Evaluation of Pain, Discomfort, and Acceptance during the Orthodontic Treatment of Class III Malocclusion Using Bone-Anchored Intermaxillary Traction Versus the Removable Mandibular Retractor: A Randomised Controlled Trial

Abstract

Introduction: Bone-Anchored Intermaxillary Traction (BAIMT) is a relatively new method for class III treatment in growing patients, therefore evidence about their acceptability as well as the levels of pain, discomfort and functional impairments among orthodontic patients is still lacking. Aim: To evaluate levels of pain, discomfort and acceptance between the BAIMT system and a commonly used treatment modality in the correction of Class III malocclusion. Materials and Methods: Two-arm parallel-group randomised controlled trial was conducted at the Department of Orthodontics, Al-Baath University Dental School between Febuary and October 2015. Fifty-six patients who met the inclusion criteria were distributed randomly and equally into two groups: the bone-anchored intermaxillary traction group (the BAIMT group with a mean age of 11.3 years) and the removable mandibular retractor group (the RMR group with a mean age of 11.5 years). A special questionnaire (originally designed by Sergl) was used and included six questions regarding patients’ feelings of appliance-related tension/pressure, pain, impaired speech, swallowing difficulty, oral constraint and lack of confidence in public. This questionnaire was administered at T1 (1 day), T2 (1 week), T3 (6 weeks), T4 (3 months) and T5 (6 months) following appliance initial wear. Results: Fifty-one patients were included in the analysis (BAIMT group: 26; RMR group: 25). Patients treated with the BAIMT system had higher levels of pressure, tension (p<0.001) and pain (p<0.001) compared to those in the control group. No statistically significant differences were found between the two groups in relation to impaired swallowing, whereas the RMR caused more constraint in mandibular movements (p<0.05) and more speech impairment (p<0.001) in addition to increased levels of lack of confidence (p<0.001). Conclusion: The BAIMT system caused more pain than the RMR but the levels of pain gradually decreased especially after one week following application. RMR caused more mandibular restriction and more speech impairment because of the presence of the reverse bow, and it caused relatively high levels of social avoidance and lack of confidence for the patient.

Keywords

• ache
• distress
• mini-implants
• oral impairment