Patient and Parental Satisfaction Following Treatment of Anterior Crossbite in Mixed Dentition: A Comparative Study of cemented lower inclined plane (CLIP) and removable anterior expansion screw (RAES)

Patient and Parental Satisfaction Following Treatment of Anterior Crossbite in Mixed Dentition: A Comparative Study of cemented lower inclined plane (CLIP) and removable anterior expansion screw (RAES) | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Patient and Parental Satisfaction Following Treatment of Anterior Crossbite in Mixed Dentition: A Comparative Study of cemented lower inclined plane (CLIP) and removable anterior expansion screw (RAES) Amira ElKhatib, Asser Gad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4227859/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Anterior crossbite in mixed dentition is one of the problems that require early intervention aiming at stimulating well balance growth and occlusal development. Aim: of the comparative study was to assess patient and parental satisfaction following the treatment of anterior crossbite in the mixed dentition using: cemented lower inclined plane (CLIP) and removable anterior expansion screw (RAES). Methods: Thirty-four children (17 per group) who had received either CLIP or RAES for the correction of anterior crossbite in the mixed dentition. Patient and parental satisfaction was assessed using a validated questionnaire, which included items related to treatment experience, and overall satisfaction. Statistical analysis: Fisher’s exact or χ2 test, for categorical variables, and a two-sample Wilcoxon rank sum (Mann–Whitney) test for continuous data were performed to investigation differences between the two groups. Results: In terms of treatment duration, RAES appliance, with most participants who received RAES appliance reported that the treatments lasted longer than expected compared to the CLIP (p-value: <0.001). Parents reported that RAES appliances were more enjoyable to wear by children. Regarding functional improvement, both groups reported similar levels of satisfaction. (CLIP: 94%, RAES: 92%). Overall, patient satisfaction was comparable between the two study arms. Conclusion: Both CLIP and RAES treatment modalities were effective in the treatment of anterior crossbite in the mixed dentition, and showed high levels of patient and parental satisfaction. CLIP was notably perceived as a more painful intervention than RAES. Anterior crossbite Mixed dentition Cemented anterior inclined plane Removable acrylic expansion screw - patient satisfaction Figures Figure 1 Introduction Mixed dentition stage is the period of adaptive changes in the alveolar process that occur during the transition from primary to permanent dentition. It is the ideal time for the most of major orthodontic intervention including crossbite correction, to avoid severe malocclusion and growth disturbance in the future. ( 1 ) Anterior crossbite is a common mixed dentition problem. ( 2 , 3 ) According to a systematic review published in 2022, the prevalence of anterior crossbite in the mixed dentition stage was 7.8% ± 6.5. ( 4 ) Anterior crossbite could progress to true Class III malocclusion if untreated. Thus, early intervention is encouraged and indicated to avoid negative effects on dentoalveolar growth and development, as well as disruption of temporal and masseter muscle activity, which would raise the likelihood of craniomandibular diseases during adolescence. ( 2 , 3 ) Furthermore, early intervention enhances facial attractiveness and maxillary lip posture. ( 5 ) Generally, dental alignment is a crucial component of oral health; which is fundamental for better overall well-being, and quality of life. ( 6 ) Occlusal problems could also hinder proper hygiene and increase caries susceptibility and periodontal diseases. Moreover, early treatment reduces costs and long-term invasive approaches. ( 6 ) An anterior crossbite is an abnormal labiolingual association of one or more maxillary incisors which can compromise the facial aesthetic. ( 1 ) The etiology includes imbalance between the dental, functional and skeletal components of a developing child.( 2 ) Functional anterior crossbite (Pseudo Class III malocclusion) is caused by anterior interferences leading to mandibular restriction or deviation, potentially resulting from skeletal abnormalities as retrognathic maxilla, prognathic mandible or a combination of both. ( 7 ) To provide an effective interceptive treatment, it is necessary to differentiate between skeletal and dental anterior crossbite. ( 7 ) Anterior crossbite of dental origin can be corrected by simple appliances to correct the axial inclination of the involved teeth as tongue blade, Catlan’s appliance or removable appliances incorporating some springs or screws. However, Crossbites if left untreated up to adulthood may require more complicated interventions as the use of extra-oral devices like a face mask, chin cup, or surgical intervention.( 8 ) The best orthodontic treatment for the early correction of anterior crossbite should not only be clinically successful with long-term stability, but also cost-effective, have a high level of parental satisfaction, and well accepted by the patient (little to no reported pain/discomfort). Similar to many other psychological notions, Patient satisfaction is difficult to define. To date, there is no sufficient evidence to determine the preferred method for anterior cross bite correction. The concept of satisfaction is related to issues such as acceptance, contentment, and quality of life. Satisfaction is not an entity that could to be measured; rather, it is a judgment developed over time as people reflect on their experiences. A basic and practical definition of satisfaction would be ‘the extent to which intended goals have been achieved’. ( 9 ) Patient satisfaction is important because it encourages patient participation in health care and treatment decisions. Nowadays, patient satisfaction in health centers is acknowledged as a vital measure of organizational performance. ( 10 ) The aim of the current study is to assess the patient and parental satisfaction following treatment of cross-bite during mixed dentition using either cemented lower inclined plane (CLIP) or removable anterior expansion screw (RAES). The null hypothesis was that there was no difference in satisfaction between the two therapies. This survey shall provide clinicians with realistic insights about patients` challenges during treatment with cemented or removable devices, thus maximizing compliance and promoting the best treatment experience. Materials and Methods Study Sample This cross-sectional study was outlined and reported according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. ( 11 ) The study recruited a group of thirty-four children (17 participants per group) who were diagnosed with anterior crossbite and had received either CLIP or RAES treatment in the pediatric dentistry department, faculty of oral and dental medicine, Kafrelsheikh university. The treatment plan for the anterior crossbite was previously set by an orthodontist or a pediatric dentist. Treatment plan selection was individualized per case with total dependence on the clinical needs of each case. Participants were recruited via convenience sampling between January and August 2023. Included participants were healthy children ( ASA I & II) ( 12 ) in mixed dentition stage; aged between 8 and 12 years; suffering from anterior crossbite provided that there was sufficient mesiodistal distance to place the tooth labially. Children included have class I molar relation occlusion according to Angel’s classification. If the child had accompanied posterior crossbite or any oral habits, he was excluded. Children who had previous orthodontic treatment, or with craniofacial malformatins, cleft lips and palates were excluded. The Research Ethical Committee of the Faculty of oral and dental medicine, Kafrelsheikh University, had approved the research protocol (#IRB NO: KD/08/35). The study was performed in line with the Declaration of Helsinki and its further amendments. No external funding was received to perform the study. Materials: The cemented lower inclined plane (CLIP), the appliance was custom-fabricated to fit the lower incisors using self-curing acrylic resin. The lower model was isolated with thin layer of wax utility and thin layer of self-curing acrylic resin on the middle and incisal thirds, buccal and lingual side of lower anterior teeth was performed. The inclined plane may extend beyond the lingual surfaces of the lower incisors to provide proper occlusal contact with the upper teeth at a 45 ° angle, without making contact with the gingival tissue. Subsequently, the finishing and polishing of the appliance was performed on a weekly basis and accomplished by maintaining the 45-degree angulation to the tooth to be crossed. The appliance was removed within maximum 4 weeks when the realignment of the teeth, was obtained thickness and height: The inclined plane is typically designed to be of appropriate thickness and height to achieve the desired jaw positioning and occlusal relationship. The dimensions of the inclined plane may vary based on the severity of the malocclusion and the specific treatment goals. For the removable anterior expansion screw (RAES), the appliance was manufactured using acrylic resin, bilateral occlusal coverage of the posterior teeth, and an anterior expansion mini-screw palatal to the tooth in crossbite. Study participants were given a full manual about the appliance. They were instructed to activate the mini-screw twice per week (0.5mm) until normal incisor overjet was achieved. The patients were firmly instructed to wear the appliance day and night, except for meals, tooth brushing, and physical activities. The children and their parents/guardians were given instruction on diet restrictions and oral hygiene measures. This information was emphasized again on subsequent follow up appointments. The progress was evaluated every 2 weeks, until dental crossbite correction was achieved. (Fig. 1) Intervention: After parents and patients were fully informed of the aim of the study, a written informed consent was obtained. Medical/dental history was obtained from the 34 participants. Oral examination was also performed. Each patient’s record (Orthopantograph record and plaster study models) was then presented, collected, and serialized. Each participant was given a questionnaire to assess the child and parental satisfaction about treatment. the questionnaires’ items were derived and adapted from orthodontic specific questionnaires used in previous studies. ( 13 ) The questionnaire composed of 4 sections: Section 1 included demographic data of the child (age and gender); Section 2 consisted of eight questions addressing the parents and comprised items concerning their general satisfaction with the orthodontic treatment and perception of their child’s satisfaction; while Section 3 contained three questions about changes in function and lifestyle of their children during treatment, addressed to the parents; Section 4 was addressed to the child and comprised five questions concerning their satisfaction with the treatment and the results obtained. ( 14 ) The questionnaire was handed in written form to the child and his parents, with the help of a single operator, in order to ensure the correct understanding of the items. Afterward, the collected data were transferred onto a spreadsheet, and the identification codes were used to guarantee data anonymization. Internal consistency of the data collection instrument was assessed via Cronbach’s alpha values of 0.72 for the whole questionnaire, 0.75 for the parental satisfaction sub-scale, and 0.54 for the patient satisfaction sub-scale (consisted of only 5 items). Structural validity of the questionnaire was assessed via confirmatory factor analysis. With a normed fit index (CFI) of 0.50 and a root mean square error of approximation (RMSEA) value of 0.14 (90% upper limit of 0.18). These goodness-of-fit indices are more than satisfactory given the limited sample size (n = 34). Factor loading of a two-factor structure showed moderate to high loadings for most of the items, validating the structural construct of the questionnaire in use. Statistical Analysis The statistical analysis of this study included descriptive statistics for all collected variables. For the categorical data, absolute and relative frequencies are presented; for the continuous data, the median and interquartile range (IQR) were shown. The investigation of differences between the two groups was performed using Fisher’s exact or χ2 test, as appropriate, for categorical variables, and a two-sample Wilcoxon rank sum (Mann–Whitney) test for continuous data. All the tests were two-tailed, and the statistical significance was set at p < 0.05. Results The current study included a total of 34 participants who were evenly recruited with gender match; males and females represented 50% of each group. Participants in RAES group had a significantly higher mean age (9.5 years) than CLIP group (8.9 years; p-value: 0.02). (Table 1 ) Table 1 Distribution of sociodemographic variables between study arms. Term Overall N (%) CLIP N (%) (n = 17) RAES N (%) (n = 17) p-value Gender 0.99 Female 17 ± 50 8 ± 47.1 9 ± 52.9 Male 17 ± 50 9 ± 52.9 8 ± 47.1 P-values obtained from Pearson's chi-square test of independence Term Overall Avg (SD) Lower anterior inclined plane Removable appliance p-value Age (years) 9.2 ± 0.7 8.9 ± 0.7 9.5 ± 0.6 t: 0.0201* α = 0.05. p < 0.05*, p < 0.01**, p < 0.001*** P-values obtained from two-sample t-test (t) or Mann-Whitney test (U) As noted by parents, the duration of treatment was higher in RAES appliance (p-value: <0.001), with most participants who received RAES appliance reported that the treatments lasted longer than expected (58.8%) compared to 0% in the CLIP. However, per parents’ reports, RAES appliances were more enjoyable to wear by children (76.5%) compared to only (23.5%) in the CLIP group. All other items showed no remarkable difference between the two study groups. (Table 2 ) Table 2 Parental satisfaction toward CLIP and RAES intervention to correct anterior crossbite Term Overall N (%) CLIP N (%) (n = 17) RAES N (%) (n = 17) p-value Would you ask your child to do this orthodontic treatment again? 0.135 1. Absolutely not/I think not 8 ± 23.53 2 ± 11.8 6 ± 35.3 2. I don’t know 8 ± 23.53 6 ± 35.3 2 ± 11.8 3. I think yes /Absolutely yes 18 ± 52.94 9 ± 52.9 9 ± 52.9 Would you recommend this orthodontic treatment to other people? 0.99 2. I don’t know 18 ± 52.94 9 ± 52.9 9 ± 52.9 3. I think yes /Absolutely yes 16 ± 47.06 8 ± 47.1 8 ± 47.1 How much satisfied are you with the improvement of your child’s aesthetic appearance after orthodontic treatment? 2. Satisfied 16 ± 47.06 8 ± 47.1 8 ± 47.1 3. Very satisfied 18 ± 52.94 9 ± 52.9 9 ± 52.9 Did the entire treatment of your child last as long as you expected? 0.001** 1. Much longer/ Longer 10 ± 29.41 0 10 ± 58.8 2. As long as 13 ± 38.24 8 ± 47.1 5 ± 29.4 3. Shorter/Much Shorter 11 ± 32.35 9 ± 52.9 2 ± 11.8 How painful it was to wear the device for your child? 0.12 1. Very much/Much/Moderately 9 ± 26.47 7 ± 41.2 2 ± 11.8 2. Little/Not at all 25 ± 73.53 10 ± 58.8 15 ± 88.2 How uncomfortable it was to wear the appliance for your child? 0.158 1. Very much/Much/Moderately 21 ± 61.76 13 ± 76.5 8 ± 47.1 2. Little/Not at all 13 ± 38.24 4 ± 23.5 9 ± 52.9 How difficult it was to get used to wearing the appliance for your child? 0.99 1. Very much/Much/Moderately 19 ± 55.88 9 ± 52.9 10 ± 58.8 2. Little/Not at all 15 ± 44.12 8 ± 47.1 7 ± 41.2 Did your child enjoyed wearing the appliance? 0.006** 1. No 17 ± 50 13 ± 76.5 4 ± 23.5 2. Yes 17 ± 50 4 ± 23.5 13 ± 76.5 Do you think that the treatment has affected the school life of your child? 0.99 2. Not influenced 16 ± 47.06 8 ± 47.1 8 ± 47.1 3. Moderately improved/Greatly improved 18 ± 52.94 9 ± 52.9 9 ± 52.9 Do you think that the treatment has affected the social life of your child? 2. Not influenced 11 ± 32.35 6 ± 35.3 5 ± 29.4 3. Moderately improved/Greatly improved 23 ± 67.65 11 ± 64.7 12 ± 70.6 Improvement 2. Yes 34 ± 100 17 ± 100 17 ± 100 Breathing 1. No 28 ± 82.35 14 ± 82.4 14 ± 82.4 2. Yes 6 ± 17.65 3 ± 17.6 3 ± 17.6 Snoring 1. No 28 ± 82.35 14 ± 82.4 14 ± 82.4 2. Yes 6 ± 17.65 3 ± 17.6 3 ± 17.6 Grinding 1. No 17 ± 50 8 ± 47.1 9 ± 52.9 2. Yes 17 ± 50 9 ± 52.9 8 ± 47.1 α = 0.05. p < 0.05*, p < 0.01**, p < 0.001*** P-values obtained from Pearson's chi-square test of independence Most cases were largely satisfied with the appearance of their teeth after treatment. Little or higher difficulty in wearing the device was reported by nearly 72% of the study participants. Device-associated pain (moderate or severe) was reported in 52.9% of cases who received CLIP compared to only 23.5% in the RAES appliance group. Although there was no significance difference between groups, CLIP was notably perceived as a more painful intervention than RAES appliance in the current study sample. (Table 3 ) Table 3 Patient satisfaction toward CLIP and RAES intervention to correct anterior crossbite Term Overall N (%) CLIP N (%) (n = 17) RAES N (%) (n = 17) p-value I am satisfied with the appearance of my teeth after treatment , 0.72 2. Quite satisfied 12 ± 35.29 7 ± 41.2 5 ± 29.4 3. Satisfied 22 ± 64.71 10 ± 58.8 12 ± 70.6 I understood that it was important to wear the orthodontic device , 0.463 1. Enough/No 11 ± 32.35 7 ± 41.2 4 ± 23.5 2. Yes 23 ± 67.65 10 ± 58.8 13 ± 76.5 Wearing the orthodontic device was painful , 0.053 1.very much 1 ± 2.94 0 1 ± 5.9 2. Moderately 12 ± 35.29 9 ± 52.9 3 ± 17.6 3. Little 11 ± 32.35 6 ± 35.3 5 ± 29.4 4. Not at all 10 ± 29.41 2 ± 11.8 8 ± 47.1 Wearing the orthodontic device was difficult , 0.641 1. Much/Moderately 6 ± 17.65 4 ± 23.5 2 ± 11.8 2. Little 18 ± 52.94 8 ± 47.1 10 ± 58.8 3. Not at all 10 ± 29.41 5 ± 29.4 5 ± 29.4 I was happy to wear the orthodontic device , 0.196 1. Not at all/Little/Moderately 9 ± 26.47 6 ± 35.3 3 ± 17.6 2. Much 12 ± 35.29 7 ± 41.2 5 ± 29.4 3. Very much 13 ± 38.24 4 ± 23.5 9 ± 52.9 α = 0.05. p < 0.05*, p < 0.01**, p < 0.001*** P-values obtained from Pearson's chi-square test of independence Discussion 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. Conclusion In conclusion, both the cemented lower inclined plane and the removable anterior expansion screw appliance were effective in correcting anterior crossbite during mixed dentition. However, the removable anterior expansion screw appliance had the edge in terms of patient and parental satisfaction. These findings underscore the importance of considering patient and parental satisfaction. Declarations Ethics approval and consent to participate: Before commencing the study, ethical approval was obtained from the Research Ethics Committee of the Faculty of oral and dental medicine, Kafrelsheikh University, had approved the research protocol (#IRB NO: KD/08/35). The study was performed in line with the Declaration of Helsinki and its further amendments. The informed consents from the parents/legal guardians were obtained. The research was performed and reported according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines Consent for publication: Not applicable. Availability of data and materials: The database generated and analysed for the study are available in patient’s records in the Pediatric Dentistry and Dental Public Health Department, Faculty of oral and dental medicine, Kafrelsheikh University. These data are not for publish and were used under the licence for the current study. Data are available from the correspondent author upon reasonable request with the permission of the Pediatric Dentistry and Dental Public Health Department, Faculty of oral and dental medicine, Kafrelsheikh University. Declaration of interests: The authors declare that they have no known competing financial interests or personal relationships that could appear to have influenced the work reported in this paper. Funding: The authors declare there is no funding for the study. Authors' contributions: A.E., and A.G. conceptualized and planned the research. A.E. and A.G. collected the data, analysed the results. A.E. wrote the manuscript draft. A.G. reviewed and edited the manuscript. All authors approved the manuscript. Acknowledgements : The authors would like to express their gratitude to Dr Hossam Ghorab for his help structuring the statistical analysis of the study. References Kotadiya J, Fernandes S, Bafna Y, Soni S, Patel J (2019) Anterior cross bite correction with three different approaches: a series of three cases. J Med Sci Clin Res 7(1):179 Schopf P (2003) Indication for and frequency of early orthodontic therapy or interceptive measures. J Orofac Orthop Fortschr Kieferorthop Organofficial J Dtsch Ges Kieferorthop 64(3):186–200 Lux CJ, Dücker B, Pritsch M, Komposch G, Niekusch U (2009) Occlusal status and prevalence of occlusal malocclusion traits among 9-year-old schoolchildren. 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Angle Orthod 86(2):324–330 De Lira ADLS, da Fonseca GHA (2019) Anterior crossbite malocclusion: prevalence and treatment with afixed inclined plane orthodontic appliance. Braz J Oral Sci 18:e191502–e191502 Woitchunas DR, Busato C, Tocheto LR, Brockstedt RH (2001) Mordidas cruzadas anteriores: diagnóstico e tratamento da pseudoclasse III-relato de um caso clínico. Rev Fac Odontol-UPF. ;6(2) Wiedel AP, Bondemark L (2015) Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition—a randomized controlled trial. Eur J Orthod 37(2):123–127 Ulusoy AT, Bodrumlu EH (2013) Management of anterior dental crossbite with removable appliances. Contemp Clin Dent 4(2):223 Christiono S, Agusmawanti P (2018) Penatalaksaan anterior crossbite dengan incline bite plane lepasan. Indones J Paediatr Dent 1(2):184–187 Additional Declarations No competing interests reported. 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It is the ideal time for the most of major orthodontic intervention including crossbite correction, to avoid severe malocclusion and growth disturbance in the future. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Anterior crossbite is a common mixed dentition problem. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) According to a systematic review published in 2022, the prevalence of anterior crossbite in the mixed dentition stage was 7.8% \u0026plusmn; 6.5. (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Anterior crossbite could progress to true Class III malocclusion if untreated. Thus, early intervention is encouraged and indicated to avoid negative effects on dentoalveolar growth and development, as well as disruption of temporal and masseter muscle activity, which would raise the likelihood of craniomandibular diseases during adolescence. (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Furthermore, early intervention enhances facial attractiveness and maxillary lip posture. (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Generally, dental alignment is a crucial component of oral health; which is fundamental for better overall well-being, and quality of life. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Occlusal problems could also hinder proper hygiene and increase caries susceptibility and periodontal diseases. Moreover, early treatment reduces costs and long-term invasive approaches. (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eAn anterior crossbite is an abnormal labiolingual association of one or more maxillary incisors which can compromise the facial aesthetic. (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) The etiology includes imbalance between the dental, functional and skeletal components of a developing child.(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Functional anterior crossbite (Pseudo Class III malocclusion) is caused by anterior interferences leading to mandibular restriction or deviation, potentially resulting from skeletal abnormalities as retrognathic maxilla, prognathic mandible or a combination of both. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) To provide an effective interceptive treatment, it is necessary to differentiate between skeletal and dental anterior crossbite. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) Anterior crossbite of dental origin can be corrected by simple appliances to correct the axial inclination of the involved teeth as tongue blade, Catlan\u0026rsquo;s appliance or removable appliances incorporating some springs or screws. However, Crossbites if left untreated up to adulthood may require more complicated interventions as the use of extra-oral devices like a face mask, chin cup, or surgical intervention.(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eThe best orthodontic treatment for the early correction of anterior crossbite should not only be clinically successful with long-term stability, but also cost-effective, have a high level of parental satisfaction, and well accepted by the patient (little to no reported pain/discomfort). Similar to many other psychological notions, Patient satisfaction is difficult to define. To date, there is no sufficient evidence to determine the preferred method for anterior cross bite correction.\u003c/p\u003e \u003cp\u003eThe concept of satisfaction is related to issues such as acceptance, contentment, and quality of life. Satisfaction is not an entity that could to be measured; rather, it is a judgment developed over time as people reflect on their experiences. A basic and practical definition of satisfaction would be \u0026lsquo;the extent to which intended goals have been achieved\u0026rsquo;. (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) Patient satisfaction is important because it encourages patient participation in health care and treatment decisions. Nowadays, patient satisfaction in health centers is acknowledged as a vital measure of organizational performance. (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e) The aim of the current study is to assess the patient and parental satisfaction following treatment of cross-bite during mixed dentition using either cemented lower inclined plane (CLIP) or removable anterior expansion screw (RAES). The null hypothesis was that there was no difference in satisfaction between the two therapies. This survey shall provide clinicians with realistic insights about patients` challenges during treatment with cemented or removable devices, thus maximizing compliance and promoting the best treatment experience.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Sample\u003c/h2\u003e \u003cp\u003e This cross-sectional study was outlined and reported according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) The study recruited a group of thirty-four children (17 participants per group) who were diagnosed with anterior crossbite and had received either CLIP or RAES treatment in the pediatric dentistry department, faculty of oral and dental medicine, Kafrelsheikh university. The treatment plan for the anterior crossbite was previously set by an orthodontist or a pediatric dentist. Treatment plan selection was individualized per case with total dependence on the clinical needs of each case. Participants were recruited via convenience sampling between January and August 2023.\u003c/p\u003e \u003cp\u003eIncluded participants were healthy children ( ASA I \u0026amp; II) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) in mixed dentition stage; aged between 8 and 12 years; suffering from anterior crossbite provided that there was sufficient mesiodistal distance to place the tooth labially. Children included have class I molar relation occlusion according to Angel\u0026rsquo;s classification. If the child had accompanied posterior crossbite or any oral habits, he was excluded. Children who had previous orthodontic treatment, or with craniofacial malformatins, cleft lips and palates were excluded.\u003c/p\u003e \u003cp\u003e The Research Ethical Committee of the Faculty of oral and dental medicine, Kafrelsheikh University, had approved the research protocol (#IRB NO: KD/08/35). The study was performed in line with the Declaration of Helsinki and its further amendments. No external funding was received to perform the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eMaterials:\u003c/h2\u003e \u003cp\u003eThe cemented lower inclined plane (CLIP), the appliance was custom-fabricated to fit the lower incisors using self-curing acrylic resin. The lower model was isolated with thin layer of wax utility and thin layer of self-curing acrylic resin on the middle and incisal thirds, buccal and lingual side of lower anterior teeth was performed. The inclined plane may extend beyond the lingual surfaces of the lower incisors to provide proper occlusal contact with the upper teeth at a 45 \u0026deg; angle, without making contact with the gingival tissue. Subsequently, the finishing and polishing of the appliance was performed on a weekly basis and accomplished by maintaining the 45-degree angulation to the tooth to be crossed. The appliance was removed within maximum 4 weeks when the realignment of the teeth, was obtained thickness and height: The inclined plane is typically designed to be of appropriate thickness and height to achieve the desired jaw positioning and occlusal relationship. The dimensions of the inclined plane may vary based on the severity of the malocclusion and the specific treatment goals.\u003c/p\u003e \u003cp\u003eFor the removable anterior expansion screw (RAES), the appliance was manufactured using acrylic resin, bilateral occlusal coverage of the posterior teeth, and an anterior expansion mini-screw palatal to the tooth in crossbite. Study participants were given a full manual about the appliance. They were instructed to activate the mini-screw twice per week (0.5mm) until normal incisor overjet was achieved. The patients were firmly instructed to wear the appliance day and night, except for meals, tooth brushing, and physical activities. The children and their parents/guardians were given instruction on diet restrictions and oral hygiene measures. This information was emphasized again on subsequent follow up appointments. The progress was evaluated every 2 weeks, until dental crossbite correction was achieved. (Fig.\u0026nbsp;1)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eIntervention:\u003c/h2\u003e \u003cp\u003e After parents and patients were fully informed of the aim of the study, a written informed consent was obtained. Medical/dental history was obtained from the 34 participants. Oral examination was also performed. Each patient\u0026rsquo;s record (Orthopantograph record and plaster study models) was then presented, collected, and serialized. Each participant was given a questionnaire to assess the child and parental satisfaction about treatment. the questionnaires\u0026rsquo; items were derived and adapted from orthodontic specific questionnaires used in previous studies. (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) The questionnaire composed of 4 sections: Section 1 included demographic data of the child (age and gender); Section 2 consisted of eight questions addressing the parents and comprised items concerning their general satisfaction with the orthodontic treatment and perception of their child\u0026rsquo;s satisfaction; while Section 3 contained three questions about changes in function and lifestyle of their children during treatment, addressed to the parents; Section 4 was addressed to the child and comprised five questions concerning their satisfaction with the treatment and the results obtained. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) The questionnaire was handed in written form to the child and his parents, with the help of a single operator, in order to ensure the correct understanding of the items. Afterward, the collected data were transferred onto a spreadsheet, and the identification codes were used to guarantee data anonymization.\u003c/p\u003e \u003cp\u003eInternal consistency of the data collection instrument was assessed via Cronbach\u0026rsquo;s alpha values of 0.72 for the whole questionnaire, 0.75 for the parental satisfaction sub-scale, and 0.54 for the patient satisfaction sub-scale (consisted of only 5 items). Structural validity of the questionnaire was assessed via confirmatory factor analysis. With a normed fit index (CFI) of 0.50 and a root mean square error of approximation (RMSEA) value of 0.14 (90% upper limit of 0.18). These goodness-of-fit indices are more than satisfactory given the limited sample size (n\u0026thinsp;=\u0026thinsp;34). Factor loading of a two-factor structure showed moderate to high loadings for most of the items, validating the structural construct of the questionnaire in use.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis of this study included descriptive statistics for all collected variables. For the categorical data, absolute and relative frequencies are presented; for the continuous data, the median and interquartile range (IQR) were shown. The investigation of differences between the two groups was performed using Fisher\u0026rsquo;s exact or χ2 test, as appropriate, for categorical variables, and a two-sample Wilcoxon rank sum (Mann\u0026ndash;Whitney) test for continuous data. All the tests were two-tailed, and the statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe current study included a total of 34 participants who were evenly recruited with gender match; males and females represented 50% of each group. Participants in RAES group had a significantly higher mean age (9.5 years) than CLIP group (8.9 years; p-value: 0.02). (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDistribution of sociodemographic variables between study arms.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCLIP\u003c/p\u003e \u003cp\u003eN (%) (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRAES\u003c/p\u003e \u003cp\u003e N (%) (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP-values obtained from Pearson's chi-square test of independence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTerm\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eOverall\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAvg (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eLower anterior inclined plane\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eRemovable appliance\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.9\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003et: 0.0201*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eα\u0026thinsp;=\u0026thinsp;0.05. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05*, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01**, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP-values obtained from two-sample t-test (t) or Mann-Whitney test (U)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs noted by parents, the duration of treatment was higher in RAES appliance (p-value: \u0026lt;0.001), with most participants who received RAES appliance reported that the treatments lasted longer than expected (58.8%) compared to 0% in the CLIP. However, per parents\u0026rsquo; reports, RAES appliances were more enjoyable to wear by children (76.5%) compared to only (23.5%) in the CLIP group. All other items showed no remarkable difference between the two study groups. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eParental satisfaction toward CLIP and RAES intervention to correct anterior crossbite\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCLIP\u003c/p\u003e \u003cp\u003e N (%) (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRAES\u003c/p\u003e \u003cp\u003e N (%) (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWould you ask your child to do this orthodontic treatment again?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Absolutely not/I think not\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;35.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. I don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;23.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;35.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. I think yes /Absolutely yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;52.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWould you recommend this orthodontic treatment to other people?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. I don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;52.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. I think yes /Absolutely yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026thinsp;\u0026plusmn;\u0026thinsp;47.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow much satisfied are you with the improvement of your child\u0026rsquo;s aesthetic appearance after orthodontic treatment?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026thinsp;\u0026plusmn;\u0026thinsp;47.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Very satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;52.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDid the entire treatment of your child last as long as you expected?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003e0.001**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Much longer/ Longer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;29.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. As long as\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;38.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Shorter/Much Shorter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;32.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow painful it was to wear the device for your child?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Very much/Much/Moderately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;26.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Little/Not at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026thinsp;\u0026plusmn;\u0026thinsp;73.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;88.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow uncomfortable it was to wear the appliance for your child?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Very much/Much/Moderately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026thinsp;\u0026plusmn;\u0026thinsp;61.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;76.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Little/Not at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;38.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow difficult it was to get used to wearing the appliance for your child?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Very much/Much/Moderately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u0026thinsp;\u0026plusmn;\u0026thinsp;55.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Little/Not at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026thinsp;\u0026plusmn;\u0026thinsp;44.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDid your child enjoyed wearing the appliance?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003e0.006**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;76.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;76.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you think that the treatment has affected the school life of your child?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"16\" rowspan=\"17\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Not influenced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u0026thinsp;\u0026plusmn;\u0026thinsp;47.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Moderately improved/Greatly improved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;52.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you think that the treatment has affected the social life of your child?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Not influenced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;32.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;35.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Moderately improved/Greatly improved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;67.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;64.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;70.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eImprovement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBreathing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u0026thinsp;\u0026plusmn;\u0026thinsp;82.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;82.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;82.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSnoring\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u0026thinsp;\u0026plusmn;\u0026thinsp;82.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;82.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u0026thinsp;\u0026plusmn;\u0026thinsp;82.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrinding\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u0026thinsp;\u0026plusmn;\u0026thinsp;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eα\u0026thinsp;=\u0026thinsp;0.05. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05*, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01**, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP-values obtained from Pearson's chi-square test of independence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eMost cases were largely satisfied with the appearance of their teeth after treatment. Little or higher difficulty in wearing the device was reported by nearly 72% of the study participants. Device-associated pain (moderate or severe) was reported in 52.9% of cases who received CLIP compared to only 23.5% in the RAES appliance group. Although there was no significance difference between groups, CLIP was notably perceived as a more painful intervention than RAES appliance in the current study sample. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003ePatient satisfaction toward CLIP and RAES intervention to correct anterior crossbite\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTerm\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCLIP\u003c/p\u003e \u003cp\u003e N (%) (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRAES\u003c/p\u003e \u003cp\u003e N (%) (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am satisfied with the appearance of my teeth after treatment\u003c/b\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Quite satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;35.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Satisfied\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u0026thinsp;\u0026plusmn;\u0026thinsp;64.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;70.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI understood that it was important to wear the orthodontic device\u003c/b\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.463\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Enough/No\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;32.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Yes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026thinsp;\u0026plusmn;\u0026thinsp;67.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;76.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWearing the orthodontic device was painful\u003c/b\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.very much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Moderately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;35.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026thinsp;\u0026plusmn;\u0026thinsp;32.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;35.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Not at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;29.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWearing the orthodontic device was difficult\u003c/b\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.641\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Much/Moderately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;17.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u0026thinsp;\u0026plusmn;\u0026thinsp;11.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Little\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026thinsp;\u0026plusmn;\u0026thinsp;52.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u0026thinsp;\u0026plusmn;\u0026thinsp;47.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;58.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Not at all\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u0026thinsp;\u0026plusmn;\u0026thinsp;29.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI was happy to wear the orthodontic device\u003c/b\u003e,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Not at all/Little/Moderately\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;26.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u0026thinsp;\u0026plusmn;\u0026thinsp;35.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u0026thinsp;\u0026plusmn;\u0026thinsp;17.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u0026thinsp;\u0026plusmn;\u0026thinsp;35.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026thinsp;\u0026plusmn;\u0026thinsp;41.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u0026thinsp;\u0026plusmn;\u0026thinsp;29.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Very much\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026thinsp;\u0026plusmn;\u0026thinsp;38.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026thinsp;\u0026plusmn;\u0026thinsp;23.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u0026thinsp;\u0026plusmn;\u0026thinsp;52.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eα\u0026thinsp;=\u0026thinsp;0.05. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05*, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01**, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP-values obtained from Pearson's chi-square test of independence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe 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\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7. Based on the literature, (\u003cspan additionalcitationids=\"CR16 CR17\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) 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. (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn 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 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), 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. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eNo higher prevalence of anterior crossbite among females and males was found, this was in accordance to Wiedel and Bondemark. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e) On the other hand, De Lira and da Fonseca, (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) that showed a higher prevalence for the female gender (60%), while Woitchunas et al, (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) which showed a slightly higher tendency for males (56%).\u003c/p\u003e \u003cp\u003eA 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 (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e) who found that either treatment modality was accepted by the children and parents.\u003c/p\u003e \u003cp\u003eSome 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. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) Patient compliance partly play a role in the longer treatment duration for the removable appliance, so patients\u0026rsquo; compliant prior to starting treatment with removable appliance must be considered. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIt 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. (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) Fixed appliances apply constant forces that might induce painful responses because of the application of constant force, whereas the removable appliances apply intermittent forces.\u003c/p\u003e \u003cp\u003eIt 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 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) 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. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) 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. (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) However, the presence of the appliance in the mouth can cause soreness and irritation. (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) 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.\u003c/p\u003e \u003cp\u003eUltimately, 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. (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) 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.\u003c/p\u003e \u003cp\u003eUnderstanding 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.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, both the cemented lower inclined plane and the removable anterior expansion screw appliance were effective in correcting anterior crossbite during mixed dentition. However, the removable anterior expansion screw appliance had the edge in terms of patient and parental satisfaction. These findings underscore the importance of considering patient and parental satisfaction.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBefore commencing the study, ethical approval was obtained from the Research Ethics Committee of the Faculty of oral and dental medicine, Kafrelsheikh University, had approved the research protocol (#IRB NO: KD/08/35).\u003c/p\u003e\n\u003cp\u003eThe study was performed in line with the Declaration of Helsinki and its further amendments. The informed consents from the parents/legal guardians were obtained. The research was performed and reported according to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe database generated and analysed for the study are available in patient\u0026rsquo;s records in the Pediatric Dentistry and Dental Public Health Department, Faculty of oral and dental medicine, Kafrelsheikh University. These data are not for publish and were used under the licence for the current study. Data are available from the correspondent author upon reasonable request with the permission of the Pediatric Dentistry and Dental Public Health Department, Faculty of oral and dental medicine, Kafrelsheikh University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could appear to have influenced the work reported in this paper.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare there is no funding for the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA.E., and A.G. conceptualized and planned the research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA.E. and A.G. collected the data, analysed the results.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA.E. wrote the manuscript draft.\u003c/p\u003e\n\u003cp\u003eA.G. reviewed and edited the manuscript. All authors approved the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their gratitude to Dr Hossam Ghorab for his help\u0026nbsp;\u003c/p\u003e\n\u003cp\u003estructuring the statistical analysis of the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKotadiya J, Fernandes S, Bafna Y, Soni S, Patel J (2019) Anterior cross bite correction with three different approaches: a series of three cases. J Med Sci Clin Res 7(1):179\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSchopf P (2003) Indication for and frequency of early orthodontic therapy or interceptive measures. 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Eur Arch Paediatr Dent 15:27\u0026ndash;32\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTomlinson D, von Baeyer CL, Stinson JN, Sung L (2010) A systematic review of faces scales for the self-report of pain intensity in children. Pediatrics 126(5):e1168\u0026ndash;1198\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeabra LMA, Fernandes NLF, Lira RM, Souto DG, de Oliveira LP, Medina DT (2019) Mordida cruzada anterior: possibilidades de tratamento na denti\u0026ccedil;\u0026atilde;o dec\u0026iacute;dua e mista. Rev Nav Odontol. ;46(1)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZegan G, Dascalu CG, Mavru RB, Golovcencu L (2015) Risk factors and predictors of crossbite at children. Med-Surg J 119(2):564\u0026ndash;571\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiedel AP, Bondemark L (2014) Stability of anterior crossbite correction: A randomized controlled trial with a 2-year follow-up. Angle Orthod [Internet]. Jul 8 [cited 2023 Dec 24];85(2):189\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2319/041114-266.1\u003c/span\u003e\u003cspan address=\"10.2319/041114-266.1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNasir M, Mansjur KQ, Himayanti T (2021) Correction of anterior crossbite with inclined bite plane: a literature review. Makassar Dent J 10(3):241\u0026ndash;245\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStaderini E, Patini R, Meuli S, Camodeca A, Guglielmi F, Gallenzi P (2020) Indication of clear aligners in the early treatment of anterior crossbite: A case series. Dent Press J Orthod 25:33\u0026ndash;43\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosgun A, Altan H (2020) Treatment of Anterior Dental Crossbite with Different Methods in the Early Mixed Dentition Period: Report of Two Cases. J Pediatr Dent 6(2):61\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiedel AP, Bondemark L (2016) A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances. Angle Orthod 86(2):324\u0026ndash;330\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDe Lira ADLS, da Fonseca GHA (2019) Anterior crossbite malocclusion: prevalence and treatment with afixed inclined plane orthodontic appliance. Braz J Oral Sci 18:e191502\u0026ndash;e191502\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWoitchunas DR, Busato C, Tocheto LR, Brockstedt RH (2001) Mordidas cruzadas anteriores: diagn\u0026oacute;stico e tratamento da pseudoclasse III-relato de um caso cl\u0026iacute;nico. Rev Fac Odontol-UPF. ;6(2)\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiedel AP, Bondemark L (2015) Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition\u0026mdash;a randomized controlled trial. Eur J Orthod 37(2):123\u0026ndash;127\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlusoy AT, Bodrumlu EH (2013) Management of anterior dental crossbite with removable appliances. Contemp Clin Dent 4(2):223\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChristiono S, Agusmawanti P (2018) Penatalaksaan anterior crossbite dengan incline bite plane lepasan. Indones J Paediatr Dent 1(2):184\u0026ndash;187\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Anterior crossbite, Mixed dentition, Cemented anterior inclined plane, Removable acrylic expansion screw - patient satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-4227859/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4227859/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Anterior crossbite in mixed dentition is one of the problems that require early intervention aiming at stimulating well balance growth and occlusal development.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eof the comparative study was to assess patient and parental satisfaction following the treatment of anterior crossbite in the mixed dentition using: cemented lower inclined plane (CLIP) and removable anterior expansion screw (RAES).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThirty-four children (17 per group) who had received either CLIP or RAES for the correction of anterior crossbite in the mixed dentition. Patient and parental satisfaction was assessed using a validated questionnaire, which included items related to treatment experience, and overall satisfaction. Statistical analysis: Fisher’s exact or χ2 test, for categorical variables, and a two-sample Wilcoxon rank sum (Mann–Whitney) test for continuous data were performed to investigation differences between the two groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn terms of treatment duration, RAES appliance, with most participants who received RAES appliance reported that the treatments lasted longer than expected compared to the CLIP (p-value: \u0026lt;0.001). Parents reported that RAES appliances were more enjoyable to wear by children. \u0026nbsp;Regarding functional improvement, both groups reported similar levels of satisfaction. \u0026nbsp;(CLIP: 94%, RAES: 92%). Overall, patient satisfaction was comparable between the two study arms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eBoth CLIP and RAES treatment modalities were effective in the treatment of anterior crossbite in the mixed dentition, and showed high levels of patient and parental satisfaction. \u0026nbsp;CLIP was notably perceived as a more painful intervention than RAES.\u003c/p\u003e","manuscriptTitle":" Patient and Parental Satisfaction Following Treatment of Anterior Crossbite in Mixed Dentition: A Comparative Study of cemented lower inclined plane (CLIP) and removable anterior expansion screw (RAES)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 17:56:48","doi":"10.21203/rs.3.rs-4227859/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d0a5ed9a-96ea-48ec-bbaa-0013e4e5e583","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-08T01:23:12+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 17:56:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4227859","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4227859","identity":"rs-4227859","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}