (PROMs). There is consensus today that an implant-supported overdenture is a valid treatment option for the edentulous mandible, but the same recommendation cannot be made for maxillary overdentures due to a lack of evidence.The present study investigates implant-supported maxillary overdentures regarding implant and prosthesis survival, costs and PROMs in comparison to fixed implant-supported prostheses.The thesis comprises four studies.Study I analysed implant and prosthesis failure rates with implant-supported maxillary overdentures in a systematic review. The cumulative survival rate (CSR) for the implants and the prostheses was 70.4% and 79.8%, respectively. The main finding was that patients with few implants presented higher prosthesis failure rates than patients with more implants per prosthesis.Of the most commonly used attachment systems, the ball/O-ring and the Ceka were the ones with the highest rates of patients with at least one implant failure. Most of the failures happened within the first year after installation for both implants (52.1%) and prostheses (41.8%).Study II, a retrospective analysis, compared the clinical outcomes of implantsupported overdentures (ISODs) with either bar-clip or ball attachments. The results showed that all ISOD failures resulted from loss of implants. The bar-clip system resulted in more complications than the ball attachment system, suggesting that ISODs with the bar-clip system may necessitate a greater number of appointments and chair time for adjustments, thus increasing the maintenance costs for the patient.Studies III and IV were based on a prospective clinical trial comparing different implant-supported prosthetic rehabilitations for the edentulous maxilla: implantsupported full-arch fixed partial dentures on 4 or 6 implants (ISFAFDP 4 orISFAFDP 6) versus maxillary overdentures on 2 implants.Study III is a comparative cost analysis, the results of which showed that all implants and restorations were in function at follow-up after the first year, i.e., the survival rate was 100%. Initial costs, i.e., cost of prostheses at delivery, were higher for ISFAFDP 6 and ISFAFDP 4 due to the higher number of implants and higher cost of materials and fees. There were no statistically significant differences in post-treatment costs between the groups.In study IV, patient-reported outcomes regarding aesthetics and function were compared. The results showed that all patients, irrespective of group, showed improved patient-reported outcomes from before treatment to the one-year follow-up. There were no significant differences between groups regarding functional status of the masticatory system (Jaw Functional Limitation Scale -JFLS parameters) or how patients perceive their dental and Orofacial Aesthetic Scale (OAS), and only minor differences between the two groups with fixed restorations regarding patients’ perception of the social impact of oral disorders on their well-being (Oral Health Impact Profile - OHIP).
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| 7. |
- Hansson, Stina, 1988-, et al.
(författare)
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Posterior crossbite corrections in the early mixed dentition with quad helix or rapid maxillary expander : a cost-effectiveness analysis of a randomized controlled trial
- 2024
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Ingår i: European Journal of Orthodontics. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 46:3
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Tidskriftsartikel (refereegranskat)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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| 8. |
- Hansson, Stina, 1988-, et al.
(författare)
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Posterior crossbite corrections in the early mixed dentition with quad helix or rapid maxillary expander: a cost-effectiveness analysis of a randomized controlled trial
- 2024
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Ingår i: EUROPEAN JOURNAL OF ORTHODONTICS. - : Oxford University Press. - 0141-5387 .- 1460-2210. ; 46:3
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Tidskriftsartikel (refereegranskat)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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| 9. |
- 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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| 10. |
- 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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