Posterior crossbite corrections in the early mixed dentition with quad helix or rapid maxillary expander: a cost-effectiveness analysis of a randomized controlled trial.

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.

Erratum to: The Vectra M3 3-dimensional digital stereophotogrammetry system: A reliable technique for detecting chin asymmetry.

[This corrects the article on p. 43 in vol. 52, PMID: 35387095.].

Pain and discomfort during the first week of maxillary expansion using two different expanders: patient-reported outcomes in a randomized controlled trial.

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.

The Vectra M3 3-dimensional digital stereophotogrammetry system: A reliable technique for detecting chin asymmetry.

Purpose: The aim of this study was to evaluate the reliability of the Vectra M3 (3D Imaging System; Canfield Scientific, Parsippany, NJ, USA) in detecting chin asymmetry, and to assess whether the automatic markerless tracking function is reliable compared to manually plotting landmarks. Materials and Methods: Twenty subjects (18 females and 2 males) with a mean age of 42.5±10.5 years were included. Three-dimensional image acquisition was carried out on all subjects with simulated chin deviation in 4 stages (1-4 mm). The images were analyzed by 2 independent observers through manually plotting landmarks and by Vectra software auto-tracking mode. Repeated-measures analysis of variance and the Tukey post-hoc test were performed to evaluate the differences in mean measurements between the 2 operators and the software for measuring chin deviation in 4 stages. The intraclass correlation coefficient (ICC) was calculated to estimate the intra- and inter-examiner reliability. Results: No significant difference was found between the accuracy of manually plotting landmarks between observers 1 and 2 and the auto-tracking mode (P=0.783 and P=0.999, respectively). The mean difference in detecting the degree of deviation according to the stage was <0.5 mm for all landmarks. Conclusion: The auto-tracking mode could be considered as reliable as manually plotted landmarks in detecting small chin deviations with the Vectra® M3. The effect on the soft tissue when constructing a known dental movement yielded a small overestimation of the soft tissue movement compared to the dental movement (mean value<0.5 mm), which can be considered clinically non-significant.