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.

Comparison of effectiveness of quad helix appliance with other slow maxillary expanders in children with posterior crossbite: A systematic review.

OBJECTIVE: The present review was conducted to compare the effectiveness of Quad Helix (QH) appliance with other slow maxillary expanders in children with posterior crossbite. MATERIALS AND METHODS: Randomized controlled clinical trials and retrospective studies published between January 1, 1995, and December 31, 2016, were identified from MEDLINE, the Cochrane Central Register of Controlled Trials, the National Institutes of Health Trials, Clinical Trials Registry India, Google Scholar and major journals. After a comprehensive search, the articles were independently screened for eligibility by two reviewers. All cross-reference lists of the selected studies were screened for any additional papers. RESULTS: The preliminary screening consisted of 608 articles, of which 33 articles were selected. A final total of only 9 articles were included as they met the inclusion and exclusion criteria. Of the nine papers, four articles clearly state that QH appliance was a more effective appliance, while the remaining five studies suggest that the maxillary expansion caused by QH is comparable to other slow maxillary expansion appliances. Of the nine included articles, four articles also describe the complications of QH in comparison to other slow maxillary expansion devices. CONCLUSION: The QH appliance is a viable alternative for the correction of posterior crossbite. The QH appliance is comparable to or even better than other slow maxillary expanders in terms of maxillary expansion while being cost-effective with very few complications.

Early correction of posterior crossbite--a cost-minimization analysis.

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.

Correction of unilateral posterior crossbite in the mixed dentition. Studies of treatment effects, stability and cost-effectiveness.

Unilateral posterior crossbite of dento-alveolar origin is a transverse discrepancy of the maxillo-mandibular relationship and is one of the most common malocclusions in the mixed dentition. If untreated, the crossbite and the abnormal lateral movement of the lower jaw may strain the orofacial structures, causing adverse effects on the temporomandibular joints, the masticatory system and facial growth. Thus, early orthodontic intervention is usually undertaken to correct the condition at the mixed dentition stage and the orthodontist may choose from a range of treatment methods. The method of choice for orthodontic treatment should not only be clinically effective, with long-term stability, but also cost-effective. The overall aim of this thesis was to compare and evaluate different methods of correcting unilateral posterior crossbite, in terms of clinical effectiveness, stability and cost-effectiveness. The approach was evidence-based; randomized controlled trial (RCT)-methodology was used in order to generate a high level of evidence.

Treatment of posterior crossbite comparing 2 appliances: a community-based trial.

INTRODUCTION: The aim of this community-based trial was to compare the effectiveness of the quad-helix appliance and removable plates for treating posterior crossbite. METHODS: Ninety-nine patients were randomly divided into 3 groups: quad-helix, expansion plate, and untreated. All subjects were in the mixed dentition, had posterior crosssbite, no sucking habits, no previous orthodontic treatment, and no Class III malocclusion. The following aspects were evaluated: posterior crossbite correction, maxillary and mandibular intermolar and intercanine expansions, length of treatment, cost-benefit analysis, success rate, and number of complications. RESULTS: The length of treatment and the costs were higher in the expansion plate group than in the quad-helix group. The success rates were similar for the quad-helix and the expansion plate groups, and the number of complications was higher in the quad-helix group. No self-correction was observed in the untreated group, and relapses occurred in both experimental groups. CONCLUSIONS: The average treatment time was significantly shorter and 11% less expensive than in the quad-helix group, making it the more cost-effective choice for treatment.

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.

A clinical comparison of the quadhelix appliance and the nickel titanium (tandem loop) palatal expander: a preliminary, prospective investigation.

Maxillary expansion using either a quadhelix appliance (Qx) or a nickel titanium palatal expander (Nt) was prospectively compared in 28 consecutive new patients (19 female, nine male) presenting with posterior buccal segment crossbites. Study models taken at each activation were measured to determine the mean maxillary expansion efficacy (Emax) and the mean expansion rate (m(max)) across the first molars and first premolars. Patient discomfort was assessed using visual analogue scores, and cost-effectiveness was also considered. Neither Emax nor m(max) differed significantly between Qx and Nt across either the first molars or the first premolars. However, both Emax and m(max) were significantly greater across the first molars than across the first premolars only with Qx (Emax: 8.4 +/- 0.7 mm versus 5.1 +/- 0.6 mm, P = 0.001; m(max): 0.09 +/- 0.005 mm/day versus 0.05 +/- 0.006 mm/day, P = 0.0001). In addition, greater variance was apparent in m(max) with Nt than with Qx across both the first molars and the first premolars. Overall, Qx and Nt elicited similar discomfort. However, significantly less was reported with Nt on days 6 (P = 0.04) and 7 (P= 0.03) following the second 'activation'. These preliminary results suggest that Qx and Nt are equally efficacious maxillary expanders. However, Qx expansion appeared significantly more controlled, as well as more individually predictable in expansion rate. Overall, Qx and Nt probably elicit similar discomfort, but significantly less discomfort may be seen with Nt following the second activation. Finally, because more than one appliance is invariably required with Nt, Qx expansion is potentially less costly.

Chair-side procedure for connecting transpalatal arches with palatal implants.

The present investigation examined a chair-side procedure for connecting a transpalatal arch (TPA) with palatal implants, which does not involve any laboratory work. This new technique was compared with the standard procedure in terms of the number of steps, the time required, and the cost. The total chair-side time needed with the standard procedure was 38 minutes, with the material costs amounting to [symbol: see text] 159.6. With the chair-side procedure the total time required was 55 minutes, and the cost of the material totalled [symbol: see text] 34.1. The chair-side procedure was derived from orthodontic treatment concepts and is independent of laboratory input. Its major advantage is that it does not require transfers, which necessitate additional steps. These steps, which are inevitable with the standard procedure, resulted in an unexpectedly high cost level and increased the total cost. The difference in the cost of the material between the two procedures amounted to [symbol: see text] 125.5 and timewise the difference was 17 minutes. Whilst TPA-implant connections can be made with both the standard and chair-side procedures, the standard procedure, although taking considerably less chair-side time, was four times more expensive than the chair-side procedure.

Quad-helix treatment in general practice. A retrospective study of failures of appliance and estimation of costs.

From a Public Dental Service register of patients with malocclusion, 1688 patients were selected at random. Ninety-nine patients, 5.9 per cent, had received treatment with quad-helix appliance in General Practice and were selected for the study. From the patient's records the cost of quad-helix treatment was estimated and failure of the appliance was recorded. The mean quad-helix treatment cost was 2900 SEK (range 1298-6534). At the time of the study (1991) 10 SEK was equivalent to approximately 1 pound sterling. Fifty-nine per cent of the patients had at least one failure of the appliance, on average 2.5 number of times (range 1-11). Forty-six per cent of the patients had a minimum of one loose band.