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

Area of Science:

• Orthodontics
• Pediatric Dentistry
• Dental Public Health

Background:

• Anterior crossbite with functional shift (pseudo Class III) requires early intervention during mixed dentition to prevent severe malocclusion and temporomandibular joint issues.
• Treatment options include fixed appliances (FA) and removable appliances (RA), but evidence comparing their effectiveness, stability, cost, and patient acceptance is limited.

Purpose of the Study:

• To compare and evaluate fixed versus removable appliances for correcting anterior crossbite with functional shift in the mixed dentition.
• To assess clinical effectiveness, long-term stability, cost-effectiveness, and patient perceptions (pain, discomfort) of both treatment methods.

Main Methods:

• A randomized controlled trial (RCT) methodology was employed.
• Sixty-two patients with anterior crossbite and functional shift in mixed dentition were randomly assigned to FA or RA treatment.
• Studies evaluated short-term correction efficiency, long-term stability (2 years post-treatment), cost-minimization, and patient-reported outcomes.

Main Results:

• Both FA and RA effectively corrected anterior crossbite with functional shift in the short term; FA treatment time was shorter but with minor clinical relevance.
• Long-term stability and prognosis were similar for both FA and RA, making either appliance type recommendable.
• FA treatment was significantly more cost-effective than RA, with lower direct and indirect costs, even when considering only successful outcomes.
• Patient-reported pain and discomfort were generally low to moderate for both, with slightly higher intensity in the initial days for FA. Removable appliances caused more disruption to activities and speech, while fixed appliances led to more difficulty eating hard foods, though differences were minor.

Conclusions:

• Both fixed and removable appliances are effective and well-accepted for correcting anterior crossbite with functional shift in the mixed dentition, offering stable long-term results.
• Fixed appliances present significant economic advantages and are therefore recommended from a cost-effectiveness standpoint.
• While minor differences in patient experience exist, neither appliance type shows a clear disadvantage in terms of overall patient acceptance or clinical relevance.