Title	A Fixed Appliance Is More Effective Than a Removable Appliance for the Correction of Anterior Crossbite in Patients with Mixed Dentition
Clinical Question	In patients with mixed dentition and an anterior crossbite, is a fixed appliance more effective than a removable appliance in the correction of the malocclusion?
Clinical Bottom Line	For patients in mixed dentition with anterior crossbite, a fixed appliance is more effective than a removable appliance for the correction of the malocclusion. However, both appliances produce acceptable results. This is supported by a randomized control trial in which treatment with a fixed appliance outperformed the removable appliance in terms of a significantly shorter treatment duration and a significant increase in arch length and overjet.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 25114123 Wiedel/2015 62 Children with anterior crossbite in mixed dentition Randomized Controlled Trial Key results All patients in the fixed appliance group had their anterior crossbite successfully corrected. In the removable appliance group, the malocclusion was corrected in all patients except for one (due to failure to comply). There was a significant difference (P<0.05) in the duration of treatment, with the fixed appliance being 1.4 months shorter. Both treatments resulted in significant increases in arch length and overjet; however, the fixed appliance group showed significantly greater increases in both (P<0.05 and P<0.01).
Evidence Search	((fixed[All Fields] AND appliance[All Fields]) AND (removable[All Fields] AND appliance[All Fields])) AND (anterior[All Fields] AND ("malocclusion"[MeSH Terms] OR "malocclusion"[All Fields] OR "crossbite"[All Fields]))
Comments on The Evidence	This study was a randomized control trail that included 62 patients in mixed dentition, all with similar anterior crossbite malocclusion. There was a 98% completion rate; one patient in the removable appliance group dropped out due to failure to comply. Both groups were treated equally and received adequate follow-up. The study design allowed for the measurements to be obtained in a blinded and unbiased manner from study casts and evaluating the average duration of treatment, thus increasing the validity of the study. Although the fixed appliance demonstrated statistically significant treatment effectiveness, the differences are not clinically relevant. Removable appliances can render the same clinical result as fixed appliances if there is full compliance.
Applicability	Anterior crossbite malocclusions are a very common finding, especially in children. Since removable appliances depend on patient compliance, fixed appliances should provide faster and more dependable results, especially in non-compliant patients. The results for the removable appliances in the study might be skewed since the patients knew that they were being studied and might have increased their compliance above what is to be expected in the average community-based pediatric patient.
Specialty	(General Dentistry) (Orthodontics) (Pediatric Dentistry)
Keywords	Anterior crossbite, mixed dentition, fixed appliances, removable appliances, malocclusion correction
ID#	3074
Date of submission	04/08/2016
E-mail	ramireze8@livemail.uthscsa.edu
Author	Enrique Ramirez
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Maria Cervantes Mendez, DDS, MS
Faculty mentor e-mail	CervantesMen@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available