Educational support and weekly telemonitoring during rapid maxillary expansion in children: a prospective...

Rapid maxillary expansion requires substantial caregiver participation in screw activation, oral hygiene and early recognition of appliance-related problems. Structured education and remote photographic monitoring may support families during the active expansion phase.

This single-center, prospective, preference-based comparative cohort study included 100 children aged 7-11 years requiring rapid maxillary expansion. After receiving standardized information, caregivers independently selected conventional weekly in-office follow-up or an educational telemonitoring pathway comprising illustrated materials, standardized weekly caregiver-taken intraoral photographs acquired at home, clinician-led remote review and feedback and an in-office examination at completion of active expansion or earlier when clinically indicated. Quota-based consecutive recruitment continued until 50 participants were included in each cohort. The primary outcome was the proportion of participants with at least one recorded biological or technical complication during active expansion. All participants underwent the same standardized final in-office clinical examination.

All participants completed follow-up. In the telemonitoring cohort, 188 of 200 scheduled photographic sets were submitted, of which 174 (92.6%) were adequate for remote assessment. At least one recorded complication occurred in 12 of 50 participants (24.0%) in the telemonitoring cohort and 23 of 50 (46.0%) in the conventional cohort [unadjusted risk ratio [RR], 0.52; 95% confidence interval [CI], 0.29-0.93; p = 0.021]. Recorded biological complications occurred in 16.0% and 36.0% of participants, respectively (RR, 0.44; 95% CI, 0.21-0.93; p = 0.023), and recorded technical complications in 12.0% and 30.0%, respectively (RR, 0.40; 95% CI, 0.17-0.95; p = 0.027). Mean activation adherence was higher in the telemonitoring cohort (94.8 ± 6.1% vs. 89.3 ± 9.7%; mean difference, 5.5 percentage points; 95% CI, 2.3-8.7; p = 0.001). Child- and caregiver-reported treatment acceptance scores were also higher. Unscheduled in-office visits did not differ significantly between cohorts, and no delayed detection of clinically relevant complications occurred.

The educational telemonitoring pathway was feasible and associated with fewer recorded complications, higher activation adherence, and greater treatment acceptance. However, because caregivers selected the follow-up pathway, estimates were unadjusted, and interim assessment modalities differed between cohorts, the findings should be considered exploratory and not interpreted as evidence of a causal treatment effect.