Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation

Fixed orthodontic appliances and adolescents' peer relations in school : A social network analysis using cross-sectional survey data

PURPOSE

Studies from the 1970s and 1980s, but also recent investigations on social media suggest that wearing a fixed orthodontic appliance can be a cause of bullying and social exclusion. With the greater uptake of orthodontic treatment in recent decades, it can be assumed that fixed braces are increasingly perceived as normal or even socially desirable. This study investigated how wearing visible fixed braces affects adolescents' social position in their peer networks using cross-sectional survey data.

METHODS

A total of 3002 students in the seventh grade (ages 12/13) at 39 secondary schools were asked about their social relationships in school. These directed network data were used to compare different indegrees (friendship, popularity and victimisation) of students with and without fixed braces. Statistical analyses were performed using ordinary least squares multiple regression models with school cohort fixed effects.

RESULTS

In all, 19% of the surveyed students indicated that they wear visible fixed braces. Girls with fixed braces were slightly more likely to be nominated for friendship and popularity and slightly less likely to be nominated for victimisation than girls without fixed braces (p < 0.05). These associations also remained stable when controlling for socioeconomic differences. Among boys, all observed associations were statistically insignificant.

CONCLUSION

We found no evidence that wearing fixed braces in adolescence is socially sanctioned by peers. Rather, female students with fixed braces even tend to hold a slightly more favourable position in their peer networks than girls without braces do. These analyses exemplify how network-analytic approaches can be successfully applied in interdisciplinary research at the intersection of sociology, epidemiology and medicine.

Influence of daily usage times on patients' compliance during at-home bleaching: a randomized clinical trial

The effectiveness of at-home dental bleaching treatments depends on the time that bleaching products are in contact with the teeth surface and, consequently, on the adequate use of associated custom acetate trays.

OBJECTIVE

This randomized single-blinded trial aimed to analyze if the daily usage time of these products influences the patient's compliance behavior when submitted to monitored at-home dental bleaching. Secondary outcomes were color change and tooth sensitivity.

METHODOLOGY

Sixty-six volunteers were randomly distributed into three groups (n=22): patients were instructed to use the trays for 2 (G2), 4 (G4), and 8 (G8) hours daily. The daily dental bleaching compliance behavior was measured using a microsensor inserted into the trays. Subjective and objective color evaluation assessments were adopted at baseline (T0), one (T1), two (T2), and three weeks (T3) after the beginning of the bleaching treatment, as well as two weeks after the treatment (T4). Tooth sensitivity was analyzed using the VAS scale, ranging from T1 to T4.

RESULTS

G2 showed a greater degree of cooperation than G8 and cooperation was inversely proportional to the recommended usage time. Significantly higher color change was observed in the upper arch for G8 when compared to G2 in subjective analysis, from T1 to T4. There were no statistical differences between the groups in objective analysis.

CONCLUSION

Shorter recommended usage time of the bleaching product may improve the patient's compliance with at-home dental bleaching treatments. However, increased daily usage time may promote better subjective color change. Bleaching sensitivity was more significant in the first week for a longer time of use.

Is wear time of Hawley retainers measured with microsensors related to mandibular arch stability?

PURPOSE

The aim of this study was to show a possible correlation between the mean wear time of Hawley retainers and long-term mandibular arch stability as assessed via wear time analysis with microsensors.

METHODS

This longitudinal retrospective study comprised 47 subjects (mean age 16.30 ± 1.06 years) having been treated with a nonextraction protocol and presenting moderate crowding at pretreatment. For retention, all patients were instructed to use a mandibular Hawley retainer for 12 months, and wear time was documented every 3 months during a posttreatment period of 6 months using TheraMon software. These individuals were divided into two groups. Those who adhered to a wear time equal to or more than 12 h/day (group 1A; N = 17) and those who complied for less than 12 h/day (group 2A; N = 30) were compared with respect to changes of the mandibular arch during the first 6 months of retention. Furthermore, a subgroup of 28 patients who completed a 12-month follow-up period were again divided into two groups: the individuals in group 1B (N = 12) adhered to a wear time equal to or more than 8 h/day, while those in group 2B (N = 16) complied for less than 8 h/day. Little's Irregularity Index, intercanine and intermolar widths, arch length, overjet, and overbite were measured on mandibular models taken at pretreatment (T0) and posttreatment (T1), as well as 6 months (T2) and 12 months (T3) after debonding. Pearson correlation test, independent samples t‑test, and Mann-Whitney U test were used for statistical evaluation.

RESULTS

From T1 to T2, group 1A and group 2A showed a significant relapse in intermolar width with a difference in the median value of 0.38 mm (p = 0.019). At the complete 12-month follow-up, the increase in Little's irregularity score was significantly greater in group 2B (2.54 ± 1.29 mm) than in group 1B (1.32 ± 1.03 mm; p = 0.012). The established wear time measurements showed significant negative correlations with the Little's irregularity score and overjet changes between T1 and T3 (p < 0.05).

CONCLUSIONS

The results emphasized that the use of a retainer should not fall below a level of at least 8 h/day.

The effect of tooth borne versus skeletally anchored Alt-RAMEC protocol in early treatment of Class III malocclusion: a single-centre randomized clinical trial

TRIAL DESIGN

This was a randomized, controlled trial designed to compare outcomes between the use of dental and skeletal anchorage, using the Face mask/Alternate Rapid Maxillary Expansion and Contraction (FM/Alt-RAMEC) protocol.

METHODS AND PARTICIPANTS

The study was carried out at Mater Dei Hospital, Malta and included prepubertal skeletal Class III malocclusion patients where the aetiology was primarily maxillary hypoplasia.

INTERVENTIONS

Two groups were assigned. Group I was treated with FM/Alt-RAMEC and group II was treated with skeletally anchored FM/Alt-RAMEC. Wear-time (WT) of the FM was monitored using TheraMon microsensors. Patients were instructed to wear the FM for 12-14 hours/day for 9 months. Changes were evaluated with lateral cephalograms and analysed with Wilcoxon and Mann-Whitney U tests. ANOVA was used to analyse the effect of gender on compliance parameters. Spearman's correlation coefficient was used to assess the correlation between compliance and skeletal changes.

OBJECTIVE

To compare the skeletal and dentoalveolar changes in patients treated with these two protocols.

OUTCOMES

The primary outcome was to assess skeletal and dentoalveolar outcomes in patients treated with skeletally anchored FM/RME and tooth-borne FM/RME; utilizing Alt-RAMEC protocol. The secondary outcome was compliance rate and adherence to FM wear among patients.

RANDOMIZATION

Randomizer software and the sealed envelope technique were used to randomly allocate patients 1:1 into either group I (tooth-borne FM/Alt-RAMEC) or group II (skeletally anchored FM/Alt-RAMEC).

BLINDING

It was not possible to blind to treatment allocation, but blinding was used when assessing the outcomes.

RESULTS

Numbers randomized and analysed. Thirty-five patients were allocated. Group I consisted of 18 subjects and group II consisted of 17 subjects. One patient in group I dropped out due to illness, so 17 subjects in each group completed the study.

OUTCOMES

Post-treatment changes in group I showed significant increases in SNA (2.10°), ANB (3.90°), Wits (4.70 mm), and overjet (5.40 mm). Group II showed significant increases in ANB (3.10°), Wits (3.20 mm), and overjet (4.50 mm). Wearing time for group I patients was 7.87 ± 2.88 hours/day and for group II was 6.98 ± 2.68 hours/day, with no significant difference between the groups.

LIMITATIONS

Lack of long-term follow-up post-treatment, making the conclusion applicable only in the short term.

HARMS

No harm was observed in both groups.

CONCLUSION

Despite the large difference between the measured and the patient-reported daily WT, both tooth-borne and skeletally anchored FM/Alt-RAMEC showed positive, similar, skeletal and dental effects.

CLINICAL TRIAL REGISTRATION

ISRCTN12197405.

Compliance with retainer wear using audiovisual integration and reminder: a randomized clinical trial

Active audiovisual representation of instructions ensures vibrant knowledge acquisition and improves acquaintance needed for self-care with retainer wear. The aim of this trial is to assess the impact of audiovisual instructions with additional weekly electronic reminder messages on improving adherence to instructed wear time of Hawley retainer, periodontal outcomes, and participants' experiences. Fifty-two participants (mean age 26.1 y) planned for removable retention, were randomly assigned to two parallel groups to receive either (1) audiovisual instructions with an additional weekly reminder, or (2) verbal instructions alone. Each participant received a Hawley retainer equipped with a TheraMon microsensor and was instructed to wear it for 22 h daily. Participants were monitored for adherence to the wear time after 3 (T1) and 6 months (T2), and had their periodontal health and experiences assessed at T2. Overall, the mean objectively measured daily wear time at T1 was 14.9 (± 4.9 h), and 14.3 (± 5.4 h) at T2. After 3 months, no significant differences were found between the groups (p = 0.065), however, a significant difference favoring better compliance with wear instructions was observed in the audiovisual group after 6 months (p = 0.033). A non-significant difference was observed between both groups regarding the gingival (p = 0.165) and plaque index scores (p = 0.173). Participants' experiences were similar in both groups, except for satisfaction with the way of delivering instructions, being favorably reported in the audiovisual group. Audiovisual instructions with weekly reminders seem to have a significant effect on patient compliance in the longer term.Trial registration: TCTR20230220002.

Clear aligner therapy in the mixed dentition: Indications and practitioner perspectives

INTRODUCTION

This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors.

METHODS

An original, 22-item survey was mailed to a randomized, nationally representative sample of practicing orthodontists (n = 800) and a specific, randomized subsample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents' demographic information, experience with clear aligner therapy, and perceived advantages and disadvantages of CAMD compared with fixed appliances (FAs). Responses were compared using McNemar's chi-square and paired t tests to assess CAMD vs FAs.

RESULTS

One thousand orthodontists were surveyed, and 181 (18.1%) responded over 12 weeks. CAMD use was less common than mixed dentition FAs, but most respondents predicted an increase in their future CAMD use (57.9%). Among respondents using CAMD, the number of patients with mixed dentition treated with clear aligners was significantly lower than the number of total patients with clear aligners (23.7% vs 43.8%; P <0.0001). Fewer respondents considered skeletal expansion, growth modification, sagittal correction, and habit cessation feasible indications for CAMD compared with FAs (P <0.0001). Perceived compliance was similar for CAMD and FAs (P = 0.5841), but perceived oral hygiene was significantly better with CAMD (P <0.0001).

CONCLUSIONS

CAMD is an increasingly common treatment modality for children. Most surveyed orthodontists reported limited indications for CAMD compared with FAs but perceived noticeable benefits for oral hygiene with CAMD.

Wearable Orofacial Technology and Orthodontics

Wearable technology to augment traditional approaches are increasingly being added to the arsenals of treatment providers. Wearable technology generally refers to electronic systems, devices, or sensors that are usually worn on or are in close proximity to the human body. Wearables may be stand-alone or integrated into materials that are worn on the body. What sets medical wearables apart from other systems is their ability to collect, store, and relay information regarding an individual's current body status to other devices operating on compatible networks in naturalistic settings. The last decade has witnessed a steady increase in the use of wearables specific to the orofacial region. Applications range from supplementing diagnosis, tracking treatment progress, monitoring patient compliance, and better understanding the jaw's functional and parafunctional activities. Orofacial wearable devices may be unimodal or incorporate multiple sensing modalities. The objective data collected continuously, in real time, in naturalistic settings using these orofacial wearables provide opportunities to formulate accurate and personalized treatment strategies. In the not-too-distant future, it is anticipated that information about an individual's current oral health status may provide patient-centric personalized care to prevent, diagnose, and treat oral diseases, with wearables playing a key role. In this review, we examine the progress achieved, summarize applications of orthodontic relevance and examine the future potential of orofacial wearables.

Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions

BACKGROUND

Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking.

OBJECTIVES

To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block.

TRIAL DESIGN

Two-arm parallel group, single-centre, randomized controlled trial.

MATERIALS AND METHODS

Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon® microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis.

RESULTS

In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion.

HARMS

No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment.

LIMITATIONS

The trial was a single-centre study and long-term effects were not evaluated.

CONCLUSIONS

During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

CLINICAL TRIAL REGISTRATION

NCT05155774.

Orthodontic Compliance Assessment: A Systematic Review

Objectives

The aim of this review was to determine whether the type of removable appliance, as well as the age and sex of the patient, may affect the extension or reduction of wear time by assessing the correlation between the mean actual and orthodontist-recommended wear times.

Methods

Randomised case control trials, cohort studies, case series, observational studies, reviews, and retrospective analyses were identified. The quality of the studies was assessed using the Cochrane Collaboration Tool and modified Newcastle-Ottawa Scale. The electronic databases Embase, PubMed, Scopus, and Web of Science were reviewed, and 542 articles were obtained, of which 31 were qualified for qualitative synthesis. The data from 1674 participants were collected and a weighted average was determined for the mean wear time of each appliance.

Results

Regardless of the type of extra- or intraoral appliances, mean wear time was shorter than recommended, although patients using intraoral appliances cooperated more. The best compliance was noted for Schwarz appliances (73.70%) and plate retainers (85%). There was no evidence of an influence of patients’ age and sex on compliance during treatment.

Conclusions

The considerable inconsistency and imprecision of articles could affect the reliability of the results. Previous studies analysing the effectiveness of treatment with removable appliances based on an arbitrarily assumed average wear time need to be revised in order to verify the actual wear time with the use of microsensors.

Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review

This review aims to analyze the multiple factors affecting patients’ level of compliance (how much they wear removable devices/clear aligners) during orthodontic treatments and to investigate the available methods and devices to monitor the appliance wearing time and to improve it. A literature search was conducted on electronic databases (Pubmed, Scopus, and Google Scholar). The results of the present study suggest that compliance indicators may misestimate the intraoral wearing time. Compliance is affected by patient-related factors (age, personality traits, the importance of personal appearance, self-perception of malocclusion), appliance-related factors (visibility, pain/discomfort), and clinician-related factors (trust, clear and complete communication, motivation). The motivation of pre-pubertal patients is mostly external, while adolescents/young adults have intrinsic motivation for orthodontic treatment. Patients’ self-reports tend to overestimate the appliance wearing time. Even if there is a lack of evidence, teledentistry might improve patients’ awareness of being monitored, thus increasing the time for which orthodontic devices are worn. Compliance is a key factor for clear aligner treatments, but high-quality studies focusing on this aspect are missing. Further studies should focus on how to handle the lack of cooperation and how to increase compliance in order to maximize the treatment’s results.

The Use of Microsensors to Assess the Daily Wear Time of Removable Orthodontic Appliances: A Prospective Cohort Study

Orthodontic treatment with removable appliances is still common in children and adolescents. However, their effectiveness depends primarily on the patients’ compliance. Currently, it is possible to check the daily wear time (DWT) of the removable appliances using special microsensors. The aim of this prospective cohort study was to assess the degree of patients’ compliance depending on the type of removable appliance used. In total, 167 patients (87 F, 80 M) were enrolled in the study and were treated with block appliances (Klammt, Twin-Block), Schwarz plates, and block appliances in combination with headgear. All patients were followed up for 6 months with the mean daily wear time checked at followup visits using TheraMon^® microsensors fitted in the appliances. It has been shown that the type of appliance influences the patients’ compliance. The DWT for the Twin Block was significantly longer compared to the DWT for the other appliances. Girls have been shown to wear removable appliances better than boys. It has been proven that the majority of patients do not follow the orthodontist’s recommendations, wearing removable appliances for just over half of the recommended time. Microsensors can be used for objective verification of patients’ compliance, which allows for a reliable assessment of the effectiveness of treatment with removable appliances.

Comparison of objective wear time between monoblock and twin-block appliances measured by microsensor

OBJECTIVES

To assess the objective compliance levels in skeletal Class II patients with mandibular retrognathia wearing monoblock and twin-block appliances.

MATERIALS AND METHODS

A prospective clinical study was conducted with 30 patients between 10 and 15 years old who were equally divided into two study groups. Group 1 was treated with monoblock, and group 2 was treated with twin-block appliances. The patients were instructed to wear their appliance for 15 hours per day. Wear times were monitored by a microsensor. (TheraMon; MCTechnology, Hargelsberg, Austria) for an average of six appointments. Patients were also instructed to record their wear times on a chart, and this record was admitted as subjective wear time. Statistical analysis was performed with the data derived from both the patients' charts and the monitoring records.

RESULTS

The mean wear time by the patients was 10.67 ± 3.93 hours, which was less than the 15 hours prescribed by the orthodontist, with no difference between the two appliances (P > .05). The regular use rate, which included the days with a wear time of 8 hours or more per day, was 75%. Compliance levels decreased by 35% throughout the six control appointments. Patients declared that their wear time was more than their objective wear time by an average of 3.76 hours.

CONCLUSIONS

Despite their different designs, there was no significant difference between the monoblock and twin-block appliances in terms of compliance.

Factors Influencing Patient Compliance during Clear Aligner Therapy: A Retrospective Cohort Study

Compliance is highly relevant during clear aligner therapy (CAT). In this retrospective cohort study, we assessed compliance and associated covariates in a large cohort of CAT patients. A comprehensive sample of 2644 patients (75.0% females, 25.0% males, age range 18–64 years, median 27 years), all receiving CAT with PlusDental (Berlin, Germany) finished in 2019, was analyzed. Covariates included demographic ones (age, gender) as well as self-reported questionnaire-obtained ones (satisfaction with ones’ smile prior treatment, the experience of previous orthodontic therapy). The primary outcome was compliance: Based on patients’ consistent use of the mobile application for self-report and aligner wear time of ≥22 h, patients were classified as fully compliant, fairly compliant, or poorly compliant. Chi-square test was used to compare compliance in different subgroups. A total of 953/2644 (36.0%) of patients showed full compliance, 1012/2644 (38.3%) fair compliance, and 679/2644 (25.7%) poor compliance. Males were significantly more compliant than females (p = 0.000014), as were patients without previous orthodontic treatment (p = 0.023). Age and self-perceived satisfaction with ones’ smile prior to treatment were not sufficiently associated with compliance (p > 0.05). Our findings could be used to guide practitioners towards limitedly compliant individuals, allowing early intervention.

Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment

OBJECTIVES

To determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment.

MATERIALS AND METHODS

The sample consisted of 77 subjects (aged 11-13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed.

RESULTS

There were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2-9.4; P = .017). Patients were 3.2 times (95% CI, 1.1-9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0-9.4; P = .044).

CONCLUSIONS

Parental perception of child's emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.

Robotic Applications in Orthodontics: Changing the Face of Contemporary Clinical Care

The last decade (2010-2021) has witnessed the evolution of robotic applications in orthodontics. This review scopes and analyzes published orthodontic literature in eight different domains: (1) robotic dental assistants; (2) robotics in diagnosis and simulation of orthodontic problems; (3) robotics in orthodontic patient education, teaching, and training; (4) wire bending and customized appliance robotics; (5) nanorobots/microrobots for acceleration of tooth movement and for remote monitoring; (6) robotics in maxillofacial surgeries and implant placement; (7) automated aligner production robotics; and (8) TMD rehabilitative robotics. A total of 1,150 records were searched, of which 124 potentially relevant articles were retrieved in full. 87 studies met the selection criteria following screening and were included in the scoping review. The review found that studies pertaining to arch wire bending and customized appliance robots, simulative robots for diagnosis, and surgical robots have been important areas of research in the last decade (32%, 22%, and 16%). Rehabilitative robots and nanorobots are quite promising and have been considerably reported in the orthodontic literature (13%, 9%). On the other hand, assistive robots, automated aligner production robots, and patient robots need more scientific data to be gathered in the future (1%, 1%, and 6%). Technological readiness of different robotic applications in orthodontics was further assessed. The presented eight domains of robotic technologies were assigned to an estimated technological readiness level according to the information given in the publications. Wire bending robots, TMD robots, nanorobots, and aligner production robots have reached the highest levels of technological readiness: 9; diagnostic robots and patient robots reached level 7, whereas surgical robots and assistive robots reached lower levels of readiness: 4 and 3, respectively.

Effectiveness of removable appliances with temperature sensors in orthodontic patients: a systematic review and meta-analysis

BACKGROUND/OBJECTIVE

Patient compliance during orthodontic treatment is one of the factors that most affects success in the final result. The use of removable appliances is frequent at an early age and the monitoring of its use is essential to assess the collaboration of the patient. The aim of this study was to establish the effectiveness of microsensors included in removable appliances during orthodontic treatment or in the retention phase to enable a reliable and individualized follow-up of the patient.

SEARCH METHODS

The article search was carried out in various electronic databases and journals without any language restrictions.

SELECTION CRITERIA

Studies using microsensors into removable appliances were selected with the key selection criterion of a minimum follow-up of 4 weeks.

DATA COLLECTION AND ANALYSIS

The quality of the studies included was evaluated using the Cochrane scale for the randomized controlled trials and the Newcastle Ottawa Scale for control-case, cohort, and transversal studies. The mean of the differences with a 95% confidence interval was expressed for the continuous data.

RESULTS

Twenty-nine full-text articles were analysed and included in the qualitative synthesis. In general, the mean daily wear time of removable appliances measured objectively was less than the time that the professional had predetermined.

CONCLUSIONS

The use of microsensors as an objective measurement method enhances communication and boosts confidence in the orthodontist-patient relationship. More random clinical studies with temperature sensors are needed to establish to what extent they influence the orthodontic outcome.

REGISTRATION

PROSPERO (CRD42019120525).

Does daily wear time of Twin Block reliably predict its efficiency of class II treatment?

PURPOSE

The objective of this study was to investigate how daily wear time (DWT) influences class II malocclusion treatment efficiency.

MATERIALS AND METHODS

The study group consisted of 55 patients (mean age 10.4 years) diagnosed with a class II/1 malocclusion. Twin block appliances, with built-in Theramon® microsensors (MC Technology, Hargelsberg, Austria) to monitor patients' cooperation (daily wear time assessment), were used for treatment. Cephalograms were taken and the following initial and final measurements were compared: Co-Gn, Co-Go, Co-Olp, Pg-Olp, WITS, SNA, SNB, ANB, Co-Go-Me, overjet, molar and canine relationships. The Shapiro-Wilk test, Wilcoxon signed-rank test, Student's t-test, Levene's test, Mann-Whitney U test, Kruskal-Wallis test, χ² test, and Spearman's rank correlation coefficient with p < 0.05 set as the statistical significance level were used to determine the correlation of the outcomes with DWT; a ROC (receiver operating characteristic) curve was calculated to illustrate diagnostic ability of the binary classifier system.

RESULTS

DWT was very highly positively correlated with change of the Pg-Olp parameter and highly with an improvement in the ANB, SNA, and SNB angles, an increase in the WITS parameter and an increase in Co-Gn distance. DWTs < 7.5 h correlated with significantly less improvement of the investigated variables. However, DWT > 7.5 h did not significantly correlate with the improvement of the overjet and most of the linear parameters in the mandible. The ROC curve and its AUC (area under curve) allowed the determination of a DWT of 7 h and 48 min to be capable of establishing a class I relationship with 83% probability.

CONCLUSIONS

Class II treatment efficiency was influenced by DWT; an 8 h threshold value had an 83% probability of establishing a class I relationship.

What Do We Know About Adherence to Oral Appliances?

Long-term effective therapy is essential for obstructive sleep apnea (OSA) control and preventing comorbidity. OSA patients are often reported to be more receptive to oral appliance therapy over positive airway pressure (PAP). Oral appliance usage can now be objectively recorded by temperature microsensors. Studies using commercially available microsensor chips have reported data out to 1 year, with high rates of adherence (>80%), albeit in small samples. There is opportunity to further use this technology to understand individual adherence factors and patterns and in obtaining objective measures of treatment effectiveness, particularly for longer-term health outcomes and allowing comparison to PAP.

Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation

Background

Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance.

Materials/methods

The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire.

Results

In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7–23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type.

Limitations

Study assessed a relatively small number of patients.

Conclusions/implications

Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.

Evaluation of the effectiveness of a tailored mobile application in increasing the duration of wear of thermoplastic retainers: a randomized controlled trial

Background

The ‘My Retainers’ mobile application is a patient-informed intervention designed to enhance removable retainer wear and associated patient experiences during the retention phase.

Objectives

To evaluate the effect of receiving the ‘My Retainers’ application on objectively assessed thermoplastic retainer (TPR) wear time, stability, periodontal outcomes, patient experiences, and knowledge related to retainers.

Materials and methods

Eighty-four participants planned for removable retention with TPRs were assigned either to receive the ‘My Retainers’ application or to control not receiving electronic reminders during the 3-month period. Randomization was based on computer-generated random numbers and allocation was concealed using opaque, sealed envelopes. The primary outcome was objectively assessed retainer wear recorded using an embedded TheraMon® micro-electronic sensor. Secondary outcomes, including irregularity of the maxillary and mandibular incisors, plaque levels, bleeding on probing and probing depth, were assessed at baseline and 3-month follow-up; and analysed using a series of mixed models. Experiences and knowledge related to orthodontic retainers were recorded using questionnaires. The outcome assessor was blinded when possible.

Results

Receipt of the mobile application resulted in slightly higher median wear time (0.91 hours/day); however, this difference was not statistically significant (P = 0.56; 95% confidence interval [CI]: −2.19, 4.01). No significant differences were found between the treatment groups in terms of stability (P = 0.92; 95% CI: −0.03, 0.04), plaque levels (P = 0.44; 95% CI: −0.07, 0.03), bleeding on probing (P = 0.61; 95% CI: −0.05, 0.03) and probing depth (P = 0.79; 95% CI: −0.09, 0.07). Furthermore, similar levels of patient experiences (P = 0.94) and knowledge related to retainers (P = 0.26) were found. However, marginally better levels of knowledge were identified in the intervention group. No harms were observed.

Limitations

A relatively short follow-up period with the study confined to a single-center in a university-based hospital.

Conclusions

Provision of the bespoke ‘My Retainers’ application did not lead to an improvement in adherence with TPR wear over a 3-month follow-up period. Further refinement and research are required to develop and investigate means of enhancing adherence levels.

Clinical registration

NCT03224481.

Adherence to Orthodontic Treatment in Youth With Craniofacial Conditions: A Survey of US Orthodontists

OBJECTIVE

(1) To explore orthodontists' perceptions of nonadherence and related factors in their patients with craniofacial conditions; (2) to examine differences in adherence perceptions by provider characteristics; (3) to evaluate current adherence interventions.

DESIGN

Cross-sectional.

SETTING

United States-based orthodontists affiliated with a nonprofit association for providers treating oral cleft and craniofacial conditions received survey invitations via list-serv, e-mail, and social media.

PARTICIPANTS

Thirty-eight orthodontists participated (mean age = 50.5 ± 10.7 years; 76% Caucasian; 55% male; 54% private practice).

MAIN OUTCOME MEASURE

An 80-item survey assessed demographic characteristics; frequencies of various adherence problems and adherence-related prolonged or terminated treatment; importance of adherence to treatment outcomes; factors that may impact adherence; interest in improving adherence; and use of adherence-enhancing interventions.

RESULTS

Adherence problems were common, yet 80.6% of participants rated adherence as "very important" to cleft treatment outcomes. Child behavior and motivation, caregiver reinforcement of behavior, and provider communication with the family were identified as factors that greatly impact adherence. Orthodontists in university-affiliated programs were more likely to rate individual, family, health-care system, and community factors as impacting adherence compared to private practice orthodontists; 80.6% used adherence interventions; these strategies were all rated as "sometimes successful."

CONCLUSIONS

Nonadherence to cleft lip/palate-related orthodontic care is common and potentially detrimental to care. Current interventions are not uniformly successful and could be better tailored. Understanding provider, patient, and family factors that affect adherence can inform individualized treatment planning to improve adherence and ultimately, treatment outcomes.

Headgear compliance as assessed by a temperature-sensitive recording device: a prospective clinical study

Objective

To accurately describe compliance in headgear wearing time by using a temperature- and force-sensitive device over an 8 month period of use in a prospective clinical manner.

Materials and methods

Twenty children with Class II malocclusion aged 8–12 years were randomly selected for treatment with cervical headgear. The headgears were equipped with an electronic module, which measured temperature and force, and patients were instructed to wear the headgear 12 hours daily. The recorded values were analysed to determine the number of days the headgear was used, the number of hours per day it was worn, and the percentage of compliance (100 per cent corresponding to 12 hours daily).

Results

The average treatment period was 8.4 months with 5.8 months of effective use. When effectively used, headgear was worn 8.7 hours a day (compliance of 73 per cent). Including days where it was not worn, compliance was 6.4 hours (54 per cent). The appliance was used on average 0.5 hours during the day (8 am–8 pm) and 5.9 hours during the night (8 pm–8 am). Very low compliance was recorded during July and August.

Conclusion

The average compliance with cervical headgear use was 54 per cent of the 12 hour prescription. The headgear was effectively used only 5.8 months over the study period, with roughly 30 per cent of no use. Headgear was used almost exclusively during evening and night-time. During the summer period, compliance was particularly poor.

Adherence to gynecological screening impacted by experienced orthodontic treatment in childhood

BACKGROUND

Dental and cervical controls are two established screening programs in Germany. Compliance to orthodontic treatment in childhood is essential for dental health and one of the first health interventions that requires adherent behavior; therefore, it may be associated with participation in further screening programs in adulthood. However, it is not yet known whether early orthodontic treatment influences long-term screening adherence.

METHODS

Using a questionnaire administered during a visit to a special dysplasia outpatient service, this case-control study evaluated women's personal history of orthodontic care, long-term satisfaction, and dental and gynecological screening adherence. Oral health status and dental anxiety were assessed with validated instruments. Cases were categorized as cervical dysplasia only (S2) or cervical dysplasia with conization (S1) and compared to healthy controls with a normal PAP smear.

RESULTS

A study population of 233 participants included 132 cases and 101 controls. The control group had had orthodontic treatment during childhood more often than our study population with abnormal PAP smears (68.3% controls versus 56.1% subjects; p < 0.005). Orthodontic treatment was not associated with attending dental appointment or gynecological check-ups. However, women with an orthodontic treatment in childhood were significantly more often vaccinated against human papillomavirus than women without orthodontic treatment (p < 0.03).

CONCLUSION

Data suggest that women with orthodontic treatment in childhood are more conscious about prevention strategies in adulthood; therefore, compliant behavior might be established in childhood.

Patient compliance and orthodontic treatment efficacy of Planas functional appliances with TheraMon microsensors

OBJECTIVES

To assess patient compliance and treatment efficacy of preventive expansion treatment with removable Planas functional appliances using an integrated microsensor.

MATERIALS AND METHODS

Wear time (WT) and behavior of 69 patients undergoing treatment with Planas functional appliances were assessed and analysed using TheraMon microsensors (Gschladt, Hargelsberg, Austria). Patients were followed up for a period of 9 months, and visits were made every 3 months to download WT data from the microsensor and to assess wearing behavior. From individual WT graphs,10 parameters were derived to characterize compliance for each patient. Treatment efficacy was measured by eight parameters determining the level of expansion after 9 months of treatment.

RESULTS

Patients wore their device on average 15.8 ± 5.2 h/d. WT was unrelated to age and gender, but it was positively influenced by patient habits when keeping appliances during eating, sports, care and handling. Treatment efficacy in terms of intercanine and intermolar expansion was 4.4 ± 1.9 mm and 4.6 ± 2.0 mm for the maxilla, and 5.3 ± 2.0 mm and 4.7 ± 2.3 mm for the mandible, respectively. Efficacy was negatively affected by poor compliance (WT < 9 h/d) and by high variability of within-subject WT recordings.

CONCLUSIONS

Perfect compliance is not necessary to achieve treatment success, but patients should exhibit sufficient wear time to allow maxillary expansion to occur. The TheraMon microsensor offers a new perspective and aid to individualize treatment prescriptions.

How patient-selected colors for removable appliances are reflected in electronically tracked compliance (wear times and wear behavior)

OBJECTIVES

A broad spectrum of colors for removable appliances, intended to optimize acceptance of treatment and patient cooperation, have been available on the dental market for years. This is the first study to analyze how patient-selected colors are reflected in wear times and wear behavior of removable appliances.

MATERIALS AND METHODS

The study included 117 children (55 girls and 62 boys) who were treated with active removable plate or functional appliances. All patients were offered to choose from 11 different colors, which were pooled into six groups (black, blue, green, yellow, pink, red) for analysis, or to combine any two to four colors ("multicolored" group) for their appliances. All appliances featured a built-in microsensor (TheraMon; MC Technology, Hargelsberg, Austria) for objective wear-time tracking. Differences between wear times were analyzed using pairwise t tests and Tukey correction.

RESULTS

The longest median wear times were recorded in the blue and green groups (≈11 h/d) and the shortest ones in the red and pink groups (≈9 h/d), but they were not significantly influenced by the patient-selected colors. The median wear times involved an age-related decrease by 0.56 h/y that was statistically significant ( P = .00005). No gender-specific patterns of wear behavior were observed.

CONCLUSIONS

Patient-selected colors for removable appliances can presumably improve acceptance of treatment, but they are not associated with statistically significant improvements in wear time or wear behavior.

Home Dental Bleaching Monitored With Microelectronic Sensors to Record the Wearing Times of an Acetate Tray/Bleaching Product

The present case study quantifies the clinical wearing time of an acetate tray/bleaching product during home dental bleaching. The patient was instructed to use a 10% carbamide peroxide gel for 6-8 hours each day for 20 days. The wearing time of the tray was measured by a microsensor from TheraMon microelectronic system (Sales Agency Gschladt, Hargelsberg, Austria) completely embedded in the tray so that the clinician would be informed as to the precise time the tray was placed in the mouth. Evaluation of the daily printout during dental bleaching demonstrated that the patient did not correctly follow the clinician's instructions as to the wearing time of the tray. Recording the wearing time of dental bleaching agents can be beneficial for both dental professional and patient to obtain a more effective treatment according to the patient's needs and expectations.

Compliance with removable orthodontic appliances

Data sourcesMedline via OVID, PubMed, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, LILACS and BBO databases. Unpublished clinical trials accessed using ClinicalTrials.gov, National Research Register, ProQuest Dissertation and Thesis database.Study selectionTwo authors searched studies from inception until May 2016 without language restrictions. Quantitative and qualitative studies incorporating objective data on compliance with removable appliances, barriers to appliance wear compliance, and interventions to improve compliance were included.Data extraction and synthesisQuality of research was assessed using the Cochrane Collaboration's risk of bias tool, the risk of bias in non-randomised studies of interventions (ROBINS-I), and the mixed methods appraisal tool. Statistical heterogeneity was investigated by examining a graphic display of the estimated compliance levels in conjunction with 95% confidence intervals and quantified using the I-squared statistic. A weighted estimate of objective compliance levels for different appliances in relation to stipulated wear and self-reported levels was also calculated. Risk of publication bias was assessed using funnel plots. Meta-regression was undertaken to assess the relative effects of appliance type on compliance levels.ResultsTwenty-four studies met the inclusion criteria. Of these, 11 were included in the quantitative synthesis. The mean duration of objectively measured wear was considerably lower than stipulated wear time amongst all appliances. Headgear had the greatest discrepancy (5.81 hours, 95% confidence interval, 4.98, 6.64). Self-reported wear time was consistently higher than objectively measured wear time amongst all appliances. Headgear had the greatest discrepancy (5.02 hours, 95% confidence interval, 3.64, 6.40). Two studies found an increase in compliance with headgear and Hawley retainers when patients were aware of monitoring. Five studies found younger age groups to be more compliant than older groups. Three studies also found compliance to be better in the early stages of treatment. Integration between quantitative and qualitative studies was not possible.ConclusionsCompliance with removable orthodontic appliances is suboptimal. Patients wear appliances for considerably less time than stipulated and self-reported. Compliance may be increased when patients are aware of monitoring; however, further research is required to identify effective interventions and possible barriers in order to improve removable orthodontic appliance compliance.

Twin Block appliance with acrylic capping does not have a significant inhibitory effect on lower incisor proclination

OBJECTIVE

To investigate the effect of acrylic capping, treatment duration, overjet, and lower incisor inclination on the posttreatment tooth position in patients treated with 2 Twin Block (TB) appliance versions.

MATERIALS AND METHODS

Cephalograms of 56 patients with Class II malocclusion (21 boys, 35 girls; mean age before treatment [T1] = 12.5 years; standard deviation, 0.7) treated with a TB appliance with either acrylic capping or ball-ended clasps on lower incisors were retrospectively collected and traced. Lower incisor inclination (L1-GoGn, L1-GoMe, L1-MP) was measured at T1 and after TB appliance removal (T2). Regression analysis was performed to evaluate the effect on the lower incisor inclination of appliance type, overjet, lower incisor inclination at T1, and treatment duration after adjusting for baseline measurements.

RESULTS

Appliance design was not a significant predictor for either incisor inclination measurement (P< .05). Pretreatment lower incisor inclination was the only factor significantly associated with final tooth inclination (L1-GoGn: β = 0.57, 95% confidence interval [CI] = 0.30, 0.84, P < .001; L1-GoMe: β = 0.56, 95% CI = 0.28, 0.84, P < .001; L1-MP: β = 0.46, 95% CI = 0.17, 0.75, P = .003). There was weak evidence that treatment duration excluding L1-MP (95% CI = -1.85, -0.02; P = .045) and overjet might be associated with inclination of lower incisors at T2.

CONCLUSIONS

TB appliance design with acrylic capping on lower incisors appears not to significantly control incisor proclination. Pretreatment lower incisor inclination may be significantly associated with tooth inclination after active TB treatment and should be considered in treatment planning.

When Do Skeletal Class III Patients Wear Their Reverse Pull Headgears?

Objective. The aim of this study is to evaluate the factors that affect wearing time and patient behavior during reverse pull headgear therapy with a newly designed reverse pull headgear. Methods. In clinical practice, new reverse pull headgears were applied to fifteen patients. The patients were monitored during reverse pull headgear therapy and the data were evaluated. Statistical analysis was made. Results. During the study, patients were monitored successfully and the evaluations showed that patients wear the new reverse pull headgears mostly at night. There are differences between days of week and hours of day. Weekends are more popular than weekdays for wearing reverse pull headgear. Conclusions. This new type of reverse pull headgears can be used successfully in clinical practice and can help the clinician. Study showed that the most important factor that affects the cooperation of reverse pull headgear patient is aesthetic appearance.

Objective assessment of compliance with intra- and extraoral removable appliances

OBJECTIVE

To conduct an objective assessment of the level of compliance in young patients prescribed various types of removable appliances and to determine the influence of device type, treatment duration, and patient age, gender, psychological maturity, and awareness of monitoring on compliance.

MATERIALS AND METHODS

A total of 30 patients were fitted with either a class 2 (Frankel or bionator) or a class 3 (face mask) removable appliance, each bearing a compliance indicator chip, and they were instructed to wear them for 13 hours per day. Compliance was monitored by means of the sensor for an average of 8 months. Of the patients, 14 were informed that their appliance was fitted with a monitoring sensor, and 16 were not. The psychological maturity of all patients was assessed on the Nowicki-Strickland Locus of Control Scale, and the effect on compliance of this score as well as the patient- and treatment-related variables considered were determined via statistical analysis Results: The mean compliance recorded by the chips was 8.6 ± 2.9 hours, far lower than the 13 hours prescribed, and younger patients showed significantly greater compliance than adolescents (P < .01). However, no significant differences in compliance were found between intra- and extraoral appliances, and neither gender, psychological scores, treatment duration, nor awareness of being monitored had any significant effect.

CONCLUSIONS

Compliance is generally very poor in young patients, regardless of their gender and psychological maturity. Although awareness of monitoring does not appear to boost compliance, such systems may be a valuable means of providing a dentist with objective information regarding their patients' compliance.

Performance of clear vacuum-formed thermoplastic retainers depending on retention protocol: a systematic review

We aimed at comparing the performance of vacuum-formed thermoplastic retainers (VFR) worn either full-time or part-time, in maintaining orthodontic treatment results in terms of tooth alignment, arch form and occlusion. We reviewed randomized and prospective controlled clinical trials comparing VFR wearing protocols and searched databases, without restrictions, for published and unpublished literature. The risk of bias was assessed using the Cochrane Risk of Bias tool and the overall level of certainty in the evidence following ADA methodology. 184 studies were initially identified and reduced to the 3 randomized controlled trials included in the systematic review by means of specific criteria. One study followed patients 1 year into retention, and the other two for 6 months. Little's Irregularity Index, intermolar and intercanine width, arch length, overjet and PAR score did not differ significantly between the patients wearing their retainers part time or full time. We observed a slight increase in the overbite in the part-time group in only one trial. With a moderate level of certainty, we found that during the observation period, full-time VFR wear is not superior to part-time, bearing in mind the potential implications for health burden, retainer longevity and cost-effectiveness, as well as patient satisfaction and compliance.

Treatment effects of fixed functional appliances in patients with Class II malocclusion: a systematic review and meta-analysis

OBJECTIVE

To assess the treatment effects of fixed functional appliances (FFAs) in treated versus untreated Class II patients by means of lateral cephalometric radiographs.

SEARCH METHODS

Unrestricted electronic search of 18 databases and additional manual searches up to October 2014.

SELECTION CRITERIA

Prospective randomized and non-randomized controlled trials reporting on cephalometric angular measurements of Class II patients treated with FFAs and their matched untreated controls.

DATA COLLECTION AND ANALYSIS

Skeletal, dental, and soft tissue cephalometric data were annualized and stratified according to the time of evaluation in effects. Following risk of bias evaluation, the mean differences (MDs) and 95 % confidence intervals (CIs) were calculated with random-effects models. Patient- and appliance-related subgroup analyses and sensitivity analyses were performed with mixed-effects models.

RESULTS

Nine studies were included (244 patients; mean age: 13.5 years and 174 untreated controls; mean age: 12.8 years) reporting on cephalometric effects directly after the removal of FFAs. FFAs were found to induce a small reduction of SNA angle (MD = -0.83 degree/year, 95 % CI: -1.17 to -0.48), a small increase of SNB angle (MD = 0.87 degree/year, 95 % CI: 0.30-1.43), and moderate decrease of ANB angle (MD = -1.74 degree/year, 95 % CI: -2.50 to -0.98) compared to untreated Class II patients. FFA treatment resulted in significant dentoalveolar and soft tissue changes. Several patient- or appliance-related factors seem to affect the treatment outcome. Long-term effectiveness of FFAs could not be assessed due to limited evidence.

CONCLUSIONS

According to existing evidence, FFAs seem to be effective in improving Class II malocclusion in the short term, although their effects seem to be mainly dentoalveolar rather than skeletal.

Treatment of large overjet in Angle Class II: division 1 malocclusion with Andresen activators versus prefabricated functional appliances-a multicenter, randomized, controlled trial

OBJECTIVES

The purpose of this study was to compare the clinical effectiveness in reducing large overjet between a prefabricated functional appliance (PFA) and a slightly modified Andresen activator (AA).

SETTING AND SAMPLE POPULATION

Public Dental Service, Gothenburg, Sweden.

PARTICIPANTS, STUDY DESIGN, AND METHODS

A multicentre, prospective randomized clinical trial was conducted with patients from 12 general dental practices. One hundred and five patients with an Angle Class II, division 1 malocclusion and an overjet of ≥6mm were eligible for the study. Eight patients were excluded due to various reasons and the sample consisted thus of 97 subjects (44 girls, 53 boys) with a mean age of 10.3 years. The study was designed as intention to treat and the patients were randomly allocated by lottery to treatment with either a PFA or an AA. The PFA and AA group consisted of 57 subjects (28 girls, 29 boys) and 40 subjects (16 girls, 24 boys), respectively. Overjet, overbite, lip seal, and sagittal molar relationship were recorded before, at the end of treatment and 1-year post-treatment. Blinding was not performed. The endpoint of treatment was set to overjet ≤3mm and after this a 6 months retention period followed.

RESULTS

No significant difference was found in overjet, overbite, sagittal relation, and lip seal between the two groups for the total observation period. The treatment of 40 (70 per cent) patients with PFA and 21 (53 per cent) with AA were considered unsuccessful mainly due to poor compliance.

LIMITATIONS

No cephalometric records were taken as only patient-centred clinical outcome were used as an indicator for treatment success. The criteria of reduction of overjet to as low as 3mm could have affected the success rate.

CONCLUSION

No difference in effectiveness could be shown between PFAs and AAs in correcting overjet, overbite, sagittal molar relation, and lip seal. The success rate in treatment with both appliances is, however, low.

REGISTRATION

This trial was registered in "FoU i Sverige" (http://www.fou.nu/is/sverige), registration number: 97131.

PROTOCOL

The protocol was not published before trial commencement.

Quantification of wear-time adherence of removable appliances in young orthodontic patients in relation to their BMI: a preliminary study

PURPOSE

The relationship between unhealthy body mass index (BMI) and adherence to orthodontic treatment with removable appliances has not previously been evaluated.

OBJECTIVE

The aim of this study was to quantify the association between BMI and wear time of removable orthodontic appliances and to evaluate BMI changes during orthodontic treatment.

PATIENTS AND METHODS

Fifty-three normal-weight and 39 overweight/obese children and adolescents (7-15 years old) undergoing orthodontic treatment with removable appliances were enrolled into the study. BMI categories were determined using standardized age-specific and sex-specific BMI criteria, using data measured at the beginning of therapy and once during orthodontic treatment. Wear times of removable appliances were measured at 15-minute intervals over a period of 5 months using implanted microelectronic sensors. Median wear-time values were used in the analysis with the Mann-Whitney U-test used to test statistical differences between groups.

RESULTS

The median wear time of removable orthodontic appliances was 9.3 hours for normal-weight patients and 9.2 hours for overweight/obese patients. No statistically significant (P>0.05) or clinically relevant differences in usage or adherence were detected between normal-weight and overweight/obese patients. BMI did not influence wear time or behavior of removable orthodontic appliances by young patients. The majority of patients showed qualitative decreases in BMI during therapy.

CONCLUSION

The orthodontic treatment of young patients with removable devices does not require BMI-dependent changes in the treatment strategy. However, the use of removable appliances during meal times raises the possibility of reducing food intake, and in this way the orthodontist may have an active role to play in weight reduction.