Short term outcomes with early protraction facemask use
Mandall N, DiBiase A, Littlewood S, Nute S, Stivaros N, McDowall R, et al. Is early Class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 15-month follow-up. J Orthod 2010;37:149-61
This 8-center, prospective study examined the early use of protraction facemasks with maxillary expansion. The patients were younger than 10 years and exhibited Class III malocclusions associated with maxillary retrusion. They were randomly assigned to the protraction facemask group (PFG) or the control (no treatment) group (CG). After expansion, the PFG subjects were fitted with facemasks and instructed to wear these for 14 hours per day. Facemask treatment was discontinued, on average after 8.6 months, when a positive overjet and a Class I dental or skeletal relationship were achieved. Records were made before treatment and 15 months later. At 15 months, relative to the CG, the PFG had a 2.6° improvement in the ANB, attributable to significantly more movement of A-point forward ( P = 0.018) and B-point backward ( P <0.001). Mean improvements in overjet were 4.4 mm in the PFG and 0.3 mm in the CG, and were significantly different ( P <0.001). The results of treatment were variable, but 70% of the PFG subjects achieved a positive overjet. After treatment, the PFG subjects reported significantly less concern with their malocclusions compared with the CG subjects ( P = 0.003) but no improvement in self-esteem. Temporomandibular dysfunction was uncommon in both groups at both times. Future follow-up of these subjects at 15 years of age is intended and could elucidate the need for overcorrection, which has been advocated to prevent Class III relapse. However, at age 15 years, occlusions might not be stable, especially in boys, who could have further growth potential. Although clinically meaningful psychosocial benefits could not be claimed, this study showed the incidence and magnitude of effectiveness of early intervention for most Class III malocclusions in the short term.
Reviewed by Stephen Darmitzel
Differences in pain experienced by subjects with labial and lingual appliances
Wu AK, McGrath C, Wong RW, Wiechmann D, Rabie AB. A comparison of pain experienced by patients treated with labial and lingual orthodontic appliances. Eur J Orthod 2010;32:403-7
Lingual appliances offer superior esthetics compared with conventional labial metal and ceramic brackets. However, information is sparse regarding pain associated with lingual compared with labial appliances. This age-matched case-control prospective study compared the pain experienced: intensity overall and at 6 sites (tongue, lips, cheek, gums, face, and jaw), pain frequency, sleep disturbance, and analgesic consumption at 1 week (T1), 1 month (T2), and 3 months (T3) after placement of fixed appliances in subjects with labial appliances and subjects with lingual appliances. Twenty-two female and 8 male patients received lingual appliances, and 18 female and 12 male patients received labial appliances. The subjects rated their pain intensity using a visual analog scale, with 10 as the worst pain imaginable. The data were assessed by using Friedman analysis of variance, area under the curve analysis, and t and chi-square tests to compare differences. Overall pain intensities decreased significantly over the study period for both appliances (averages, <6 for both groups at T1) but were not significantly different between the 2 groups at any time point. There was significantly greater tongue pain reported with lingual appliances and significantly more lip and cheek pain reported with labial appliances. Significantly earlier onset of pain was reported by subjects treated with lingual appliances at all time points. These results indicate that, although there were no significant differences in overall pain, pain at various sites differed depending on the type of appliance. Only 7 instances of use of analgesics were reported during the study; 6 of these were associated with lingual appliances and 5 were associated with T1. The raw data were not reported, so readers could not assess these and make other comparisons, such as sex differences.
Reviewed by Jodi Hentscher-Johnson