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Early correction of unilateral posterior crossbite: evidence-based evaluations of oral health related quality of life, cost-effectiveness and 3D treatment effects
Malmö universitet, Odontologiska fakulteten (OD).
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Unilateral posterior crossbite (UPC) with functional shift is one ofthe most common malocclusions in mixed dentition. Left untreated,it may cause long-term effects on the growth and development of thejaws and teeth. Early orthodontic intervention is usually undertakento correct the condition at the primary or mixed dentition stage.Quad-helix (QH) or removable expansion plates (EP) are commontreatment alternatives to correct crossbites and treatment ofcrossbite may consume a relatively large part of the total resourcesin orthodontic care. In Sweden the treatment can be performed eitherin specialist orthodontic clinics or in general dentistry. The role ofthe orthodontist in general dental care is essential in diagnostics andtreatment planning, whereas general dentists may often provide apart of the treatment after consultation with, or under the supervisionof, an orthodontist. Economic evaluations have become an integral component of healthservices. The main reason is that resources within the health sector(personnel, time, facilities, equipment, and knowledge) are limited.Nevertheless, studies comparing the costs of orthodontic treatmentsperformed in general versus specialist dentistry are virtuallynon-existent.To date there are no studies evaluating the oral health related qualityof life (OHRQoL) in children with unilateral posterior crossbite. Itis thus important to analyse and compare the OHRQoL betweenchildren with and without malocclusions (children with normalocclusion). When treatment effects of unilateral crossbite correction have beenassessed, most studies have used two-dimensional evaluations suchas linear measurements. However, orthodontic treatment effectsincluding crossbite correction may, if possible, be described in allthree planes. There are no studies in the literature that have explicitlyinvestigated the three-dimensional treatment effects of unilateralcrossbite correction between different appliances and, in this context,related the treatment changes to growth changes associated withuntreated subjects with unilateral posterior crossbite as well as insubjects with normal occlusion and with no or mild orthodontictreatment need. The research questions addressed in this thesis originate fromidentified knowledge gaps and clinical needs in orthodontic care,and to provide as high clinical evidence as possible a multi-centrerandomised control trial (RCT) has been performed as well as acontrolled trial regarding comparisons and the impact differentmalocclusions may have on OHRQoL.The results are expected to be beneficial for the patients who willbe offered the most widely accepted and effective treatment, which isof importance for the dentists for decisions as to which treatment willgive the best outcome, and beneficial for both dental care providersand society in care planning and the allocation of resources.Therefore, this thesis was based on four studies: Paper I: a systematic literature review was undertaken to answer thefollowing questions:• Are there any articles regarding health economics in orthodonticsand is it possible to make any conclusions from thearticles?The literature search spanned from January 1966 to September2014 and was later supplemented and extended to April 2019.Paper II: the aims were to investigate:• The OHRQoL using the Child Perceptions Questionnaire(CPQ8-10) in 93 children with unilateral posterior crossbite,71 children with excessive overjet and 65 children with normalocclusion with no or mild orthodontic treatment need. Paper III and IV: these two papers originated from a multi-centreRCT. The aims were to investigate:• Clinical effectiveness and cost-analysis in specialist and generaldentistry (Paper III)• Three-dimensional evaluations of crossbite correction (PaperIV)Key findings in Paper I and the supplementary search:• Few orthodontic studies have presented both economic andclinical outcomes. There is currently insufficient evidence availableabout the health economics of orthodontic interventions.• Further studies are still warranted and preferably using thesame clinical outcomes. Key findings in Paper II• Children with excessive overjet reported significantly lowerOHRQoL compared to children with unilateral posteriorcrossbite or normal occlusion.• The children generally reported low CPQ scores that imply anoverall fairly good OHRQoL.Key findings in Paper III• Treatment of unilateral posterior crossbite in mixed dentitionis recommended to be performed by a specialist orthodontistusing the quad-helix appliance since the quad-helix treatmentperformed in specialist orthodontic clinics had the highest costeffectiveness. Key findings in Paper IV• Crossbite children had, before treatment, significantly smallerpalatal surface and volume than normal control children.• After treatment, there were no significant differences betweenthe treatment groups and the normal group, which impliesthat the palatal surface and projection area together with thepalatal shell volume for the treatment groups and the normalgroup were equivalent. Conclusions and clinical implications:With a superior success rate and cost-effectiveness, it is concludedthat treatment of unilateral posterior crossbite in mixed dentition isrecommended to be performed by specialist orthodontists using thequad-helix appliance.The unilateral posterior crossbite correction resulted in a normalisationof the occlusion, palatal area and volume.

Ort, förlag, år, upplaga, sidor
Malmö university, Faculty of Odontology , 2019. , s. 92
Serie
Doctoral Dissertation in Odontology
Nyckelord [en]
Malocclusion
Nationell ämneskategori
Odontologi
Identifikatorer
URN: urn:nbn:se:mau:diva-7664DOI: 10.24834/isbn.9789178770199Lokalt ID: 30320ISBN: 9789178770182 (tryckt)ISBN: 9789178770199 (tryckt)OAI: oai:DiVA.org:mau-7664DiVA, id: diva2:1404604
Tillgänglig från: 2020-02-28 Skapad: 2020-02-28 Senast uppdaterad: 2022-06-27Bibliografiskt granskad
Delarbeten
1. Health economic evaluations in orthodontics: a systematic review
Öppna denna publikation i ny flik eller fönster >>Health economic evaluations in orthodontics: a systematic review
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2016 (Engelska)Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 38, nr 3, s. 259-265Artikel, forskningsöversikt (Refereegranskat) Published
Abstract [en]

Background: Economic evaluation is assuming increasing importance as an integral component of health services research. Aim: To conduct a systematic review of the literature and assess the evidence from studies presenting orthodontic treatment outcomes and the related costs. Materials/methods: The literature review was conducted in four steps, according to Goodman’s model, in order to identify all studies evaluating economic aspects of orthodontic interventions. The search covered the databases Medline, Cinahl, Cochrane, Embase, Google Scholar, National Health Service Economic Evaluation Database, and SCOPUS, for the period from 1966 to September 2014. The inclusion criteria were as follows: randomized controlled trials or controlled clinical trials comparing at least two different orthodontic interventions, evaluation of both economic and orthodontic outcomes, and study populations of all ages. The quality of each included study was assessed as limited, moderate, or high. The overall evidence was assessed according to the GRADE system (The Grading of Recommendations Assessment, Development and Evaluation). Results: The applied terms for searches yielded 1838 studies, of which 989 were excluded as duplicates. Application of the inclusion and exclusion criteria identified 26 eligible studies for which the full-text versions were retrieved and scrutinized. At the final analysis, eight studies remained. Three studies were based on cost-effectiveness analyses and the other five on cost-minimization analysis. Two of the cost-minimization studies included a societal perspective, i.e. the sum of direct and indirect costs. The aims of most of the studies varied widely and of studies comparing equivalent treatment methods, few were of sufficiently high study quality. Thus, the literature to date provides an inadequate evidence base for economic aspects of orthodontic treatment. Conclusion: This systematic review disclosed that few orthodontic studies have presented both economic and clinical outcomes.There is currently insufficient evidence available about the health economics of orthodontic interventions. Further investigation is warranted.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2016
Nyckelord
health economy, orthodontics
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-948 (URN)10.1093/ejo/cjv040 (DOI)000377921000006 ()26070925 (PubMedID)21683 (Lokalt ID)21683 (Arkivnummer)21683 (OAI)
Tillgänglig från: 2020-02-27 Skapad: 2020-02-27 Senast uppdaterad: 2022-06-27Bibliografiskt granskad
2. Oral health-related quality of life among children with excessive overjet or unilateral posterior crossbite with functional shift compared to children with no or mild orthodontic treatment need.
Öppna denna publikation i ny flik eller fönster >>Oral health-related quality of life among children with excessive overjet or unilateral posterior crossbite with functional shift compared to children with no or mild orthodontic treatment need.
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2019 (Engelska)Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 41, nr 2, s. 111-116Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives: To compare Oral health-related quality of life (OHRQoL) among 9-year-old children with excessive overjet (EO) to children with unilateral posterior crossbite (UPC) and children with normal occlusion (NO). Materials and methods: The study sample sourced from 19 Public Dental Service Clinics in Sweden. Reported are baseline data originating from two controlled trials, one regarding UPC and the other focusing on EO. The NO children derive from the same trials. The UPC group comprised 93 children (45 boys and 48 girls), the EO group 71 children (36 boys and 35 girls), and the NO group 65 children (32 boys and 33 girls). In conjunction to a clinical examination, all children completed the Child Perceptions Questionnaire (CPQ8-10) for evaluation of OHRQoL. The CPQ8-10 comprises 25 questions grouped into four domains: oral symptoms, functional limitations, emotional, and social well-being. Validated questions about pain in the jaws and face were also included. Results: The total mean CPQ score was 5.1 for the UPC, 7.4 for the EO, and 4.4 for the NO group, showing a significant difference between the UPC and EO (P = 0.048) and between EO and NO group (P = 0.012). These differences remained when adjusted for the confounders' caries, trauma, enamel defects, and headache. No difference between UPC and NO was found. The EO children also reported significantly higher scores in the domains emotional and social well-being (P = 0.039 and P = 0.012). Limitations: The study would be strengthened if a longitudinal design had been performed. Conclusion: Children with EO reported significantly lower OHRQoL compared to children with UPC or NO. The children generally reported low CPQ scores that imply an overall fairly good OHRQoL.

Ort, förlag, år, upplaga, sidor
Oxford Academic, 2019
Nyckelord
child, health-related quality of life, posterior crossbite, overjet, dental
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-15726 (URN)10.1093/ejo/cjy033 (DOI)000464935900001 ()26663 (Lokalt ID)26663 (Arkivnummer)26663 (OAI)
Tillgänglig från: 2020-03-30 Skapad: 2020-03-30 Senast uppdaterad: 2022-06-27Bibliografiskt granskad
3. An RCT on clinical effectiveness and cost analysis of correction of unilateral posterior crossbite with functional shift in specialist and general dentistryd
Öppna denna publikation i ny flik eller fönster >>An RCT on clinical effectiveness and cost analysis of correction of unilateral posterior crossbite with functional shift in specialist and general dentistryd
2020 (Engelska)Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 42, nr 1, s. 44-51, artikel-id cjz014Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objectives: To evaluate the costs of quad-helix (QH) and removable expansion plate (EP) treatments performed either in specialist or general dentistry for the correction of unilateral posterior crossbite with functional shift in the mixed dentition. Trial design: Four-arm parallel group multicentre randomized controlled trial. Materials and methods: One hundred and ten patients with unilateral posterior crossbite with functional shift were recruited. The patients were randomized by an independent person not involved in the trial. The randomization used blocks of 20 and into the following four groups: QH treatments in specialist orthodontic clinics (QHS), QH treatments in general dentistry (QHG), EP treatments in specialist orthodontic clinics (EPS), and EP treatments in general dentistry (EPG). Blinding was accomplished of the outcome assessor and data analyst. A cost analysis was performed with reference to intention-to-treat (ITT), regarding direct costs, indirect costs, and societal costs (the sum of direct and indirect costs) for calculations of successful treatments alone and for retreatments when required. To determine which alternative has the lower cost, a cost-minimization analysis was undertaken, based on that the outcome of the treatment alternatives were broadly equivalent, so the difference between them reduces to a comparison of costs. Results: In the QHS group, 28 of 28 patients were successfully corrected compared to 23 of 27 in the QHG group. Treatment with expansion plate was less successful: 18 of 27 patients in the EPS group and 18 of 28 in the EPG group. QH treatment performed in specialist orthodontic clinics had significantly lower costs than QH or EP treatment accomplished in general dentistry as well as EP treatments in specialist orthodontic clinics. Limitations: Costs depend on local factors and should not be directly extrapolated to other locations. Conclusion: Treatment of unilateral posterior crossbite in the mixed dentition is recommended to be performed by a specialist orthodontist using the QH appliance. Trial registration: The trial was not registered.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2020
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-5845 (URN)10.1093/ejo/cjz014 (DOI)000527389000007 ()31067324 (PubMedID)30180 (Lokalt ID)30180 (Arkivnummer)30180 (OAI)
Tillgänglig från: 2020-02-28 Skapad: 2020-02-28 Senast uppdaterad: 2022-06-27Bibliografiskt granskad
4. Three-dimensional evaluation of forced unilateral posterior crossbite correction in the mixed dentition: a randomized controlled trial
Öppna denna publikation i ny flik eller fönster >>Three-dimensional evaluation of forced unilateral posterior crossbite correction in the mixed dentition: a randomized controlled trial
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2020 (Engelska)Ingår i: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 42, nr 4, s. 415-425, artikel-id cjz054Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVES: The objectives of this study were to assess the three-dimensional (3D) treatment changes (palatal surface area and volume) of forced unilateral posterior crossbite correction using either quad-helix or removable expansion plate appliances in the mixed dentition, and to compare the treatment changes with the three-dimensional changes occurring in age-matched untreated unilateral posterior crossbite patients as well as in subjects with normal occlusion and with no or mild orthodontic treatment need. TRIAL DESIGN: Six-arm parallel group multicentre randomized controlled trial. MATERIALS AND METHODS: One-hundred and thirty-five patients with unilateral posterior crossbite with functional shift were recruited. The patients were randomized by an independent person not involved in the trial. The randomization used blocks of 25, and the patients were randomized into the following five groups: quad-helix treatments in specialist orthodontic clinics (QHS), quad-helix treatments in general dentistry (QHG), removable expansion plate treatments in specialist orthodontic clinics (EPS), removable expansion plate treatments in general dentistry (EPG), and untreated crossbite (UC). Twenty-five patients with normal occlusion who served as normal controls were also included in the trial. Blinding of the outcome assessor and data analyst was accomplished. Data on all children were evaluated on an intention-to-treat basis, regarding 3D palatal surface area, palatal projection area, and palatal shell volume; two-dimensional linear measurements were registered at the same time. RESULTS: After treatment, the surface and projection area and shell volume increased in the four treatment groups (QHS, QHG, EPS, and EPG). QHS increased significantly more than EPG for the surface and projection area. The QHS and EPS had significantly higher mean difference for shell volume. LIMITATIONS: The trial considers a short-term evaluation. CONCLUSION: After treatment, there were no significant differences between the four treatment groups and the normal group, which implies that the surface and projection area together with the shell volume for the four treatment groups and the normal group were equivalent. TRIAL REGISTRATION: The trial was registered with https://www.researchweb.org/is/sverige, registration number: 220751.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2020
Nationell ämneskategori
Odontologi
Identifikatorer
urn:nbn:se:mau:diva-6769 (URN)10.1093/ejo/cjz054 (DOI)000607056500008 ()31369676 (PubMedID)30263 (Lokalt ID)30263 (Arkivnummer)30263 (OAI)
Tillgänglig från: 2020-02-28 Skapad: 2020-02-28 Senast uppdaterad: 2022-06-27Bibliografiskt granskad

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