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Orthodontics

Do patient-reported outcomes of miniscrew-supported maxillary expansion in adolescent patients differ between slow and rapid activation protocol?

Evidence-Based Dentistry volume 24, pages 28–29 (2023)Cite this article

Subjects

Abstract

Design

Single-center randomized clinical trial with two parallel arms. The protocol of the study was approved by the institutional review board (IRB) of the Faculty of Dentistry, Alexandria University (IRB: 00010556–IORG: 0008839) and registered in Clinicaltrials.gov (identifier number: NCT04225637). Before the trial commencement, parents/legal guardians signed informed consents. The study complied with the CONSORT (Consolidated Standards of Reporting Trials).

Case selection

30 adolescent patients aged between 12 to 16 years with transversely deficient maxilla requiring skeletal maxillary expansion were recruited to be included in the study. Patients received miniscrew-supported Penn expanders and they were randomly allocated (ratio 1:1) into two groups based on the activation protocol; slow maxillary expansion (SME = turn every other day) or rapid maxillary expansion (RME = 2 turn/day).

Data analysis

The patient-reported outcome measures were the following: pain, headache, pressure, dizziness, speech, chewing and swallowing difficulties, swallowing difficulty. The participants rated the reported outcomes using numeric rating scale (NRS) at 4 time points: t1 = before appliance insertion, t2 = after first activation, t3 = after 1 week of activation, and t4 = after last activation. Patients were advised not to use analgesics, and to contact their provider in case of severe pain. Descriptive measures and patient-reported outcomes at various time points were calculated. Comparisons between the two groups at each time point were assessed using Mann–Whitney U-test. Comparisons of time points in each group were assessed using the Friedman test and followed by post-hoc tests with Bonferroni correction.

Results

6 patients were not included in the analysis for different reasons, allowing a total of 24 patients (12 patients in each group) to be analyzed. Mean ages of the patients in the SME and RME group were 14.30 ± 1.37 and 15.07 ± 1.59, respectively. Median scores were in the bottom quartiles of NRS for all reported outcomes. RME group reported significantly higher scores for all measured variables, with exception of headache and dizziness, which showed no statistical difference between the two group.

Conclusions

Mild to moderate discomfort and functional limitation is anticipated with the activation of miniscrew-anchored Penn expanders. Slow activation protocol provided a better overall patient experience when compared to a rapid activation protocol.

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References

  1. Rutili V, Mrakic G, Nieri M, Franceschi D, Pierleoni F, Giuntini V. et al. Dento-skeletal effects produced by rapid versus slow maxillary expansion using fixed jackscrew expanders: a systematic review and meta-analysis. Eur J Orthod. 2021;43:301–12. https://doi.org/10.1093/ejo/cjaa086.

    Article  PubMed  Google Scholar 

  2. Hua F. Increasing the value of orthodontic research through the use of dental patient-reported outcomes. J Evid Based Dent Pract. 2019;19:99–105. https://doi.org/10.1016/j.jebdp.2019.04.005.

    Article  PubMed  Google Scholar 

  3. Abed Al Jawad FH, Alhashimi NA. Evaluation of self-perceived pain and jaw function impairment in children undergoing slow and rapid maxillary expansion. Angle Orthod. 2021;91:725–32. https://doi.org/10.2319/020221-100.1.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bradley E, Shelton A, Hodge T, Morris D, Bekker H, Fletcher S. et al. Patient-reported experience and outcomes from orthodontic treatment. J Orthod. 2020;47:107–15. https://doi.org/10.1177/1465312520904377.

    Article  PubMed  Google Scholar 

  5. Yacout YM, Abdalla EM, El Harouny NM Patient-reported outcomes of slow vs rapid miniscrew-supported maxillary expansion in adolescents: secondary outcomes of a randomized clinical trial. [published online ahead of print, 2022 Oct 18]. Angle Orthod. 2022. https://doi.org/10.2319/061022-418.1.

  6. Yacout YM, Abdalla EM, El Harouny NM. Skeletal and dentoalveolar effects of slow vs rapid activation protocols of miniscrew-supported maxillary expanders in adolescents: A randomized clinical trial [published online ahead of print, 2022 Jun 30]. Angle Orthod. 2022;92:579–88. https://doi.org/10.2319/112121-856.1.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Seong EH, Choi SH, Kim HJ, Yu HS, Park YC, Lee KJ. Evaluation of the effects of miniscrew incorporation in palatal expanders for young adults using finite element analysis. Korean J Orthod. 2018;48:81–89. https://doi.org/10.4041/kjod.2018.48.2.81.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Williamson A, Hoggart B. Pain: a review of three commonly used pain rating scales. J Clin Nurs. 2005;14:798–804. https://doi.org/10.1111/j.1365-2702.2005.01121.x.

    Article  PubMed  Google Scholar 

  9. Baldini A, Nota A, Santariello C, Assi V, Ballanti F, Cozza P. Influence of activation protocol on perceived pain during rapid maxillary expansion. Angle Orthod. 2015;85:1015–20. https://doi.org/10.2319/112114-833.1.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Feldmann I, Bazargani F. Pain and discomfort during the first week of rapid maxillary expansion (RME) using two different RME appliances: A randomized controlled trial. Angle Orthod. 2017;87:391–6. https://doi.org/10.2319/091216-686.1.

    Article  PubMed  Google Scholar 

  11. Rutili V, Nieri M, Franceschi D, Pierleoni F, Giuntini V, Franchi L. Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis. Prog Orthod. 2022;23:47. https://doi.org/10.1186/s40510-022-00440-5.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Graduate Orthodontics, University of Detroit Mercy, Detroit, MI, USA

    Rahma ElNaghy, Riyad Al-Qawasmi & Majd Hasanin

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  1. Rahma ElNaghy
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  2. Riyad Al-Qawasmi
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  3. Majd Hasanin
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Correspondence to Rahma ElNaghy.

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ElNaghy, R., Al-Qawasmi, R. & Hasanin, M. Do patient-reported outcomes of miniscrew-supported maxillary expansion in adolescent patients differ between slow and rapid activation protocol?. Evid Based Dent 24, 28–29 (2023). https://doi.org/10.1038/s41432-023-00858-8

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