The current study explored the possible associations between patient/parental satisfaction and the success of two varieties of anterior crossbite treatment in mixed dentition from 8 to 12 years with mean age 9.2 ± 0.7. Based on the literature, (15–18) the ideal age to treat anterior crossbite is 8-11years as early as possible. This was in contrast with Staderini et al., who suggested early treatment is approached only in cases of occlusal interference, to avoid Class III growth pattern. (19)
In the current study, children treated with CLIP were significantly younger than children treated with RAES appliance. It can be attributed to the effect of CLIP on teeth during active eruption movement and roots development Also, Nasir et al (18), recommended the use of lower anterior inclined plane with the amount of overbite and the available space for the maxillary teeth alignment. Moreover, treatment success was related to the eruption phase of the tooth. (20)
No higher prevalence of anterior crossbite among females and males was found, this was in accordance to Wiedel and Bondemark. (21) On the other hand, De Lira and da Fonseca, (22) that showed a higher prevalence for the female gender (60%), while Woitchunas et al, (23) which showed a slightly higher tendency for males (56%).
A crucial metric in interceptive orthodontics, is the child and parental satisfaction, which serve as an essential indicators of treatment success. This satisfaction not only stems from esthetic improvements but also from the overall experience during treatment. Both appliances were generally well accepted by both children and their parents, in addition to their satisfaction with the treatment outcome for both appliances. This was in accordance to Weidel and Bondemark (17) who found that either treatment modality was accepted by the children and parents.
Some minor statistically significant differences between children and parental perceptions of CLIP or RAES was found. Both appliances were well accepted by the patients and can be recommended. The parental expectation about the treatment duration was associated with the acceptance of appliance. The significant difference between parental expectation about the treatment duration was in favor of CLIP, this might explain that more parents in that group had the potential to repeat the treatment again for their children. The treatment duration required for correction of an anterior crossbite varied according to appliance used. It is well known that a significant shorter treatment time is required for the fixed appliance therapy. (24) Patient compliance partly play a role in the longer treatment duration for the removable appliance, so patients’ compliant prior to starting treatment with removable appliance must be considered. (24)
It is expected that children undergoing interceptive orthodontic therapy may experience pain, discomfort, and difficulty in daily practices. However, it's important to note that the severity and duration of pain are subjective experiences and vary among individuals. Although, Patients reported that they experienced pain and discomfort, but this seems to have minor clinical relevance since both appliances were generally well accepted. No significant difference was detected regarding pain, discomfort, or perceived treatment difficulty between CLIP and RAES. This finding was consistent with other studies in which pain and discomfort were not frequent during the course of successful malocclusion treatment. (21, 25) Fixed appliances apply constant forces that might induce painful responses because of the application of constant force, whereas the removable appliances apply intermittent forces.
It is interesting to note that parents' reports indicated that children who wore removable appliances significantly enjoyed them more than children with fixed appliances. This could be attributed to the removability of the appliance, which allowed children to have more control over their treatment and made them feel less invaded. The ability to remove the appliance can also reduce interference with daily activities such as eating and oral hygiene routines. Similarly, Ulusoy and Bodrumlu (25) reported that removable appliances had the advantage to be removed on social occasions when visible wires would be undesirable. In addition they are easily cleaned. (24, 25) On the other hand, the CLIP eliminates the need for patient compliance. It provides a controlled and predictable movement of the teeth. It is important to consider that the cemented lower anterior inclined plane may cause discomfort and difficulty in daily practices. (18) However, the presence of the appliance in the mouth can cause soreness and irritation. (26) Another factor to be consider is the need for frequent dental visits for adjustments and monitoring with the cemented appliances, which require more commitment from both the child and the parents.
Ultimately, the choice between a removable or cemented appliance for the correction of anterior crossbite depends on various factors, including the specific needs of the child, the complexity of the case, and the compliance of the patient. patient compliance is a major determinant of the effectiveness of treatment. A child's motivation plays a significant role in the success of any treatment or intervention, especially with removable appliance therapy. (24) A well child is motivated would follow thoroughly with recommendations, and make progress towards their goals. Notably, most children were largely satisfied with the appearance of their teeth after treatment, and they were understanding the need to align their teeth. To our best knowledge, this is the first specifically-designed study to evaluate children satisfaction towards their fixed versus removable orthodontic appliance therapy to correct anterior crossbite in the mixed dentition. Thus, no comparison could be made with previous studies.
Understanding patient and parental satisfaction is essential for orthodontic treatment planning and improving treatment outcomes. The findings of this study will aid clinicians in selecting the most suitable treatment approach for anterior crossbite correction, promoting patient compliance, and ensuring a positive treatment experience. By addressing patient and parental concerns and optimizing satisfaction levels, orthodontic practitioners can enhance the quality of care and ultimately improve patient outcomes. The main limitation of the current study is the subjectivity in questionnaire-dependent studies, which needs to be carefully considered and addressed. Another potential limitation is the relatively small sample size, which restricts the generalizability of the findings and may limit the representativeness of the study population. Cost-effectiveness is of course an important variable and should be assessed in a forthcoming study. An important strength of this study was that the questionnaire had previously been shown to have good reliability and validity with orthodontic treatment.