Randomized controlled trial
Dental arch changes after open bite treatment with spurs associated with posterior build-ups in the mixed dentition: A randomized clinical trial

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Highlights

  • The anterior open bite was treated with bonded spurs, with or without posterior build-ups.

  • The therapies produced similar improvements in anterior open bite.

  • Dentoalveolar and dental arch dimensional changes were similar.

  • Group with build-ups had a slight decrease in maxillary intermolar distance.

  • This group also had a slight increase in the mandibular intermolar distance.

  • The opposite was found in the group treated with bonded spurs alone.

Introduction

This single-center, 2-arm, parallel-group randomized clinical trial aimed to compare the dimensional dental arch changes after anterior open bite (AOB) treatment with bonded spurs associated with posterior build-ups vs bonded spurs alone.

Methods

Patients aged between 7 and 11 years with AOB were recruited at a university clinic and randomly allocated into 2 groups. The experimental group was treated with bonded spurs associated with posterior build-ups (SBU) and the comparison group with bonded spurs alone (S). Digital dental models were obtained at pretreatment and after 12 months of treatment. The overbite change was the primary outcome. The randomization list was obtained at the Web site www.randomization.com. Allocation concealment involved sequentially numbered, sealed, and opaque envelopes. The outcomes’ assessment was blinded. Analysis of covariance was used for intergroup comparisons (P <0.05). Mean difference (MD) and 95% confidence interval (CI) were obtained.

Results

Twenty-four patients (mean age, 8.22 ± 1.06 years; 7 males and 17 females) were included in the SBU group, and 25 patients (mean age, 8.30 ± 0.99 years; 11 males and 14 females) were included in the comparison group. After a 12-month follow-up, the overbite increased approximately 4 mm in both groups (MD, −0.11 mm; 95% CI, −1.03 to 0.80). Means of anterior dentoalveolar vertical development ranged from 2.24 mm (S group) to 2.49 mm (SBU group) and from 1.31 mm (SBU group) to 1.55 mm (S group) for the maxilla (MD, −0.24 mm; 95% CI, −0.91 to 0.44) and mandible (MD, 0.29 mm; 95% CI, −0.39 to 0.96), respectively. The maxillary intermolar distance decreased in the SBU group and increased in the S group (MD, −0.48 mm; 95% CI, −0.92 to −0.03). The mandibular intermolar distance increased in the SBU group and decreased in the comparison group (MD, 0.26 mm; 95% CI, 0.004-0.52). Plaque accumulation around the spurs was observed in some patients.

Conclusions

Both protocols demonstrated similar improvements in the AOB with similar effects on the dental arches. The SBU group showed a slight decrease in the maxillary intermolar distance and a slight increase in the mandibular intermolar distance, whereas opposite changes were observed for the S group.

Registration

This trial was registered at Clinicaltrials.gov (Identifier NCT03702881).

Protocol

The study protocol was not published.

Funding

This work was supported by the São Paulo Research Foundation (FAPESP) grants nos. 2017/06440-3, 2018/05238-9, and 2018/24003-2; and financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES), Finance Code 001.

Section snippets

Specific objectives or hypotheses

This RCT aimed to compare the dimensional changes on maxillary and mandibular dental arches after AOB treatment with bonded spurs associated with posterior build-ups (SBU) and bonded spurs alone (S). The null hypothesis tested was that both therapies have similar dental arch outcomes.

Trial design and any changes after trial commencement

This study was conducted as a 2-arm parallel, single-center RCT with a 1:1 allocation ratio, following the Consolidated Standards of Reporting Trials guidelines.19 An untreated control group was not included because of ethical reasons.

Participants, eligibility criteria, and settings

The Ethics in Research Committee of Bauru Dental School, University of São Paulo, Bauru, Brazil approved the study (protocol no. 68551617.8.0000.5417/2.112.035). The protocol was registered at Clinicaltrials.gov with the identifier NCT03702881. Subjects’

Participant flow

During recruitment (June 2017 to April 2018), 1025 children were assessed for eligibility. From this sample, 969 were excluded because they did not meet the selection criteria, and 6 declined to participate in the study. Fifty patients were randomized in a 1:1 ratio (Fig 3).

Baseline data

The groups showed similar age and sex distribution (Table II). Baseline characteristics were also similar in both groups (Table III).

Number analyzed for each outcome, estimation, and precision

The SBU group had 1 patient (4%) lost to follow-up because the patient moved to another

Main findings in the context of the existing evidence and interpretation

Digital dental model assessment after AOB treatment allows evaluation of specific tooth areas that are, sometimes, difficult to visualize in lateral cephalograms because of the superimposition of dental structures. Few studies have reported the treatment changes of AOB after crib therapy using dental models.18,27 The present study is the first randomized clinical trial evaluating the dimensional changes of the dental arches after AOB early treatment with bonded spurs and posterior build-ups by

Conclusions

After a 12-month treatment period:

  • 1.

    Both treatment protocols showed similar overbite increases, anterior dentoalveolar vertical development, clinical crown height increases, and similar decreases of the arch perimeters and lengths.

  • 2.

    Bonded spurs associated with posterior build-ups showed a slight decrease in the maxillary intermolar distance and a slight increase in the mandibular intermolar distance, whereas opposite changes were observed when bonded spurs were used alone.

Author Credit Statement

Aron Aliaga-Del Castillo contributed to conceptualization, methodology, investigation, resources, data curation, original draft preparation, visualization, project administration, funding acquisition; Silvio Augusto Bellini-Pereira contributed to the methodology, validation, investigation, resources, original draft preparation, and visualization. Lorena Vilanova contributed to the investigation, resources, original draft preparation; Felicia Miranda contributed to the investigation, resources,

Acknowledgments

The authors thank Dr Bruno Gribel (Compass 3D; Belo Horizonte, Minas Gerais, Brazil), FGM Dental Products (Joinville, Santa Catarina, Brazil), and Morelli (Sorocaba, São Paulo, Brazil) for their support in the present study.

This work was supported by the São Paulo Research Foundation (FAPESP), grants nos. 2017/06440-3, 2018/05238-9 and 2018/24003-2; and financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

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  • Cited by (0)

    All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.

    This work was supported by the São Paulo Research Foundation (FAPESP) grants nos. 2017/06440-3, 2018/05238-9, and 2018/24003-2; and financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brasil (CAPES), Finance Code 001.

    This article is based on research submitted by Aron Aliaga-Del Castillo in partial fulfillment of the requirements for the degree of PhD in Orthodontics at Bauru Dental School, University of São Paulo, Bauru, Brazil.

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