A Randomized Controlled Trial Comparing the Quadhelix and the Expansion Arch for the Correction of Crossbite

Abstract

Objective

To compare the use of the quadhelix and the expansion arch for the correction of crossbite.

Design

A prospective randomized clinical trial supported by preliminary laboratory measurements. The null hypothesis was that there was no difference in the clinical effectiveness of the two expansion devices in terms of crossbite correction.

Setting

Queen's Hospital, Burton on Trent and The University of Birmingham, School of Dentistry.

Participants

The first 60 patients on the orthodontic waiting list at Queen's Hospital who required expansion of the maxillary arch as part of the treatment plan were allocated to be treated with either a quadhelix or an expansion arch by random allocation. Twenty-eight and 27 members of each respective group completed the study.

Materials

Commercial quadhelix arches (3M Unitek) and custom-made expansion arches

Methods

The force produced by the type of expansion arches used in the study was measured in the laboratory to be 1.8 N at 10 mm of expansion. Quadhelix arches of sizes 2 and 3 were found to produce equivalent forces at 5 and 7 mm of expansion respectively. Either expansion device was fitted to the 60 participants according to random allocation and expanded by the standard amount. Intermolar and intercanine expansion was measured after 4, 8 and 12 weeks. Patient opinion was assessed by using a questionnaire.

Results

The quadhelix and the expansion arch were equally effective in producing expansion (p>0.05). After 12 weeks, the two types of archwire had produced mean intermolar expansions of 4.54 and 5.09 mm and intercanine expansions of 1.41 and 2.12 mm, respectively. Both types of arch were reported as uncomfortable by a majority of patients, the quadhelix affected mainly the tongue and the expansion arch the cheeks. The appearance of the quadhelix was disliked by 25% of participants, while 70% disliked the expansion arch.

Conclusions

The null hypothesis was confirmed. However, the expansion arch had several advantages that made it a cheap alternative to the quadhelix for crossbite expansion, because it can be made and fitted at the chairside.