INTRODUCTION: The objective of this trial was to compare, in a 3-week follow-up, patients' perceptions of recovery, surgery time, and complications related to surgical exposure of palatally displaced canines (PDCs) with either the closed or the open techniques.

METHODS: This study was a 2-center, 2-arm parallel randomized clinical trial with a 1:1 allocation ratio. A total of 100 participants with PDC from 2 university clinics, aged <16 years, with unilateral or bilateral PDCs with cusp tip position in sectors II-IV, were randomly allocated to either closed-exposure or open-exposure techniques. Outcomes related to surgery and surgery/dressing removal interventions were analyzed by blinded assessors. Patients' perceptions during both interventions and the week postinterventions were evaluated using take-home questionnaires, which included 3 question types: visual analog scale (VAS) questions about pain/discomfort, binary questions about analgesic intake, and open questions about complications. Surgical duration and professional-reported complications were assessed in patient journals. Mixed models with random intercepts were used to examine the effects of treatment on VAS scores (Gaussian model) and the use of analgesics (logistic model). Linear regression was used to examine the effect of the treatment on the operation. Statistical significance was set at <0.05.

RESULTS: A total of 92 participants were included with no baseline differences between the intervention groups. There were no significant differences in patient perceptions between the centers. The open approach showed higher VAS scores for pain (coefficient, 8.58 [95% confidence interval, 2.29-14.88]; P <0.01) and discomfort (coefficient, 9.15 [95% confidence interval, 2.33-15.98]; P <0.01) from the exposure operation onwards, with nonsignificantly higher scores for patients with bilateral than unilateral PDCs. No pain/discomfort score differences were observed between treatment groups or between patients with bilateral or unilateral PDCs at surgery/dressing removal intervention. There were no differences in analgesic intake after surgery, but there was significantly more consumption after suture/dressing removal with the closed technique. Overall, a shorter duration was observed for the open technique, particularly when no flap surgeries were performed. Few complications were detected and were more common in the open group.

CONCLUSIONS: There was more pain and discomfort in the open group during surgery and the following week; however, no difference was observed during suture/dressing removal or the week after. There was increased analgesic intake in the closed group after suture dressing removal. Open surgical exposure required a shorter time, particularly when no flap surgery was performed. Complications were sparse and more common in the open group.

REGISTRATION: ClinicalTrials.gov (NCT05067712) PROTOCOL: Published before trial commencement.

Introduction and objective: Agenesis of one or more teeth is common among patients who are referred for orthodontic treatment. The most common treatments are orthodontic space closure (SC) and implant replacement (IR), which are widely studied, but the experiences of patients receiving these treatments have received little attention. The aim of this qualitative study is to explore how treatments to address missing maxillary lateral incisors (MMLIs) are experienced by individuals who are treated using either orthodontic SC or IR.

Materials and methods: This study is conducted in Sweden and based on semi-structured interviews with 13 individuals who have completed treatment, either orthodontic SC (n = 7) or IR (n = 6), to address the lack of one or two maxillary lateral incisors. Data were analysed in accordance with the grounded theory approach.

Results: Findings were classified into the main category of being different during treatment and into three associated sub-categories. The first category, that is being different due to missing teeth, refers to when a person experiences being different because of the anterior spacing The second category, that is being different due to fixed appliance, refers to when the appliance itself makes a person different. The two first categories exemplify being different in terms of appearance. The third identified category, that is being different due to treatment appointments, refers to the need to spend time differently because of having appointments at the clinic for treatment.

Conclusion: Patients MMLIs consider their treatment to start at the time of diagnosis. They experience feelings of being different irrespective of whether the type of treatment is orthodontic SC or IR. The experience of being different differs in timing and causes depending on the treatment method.

Introduction The most common treatment approaches for patients missing maxillary lateral incisors are implant replacement (IT) and orthodontic space closure (SC). Treatment techniques change and improve over time, and it is of interest to know if improvements differ between the methods.Aim To compare the aesthetic outcome and other clinical findings in patients with one or two missing maxillary lateral incisors who were treated with a 10-year difference in time, with either orthodontic space closure or implant replacement.Material and methods A total of 88 patients were included in the study. Forty-four patients treated between 2011 and 2018 were included as the latter cohort (LC). The LC was compared to the early cohort (EC; n = 44), treated between 2001 and 2008. A total of 132 teeth was analysed: 62 teeth in the EC (28 teeth in IT cases and 34 teeth in SC cases) and 70 teeth in the LC (34 teeth in IT cases and 36 teeth in SC cases). Long-term clinical and aesthetic outcomes were evaluated.Results An improvement over time was found in crown length, BoP, papilla, the inclination of incisors, and overall appearance in IT cases and in crown colour and overbite in SC cases. A deterioration over time was found in crown length and BoP among the SC cases.Conclusion Among the IT cases, an improvement in outcomes was noted over time. When comparing SC cases the colour of the crown and overbite had improved, while crown length and BoP had deteriorated over time.

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 <euro>32.05 in favour of QH (P = 0.583; NS). From a societal perspective, the mean cost difference was <euro>32.61 in favour of QH (P = 0.742; NS). The total appliance cost alone was higher in the RME group <euro>202.67 resp. <euro>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 <euro>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 <euro>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.

Objectives: To assess skeletal and dental effects and evaluate possible side effects of maxillary expansion with two different appliances, directly after expansion and 1 year postexpansion. Materials and Methods: Forty-two patients with unilateral posterior crossbite (mean 9.5 +/- 0.9 years) were randomized to either rapid maxillary expansion (RME) banded on the deciduous second molars and bonded to the primary canines or slow expansion with quad helix (QH) on the permanent first molars. Cone-beam computed tomography records were taken at baseline, directly after correction of the posterior crossbite and at follow-up 1 year after expansion. Results: All patients were analyzed. RME opened the midpalatal suture more anteriorly and inferiorly (mean 4.1 mm) and less posteriorly and superiorly (mean 1.0 mm). No effect on midpalatal suture could be shown in the QH group after expansion, P < .001. Buccal bone width had significantly decreased (P < .001) in the QH group compared with the RME group. Buccal fenestrations and root resorption on the left first molar had a higher prevalence directly after expansion finished in the QH group (P = .0086, P = .013) but were not significant at 1-year follow-up (P = .11, P = .22). Conclusions: Opening of the suture with RME was more anterior and inferior, and the QH did not open the midpalatal suture at all. More buccal bone loss and fenestrations were seen on the permanent first molar in patients treated with conventional QH than RME anchored to deciduous teeth.

Objective

Few studies within orthodontics present both economic and clinical findings. Missing maxillary lateral incisors is a frequently occurring anomaly. The treatment alternatives most used are orthodontic space closure and prosthetic replacement of the missing tooth. Our aim is to compare the total societal costs of orthodontic space closure (SC) and implant therapy (IT) in patients missing maxillary lateral incisors.

Methods

Records of 32 patients treated with SC (n = 18) or IT (n = 14) due to missing maxillary lateral incisors were retrieved from the archives. Direct costs and indirect costs in the short- and long-term were analysed using a cost analysis with a societal perspective up of to 12 years post-treatment.

Results

Comparing cases treated with SC and IT, the difference in direct short-term costs for treatment is euro735.54, whereas SC is the least costly. There is no difference between SC and IT in short-term parent loss of productivity, long-term loss of productivity, costs for transportation, or direct long-term costs. A difference was found between SC and IT-in favour of SC-when comparing patients' loss of productivity (P = 0.007), short-term societal costs (P < 0.001), long-term societal costs (P = 0.037), and total societal costs (P < 0.001).

Limitations

There is a limited number of patient records. Local factors such as subsidies, urban versus rural areas, taxes, etc. can influence monetary variables, so the transferability to other settings may be limited.

Conclusion

Patients treated with SC have a lower total societal cost compared to patients treated with IT. There was a difference in productivity loss for patients between SC and IT; however, concerning other indirect parameters and direct long-term costs, there was no difference between the two treatments.

Background

Literature is scarce on malocclusion prevalence and orthodontic treatment need (OTN) in subjects with stage III-IV periodontitis. Study aims were to assess prevalence of primary and secondary malocclusions in subjects with stage III-IV periodontitis and OTN based on pathologic tooth migration (PTM) and occlusal trauma of anterior teeth (AT).

Subjects and methods

One hundred and twenty-one subjects with stage III-IV periodontitis were examined. A comprehensive periodontal-orthodontic examination was performed. Exclusion criteria: age <30 years, removable prosthetics, uncontrolled diabetes, pregnancy/lactation, and oncologic disease.

Results

Class II malocclusion was found in 49.6% (Class II div 1-20.7%, Class II div 2-9.9%, subdivision Class II-19.0%), Class I-31.4%, Class III-10.7%, no malocclusion-8.3% of subjects. PTM was observed in 74.4% of maxillary and 60.3% of mandibular AT. Spacing and extrusion were the main types of PTM of AT. Odds ratio for PTM of maxillary AT was 9.3 in cases with >30% of sites with clinical attachment loss >= 5 mm (P = 0.001). Spacing of maxillary AT was influenced by periodontitis, Class III malocclusion, and lost teeth. Tongue habit had impact on spacing of mandibular AT. Dental Health Component of Index of Orthodontic Treatment Need yielded that OTN was found in >50% and OTN due PTM, occlusal trauma and impaired function in 66.1% of subjects.

Conclusions

The most prevalent malocclusion was Class II. Spacing and extrusion were prevalent types of PTM of AT. OTN was found in more than half of the subjects. The study highlights the need for preventive measures for PTM in subjects with stage III-IV periodontitis.

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.

Objective: To investigate laypeople and dental professionals' opinions of the aesthetic outcome from implant therapy (IT) and orthodontic space closure (SC) for missing maxillary lateral incisors.

Material and methods: Evaluation was performed by three groups: laypeople 20–30 years of age (n = 26), laypeople 50–70 years of age (n = 26) and orthodontists (n = 25). The assessors viewed photographs of 44 different cases treated with IT or SC, and made an evaluation of the aesthetics.

Results: The gingival color adjacent to the replaced tooth was rated as having better aesthetics in the SC cases (p = 0.000). The orthodontists preferred the aesthetics of the dentition in the SC cases (p = 0.042). The young laypeople, compared to the older laypeople and orthodontists, were more dissatisfied with the color of the tooth replacing the missing lateral incisor in SC cases (p = 0.043).

Conclusion: The color of the gingiva adjacent to the implant-supported crowns had a lower aesthetic rating than the SC group. Laypeople rated both treatments as equally good. The orthodontists had a slight preference for the aesthetics in the SC cases.

Objective: To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs).

Trial design: A multicentre, two-arm parallel group randomized controlled trial.

Methods: One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions.The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown reaching above the mucosa through a hole punched in the flap-to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa.The trial ended when the PDC was successfully aligned in the dental arch. Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment.

Blinding: Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded.

Results: A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs.

Generalizability and limitations: Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up.

Conclusion: There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs.