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A systematic review concerning early orthodontic treatment of unilateral posterior cross-bite
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
2003 (English)In: Angle orthodontist, ISSN 0003-3219, E-ISSN 1945-7103, Vol. 73, no 5, p. 588-596Article, review/survey (Other academic) Published
Abstract [en]

The aim of this study was to assess the orthodontic treatment effects on unilateral posterior crossbite in the primary and early mixed dentition by systematically reviewing the literature. A literature search was performed by applying the Medline database (Entrez PubMed) and covering the period from January 1966 to October 2002. The inclusion criteria were primary and early mixed dentition with unilateral posterior crossbite, randomized controlled trials (RCT), prospective and retrospective studies with concurrent untreated as well as normal controls, and clinical trials comparing at least two treatment strategies without any untreated or normal group involved. Two reviewers extracted the data independently and also assessed the quality of the studies. The search strategy resulted in 1001 articles, and 12 met the inclusion criteria. Two RCTs of early treatment of crossbite have been performed, and these two studies support grinding as treatment in the primary dentition. There is no scientific evidence available to show which of the treatment modalities, grinding, Quad-helix, expansion plates, or rapid maxillary expansion, is the most effective. Most of the studies have serious problems of lack of power because of small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or lack of statistical methods. To obtain reliable scientific evidence, better-controlled RCTs with sufficient ample sizes are needed to determine which treatment is the most effective for early correction of unilateral posterior crossbite. Future studies should also include assessments of long-term stability as well as analysis of costs and side effects of the interventions.

Place, publisher, year, edition, pages
Angle Society , 2003. Vol. 73, no 5, p. 588-596
Keywords [en]
Early treatment, Crossbite, Systematic review, Quality analysis
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-16255ISI: 000185748700020PubMedID: 14580028Scopus ID: 2-s2.0-0642279696Local ID: 7908OAI: oai:DiVA.org:mau-16255DiVA, id: diva2:1419771
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-05-24Bibliographically approved
In thesis
1. Correction of unilateral posterior crossbite in the mixed dentition: studies of treatment effects, stability and cost-effectiveness
Open this publication in new window or tab >>Correction of unilateral posterior crossbite in the mixed dentition: studies of treatment effects, stability and cost-effectiveness
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Enkelsidigt korsbett är en av de vanligaste bettavvikelserna i växel-bettet, dvs. i de åldrar då barnets tänder byts ut från mjölktänder till permanenta tänder. Korsbett innebär att överkäkens och un-derkäkens bredd inte passar ihop när man biter samman käkarna. Detta innebär att när patienten skall bita ihop glider underkäken åt sidan och patienten ”biter snett”. Om korsbett inte behandlas finns risk för problem i form av avvikande funktion och smärttillstånd i käkar, ansiktsmuskler och käkleder samt att ansiktet kan bli asymmetriskt.God tandvård innebär att använda effektiva behandlingsmetoder med god långsiktig stabilitet och kostnadseffektivitet. Det över-gripande syftet med denna avhandling var att i växelbettet jämföra och utvärdera olika behandlingsmetoder för att korrigera enkelsi-digt korsbett med avseende på effektivitet, stabilitet och kostnads-effektivitet. För att uppnå ett så högt vetenskapligt underlag som möjligt, utfördes randomiserade, kontrollerade studier (RCT-studier), vilket innebär att patienterna som är med i studien har lottats till respektive behandlingsgrupp. Avhandlingen är baserad på följande studier:Delarbete I är en systematisk litteraturöversikt där den tillgäng-liga vetenskapliga litteraturen avseende behandling av enkelsidigt korsbett utvärderades från ett evidensbaserat perspektiv. Översik-ten omfattade tidsperioden januari 1966 till oktober 2002 och ut-ökades senare till december 2010.Delarbetena II, III and IV är RCT-studier. Delarbete II jämför-de och utvärderade de olika behandlingsstrategierna Quad Helix, expansionsplåt, composituppbyggnad på underkäkens kindtänder samt avvaktande för att invänta eventuell spontan korrektion. Delarbete III analyserade den långsiktiga stabiliteten och föränd-ringarna tre år efter behandling med Quad Helix respektive expan-sionsplåt och jämförelser gjordes med patienter med normalt bett. I delarbete IV utvärderades kostnadseffektiviteten mellan Quad Helix och expansionsplåt genom att utföra en kostnads-minimeringsanalys. Konklusioner i delarbete I, inklusive den kompletterande litte-ratursökningen:•Det finns måttlig evidens för att behandling med Quad Helix är mer effektiv än behandling med avtagbar expansionsplåt. •Det finns begränsad eller otillräcklig evidens för behandlingar-nas stabilitet, effekter på livskvalitet och inverkan på käk- och ansiktsstrukturerna.Konklusioner i delarbete II och III:•Quad Helix är en effektiv behandlingsmetod och är överlägsen expansionsplåten. •Composituppbyggnad på underkäkens kindtänder är inte ef-fektivt för att korrigera enkelsidigt korsbett, och spontan kor-rektion sker ej vid avvaktan/utebliven behandling.•Om korsbettsbehandlingen lyckas, antingen med Quad Helix eller med expansionsplåt, kan man förvänta sig likvärdig lång-siktig stabilitet och prognosen är gynnsam.•Trots aktiv expansion av överkäken på de patienter som tidi-gare hade korsbett uppnåddes aldrig samma vidd i överkäken som hos patienter utan tidigare korsbett (normalpatienterna).Konklusioner i delarbete IV:•Quad Helix är mer kostnadseffektiv än expansionsplåt. •Quad Helix hade lägre direkta och indirekta kostnader och färre misslyckade behandlingar som behövde göras om. •Även när enbart de lyckade behandlingarna räknades var be-handling med expansionsplåt dyrare än Quad Helix. Klinisk betydelse:För att korrigera enkelsidigt korsbett i växelbettet är Quad Helix överlägsen expansionsplåten med avseende på behandlingseffektivi-tet och kostnader och är det primära behandlingsalternativet. Båda behandlingsalternativen, förutsatt att behandlingen lyckas med ex-pansionsplåten, har god långsiktig stabilitet.

Abstract [en]

Unilateral posterior crossbite of dento-alveolar origin is a trans-verse 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 ef-fects on the temporomandibular joints, the masticatory system and facial growth. Thus, early orthodontic intervention is usually un-dertaken 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 dif-ferent methods of correcting unilateral posterior crossbite, in terms of clinical effectiveness, stability and cost-effectiveness. The ap-proach was evidence-based; RCT-methodology was used in order to generate a high level of evidence.This thesis is based on four studies:Paper I comprise a systematic review of the scientific literature and evaluation of the quality of the retrieved studies from an evidence-based perspective. The literature search spanned from January 1966 to October 2002 and was subsequently expanded to Decem-ber 2010.Papers II, III and IV were randomized controlled trials. Paper II compared and evaluated different strategies (Quad Helix, expan-sion plate, composite onlay and expectance for possible spontane-ous correction) for correcting posterior crossbite in the mixed den-tition. Paper III compared and evaluated the long-term stability and post-treatment changes associated with the Quad Helix and expansion plate methods, compared to normal controls. In paper IV, the cost-effectiveness of the Quad Helix and expansion plate methods was evaluated, using a cost-minimization analysis. The following conclusions were drawn:Paper IThe systematic review, including the supplementary literature search, disclosed that:•There is moderately strong evidence to support the clinical ef-fectiveness of both Quad Helix and RME. However, to date there is insufficient evidence to indicate that either method is superior. •There is moderately strong scientific evidence that Quad Helix is more effective than the expansion plate for correcting poste-rior crossbite in the mixed dentition. •Because there is currently limited or insufficient scientific evi-dence, further well-designed studies are needed to address the following questions: long-term stability, possible space gain, cost-effectiveness, treatment-related discomfort or pain affect-ing quality of life and possible effects on the orofacial struc-tures, for example temporomandibular disorders and facial asymmetry.Papers II and III•Quad Helix is an appropriate and successful method and supe-rior to expansion plate in terms of clinical effectiveness and cost-effectiveness; the major disadvantage of the expansion plate method is the dependence on patient compliance. •The composite onlay method is not effective for correction of posterior crossbite in the mixed dentition. Spontaneous correc-tion does not occur.•In cases of successful crossbite correction by Quad Helix or expansion plate appliances, both methods achieve similar long-term stability and the prognosis is favourable.•Despite active transverse expansion, the width of the maxilla in the former crossbite patient group never reached the mean maxillary width of the normal group.Paper IV•Quad Helix offers significant economic benefits over the ex-pansion plate appliance for correction of posterior crossbite. •Quad Helix has lower direct and indirect costs and fewer fail-ures needing re-treatment. •Even with full compliance, i.e. when only successful treatments are considered, expansion plate treatment is more expensive than Quad Helix treatment. Key conclusions and clinical implicationsFor correction of posterior crossbite in the mixed dentition, the Quad Helix appliance is superior to the expansion plate in terms of clinical effectiveness and cost-minimization and is thereby the pre-ferred method of treatment. Both methods, provided that the out-come has been successful, show similar long-term stability.

Place, publisher, year, edition, pages
Malmö University, Faculty of Odontology, Department of Orthodontics, 2011. p. 84
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672 ; 212
Keywords
orthodontics, evidence-based orthodontics, early treatment, maxillary expansion, crossbite correction
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7701 (URN)11823 (Local ID)978-91-7104-380-1 (ISBN)11823 (Archive number)11823 (OAI)
Note

Note: The papers are not included in the fulltext online

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-05Bibliographically approved

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Petrén, SofiaBondemark, LarsSöderfeldt, Björn

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