ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Does The Quadhelix Outperform The Xpansion Arch?
Clinical Question Is the quadhelix more effective at correcting a cross bite than the expansion arch in a orthodontic patient?
Clinical Bottom Line The quadhelix and expansion arch are equally effective in treatment of a cross bite. However the quadhelix seems to be a better choice since it appeared significantly more controlled and predicable in expansion rate, less costly, can be fitted at chair side and it is equally effective in expansion. In addition, the quadhelix was reported as having a less patients reporting dislike of the appearance of the appliance compared to the expansion arch.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 15784941McNally/2005Patient Group 55 pts on waiting list at Queens Hospital who required maxillary expansion Randomized Controlled Trial
Key resultsThe quadhelix and custom expansion arch were equally effective in producing expansion. Both were also equally uncomfortable with the quadhelix mainly affecting the tongue and the expansion arch affecting the cheeks. The quadhelix’s appearance was disliked only by 25% of the participants while the expansion arch’s was disliked by 70%. The benefits of the quadhelix include it being less costly and can be made to fit at the chair side.
#2) 15366386Donohue/200428 consecutive new pts presenting with posterior buccal segment cross bitesRandomized Controlled Trial
Key resultsBoth were equally effective in maxillary expansion however the quadhelix appeared significantly more controlled and predicable in expansion rate.
#3) 19732666Huynh/2009312 consecutive expansion pts with posterior cross bitesRandomized Controlled Trial
Key resultsThe two appliances were equally effective.
Evidence Search ("Palatal Expansion Technique"[Mesh]) AND "Orthodontic Appliance Design"[Mesh] and quadhelix
Comments on
The Evidence
All 3 of the articles were randomized controlled trials that were based on consecutive patients needing maxillary expansion to correct a cross bite. All of the studies had greater than 80% completion rate. All studies used a quadhelix and expansion arch while the Huynh also used a rapid palatal expander. They all adequately followed up but none of the trials were double blind. Compliance was adequate in all trails and there were not any indications of recall bias or competing interests.
Applicability The benefits for the patient are expansion of the maxilla that assists in achieving desirable occlusion and benefits future orthodontic treatment. The harms for the patient include pain/discomfort and dislike of the appearance of the appliance. Since most patients are receiving orthodontic treatment are for aesthetic gain, the benefits of expansion normally outweigh the negatives. It seems the quadhelix would suit most cases better since it is less costly, can be fitted at chair side and it is equally effective in expansion. In addition, the quadhelix was reported as having a less patients reporting dislike of the appearance of the appliance compared to the expansion arch.
Specialty/Discipline (Orthodontics) (Pediatric Dentistry)
Keywords Quadhelix, expansion arch, orthodontics, and orthodontic appliances
ID# 2272
Date of submission: 04/13/2012spacer
E-mail marabella@livemail.uthscsa.edu
Author Holly Marabella
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Norma Olvera, DDS, MS
Faculty mentor/Co-author e-mail olveran@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?)
post a rationale
None available
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Comments on the CAT
(FOR PRACTICING DENTISTS' and/or FACULTY COMMENTS ON PUBLISHED CATs)
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by Vicky Hua and Marcus Worden (San Antonio, TX) on 12/01/2017
A PubMed search on this topic on 11/27/17 resulted in the following publications: a summary review by O'Neill J. 2015 (PubMed ID 25909939) and a RCT by Godoy F. et al. 2011 (PubMed ID 21195256). Both support the original findings of this CAT. Additional findings include: quad-helix is less expensive and more effective in less time. There were some inconsistencies in efficacy and data collection standards noted between fixed vs. removable plates therefore further study would be needed to solidify a clinical recommendation in that regard.
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