{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:29:53Z","timestamp":1788535793664,"version":"build-2803163510"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T00:00:00Z","timestamp":1667520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Regional Research Council"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,31]]},"abstract":"<jats:title>Summary<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Quad Helix (QH) is the appliance most preferred by orthodontists to correct unilateral posterior crossbite in the early mixed dentition while other orthodontists suggest rapid maxillary expansion (RME) on deciduous teeth in these patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To evaluate and compare perceived pain intensity, discomfort, functional jaw impairment, and analgesic consumption during the first week of treatment with either RME or QH appliances.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Trial design<\/jats:title>\n                  <jats:p>Two-arm parallel group, two-centre, randomized controlled trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Material and methods<\/jats:title>\n                  <jats:p>Seventy-two patients, mean age 9.5 (SD \u00b10.8) years, with unilateral posterior crossbite requiring maxillary expansion were randomly allocated to either the RME (22 boys, 14 girls) or QH (22 boys, 14 girls) group. Validated questionnaires were used to assess pain intensity, discomfort, jaw function impairment, and analgesic consumption, on the first, fourth, and seventh days after appliance insertion and activation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Blinding<\/jats:title>\n                  <jats:p>Due to clinical limitations, only the outcome assessors were blinded to the groups to which the patients were allocated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Seventy patients completed the questionnaires. Pain from the tongue and chafe from the appliance were significantly higher in the QH group on the first day of treatment (P = 0.003 and P = 0.000, respectively). On the fourth day, the chafe from the appliance was still significantly higher in the QH group (P = 0.007). Speech was affected in both groups on day 1; this impairment continued and was significantly higher in the RME group days 4 and 7. No significant difference in analgesic consumption was found between the groups at any time. The analgesic consumption was highest at day 1 of treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Harms<\/jats:title>\n                  <jats:p>No harm was observed in any patient.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Limitations<\/jats:title>\n                  <jats:p>Double blinding was not possible due to the clinical limitations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>During the initial 4 days of treatment, pain from the tongue and chafe from the appliance caused the most reported inconvenience in the patients in the QH group. A majority of reported visual analogue scale values were in the lower mid-range, suggesting low to moderate pain and discomfort in both groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Clinical Trial Registration<\/jats:title>\n                  <jats:p>NCT04458506<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejo\/cjac067","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T16:33:09Z","timestamp":1667579589000},"page":"271-280","source":"Crossref","is-referenced-by-count":16,"title":["Pain and discomfort during the first week of maxillary expansion using two different expanders: patient-reported outcomes in a randomized controlled trial"],"prefix":"10.1093","volume":"45","author":[{"given":"Stina","family":"Hansson","sequence":"first","affiliation":[{"name":"Department of Orthodontics, Postgraduate Dental Education Center, \u00d6rebro , Sweden"},{"name":"Faculty of Medicine and Health, School of Medical Sciences, \u00d6rebro University , \u00d6rebro , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Josefsson","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, The Institute for Postgraduate Dental Education , J\u00f6nk\u00f6ping , Sweden"},{"name":"School of Health and Welfare, J\u00f6nk\u00f6ping University , J\u00f6nk\u00f6ping , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3223-0068","authenticated-orcid":false,"given":"Rune","family":"Lindsten","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, The Institute for Postgraduate Dental Education , J\u00f6nk\u00f6ping , Sweden"},{"name":"School of Health and Welfare, J\u00f6nk\u00f6ping University , J\u00f6nk\u00f6ping , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Magnuson","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics, School of Medical Sciences, \u00d6rebro University , \u00d6rebro , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-8996","authenticated-orcid":false,"given":"Farhan","family":"Bazargani","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Postgraduate Dental Education Center, \u00d6rebro , Sweden"},{"name":"Faculty of Medicine and Health, School of Medical Sciences, \u00d6rebro University , \u00d6rebro , Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"key":"2023053114084956600_CIT0001","first-page":"115","article-title":"Worldwide prevalence of malocclusion in the different stages of dentition: a systematic review and meta-analysis","volume":"21","author":"Lombardo","year":"2020","journal-title":"European Journal of Paediatric Dentistry"},{"key":"2023053114084956600_CIT0002","first-page":"12","article-title":"The prevalence of malocclusion in Swedish schoolchildren","volume":"81","author":"Thilander","year":"1973","journal-title":"Scandinavian Journal of Dental Research"},{"key":"2023053114084956600_CIT0003","doi-asserted-by":"crossref","first-page":"e797","DOI":"10.1016\/j.ajodo.2007.11.021","article-title":"Correction of unilateral posterior crossbite in the mixed dentition: a randomized controlled trial","volume":"133","author":"Petren","year":"2008","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023053114084956600_CIT0004","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.ajodo.2010.07.025","article-title":"Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders: a randomized clinical trial","volume":"140","author":"Weissheimer","year":"2011","journal-title":"American Journal of Orthodontics and Dentofacial Orthopedics"},{"key":"2023053114084956600_CIT0005","first-page":"121","article-title":"Orthodontic treatment by general practitioners in consultation with orthodontists -- a survey of appliances recommended by Swedish orthodontists","volume":"38","author":"Petr\u00e9n","year":"2014","journal-title":"Swedish Dental Journal"},{"key":"2023053114084956600_CIT0006","doi-asserted-by":"crossref","first-page":"33","DOI":"10.3390\/jcm10010033","article-title":"Early orthodontic treatments of unilateral posterior crossbite: a systematic review","volume":"10","author":"Caroccia","year":"2020","journal-title":"Journal of Clinical Medicine"},{"key":"2023053114084956600_CIT0007","doi-asserted-by":"crossref","first-page":"570","DOI":"10.2319\/041114-269.1","article-title":"Dental arch response to Haas-type rapid maxillary expansion anchored to deciduous vs permanent molars: a multicentric randomized controlled trial","volume":"85","author":"Ugolini","year":"2015","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0008","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s40510-015-0093-x","article-title":"Anchorage onto deciduous teeth: effectiveness of early rapid maxillary expansion in increasing dental arch dimension and improving anterior crowding","volume":"16","author":"Mutinelli","year":"2015","journal-title":"Progress in Orthodontics"},{"key":"2023053114084956600_CIT0009","doi-asserted-by":"crossref","first-page":"296","DOI":"10.2319\/0003-3219(2007)077[0296:AWCWAR]2.0.CO;2","article-title":"Arch width changes with a rapid maxillary expansion appliance anchored to the primary teeth","volume":"77","author":"Cozzani","year":"2007","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0010","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s00056-017-0092-2","article-title":"Cephalometric and dental arch changes to Haas-type rapid maxillary expander anchored to deciduous vs permanent molars: a multicenter, randomized controlled trial","volume":"78","author":"Cerruto","year":"2017","journal-title":"Journal of Orofacial Orthopedics"},{"key":"2023053114084956600_CIT0011","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1034\/j.1600-9975.2002.02034.x","article-title":"Deciduous dentition-anchored rapid maxillary expansion in crossbite and non-crossbite mixed dentition patients: reaction of the permanent first molar","volume":"4","author":"Cozzani","year":"2003","journal-title":"Progress in Orthodontics"},{"key":"2023053114084956600_CIT0012","doi-asserted-by":"crossref","first-page":"68","DOI":"10.3390\/dj7030068","article-title":"Factors associated with dental fear and anxiety in children aged 7 to 9 years","volume":"7","author":"Dahlander","year":"2019","journal-title":"Dentistry Journal (Basel)"},{"key":"2023053114084956600_CIT0013","first-page":"CD000979","article-title":"Orthodontic treatment for posterior crossbites","volume":"12","author":"Ugolini","year":"2021","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"2023053114084956600_CIT0014","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.2319\/112114-833.1","article-title":"Influence of activation protocol on perceived pain during rapid maxillary expansion","volume":"85","author":"Baldini","year":"2015","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0015","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1093\/ejo\/21.4.387","article-title":"Patients\u2019 anticipation of pain and pain-related side effects, and their perception of pain as a result of orthodontic treatment with fixed appliances","volume":"21","author":"Firestone","year":"1999","journal-title":"European Journal of Orthodontics"},{"key":"2023053114084956600_CIT0016","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/ejo\/18.1.349","article-title":"Perception of pain as a result of orthodontic treatment with fixed appliances","volume":"18","author":"Scheurer","year":"1996","journal-title":"European Journal of Orthodontics"},{"key":"2023053114084956600_CIT0017","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1093\/ejo\/6.1.48","article-title":"An investigation into the initial discomfort caused by placement of an archwire","volume":"6","author":"Jones","year":"1984","journal-title":"European Journal of Orthodontics"},{"key":"2023053114084956600_CIT0018","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1111\/j.1600-0528.1989.tb00012.x","article-title":"Traumatic ulcers and pain in adults during orthodontic treatment","volume":"17","author":"Kvam","year":"1989","journal-title":"Community Dentistry and Oral Epidemiology"},{"key":"2023053114084956600_CIT0019","doi-asserted-by":"crossref","first-page":"324","DOI":"10.2319\/040215-219.1","article-title":"A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances","volume":"86","author":"Wiedel","year":"2016","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0020","doi-asserted-by":"crossref","first-page":"391","DOI":"10.2319\/091216-686.1","article-title":"Pain and discomfort during the first week of rapid maxillary expansion (RME) using two different RME appliances: a randomized controlled trial","volume":"87","author":"Feldmann","year":"2017","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0021","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40510-022-00398-4","article-title":"The effectiveness of the early orthodontic correction of functional unilateral posterior crossbite in the mixed dentition period: a systematic review and meta-analysis","volume":"23","author":"Alsawaf","year":"2022","journal-title":"Progress in Orthodontics"},{"key":"2023053114084956600_CIT0022","doi-asserted-by":"crossref","first-page":"311","DOI":"10.2319\/0003-3219(2007)077[0311:ROAQAE]2.0.CO;2","article-title":"Reliability of a questionnaire assessing experiences of adolescents in orthodontic treatment","volume":"77","author":"Feldmann","year":"2007","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0023","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1093\/ejo\/cju100","article-title":"Effects of rapid maxillary expansion on the midpalatal suture: a systematic review","volume":"37","author":"Liu","year":"2015","journal-title":"European Journal of Orthodontics"},{"key":"2023053114084956600_CIT0024","first-page":"13","article-title":"Correlations between malocclusions and dyslalias","volume":"13","author":"Farronato","year":"2012","journal-title":"European Journal of Paediatric Dentistry"},{"key":"2023053114084956600_CIT0025","doi-asserted-by":"crossref","first-page":"725","DOI":"10.2319\/020221-100.1","article-title":"Evaluation of self-perceived pain and jaw function impairment in children undergoing slow and rapid maxillary expansion","volume":"91","author":"Abed Al Jawad","year":"2021","journal-title":"Angle Orthodontist"},{"key":"2023053114084956600_CIT0026","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1679\/aohc1950.39.379","article-title":"The distribution of nerves in human deciduous and permanent teeth","volume":"39","author":"Itoh","year":"1976","journal-title":"Archivum Histologicum Japonicum. Nippon Soshikigaku Kiroku"},{"key":"2023053114084956600_CIT0027","doi-asserted-by":"crossref","first-page":"1127","DOI":"10.1016\/S0140-6736(74)90884-8","article-title":"Measurement of pain","volume":"2","author":"Huskisson","year":"1974","journal-title":"Lancet"},{"key":"2023053114084956600_CIT0028","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1093\/ejo\/cjaa048","article-title":"Perception of pain in Class II malocclusion children treated with cervical headgear: a randomized controlled trial","volume":"43","author":"Antonarakis","year":"2021","journal-title":"European Journal of Orthodontics"},{"key":"2023053114084956600_CIT0029","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/BF01300354","article-title":"Pain in orthodontics. A review and discussion of the literature","volume":"61","author":"Bergius","year":"2000","journal-title":"Journal of Orofacial Orthopedics"}],"container-title":["European Journal of Orthodontics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ejo\/article-pdf\/45\/3\/271\/50456908\/cjac067.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ejo\/article-pdf\/45\/3\/271\/50456908\/cjac067.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,31]],"date-time":"2023-05-31T10:12:21Z","timestamp":1685527941000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejo\/article\/45\/3\/271\/6798843"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11,4]]},"references-count":29,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,11,4]]},"published-print":{"date-parts":[[2023,5,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ejo\/cjac067","relation":{},"ISSN":["0141-5387","1460-2210"],"issn-type":[{"value":"0141-5387","type":"print"},{"value":"1460-2210","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,6,1]]},"published":{"date-parts":[[2022,11,4]]}}}