A cost minimization analysis of early correction of anterior crossbite-a randomized controlled trial.

OBJECTIVE: Economic evaluations provide an important basis for allocation of resources and health services planning. The aim of this study was to evaluate and compare the costs of correcting anterior crossbite with functional shift, using fixed or removable appliances (FA or RA) and to relate the costs to the effects, using cost-minimization analysis. DESIGN, SETTING, AND PARTICIPANTS: Sixty-two patients with anterior crossbite and functional shift were randomized in blocks of 10. Thirty-one patients were randomized to be treated with brackets and arch wire (FA) and 31 with an acrylic plate (RA). Duration of treatment and number and estimated length of appointments and cancellations were registered. Direct costs (premises, staff salaries, material, and laboratory costs) and indirect costs (the accompanying parents' loss of income while absent from work) were calculated and evaluated with reference to successful outcome alone, to successful and unsuccessful outcomes and to re-treatment when required. Societal costs were defined as the sum of direct and indirect costs. INTERVENTIONS: Treatment with FA or RA. RESULTS: There were no significant differences between FA and RA with respect to direct costs for treatment time, but both indirect costs and direct costs for material were significantly lower for FA. The total societal costs were lower for FA than for RA. LIMITATIONS: Costs depend on local factors and should not be directly extrapolated to other locations. CONCLUSION: The analysis disclosed significant economic benefits for FA over RA. Even when only successful outcomes were assessed, treatment with RA was more expensive. TRIAL REGISTRATION: This trial was not registered. PROTOCOL: The protocol was not published before trial commencement.

FIXED OR REMOVABLE APPLIANCE FOR EARLY ORTHODONTIC TREATMENT OF FUNCTIONAL ANTERIOR CROSSBITE.

Anterior crossbite with functional shift also called pseudo Class III is a malocclusion in which the incisal edges of one or more maxillary incisors occlude with the incisal edges of the mandibular incisors in centric relationship: the mandible and mandibular incisors are then guided anteriorly in central occlusion resulting in an anterior crossbite. Early correction, at the mixed dentition stage, is recommended, in order to avoid a compromising dentofacial condition which could result in the development of a true Class III malocclusion and temporomandibular symptoms. Various treatment options are available. The method of choice for orthodontic correction of this condition should not only be clinically effective, with long-term stability, but also cost-effective and have high patient acceptance, i.e. minimal perceived pain and discomfort. At the mixed dentition stage, the condition may be treated by fixed (FA) or removable appliance (RA). To date there is insufficient evidence to determine the preferred method. The overall aim of this thesis was therefore to compare and evaluate the use of FA and RA for correcting anterior crossbite with functional shift in the mixed dentition, with special reference to clinical effectiveness, stability, cost-effectiveness and patient perceptions. Evidence-based, randomized controlled trial (RCT) methodology was used, in order to generate a high level of evidence. The thesis is based on the following studies: The material comprised 64 patients, consecutively recruited from the Department of Orthodontics, Faculty of Odontology, Malmö University, Sweden and from one Public Dental Health Service Clinic in Malmö, Skane County Council, Sweden. The patients were no syndrome and no cleft patients. The following inclusion criteria were applied: early to late mixed dentition, anterior crossbite affecting one or more incisors with functional shift, moderate space deficiency in the maxilla, no inherent skeletal Class III discrepancy, ANB angle > 0 degrees, and no previous orthodontic treatment. Sixty-two patients agreed to participate and were randomly allocated for treatment either with FA with brackets and wires, or RA, comprising acrylic plates with protruding springs. Paper I compared and evaluated the efficiency of the two different treatment strategies to correct the anterior crossbite with anterior shift in mixed dentition. Paper II compared and evaluated the stability of the results of the two treatment methods two years after the appliances were removed. In Paper III, the cost-effectiveness of the two treatment methods was compared and evaluated by cost-minimization analysis. Paper IV evaluated and compared the patient's perceptions of the two treatment methods, in terms of perceived pain, discomfort and impairment of jaw function. The following conclusions were drawn from the results: Paper I. Anterior crossbite with functional shift in the mixed dentition can be successfully corrected by either fixed or removable appliance therapy in a short-term perspective. Treatment time for correction of anterior crossbite with functional shift was significantly shorter for FA compared to RA but the difference had minor clinical relevance. Paper II. In the mixed dentition, anterior crossbite affecting one or more incisors can be successfully corrected by either fixed or removable appliances, with similarly stable outcomes and equally favourable prognoses. Either type of appliance can be recommended. Paper III. Correction of anterior crossbite with functional shift using fixed appliance offers significant economic benefits over removable appliances, including lower direct costs for materials and lower indirect costs. Even when only successful outcomes are considered, treatment with removable appliance is more expensive. Paper IV. The general levels of pain intensity and discomfort were low to moderate in both groups. The level of pain and discomfort intensity was higher for the first three days in the fixed appliance group, and peaked on day two for both appliances. Adverse effects on school and leisure activities as well as speech difficulties were more pronounced in the removable than in the fixed appliance group, whereas in the fixed appliance group, patients reported more difficulty eating different kinds of hard food. Thus, while there were some statistically significant differences between patients' perceptions of fixed and removable appliances but these differences were only minor and seems to have minor clinical relevance. As fixed and removable appliances were generally well accepted by the patients, both methods of treatment can be recommended.

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.

Management of palatally impacted canines: the findings of a collaborative study.

The impacted palatal canine requires a combination of both surgical and orthodontic management. Two types of approach are commonly used: simple exposure, or exposure with bracketing at the time of surgery. In this study 104 consecutively treated patients with palatally impacted canines were examined at two centres, one at which the ectopic tooth was surgically exposed alone and the other where an orthodontic bracket was bonded to facilitate early traction, and the flap replaced. The aim was to compare the outcome and complication rate for each type of procedure. In 30.7 per cent of all cases exposed and bracketed a second surgical intervention was required, compared with 15.3 per cent in the simple exposure group. Bracketing, though effective, is a more costly and time-consuming procedure, and it is suggested that simple exposure provides an equally efficient and predictable method of managing the palatally impacted canine with obvious clinical and financial benefits. The long-term periodontal status of the teeth which have been exposed in these two ways, however, needs further investigation.

Patient and parent opinion of the use of recycled orthodontic brackets: an international comparison.

The aim of this study was to determine the opinion of patients and parents to the use of recycled orthodontic brackets. The design consisted of a questionnaire survey, which took place in the orthodontic departments of two teaching hospitals (Cardiff, Wales, and Dunedin, New Zealand). The subjects were patients (and parents of those under 18 years) undergoing active fixed appliance treatment and similar groups of those on the waiting list for fixed appliance treatment. There were no significant differences of opinion between gender, patient, parent, or centre. There were significant differences of opinion between those under treatment and those on the waiting list; those under treatment were less concerned about wearing recycled brackets than those waiting for treatment. All respondents felt that they should be told if recycled brackets were to be used, and any savings arising from their use passed on to the consumer.