Maxillary Hypoplasia Clinical Trial
Official title:
Pain and Discomfort During Maxillary Expansion: A Randomized Multicentric Study
The aim of the present study is to investigate and analyze the perception of pain and function impairment during the first week of activation with two different palatal expansion screw to identify an effective pain prevention protocol.
Maxillary expansion with fixed appliance is a well-known and consolidated practice in
clinical orthodontics but current findings of "evidence based dentistry" have not yet
identified a better clinical expansion protocol. This issue is due both to the several
expansion screws available on the market and to the different screw activation protocols,
which could be grouped into rapid and slow, with several customizations. A recent systematic
review has shown that both rapid and slow expansion protocols are clinically effective on the
primary outcome, i.e. the resolution of the crossbite with a significant increase of skeletal
transversal dimension in the maxillary transverse deficiency subjects. If the type of
appliance based on its ability to solve the maxillary constriction is not any more the main
selection criteria, the choice of the orthodontist should, therefore, be based on the timing
and on a "patient-oriented" device, that minimizes the side effects, such as e.g. appliance
breakages, functional impairments and pain.
In the orthodontic daily practice, the pain of the little patient is the most frequent
symptom during treatment and is the one that most frightens/worries the child and the family.
Literature shows that rapid maxillary expansion is, among the early orthodontic therapies,
the one with the highest frequency of pain (up to 98%) as an adverse symptom reported by
patients. The pain is statistically linked to the rapid expansion protocol (2/turn/day),
during which, for each activation of the screw (0.2 or 0.25 mm) the force expressed can reach
up to 10 pounds which acts in an orthopaedic manner on the palatine suture and the
circummascellar sutures. Following this orthopedic action, a disorganized and highly
vascularized connective tissue (inflammatory) is formed in palatine suture area, which
becomes the main receptor of the pain perceived by the patient during the active maxillary
expansion. In the literature the prevention and management of pain during palate expansion is
a poorly analyzed topic, despite being a daily problem in orthodontic clinical practice and
so the aim of the present study is to investigate and analyze the perception of pain and
function impairment during the first week of activation with two different palatal expansion
screw to identify an effective pain prevention protocol.
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