TY - JOUR
T1 - Stability, survival, patient satisfaction, and cost-minimization of CAD/CAM versus conventional multistranded fixed retainers in orthodontic patients
T2 - a 2-year follow-up of a two-centre randomized controlled trial
AU - Pullisaar, Helen
AU - Cattaneo, Paolo M.
AU - Gera, Arwa
AU - Sankiewicz, Monika
AU - Bilińska, Małgorzata
AU - Vandevska-Radunovic, Vaska
AU - Cornelis, Marie A.
N1 - Publisher Copyright:
© 2024 Oxford University Press. All rights reserved.
PY - 2024/4
Y1 - 2024/4
N2 - Background: CAD/CAM (computer-aided design/computer-aided manufacturing) fixed retainers (FRs) as an alternative to multistranded FRs to maintain orthodontic treatment outcome. Objectives: The primary aim was to compare CAD/CAM versus conventional multistranded FRs in terms of stability until 2 years. Secondary outcomes were failure rates, patient satisfaction, and cost-minimization. Trial design: 2-arm parallel, two-centre randomized controlled trial. Methods: Patients were randomized to CAD/CAM or conventional FRs in both arches, in a 1:1 ratio and blocks of four. Allocation concealment was secured by using sequentially numbered envelopes. Patients were blinded. FRs were bonded at the end of treatment, and patients were recalled after 12 and 24 months. First-time retainer failures were recorded and digital impressions were taken. Arch widths and lengths, as well as Little’s Irregularity Index (LII), were measured. Additionally, patients answered satisfaction questionnaires. Linear mixed models were applied for measurements and patient satisfaction. Survival analyses were estimated with Kaplan–Meier curves, along with Cox-regression modelling. Cost-minimization analysis was undertaken. Results: One hundred and eighty-one patients were randomized (98 in Centre 1, and 83 in Centre 2): 90 in CAD/CAM and 91 in conventional group. One hundred and fifty three patients attended T24 follow-up. There were no significant differences in LII and arch dimensions between groups for failure-free patients. Within 24 months, 34% maxillary CAD/CAM FRs and 38% maxillary conventional FRs failed, along with 42% mandibular CAD/CAM FRs and 40% mandibular conventional FRs, with no significant difference in survival between groups (hazard ratios conventional to CAD/CAM: maxillary arch: 1.20 [P = 0.46], mandibular arch: 0.98 [P = 0.94]). There were no significant differences in patient satisfaction between groups. No harms were observed. Cost-minimization analysis showed that CAD/CAM FRs were slightly cheaper than conventional FRs. Conclusions: There were no clinically significant differences in LII, arch widths, and lengths between CAD/CAM and conventional FRs after 24 months. There were no differences in failures and patient satisfaction between groups. CAD/CAM FRs were slightly cheaper than conventional FRs. Trial registration: ClinicalTrials.gov NCT04389879.
AB - Background: CAD/CAM (computer-aided design/computer-aided manufacturing) fixed retainers (FRs) as an alternative to multistranded FRs to maintain orthodontic treatment outcome. Objectives: The primary aim was to compare CAD/CAM versus conventional multistranded FRs in terms of stability until 2 years. Secondary outcomes were failure rates, patient satisfaction, and cost-minimization. Trial design: 2-arm parallel, two-centre randomized controlled trial. Methods: Patients were randomized to CAD/CAM or conventional FRs in both arches, in a 1:1 ratio and blocks of four. Allocation concealment was secured by using sequentially numbered envelopes. Patients were blinded. FRs were bonded at the end of treatment, and patients were recalled after 12 and 24 months. First-time retainer failures were recorded and digital impressions were taken. Arch widths and lengths, as well as Little’s Irregularity Index (LII), were measured. Additionally, patients answered satisfaction questionnaires. Linear mixed models were applied for measurements and patient satisfaction. Survival analyses were estimated with Kaplan–Meier curves, along with Cox-regression modelling. Cost-minimization analysis was undertaken. Results: One hundred and eighty-one patients were randomized (98 in Centre 1, and 83 in Centre 2): 90 in CAD/CAM and 91 in conventional group. One hundred and fifty three patients attended T24 follow-up. There were no significant differences in LII and arch dimensions between groups for failure-free patients. Within 24 months, 34% maxillary CAD/CAM FRs and 38% maxillary conventional FRs failed, along with 42% mandibular CAD/CAM FRs and 40% mandibular conventional FRs, with no significant difference in survival between groups (hazard ratios conventional to CAD/CAM: maxillary arch: 1.20 [P = 0.46], mandibular arch: 0.98 [P = 0.94]). There were no significant differences in patient satisfaction between groups. No harms were observed. Cost-minimization analysis showed that CAD/CAM FRs were slightly cheaper than conventional FRs. Conclusions: There were no clinically significant differences in LII, arch widths, and lengths between CAD/CAM and conventional FRs after 24 months. There were no differences in failures and patient satisfaction between groups. CAD/CAM FRs were slightly cheaper than conventional FRs. Trial registration: ClinicalTrials.gov NCT04389879.
KW - computer-aided design/computer-aided manufacturing
KW - cost-minimization
KW - failure rate
KW - orthodontic fixed retainers
KW - patient satisfaction
KW - stability
KW - Follow-Up Studies
KW - Orthodontic Retainers
KW - Humans
KW - Orthodontic Appliance Design
KW - Patient Satisfaction
KW - Orthodontic Appliances, Fixed
U2 - 10.1093/ejo/cjae006
DO - 10.1093/ejo/cjae006
M3 - Journal article
C2 - 38394353
AN - SCOPUS:85185856240
SN - 0141-5387
VL - 46
JO - European Journal of Orthodontics
JF - European Journal of Orthodontics
IS - 2
M1 - cjae006
ER -