Cost analysis of two types of fixed maxillary retainers and a removable vacuum-formed maxillary retainer: a randomized controlled trial.

BACKGROUND: There has been an increased interest in conducting healthcare economic evaluations. Also, orthodontic treatments have gathered focus from an economic point of view, however orthodontic research seldom examines both clinical and economic outcomes. OBJECTIVE: To evaluate and compare the costs of three retention methods: a bonded retainer to the maxillary four incisors, a bonded retainer to the maxillary four incisors and canines, and a removable vacuum-formed retainer (VFR) in the maxilla. The null hypothesis was that there was no difference in costs for the three types of retention methods. TRIAL DESIGN: Three-arm, parallel group, single-centre, randomized controlled trial. MATERIALS AND METHODS: Ninety adolescent patients, 54 girls and 36 boys, treated with fixed or removable retainers in the maxilla, were recruited to the study. The patients were randomized in blocks of 30, by an independent person, to one of three groups: bonded multistranded PentaOne (Masel Orthodontics) retainer 13-23, bonded multistranded PentaOne (Masel Orthodontics) retainer 12-22, and removable VFR. A cost analysis was made regarding chair time costs based on the costs per hour for the specialist in orthodontics, and material costs plus any eventual costs for repairs of the appliance. Changes in Little's irregularity index and in single contact point discrepancies (CPDs) were measured on digitalized three-dimensional study casts. Data were evaluated on an intention-to-treat basis. The analysis was performed at 2 years of retention. RESULTS: No statistically significant difference in costs between the maxillary fixed retainers and the VFRs was found, however, the material and emergency costs were significantly higher for the VFR compared with the bonded retainers. All three retention methods showed equally effective retention capacity, and no statistically significant differences in irregularity or CPDs of the maxillary anterior teeth in the three groups was detected. LIMITATIONS: It was a single-centre trial, and hence less generalizable. Costs depended on local factors, and consequently, cannot be directly transferred to other settings. CONCLUSIONS: All three retention methods can be recommended when considering costs and retention capacity. TRIAL REGISTRATION: NCT04616755.

The origin and evolution of the Hawley retainer for the effectiveness to maintain tooth position after fixed orthodontic treatment compare to vacuum-formed retainer: A systematic review of RCTs.

OBJECTIVE: This systematic review aims to summarize the effectiveness and patient compliances of Hawley retainer (HR) compared to vacuum-formed retainers (VFR) and provide the best clinical evidence related to the use of these retainers for maintaining tooth position following fixed orthodontic appliance so that orthodontists can decide which are the most appropriate methods and retainers to use for each individual patient. MATERIALS AND METHODS: We searched the Cochrane Library, EMBASE, PubMed, Web of Science, Orthodontic journals, and relevant articles for eligible studies. Only RCTs studies were included; no restrictions on publication status or language were applied until May 20, 2019. We collected the study related to the effectiveness of these two retainers. Furthermore, patient-reported outcomes, survival time, cost-effectiveness, occlusal contact, and adverse effect on gingival and speech articulation were also collected. RESULTS: We finally included fifteen articles in the qualitative synthesis. No significant difference was observed in patients who had worn the retainers on a full-time or part-time, basis in both HR and VFR in terms of the change in arch widths and arch lengths. VFR appeared to be better at preventing relapses of incisor irregularity than HR. Patient satisfaction with VFR was higher than with HR, and there was no difference in survival rates for both types of retainers. In terms of cost-effectiveness, occlusal contacts, and gingival health, there were a few studies with limited evidence to compare these retainers. For speech articulation, VFR was less affected in comparison to HR. CONCLUSIONS: We found that wearing VFR provides better relapse prevention of incisor irregularity than HR in both arches, indicating their usefulness in clinical practice. However, there is no evidence to show that the pattern of time duration wearing these retainers provides excellent stability. Overall, there are insufficient high-quality RCTs to provide additional evidence, and further high-quality RCTs research is needed.

Removable cast chrome cobalt retainers for extended or indefinite period clinical use.

Patients are frequently being asked to wear orthodontic retainers for as long as they want their teeth to remain in the post-treatment position. Fixed retainers, which are placed on the lingual surface of anterior teeth only, have the advantage of minimal compliance issues but are not without their problems related to wire fracture, adhesive failure and potential gingival or periodontal disease. Plastic retainers, although associated with relatively good aesthetics and compliance, have limitations related to their physical and mechanical properties. This paper describes a chrome cobalt metal retainer that could be used as a long-term retainer with few drawbacks. The properties of chrome cobalt are described and the clinical procedure is outlined.

ORTHODONTIC RETENTION. Studies of retention capacity, cost-effectiveness and long-term stability.

Retention strategies, cost-effectiveness and long-term stability of treatment outcome are essential aspects of orthodontic treatment planning. The overall aim of this thesis was to compare and evaluate three different retention strategies, with special reference to short- and long-term clinical stability and cost-effectiveness. The approach was evidence-based, hence randomized controlled methodology was used in order to generate high levels of evidence. This thesis is based on four studies: Papers I and II are based on randomized controlled trials, evaluating the stability of treatment outcome after one and two years of retention, using three different retention strategies: a maxillary vacuum-formed retainer combined with a mandibular canine-to-canine retainer; a maxillary vacuum-formed retainer combined with stripping of the mandibular anterior teeth and a prefabricated positioner. Paper III presents a cost-minimization analysis of two years of retention treatment. Paper IV is based on a randomized controlled trial documenting the results five years post-retention. The following conclusions were drawn: Papers I and II. From a clinical perspective, asssessment after one year of retention disclosed that the three retention methods were successful in retaining the orthodontic treatment results. After two years of retention, all three retention methods were equally effective in controlling relapse at a clinically acceptable level. Most of the relapse occurred during the first year of retention; only minor or negligible changes were found during the second year. The subjects were grouped according to the level of compliance (excellent or good). After two years of retention there was a negative correlation between growth in body height and relapse of mandibular LII in the group of subjects with excellent compliance. The group with good compliance showed a positive correlation (Paper II, Figure 3). After two years of retention, growth in body height, initial crowding and gender had no significant influence on mandibular LII (Paper II, Figure 4 and Table 4). Paper III. The cost minimization analysis disclosed that although the three retention methods achieved clinically similar results, the associated societal costs differed. After two years of retention, the vacuum-formed retainer (VFR) in combination with a canine-to-canine retainer (CTC) was the least cost-effective retention appliance. Paper IV. After five years or more out of retention, the three retention methods had achieved equally favourable clinical results. Key conclusion and clinical implications. This study compared the short- and long-term outcomes of orthodontic retention by three different methods: a maxillary vacuum-formed retainer combined with a mandibular canine-to-canine retainer; a maxillary vacuum-formed retainer combined with stripping of the mandibular anterior teeth and a prefabricated positioner. All methods gave equally positive clinical results in both the short-term, i.e. after one and two years of retention, and in the long-term, five years or more post-retention. After two years of retention, the level of compliance affected the retention treatment result. However, no such effect was shown for body height, the severity of initial crowding or gender. Today, there is increasing emphasis on the importance of economic aspects of healthcare. Of the three methods evaluated in this study, the least cost-effective, after two years of retention, was a vacuum-formed retainer combined with a bonded canine-to-canine retainer. The clinical implication of this finding is that in patients meeting the inclusion criteria, interproximal stripping of the mandibular anterior teeth, or the use of a prefabricated positioner, are highly appropriate alternatives to a mandibular bonded canine-to-canine retainer. The overall conclusions are that there are a number of effective retention methods available and the clinician is not limited to routine use of a bonded mandibular canine-to-canine retainer. The most appropriate retention method should be selected on an individual, case to case basis, taking into account such variables as orthodontic diagnosis, the expected level of patient compliance, patient preferences and financial considerations.

A cost-minimization analysis of an RCT of three retention methods.

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.

eRME--rapid maxillary expansion in the economic way.

AIM AND OBJECTIVES: Rapid Maxillary Expansion constitutes a routine clinical procedure in orthodontics, involving separation of mid-palatine suture which is usually done with help of the Hyrax screw. However, because of its high cost, the use has been limited, especially in institutions. So, the purpose of this study was to construct an economical device which can expand the maxillary arch in growing patients. MATERIALS AND METHODS: Six patients having constricted maxilla and posterior skeletal crossbite were randomly selected from the Department of Orthodontics. A unique, easy and simple alternative device for expanding the maxillary arch called economic Rapid Maxillary Expander (eRME) has been fabricated at about one-tenth the cost of the conventional Hyrax. Pre- and post-treatment effects were statistically tested by using paired t-test at 0.05 level of significance. RESULTS AND CONCLUSION: The study results showed an average expansion in canine, premolar and molar regions of 4.4 mm, 6.8 mm and 9.4 mm, respectively, having significant difference pre-and post-treatment. Thus, it shows that maxillary expansion is efficiently possible with the application of this newly constructed device named eRME. This appliance also acts as a fixed retainer to avoid relapse, hence negating the need for a separate retainer.

Orthodontic practices in Australasia: practice activity.

OBJECTIVE: To collect baseline data on practice types and services provided by orthodontists in Australia and New Zealand. METHOD: A total of 510 questionnaires was sent and 258 were returned. The response rate was 53 per cent. RESULTS: The average age of respondents was 50 years (SD: 9.8 years) with female orthodontists being younger (Mean: 42.3 years; SD: 6.5). The ratio of responding female to male orthodontists was 1:8.8. Overall, more orthodontists were in solo private practice than associateships or partnerships. New Zealand orthodontists were more likely to be in associateships. Australian orthodontists had twice the number of practices (Mean: 2.4; SD: 1.4) than their New Zealand counterparts (Mean: 1.1; SD: 0.3). Orthodontists estimated they saw a mean of 21.3 (SD: 11.3) patients per day. Older orthodontists saw few patients in a day and spent fewer hours in any practice activity in a week. The mean waiting time for a consultation appointment in the private sector in New Zealand was nearly twice that in Australia. There was a significant association between male orthodontists and referral of patients by general dental practitioners. More than three quarters of respondents incorporated retention fees into the treatment fee. Overall, orthodontists were satisfied with the workload and did not want more orthodontists in their geographical area. CONCLUSION: This study provides a sound basis for consideration of challenges in practice and changes over time.