OBJECTIVES The aim of this paper is to investigate the personal experience of individual patients, treated with a palatal expansion therapy, and their parents, in order to evaluate the procedure not only from a clinical-objective point of view but also from a subjective one. MATERIALS AND METHODS The sample examined consisted of 19 growing subjects (10 females and 9 males) aged between 6 and 12 years who showed, on clinical examination, insufficient development of the transverse maxilla diameter with indication to treatment. Patients underwent orthopantomography and teleradiography of the skull in latero-lateral projection. On the teleradiography the stage of maturation of the cervical vertebrae was evaluated. Subjects who exceeded the peak of pubertal growth or presented syndromes and systemic pathologies with clinical manifestations at the level of the oral cavity, dental, muscular and craniofacial anomalies were excluded. Patients were treated using a central screw-type rapid palatal expander Hyrax type. The activation protocol included: a quarter turn of the transversal screw performed twice a day for the first 3 days and once a day in the following days until the control appointment a week later. Later it was prescribed to continue with activations of a quarter turn per day until the planned expansion was obtained based on the individual needs of the individual patient. A special questionnaire was created for both the young patient, in a simple and understandable format, and for the parents, including a series of targeted questions about aesthetic information, compliance, negative effects such as pain and possible administration of painkillers, effects positive factors such as improved breathing, digestion and concentration of the person concerned. RESULTS AND CONCLUSIONS The results of the questionnaire conducted on young patients show an aesthetic improvement of the smile in 84% of cases. Only 26% of the boys reported painful symptoms, especially during the first days of activation, with only 5% of very high pain. Only 36% say they have had discomfort especially in the early days. The questionnaires compilated by the parents reported more detailed and objective information. Very important was the information about respiratory activity and improvements following the therapy carried out: 79% of parents report their child’s oral breathing reduced to 15% following the activation period and the percentage of night snoring was reduced by 37% in young patients. Finally, more than 73% state evident respiratory improvements following orthopedic treatment. CLINICAL SIGNIFICANCE In this study we wanted to consider orthopedic-orthodontic treatment with rapid palatal expander focusing the attention on the subjective judgments of the young patients and the parents who are usually left out. The investigation allowed us to objectivate the excellent functionality and speed of the device, its simplicity and the slight discomfort easily bearable. The realization of this subjective investigation about the sensations and experience provided by young patients and their parents can be a useful tool to provide future patients with not only specialized and clinical information but also subjective judgments of those who before had benefits from this orthopedic-orthodontic therapy.
Obiettivi Si è voluto indagare l’esperienza personale dei singoli pazienti, presi in cura con una terapia di espansione palatale, e dei relativi genitori al fine di valutare la procedura non solo da un punto di vista clinico-oggettivo, ma anche soggettivo. Materiali e metodi Il campione preso in esame si compone di 19 soggetti in crescita (10 femmine e 9 maschi) di età compresa tra 6 e 12 anni che, all’esame clinico, presentavano insufficiente sviluppo del diametro traverso del mascellare superiore con indicazione al trattamento. I pazienti sono stati sottoposti a ortopantomografia delle arcate dentarie e teleradiografia del cranio in proiezione latero-laterale. Sulla teleradiografia è stato valutato lo stadio di maturazione delle vertebre cervicali. Sono stati esclusi i soggetti che avevano superato il picco di crescita puberale o che presentavano sindromi e patologie sistemiche con manifestazioni cliniche a livello del cavo orale, anomalie dentarie, muscolari e craniofacciali. I pazienti sono stati trattati mediante l’impiego di espansore rapido palatale di tipo Hyrax a vite centrale. Il protocollo di attivazione ha previsto: un quarto di giro della vite trasversale eseguito due volte al giorno per i primi 3 giorni e una volta al giorno in quelli successivi fino all’appuntamento di controllo a distanza di una settimana. In seguito, è stato prescritto di proseguire con le attivazioni di un quarto di giro al giorno fino all’ottenimento dell’espansione pianificata in base alle esigenze individuali del singolo paziente. È stato creato un questionario apposito sia per il piccolo paziente, in formato semplice e comprensibile, che per i genitori, sviluppato in una serie di domande mirate circa le informazioni di tipo estetiche, compliance, effetti negativi quale dolore ed eventuale somministrazione di antidolorifici, effetti positivi quali il miglioramento di respirazione, digestione e concentrazione del soggetto interessato. Risultati e conclusioni Per quanto riguarda il questionario condotto sui giovani pazienti, i risultati mostrano un miglioramento estetico del sorriso nell’84% dei casi. Solo il 26% dei ragazzi ha riportato sintomatologia dolorosa, riscontrata soprattutto durante i primi giorni di attivazione, con solo il 5% di dolore molto alto. Per quanto riguarda il discomfort, solamente il 36% afferma di avere avuto disagi soprattutto nei pri mi giorni. I questionari compilati dai genitori hanno riportato informazioni più dettagliate e oggettive. Molto importanti sono state le informazioni circa l’attività respiratoria e i miglioramenti in seguito alla terapia effettuata: il 79% dei genitori riporta una respirazione orale del proprio figlio ridotta al 15% in seguito al periodo di attivazione e la percentuale del russamento notturno ridotta del 37% nei giovani pazienti. Infine, più del 73% afferma evidenti miglioramenti respiratori a seguito del trattamento ortopedico. Significato clinico In questo studio si è voluto considerare il trattamento ortopedico-ortodontico con espansore rapido palatale focalizzando l’attenzione sui giudizi soggettivi dei piccoli pazienti e dei genitori che solitamente vengono tralasciati. L’indagine ha permesso di oggettivare l’ottima funzionalità e rapidità del dispositivo, la sua semplicità e il lieve discomfort facilmente sopportabile. La realizzazione di questa indagine circa le sensazioni e l’esperienza fornite dai giovani pazienti e dai relativi genitori può costituire un utile strumento per poter fornire ai futuri pazienti non solo informazioni specialistiche, ma anche giudizi soggettivi di chi prima di loro ha beneficiato di questa terapia ortopedico-ortodontica.
Espansione rapida palatale: valutazione soggettiva di bambini e genitori / I. Carminati, J. Katarzyna, J.K. Nowakowska, A. D’Apote, M. Del Fabbro, L. Francetti. - In: DENTAL CADMOS. - ISSN 0011-8524. - 87:8(2019), pp. 489-496. [10.19256/d.cadmos.08.2019.05]
Espansione rapida palatale: valutazione soggettiva di bambini e genitori
J. Katarzyna;A. D’Apote;M. Del Fabbro;L. Francetti
2019
Abstract
OBJECTIVES The aim of this paper is to investigate the personal experience of individual patients, treated with a palatal expansion therapy, and their parents, in order to evaluate the procedure not only from a clinical-objective point of view but also from a subjective one. MATERIALS AND METHODS The sample examined consisted of 19 growing subjects (10 females and 9 males) aged between 6 and 12 years who showed, on clinical examination, insufficient development of the transverse maxilla diameter with indication to treatment. Patients underwent orthopantomography and teleradiography of the skull in latero-lateral projection. On the teleradiography the stage of maturation of the cervical vertebrae was evaluated. Subjects who exceeded the peak of pubertal growth or presented syndromes and systemic pathologies with clinical manifestations at the level of the oral cavity, dental, muscular and craniofacial anomalies were excluded. Patients were treated using a central screw-type rapid palatal expander Hyrax type. The activation protocol included: a quarter turn of the transversal screw performed twice a day for the first 3 days and once a day in the following days until the control appointment a week later. Later it was prescribed to continue with activations of a quarter turn per day until the planned expansion was obtained based on the individual needs of the individual patient. A special questionnaire was created for both the young patient, in a simple and understandable format, and for the parents, including a series of targeted questions about aesthetic information, compliance, negative effects such as pain and possible administration of painkillers, effects positive factors such as improved breathing, digestion and concentration of the person concerned. RESULTS AND CONCLUSIONS The results of the questionnaire conducted on young patients show an aesthetic improvement of the smile in 84% of cases. Only 26% of the boys reported painful symptoms, especially during the first days of activation, with only 5% of very high pain. Only 36% say they have had discomfort especially in the early days. The questionnaires compilated by the parents reported more detailed and objective information. Very important was the information about respiratory activity and improvements following the therapy carried out: 79% of parents report their child’s oral breathing reduced to 15% following the activation period and the percentage of night snoring was reduced by 37% in young patients. Finally, more than 73% state evident respiratory improvements following orthopedic treatment. CLINICAL SIGNIFICANCE In this study we wanted to consider orthopedic-orthodontic treatment with rapid palatal expander focusing the attention on the subjective judgments of the young patients and the parents who are usually left out. The investigation allowed us to objectivate the excellent functionality and speed of the device, its simplicity and the slight discomfort easily bearable. The realization of this subjective investigation about the sensations and experience provided by young patients and their parents can be a useful tool to provide future patients with not only specialized and clinical information but also subjective judgments of those who before had benefits from this orthopedic-orthodontic therapy.File | Dimensione | Formato | |
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