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Abstract

Introduction: Our objective was to assess patient satisfaction and changes in oral health-related quality of life immediately after orthodontic treatment using the Invisalign system (Align Technology, Santa Clara, Calif). Methods: Adult patients were recruited from private practices in Canada and surveyed using a combination of 2 validated questionnaires: Dental Impact of Daily Living and Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and changes in quality of life. Multivariate analysis of variance, regression analysis, and canonical correlation analysis were applied in the data analysis. Results: A total of 81 patients, 29.6% men and 70.4% women, exclusively treated with the Invisalign system participated. The most significant improvements were seen in the appearance and eating and chewing categories, with patients responding positively to more than 70% of the questions in those categories. Food packing between teeth, affecting 24% of the participants, and pain affecting 16% were the most common sources of dissatisfaction. However, these negative experiences were not strong enough to reduce the overall positive experience that patients reported. Appearance and dentofacial improvement were strongly correlated. Canonical correlation of the Patient Satisfaction Questionnaire factors showed that doctor-patient relationship had a significant correlation with situational aspects, dentofacial improvement, and the residual category. Phrases from the doctor-patient relationship category such as "the orthodontist treated me with respect" and "carefully explained what treatment would be like" were associated with higher patient satisfaction. Conclusions: Although positive changes in appearance and eating categories were linked with patient satisfaction, doctor-patient relationship was the factor that correlated better with multiple aspects of patient satisfaction.

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... The assumption that the dentoalveolar status is one of the most important factors in smile esthetics, attractiveness, and happiness has led to an increase in the popularity of orthodontic treatment in children and adults, which is indicated by the concept of oral health-related quality of life (OHRQoL). 15 OHRQoL is defined as a positive sensation that leads to the development of dentofacial self-confidence and an absence of the adverse effects of poor oral conditions on social life. Oral health has a significant impact on the physiological, social, and psychological health of a person. ...
... In our study, the number of females (62.3%) was higher than the number of males, similar to earlier studies. 15,26 A possible explanation may be that girls attach more importance to their physical appearance than boys, and therefore, are more likely to seek orthodontic treatment. Moreover, female participants reported a higher impact on OHRQoL scores due to treatment than males. ...
... 48,49 Studies show that patient satisfaction positively impacts the quality of life. 15,47,49 Our study suggested that the patients who were satisfied with the treatment experienced less anxiety and showed improved quality of life. ...
Article
Objective: This study aimed to evaluate the relationship between dental anxiety and fear levels, patient satisfaction, and oral health-related quality of life (OHRQoL) in patients undergoing orthodontic treatment. Methods: The study was conducted in the Department of Orthodontics, Sivas Cumhuriyet University Faculty of Dentistry. This cross-sectional study included 252 patients, aged 11-14 years undergoing orthodontic treatment. The data collection tools were the Index of Dental Anxiety and Fear (IDAF-4C+), the Child Perceptions Questionnaire (CPQ 11-14), the Patient Satisfaction Questionnaire, and the Clinical Examination Data Form. The CPQ 11-14 was used to measure OHRQoL. Descriptive statistics, the independent samples t-test, analysis of variance (ANOVA), Cronbach's alpha, and Pearson coefficient were used for statistical analysis at a significance level of 0.05. Results: The CPQ 11-14 parameters were sufficiently reliable, and the patients mostly had problems with oral symptoms. A significant difference was observed between the type of treatment, the initiation of treatment, emotional well-being, and social well-being (P < .05). The relationship between treatment satisfaction and all parameters was significant (P < .05). There was a significant relationship between IDAF-4C+ and CPQ 11-14, while a moderate correlation was found between dental anxiety and emotional well-being. Conclusion: According to the results of this study, the type of treatment, the initiation of treatment, and dental anxiety impact the quality of life. It was found that treatment satisfaction and a positive patient-dentist relationship positively affect the quality of life and dental anxiety.
... This does indicate that older patients tend to prefer more esthetic appliances, or that they can afford aligner or lingual treatment (which is more expensive at the clinic at which the study was performed). Cooper-Kazaz et al. [22] and Pacheco-Pereira et al. [23] observed a greater number of female patients choosing lingual or aligner therapy as their choice of appliance; however, we found no significant differences in gender in all three groups. ...
... This finding is consistent with White and colleagues [14] reporting that patient experience using aligners was superior. Pacheco-Pereira [23] also reported positive patient satisfaction in aligner patients. The majority of studies [14,23,[27][28][29] have found that aligners have a lesser impact on QoL compared to other appliances, although a recent article by Antonio-Zancajo et al. [30] did find contradicting results. ...
... Pacheco-Pereira [23] also reported positive patient satisfaction in aligner patients. The majority of studies [14,23,[27][28][29] have found that aligners have a lesser impact on QoL compared to other appliances, although a recent article by Antonio-Zancajo et al. [30] did find contradicting results. These results do not advocate the use of a particular appliance based solely on QoL. ...
Article
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Background Patient quality of life (QoL) during orthodontic treatment is an important consideration that requires greater academic investigation as greater focus is placed on enhancing patient experience. Quality of life (QoL) was assessed in three orthodontic appliance groups, i.e., vestibular, lingual, and aligners during the initial stages of treatment. The sample was comprised of 117 adult patient-subjects distributed into 3 groups: vestibular ( n = 41), lingual ( n = 37), and aligner ( n = 39). A WHOQOL-BREF questionnaire surveyed four domains (physical health, psychological health, social relationships, and environment). Results Mean scores for domain 1, physical health, showed that the aligner group (28.1) had significantly greater scores than that of the vestibular (22.7) or lingual (22) groups. Domain 2, psychological health, demonstrated significant differences ( P < 0.001) between all groups, with the aligner group scoring the highest (23.2), followed by the lingual (18.4) and vestibular (15.2) groups. Domain 3, social relationship, showed that aligner (10.9) and lingual (10.2) scores were significantly greater ( P < 0.001) than those of the vestibular group (7.8). Domain 4, environment, displayed significant differences between all groups, with the aligner group scoring highest (32.1), followed by the lingual group (29.3), and lastly the vestibular group (26.4). Overall, the highest mean score was obtained by the aligner group (23.1) and the lowest mean score was by the vestibular group (18). The mean domain scores for all three groups were significantly different ( P ≤ 0.005) from each other (Table 2). Conclusions Overall, patients undergoing Aligner therapy reported the overall highest QoL scores, followed by lingual and vestibular groups.
... Several studies have focused on assessing the treatment outcome of Invisalign ® in comparison to the metal bracket system. Regardless of the limited treatment effect reported on Invisalign ® -treated patients, there was a statistically similar satisfaction outcome in comparison to bracket-based patients in the assessment of the survey of Pacheco-Pereira et al. [4] in 2018. The Invisalign ® group even reported more satisfaction with eating and chewing. ...
... Modern patients choose treatment modalities that focus not only on the treatment effects and treatment expenses, but also on their quality of life during treatment. There are several investigations to assess the quality of different treatment methods in orthodontics [4,6]; few are related to the need before treatment and satisfaction after treatment. Regarding the satisfaction survey, the assessment tools are still limited to questionnaires [7] and are subject to subjectivity. ...
Article
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Background: Clear aligners have become a treatment alternative to metal brackets in recent years due to the advantages of aesthetics, comfort, and oral health improvement. Nevertheless, few studies have analyzed the clinical characteristics and dental indices of orthodontic patients using aligners or brackets. Methods: A total of 170 patients received orthodontic treatment at Chang Gung Memorial Hospital in 2021. Patients were stratified by types of treatment (Invisalign® clear aligner (n = 60) or metal bracket (n = 110). Results: Patients were aged 26.1 ± 7.2 years, and most were female (75.0%). The Invisalign® group was older than the bracket group (p = 0.003). The skeletal relationships were mainly Class I (49.4%), followed by Class II (30.0%) and Class III (20.6%). The molar relationships were primarily Class I (38.8%), followed by Class II (37.1%) and Class III (24.1%). The decayed, missing, and filled tooth (DMFT) index was 9.9 ± 6.0, including 2.1 ± 2.9 for decayed teeth, 0.5 ± 1.1 for missing teeth, and 7.3 ± 4.3 for filled teeth. There were no significant differences in the DMFT index or skeletal and molar relationships between the groups (p > 0.05). The index of complexity outcome and need (ICON) was 56.8 ± 13.5, and the score was lower in the Invisalign® group than in the bracket group (p = 0.002). Among the variables included in the ICON assessment, only the aesthetic variable was lower in the Invisalign® group than in the bracket group (p < 0.001). The Frankfort-mandibular plane angle was 27.9 ± 5.1 degrees. Finally, the E-line of the lower lip was lower in the Invisalign® group than in the bracket group (1.5 ± 2.4 versus 2.8 ± 3.1, p = 0.005). Conclusions: Older patients showed a greater intention to choose Invisalign® treatment for improving the appearance of their teeth than younger patients, who chose metal bracket treatment. The demand for Invisalign® aligner treatment for aesthetic reasons was substantial. A soft tissue profile with more protrusive lower lips and a greater need for orthodontic treatment was found in the bracket group.
... Removable orthodontic treatment impacts daily living to lesser extent than fixed orthodontics 35 . In this context, previous studies reported positive changes and high satisfaction with Invisalign treatment especially with eating, chewing and appearance 19,36,37 . Invisalign treatment was associated with better satisfaction, better oral health related quality of life, and less negative impacts on oral health than fixed orthodontics [12][13][14][15][16]19,20,37,38 . ...
... In this context, previous studies reported positive changes and high satisfaction with Invisalign treatment especially with eating, chewing and appearance 19,36,37 . Invisalign treatment was associated with better satisfaction, better oral health related quality of life, and less negative impacts on oral health than fixed orthodontics [12][13][14][15][16]19,20,37,38 . They were associated with less disruption to eating and chewing and were rated as more satisfactory than fixed appliances 16 . ...
Article
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This within subject clinical experiment assessed oral health impacts before and after Invisalign orthodontic treatment and their relationships with personality characteristics. 50 patients (26 females and 24 males; mean age = 27.62 ± 8.25 years, SE = 1.17, 95% CI = 24.71–29.89 years) were assessed before and after treatment with Invisalign orthodontic treatment. Treatment clinical success was evaluated according defined clinical guidelines. Oral health impacts before and after Invisalign orthodontic treatment were measured via the Oral Health Impact Profile (OHIP). Personality features were measured via the NEO Five-Factor Inventory (NEO-FFI). Probability of α = .05 was utilized to identify significant findings. Females scored less OHIP scores after treatment (had less negative impacts) in comparison to baseline OHIP scores (t = 3.782, df = 25, P = .001, 95% CI of mean difference = 2.750–9.327). Among males, openness scores (R² = .911, B = 5.235, 95% CI for B = 0.062–10.407, t = 2.601, P = .048) were able to predict OHIP scores before treatment; meanwhile, extraversion (R² = .959, B = − 8.224, 95% CI for B = − 14.605–1.843, t = − 3.313, P = .021), openness (R² = .959, B = 21.795, 95% CI for B = 10.737–32.853, t = 5.067, P = .004), and conscientiousness (R² = .959, B = 10.293, 95% CI for B = 4.796–15.790, t = 4.813, P = .005) scores were useful to predict OHIP scores after treatment (R² = .959, P < .05). NEO-FFI scores were not useful to predict OHIP scores before or after treatment among females (P > .05). These findings demonstrate that oral health impacts of Invisalign orthodontic treatment and personality profiles contribution to oral health impacts were different between genders.
... Clear aligner orthodontic treatment is a quickly growing sector in orthodontic technology due to the increasing demand [1,2]. Since Align Technology Inc. first introduced the Invisalign to the orthodontic market, as one of the pioneers of clear aligner therapy, many different types of clear aligners have been developed and became commercially available. ...
Article
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Background: The composite attachment loss during orthodontic clear aligner therapy is an adverse event that commonly happens in our daily practice. However, there is a lack of related statistical analysis and studies analyzing the related risk factors. Therefore, the aim of this study is to assess the incidence of attachment loss during orthodontic clear aligner therapy and to identify rick factors that may predict such event. Materials and methods: The demographics and clinical variables of 94 patients undergoing clear aligner therapy (27 males and 67 females; average age: 27.60 ± 0.86 years) were recorded. Both patient-related and tooth-related attachment loss was recorded. The chi-squared test and logistic regressive analysis were applied to identify the potential risk factors. SPSS for Mac (version 23.0, IBM, USA) was used for statistical analyses. P < 0.05 was considered statistically significant. Results: Our study suggested that the risk factors for attachment loss include frequent aligner removal (≥ 5 times a day) (losing rate = 60.0%, P = 0.005), aligner wear time less than 18 hours a day (losing rate = 50.8%, P = 0.014), eating without aligners inserted (losing rate = 47.9%, P = 0.034), utilizing aligner tray seaters (losing rate = 48.2%, P = 0.006), and unilateral mastication (losing rate = 52.1%, P = 0.002). The multivariable logistic regression analysis indicates that aligner wear time less than 18 hours a day (P = 0.020, B = 0.925), using aligner tray seaters (P = 0.007, B = 1.168), and unilateral mastication (P = 0.034, B = -0.458) were considered independent factors that can predict the composite attachment loss in orthodontic clear aligner therapy. Conclusion: Wearing aligner less than 18 hours a day, using aligner tray seaters, and unilateral mastication may contribute to increased incidence of composite attachment loss during orthodontic clear aligner therapy.
... In recent years, continuous search for esthetic alternatives and comfortable orthodontic treatment approaches have been reasons for significant increases in the number of cases treated with clear aligners. Recent studies have shown that patients specifically treated with Invisalign were satisfied with their esthetic results and showed an improvement in their QoL, especially when related to their smile and during chewing and eating functions analyzed after treatment [13,27]. However, concerning the efficacy of treatment, recent systematic reviews have suggested that this treatment modality presents some difficulties on specific orthodontic movements when compared with fixed appliances such as in rotation and vertical movements [14], ideal occlusal contacts, torque control, increasing transverse width and retention [16]. ...
Article
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Objectives: To assess if there is any difference in pain levels between orthodontic treatment with clear aligners or fixed appliances. Materials and methods: An electronic search was completed in PubMed, The Cochrane Database, Web of Science, Scopus, Lilacs, Google Scholar, Clinical Trials, and OpenGrey databases without any restrictions until February 2019. All comparative study types contrasting pain levels between clear aligners and fixed appliances were included. The risk of bias (RoB) was assessed using the Newcastle-Ottawa Scale, ROBINS-I-Tool, or ROB 2.0 according to the study design. The level of evidence was assessed through the GRADE tool. Results: After removal of duplicates, exclusion by title and abstract, and reading the full text, only seven articles were included. Five were prospective non-randomized clinical trials (CCT), one was a cross-sectional study, and one was a randomized clinical trial (RCT). Two studies presented a high RoB, three a moderate RoB, and two a low RoB (including the RCT). A meta-analysis was not performed because of clinical, statistical, and methodological heterogeneity. Most of the studies found that pain levels in patients treated with Invisalign were lower than those treated with conventional fixed appliances during the first days of treatment. Differences disappeared thereafter. No evidence was identified for other brands of clear aligners. Conclusions: Based on a moderate level of certainty, orthodontic patients treated with Invisalign appear to feel lower levels of pain than those treated with fixed appliances during the first few days of treatment. Thereafter (up to 3 months), differences were not noted. Malocclusion complexity level among included studies was mild. Pain is one of many considerations and predictability and technical outcome are more important, mainly considering that the difference does not seem to occur after the first months of the orthodontic treatment.
... Clear aligner orthodontic treatment is a quickly growing sector in orthodontic technology due to the increasing demand [1,2]. Since Align Technology Inc. rst introduced the Invisalign to the orthodontic market, as one of the pioneers of clear aligner therapy, many different types of clear aligners have been developed and became commercially available. ...
Preprint
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Background The composite attachment loss during orthodontic clear aligner therapy is an adverse event that commonly happens in our daily practice. However, there is a lack of related statistical analysis, and studies analyzing the related risk factors. Therefore, the aim of this study is to assess the incidence of attachment loss during orthodontic clear aligner therapy and to identify rick factors that may predict such event. Methods The demographics and clinical variables of 94 patients undergoing clear aligner therapy (27 males and 67 females; average age: 27.60± 0.86 years) were recorded. Both patient-related and tooth-related attachment loss was recorded. The chi-square test and logistic regressive analysis were applied to identify the potential risk factors. SPSS for Mac (version 23.0, IBM, USA) was used for statistical analyses. P<0.05 was considered statistically significant. Results Our study suggested that the risk factors for attachment loss include: frequent aligner removal (>= 5 times a day) (losing rate=60.0%, P=0.005); aligner wear time less than 18 hours a day (losing rate=50.8%, P=0.014); eating without aligners inserted (losing rate=47.9%, P=0.034); utilizing aligner tray seaters (losing rate=48.2%, P=0.006) and unilateral mastication (losing rate=52.1%, P=0.002). The multivariable logistic regression analysis indicates that aligner wear time less than 18 hours a day (P=0.020, B=0.925), using aligner tray seaters (P=0.007, B=1.168) and unilateral mastication (P=0.034, B=-0.458) were considered independent factors that can predict the composite attachment loss in orthodontic clear aligner therapy. Conclusion Wearing aligner less than 18 hours a day, using aligner tray seaters and unilateral mastication may contribute to increased incidence of composite attachment loss during orthodontic clear aligner therapy.
... Regarding lingual orthodontics, most authors consider that there is greater pain and impact on function (speech and chewing) in these patients compared with users of conventional orthodontics; however, aesthetics are improved [19][20][21]. This improvement in the perception of aesthetics and comfort by patients has also been observed in users of the Invisalign system, with a lower perception of pain from the second day onwards when compared with patients treated with conventional orthodontics [14,22]. ...
Article
Full-text available
The aim of this study was to compare pain and its relationship with the oral quality of life of patients with different types of orthodontic appliances: conventional and conventional low-friction brackets, lingual brackets, and aligners. A prospective clinical study was carried out with a sample size of 120 patients (54 men, 66 women) divided into 4 groups of 30 patients each. The modified McGill questionnaire was used to measure pain at 4, 8, and 24 h and 2, 3, 4, 5, 6, and 7 days after the start of treatment, and the Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the oral-health-related quality of life (OHRQoL) in the first month of treatment. The maximum peak of pain was obtained between 24 and 48 h of treatment. It was found that patients in the lingual orthodontic group described lower levels of pain at all times analyzed, and their scores in the total OHIP-14 indicated less impact on their oral quality of life (1.3 ± 1.2, p < 0.01) compared with the other groups analyzed. There was little difference with the aligners group (Invisalign) (1.7 ± 1.9, p < 0.01). The technique used influences the pain and quality of life of patients at the start of orthodontic treatment.
... This finding may be related to differences in perceptions regarding aesthetics and healthcare among women, compared with those of men. There is a consensus in the literature that women more of-ten seek and receive orthodontic treatment than do men [29][30][31] . In addition, Holmes [32] suggested that, despite a lack of objective evidence, women perceive themselves as having less-attractive teeth and more treatment needs than men. ...
Preprint
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Background: Coronavirus disease (COVID-19) has led to unprecedented challenges in the arts, sports, ed- ucation, finance, and healthcare. The aim of this study was to compare demographic characteristics of new-patient visits for orthodontic treatment in the pandemic year (2020) versus previous years. Methods: The retrospective study included patients who sought care at a tertiary orthodontic referral cen- ter between January 1, 2016 and December 31, 2020. Clinical and demographic characteristics, including age, age group (child, young adult, adult), gender, and numbers of monthly and annual new-patient vis- its were compared between the pre-pandemic (2017–2020) and post-pandemic (2020) periods. The daily average numbers of appointments were compared for 2019 versus 2020. Results: The average number of monthly new-patient visits was 240.69 ±81.48 in the pre-pandemic pe- riod, as opposed to 113.75 ±88.89 in the year 2020 ( P < 0.001). The average number of monthly new- patient visits decreased by 48.3% in 2020 compared to 2019, while the average number of daily new- patient visits in 2020 decreased significantly in all months ( P < 0.05), except for January ( P = 0.613) compared to the monthly numbers from the previous year. No significant difference was found between the pre-pandemic period and 2020 with regard to gender ( P = 0.410). In all years, the numbers of new- patient visits were higher for women, compared with men, and for children, compared with adults. Conclusions: The results indicated a sharp decrease in the number of new-patient visits for orthodontic treatment in the pandemic year (2020) compared to previous years.
... In a study analyzing 1564 Twitter posts about Invisalign treatment; positive tweets were about treatment satisfaction and improved self-esteem [9]. Another study showed that pain was troublesome for 16% of Invisalign patients but this did not affect the overall positive experience [35]. In the OHQOL study, patients treated with buccal brackets, regardless of whether they were metal or esthetic, reported the worst quality of life, while the group with aligners showed almost no change. ...
Article
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Aligners are an example of how advances in dentistry can develop from innovative combinations of 3D technologies in imaging, planning and printing to provide new treatment modalities. With increasing demand for esthetic orthodontic treatment, aligners have grown in popularity because they are esthetically more pleasing and less obstructive to oral hygiene and other oral functions compared to fixed orthodontic appliances. To observe and estimate aligner treatment interest among Google Search users, Google Trends data were obtained and analyzed for the search term, “Invisalign”. A prediction of interest for the year 2022 for three European Union countries with the highest GDP was developed. “Invisalign” was chosen to represent all orthodontic aligners as the most searched term in Google Trends for aligners. This is the first study to predict interest in the query “Invisalign” in a Google search engine. The Prophet algorithm, which depends on advanced statistical analysis methods, positions itself as an automatic prediction procedure and was used to predict Google Trends data. Seasonality modeling was based on the standard Fourier series to provide a flexible model of periodic effects. The results predict an increase in “Invisalign” in Google Trends queries in the coming year, increasing by around 6%, 9% and 13% by the end of 2022 compared to 2021 for France, Italy and Germany, respectively. Forecasting allows practitioners to plan for growing demand for particular treatments, consider taking continuing education, specifically, aligner certification courses, or introduce modern scanning technology into offices. The oral health community can use similar prediction tools and methods to remain alert to future changes in patient demand to improve the responses of professional organizations as a whole, work more effectively with governments if needed, and provide better coordination of care for patients.
... The pain and discomfort that patients have reported during their orthodontic treatments were shown to influence their commitment to oral hygiene negatively [28]. The satisfaction of patients with treatments using transparent aligners (e.g., Invisalign) may be related to the patient´s perceived improvement in appearance and their food choices compared to those with fixed multibrackets [29]. Other authors concluded that there were no statistically significant differences between patients with removable aligners and patients with fixed multibrackets appliances. ...
Article
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The aim of this study was to evaluate the perception of periodontal pain in patients treated with either fixed multibrackets or removable alignment systems with a monthly follow-up over a period of twelve months. Materials and Methods: This longitudinal clinical study comprised a sample of 140 patients (72 women; 68 men) divided into two groups of 70 patients each: the bracket group (BG) with conventional fixed brackets using the MBT technique with a 0.022″ slot and the Invisalign group (IG) with aligners (Invisalign). The visual analog scale (VAS) was used to quantify patient-reported pain. Pain analysis was conducted monthly at 4 (T1), 8 (T2), and 24 h (T3) post-follow-up as well as at 2 (T4), 3 (T5), 4 (T6), 5 (T7), 6 (T8), and 7 days (T9) post-follow-up during the first twelve months after starting orthodontic treatment. Results: Statistically significant differences (p < 0.05) were observed between both study groups in the mean pain scores on the visual analog scale (VAS) during the twelve-month follow-up period, except for during the eighth month of treatment. In the first month, the group with conventional brackets reported higher pain scores. From the second month onwards, we observed that patients with aligners described a higher level of pain compared to the group of patients with conventional brackets. In both experimental groups, though at different evaluation periods, we found that the peak of maximum pain occurred between 24 and 48 h (T3–T4) after monthly follow-up appointments; from this point, the pain decreased until reaching minimum values from the fifth day onwards (T7). Conclusions: In the first month of treatment, the patients with conventional fixed multibrackets reported the highest levels of pain compared to those with removable aligners. From the second month on, this trend changed. The patients with removable aligners reported the highest levels of pain. Therefore, the orthodontic system used influenced the perception of pain in patients.
... Few studies evaluating the effect of orthodontic treatment on the OHRQoL have shown, due to functional limitations, an improvement in the OHRQoL after treatment and a decrease in the OHRQoL during the first few weeks of treatment [16]. ...
Article
Background Wearing fixed orthodontic appliances may negatively impact oral health-related quality of life (OHRQoL) during treatment. This study aimed to compare the OHRQoL of patients treated with labial or lingual appliances. Methodology A total of 38 patients (23 females, 15 males; mean age: 21.3 years) with class I malocclusion and moderate crowding in the upper and lower dental arches were included. These patients were planned to be treated on a non-extraction basis and were randomly divided into the following two groups: the lingual appliance (LA) group and the buccal appliance (BA) group. The Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the OHRQoL at the following six assessment times: before treatment (T0), one week after treatment (T1), one month after treatment (T2), three months after treatment (T3), six months after treatment (T4), and at the end of the active treatment (T5). Results In total, 19 patients in each group were included in the final analysis with no dropouts. In both groups, the overall OHIP-14 scores increased and peaked on the first week following appliance placement and then significantly decreased over time. The LA group had significantly greater overall OHIP‑14 scores than the labial group at T1 (p < 0.001) and T2 (p = 0.004) only. Conclusions The OHRQoL improved in both lingual and labial groups after treatment. Moreover, it was better in the labial group compared to the lingual group during the first month of treatment. In both groups, the greatest deterioration in OHRQoL occurred in the first week and gradually decreased over time.
Article
Introduction: Winged maxillary central incisors (WMCI), defined as mesiopalatal rotation of the crowns of maxillary central incisors, is a common dental trait that affects smile esthetics. This retrospective study aimed to determine the efficacy of rotation and uprighting tooth movements of bilateral WMCI with Invisalign (Align Technology, Santa Clara, Calif). Methods: Initial, predicted, and achieved stereolithography files of 30 adult patients, consecutively treated with the Invisalign SmartTrack appliance, were superimposed using Geomagic Control X 64 (3D Systems, Rock Hill, SC). The pairs of incisors were assessed for rotation using the interlabial angle (ILA), and individual incisors were measured for rotation and tip. Results: Programmed rotation and uprighting of WMCI are mostly undercorrected with the Invisalign appliance. The mean shortfall in ILA was 10.5° (standard deviation [SD], 10.66; 95% confidence interval [CI], 5.89-14.19; P <0.001) for a mean predicted change of 35.27°. For individual incisors, a mean shortfall of 5.38° (SD, 5.88; 95% CI, 3.58-6.76; P <0.001) was found for a mean 18.75° predicted change in rotation. A mean predicted change in tip of 7.06° showed a mean shortfall of was 2.16° (SD, 3.86°; 95% CI, 1.03-3.01; P <0.001). A moderate and statistically significant correlation between shortfalls in rotation and tip was observed (r = 0.44). Linear regression analysis was used to formulate an equation as a clinical tool to determine the likely achieved outcome on the basis of the predicted change. Conclusions: Predicted changes in rotation, ILA, and tip were both under and overexpressed. In particular, tip was dependent on the magnitude of planned change. The random inconsistencies in the clinical expression of rotation and tipping warrant careful monitoring and/or remedial actions such as overcorrections aligners.
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RESUMO: O objetivo consiste na elaboração de uma revisão bibliográfica acerca dos alinhadores estéticos ortodônticos, suas vantagens e desvantagens, benefícios e limitações. Classifica-se como uma revisão bibliográfica de caráter exploratório acerca da utilização de alinhadores invisaling®, através de buscas nas plataformas: Pubmed, Google Acadêmico e Scielo, Lilacs e Bireme, aplicando como filtro principal artigos publicados entre 2016 a 2021. A buscas realizadas totalizaram 138 artigos, que após a leitura do título, leitura do resumo e leitura total do conteúdo, permitiu a seleção 30 artigos. Conclui-se que os alinhadores invisalign® se trata de um recurso revolucionário para ortodontia estética, tendo em vista a sua estrutura conformacional, além de demonstrar eficiência no tratamento ortodônticos de maloclusões leves ou moderadas, porém suas limitações relacionam-se a casos severos que apresentem necessidade de expansão do arco através da movimentação dentária corporal, fechamento de espaços após exodontias, ajustes oclusais e em casos de discrepâncias ântero-posteriores verticais.
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Aggressive promotion by stakeholders and increased public awareness for alternative esthetic orthodontic treatment options have popularized the demand for clear aligner therapy (CAT). Patient demand is driven by appearance, comfort, convenience, and less complicated oral hygiene control. CAT is an important treatment alternative to conventional fixed appliances and a viable alternative for mild-to-moderate malocclusions in nonextraction, nongrowing patients. CAT is less effective and predictable than conventional fixed appliances for complex orthodontic tooth movements and malocclusions. However, the introduction of improved software, aligner materials, and auxiliary devices has enhanced the scope of malocclusions that may be treated. Managing complex tooth movements during CAT requires auxiliaries, overcorrections, and refinements to improve the predictability, effectiveness, and stability of treatment outcomes. The main predictors of treatment outcome are proper patient selection, patient complexity, treatment planning, compliance, clinician experience, and regular monitoring. Currently, there are no evidence-based clinical guidelines for CAT. Aligner technology and therapy are continuously evolving and improving. This literature review aimed to assess and summarize current scientific knowledge and evidence relating to CAT.
Article
Introduction The aims of this study were to (1) investigate and compare the educational value of the most popular YouTube (www.youtube.com; Google, San Bruno, Calif) orthodontic patient testimonials between braces, in-office aligners (IOA), and direct-to-consumer aligners (DTCA), and (2) classify the emotional response of the viewers through sentiment analysis of the video comments. Methods Three different phrases relevant to braces, IOA, and DTCA were searched on YouTube. The 20 most popular patient testimonial videos meeting the criteria for each group were selected for a total of 60 videos. Using the YouTube application program interface for each video, 13 video metrics were extracted. An information completeness score was assigned, and the video comments were analyzed using sentiment analysis software. Results The 60 videos included were viewed 34.4 million times by internet users. Braces videos had significantly more likes, comments, and a higher viewer interaction score than the IOA and DTCA videos. IOA videos had a higher median information completeness score than braces and DTCA videos. Of the 5149 video comments with polarity, 53.6% were positive, and 46.4% were negative (P <0.0001). There was no significant association between the treatment modality and positive or negative comments (P = 0.5679). Conclusions There is high user engagement on YouTube with orthodontic patient testimonials. YouTube users interact with braces patient testimonials the most. YouTube viewers’ comments on orthodontic patient testimonials express more positive sentiment than negative sentiment. There was no significant difference in positive and negative sentiment between the video comments for the 3 different treatment modalities.
Article
Introduction This article evaluates and reports on the satisfaction of adult patients across the United States who received orthodontic treatment for anterior open bite malocclusion. The factors that influence satisfaction are also described. Methods Practitioners were recruited from the National Dental Practice-Based Research Network. On joining the Network, practitioner demographics and information on their practices were acquired. Practitioners enrolled their adult patients in active treatment for anterior open bite. Patient demographics, patient dentofacial characteristics, and details regarding previous and current treatment were collected through questionnaires at enrollment (T1). Pretreatment lateral cephalograms and intraoral frontal photographs were submitted. Treatment performed, and details related to treatment outcome were recorded through questionnaires at the end of active treatment (T2). Posttreatment lateral cephalograms and intraoral frontal photographs were submitted. Patient satisfaction at T2 was assessed using a 5-point Likert-type scale and open-ended responses. Predictive univariate models were developed to evaluate the factors that affect patient satisfaction. Open-ended responses were reviewed for general trends. Results T2 data were received for 260 patients, and 248 of these patients completed and returned the patient satisfaction questionnaires. High levels of satisfaction were found in this sample of adult patients receiving treatment for anterior open bite malocclusion. Specifically, 96% of the sample reported being very or somewhat satisfied. Only 10 patients (4%) were not satisfied with the treatment provided or an element of the final result. Successful open bite closure, treatment modality, and certain patient characteristics may affect patient satisfaction. However, there was insufficient power to demonstrate statistical significance because of the very low number of dissatisfied patients. Open-ended responses directly associated with patient satisfaction were received from 23 patients (9%). They relayed positive, neutral, and negative feelings about the treatment received and final results. Additional responses regarding the orthodontic treatment in general, but not specifically linked to patient satisfaction, were received from 119 patients (48%). These comments depict an overwhelmingly positive experience. Conclusions Adult patients who received orthodontic treatment for anterior open bite malocclusion were generally satisfied with the treatment provided, as well as the final esthetic and functional results.
Purpose Monitoring the perception of quality by parents and the satisfaction with their children’s treatment is crucial in developing high-level health-care services. The purpose of this paper is to identify the perceived quality factors by parents of paediatric orthodontic patients according to the levels of satisfaction. Design/methodology/approach A survey with 316 parents of paediatric orthodontic patients of 45 offices in a big Brazilian city was conducted. The questionnaires included statements on the parents’ satisfaction and perception of quality concerning their children’s treatment. The data were analysed using multivariate statistics (exploratory factor analysis, cluster analysis and discriminant analysis). Findings Parents were classified into three clusters according to their level of satisfaction. This survey identified 11 quality factors perceived by parents of patients regarding their children’s orthodontic treatment. Among them, five factors discriminated the clusters: orthodontist’s technical skills, administrative organisation, location (accessibility and convenience), treatment duration and dental supplies. Practical implications This research identified the perceived quality factors that most impacted parents of orthodontic patients’ satisfaction, contributing to dentists in developing strategies and actions to improve the quality of services in dental offices. Originality/value This paper included 11 perceived quality factors in the hypothetical model, identified through literature review and a qualitative phase. Moreover, multivariate statistical analyses confirmed the validity and reliability of the questionnaires, classified respondents in clusters and identified the perceived quality factors that most discriminated them. Therefore, the current investigation presented a more comprehensive and robust analysis than the previous studies on this topic.
Article
In this study, we propose an integrated tooth segmentation and gingival tissue deformation simulation framework used to design and evaluate the orthodontic treatment plan especially with invisible aligners. Firstly, the bio-characteristics information of the digital impression is analyzed quantitatively and demonstrated visually. With the derived information, the transitional regions of tooth-tooth and tooth-gingiva are extracted as the solution domain of the segmentation boundaries. Then, a boundary detection approach is proposed, which is used for the tooth segmentation and region division of the digital impression. After tooth segmentation, we propose the deformation simulation framework driven by energy function based on the biological deformation properties of gingival tissues. The correctness and availability of the proposed segmentation and gingival tissue deformation simulation framework are demonstrated with typical cases and qualitative analysis. Experimental results show that segmentation boundaries calculated by the proposed method are accurate, and local details of the digital impression under study are preserved well during deformation simulation. Qualitative analysis results of the gingival tissues’ surface area and volume variations indicate that the proposed gingival tissue deformation simulation framework is consistent with the clinical gingival tissue deformation characteristics, and it can be used to predict the rationality of the treatment plan from both visual inspection and numerical simulation. The proposed tooth segmentation and gingival tissue deformation simulation framework is shown to be effective and has good practicability, but accurate quantitative analysis based on clinical results is still an open problem in this study. Combined with tooth rearrangement steps, it can be used to design the orthodontic treatment plan, and to output the data for production of invisible aligners. Graphical abstract
Article
Background and objectives: Clear aligner is an advanced orthodontic method with benefits of comfort, aesthetics, and convenience. This study aimed to compare pain perception, anxiety, and impacts on oral health-related quality of life (OHRQoL) between adult patients receiving clear aligners and fixed appliances during the initial stage of orthodontic treatments. Material and methods: The two groups were well matched by ages, gender, and levels of malocclusion severity. Pain perception, anxiety, and OHRQoL were assessed through visual analogue scale, state-trait anxiety inventory, and oral health impact profile-14 (OHIP-14), respectively. And the comparison of above scores was performed by two-way analysis of variance. Results: A total of 110 patients (55 pairs) were enrolled in this study. Orthodontic pain levels peaked on the first day and decreased gradually afterwards in both groups, which were significantly higher in the fixed group on the first, second, fourth, and fifth days. Likewise, anxiety levels peaked on the first day and decreased thereafter, with significant difference on the 1st, 3d, 5th, 7th, and 14th days. Moreover, the OHIP-14 scores increased and peaked on the first day and then gradually decreased for both groups, which were also significantly higher in the fixed group on the 1st, 7th, and 14th days. Limitations: More malocclusion types should be used for group matching. The effect of exclusion of small groups should be taken into consideration in sample size calculation. Income was significantly unbalanced between two groups due to higher cost of clear aligners, and random assignment of treatment modalities was unfeasible. Conclusions: Patients treated with clear aligners experienced lower pain levels, less anxiety, and higher OHRQoL as compared to those receiving fixed appliances.
Article
Elastodontic appliance (EA) is a type of removable appliance that has been widely used in interceptive orthodontics. The present case report describes a severe crowding case treated with a new two-phase protocol by using an EA and a fixed appliance. A 13-year-old patient with severe dental crowding, increased overjet and overbite on a skeletal Class II base was selected. The patient had four bicuspids extracted; during the first phase of treatment, she wore the EA for 2 h during the daytime plus overnight, combined with a myofunctional exercise. During the second phase of treatment, a fixed appliance was employed to close residual space and improve the teeth angulations. The total treatment time was 14 months, of which the second phase with fixed appliance lasted 10 months. Satisfactory improvements of the overjet and teeth alignment were achieved. This case report used a new two-phase treatment protocol which resulted in a favourable outcome after comparatively short treatment.
Article
Introduction: Our objectives were to assess patient satisfaction and quality of life among adults via 2 validated comprehensive questionnaires and to compare patient satisfaction and status in oral health-related quality of life immediately after orthodontic treatment in patients treated with Invisalign (Align Technology, San Jose, Calif) and those who received standard bracket-based treatment. Methods: Adult patients (n = 145) treated with bracket-based or Invisalign therapy were recruited from several private practices and a university clinic. The survey comprised a combination of the Dental Impacts on Daily Living index and the Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and quality of life. Multivariate analysis of variance and the bootstrap test were applied. A reliability analysis was used to assess responses at a 6-month follow-up for a small sample of patients. Results: Finally, 122 patients were assessed. The multivariate analysis of variance analysis showed that the eating and chewing dimension was significantly different between the 2 groups (Invisalign, 49%; bracket based, 24%; P = 0.047). No significant difference in any other satisfaction factors (all, P > 0.05) was identified. The follow-up assessment was only possible in a small sample of the bracket group; it showed adequate reliability values on the categories of oral comfort (intraclass correlation coefficient [ICC], 0.71), general performance (ICC, 0.755), situational (ICC, 0.80), and doctor-patient relationship (ICC, 0.75). Conclusions: Of the patients surveyed to assess their satisfaction and oral health-related quality of life immediately after completion of their orthodontic treatment, both the bracket-based and Invisalign treated patients had statistically similar satisfaction outcomes across all dimensions analyzed, except for eating and chewing: the Invisalign group reported more satisfaction. Patient satisfaction remained relatively similar 6 months later for the bracket-type treatment.
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Background: The objectives of this study were to investigated changes in OHRQoL among patients with different classifications of malocclusion during comprehensive orthodontic treatment. Methods: Clinical data were collected from 81 patients (aged 15 to 24) who had undergone comprehensive orthodontic treatment. Participants were classified 3 groups: Class I (n = 35), II (n = 32) and III (n = 14) by Angle classification. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T0), after alignment and leveling (T1), after correction of molar relationship and space closure (T2), after finishing (T3). Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the relative changes of OHRQoL among the different time points. A Bonferroni correction with P < 0.005 was used to declare significance. Results: Significant reductions were observed in all seven OHIP-14 domains of three groups except for social disability (P > 0.005) in class I and class II, Handicap in class II and class III (P > 0.005). Class I patients showed significant changes for psychological disability and psychological discomfort domain at T1, functional limitation, physical pain at T2. Class III patients showed a significant benefit in all domains except physical pain and functional limitation. Class II patients showed significant changes in the physical pain, functional disability, and physical disability domains at T1. Conclusions: The impact of comprehensive orthodontic treatment on patients' OHRQoL do not follow the same pattern among patients with different malocclusion. Class II patients benefits the most from the stage of space closure, while class I patients benefits the first stage (alignment and leveling) of treatment in psychological disability and psychological discomfort domains.
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Objective: To synthesize available evidence about factors associated with patients' satisfaction after orthodontic treatment combined with orthognathic surgery. Materials and methods: Studies that evaluated any factor associated with patients' satisfaction after the conclusion of an orthodontic treatment combined with an orthognathic surgery were identified. Orthognathic surgical procedures should have been undertaken after completion of craniofacial growth. Any satisfaction psychometric tool was considered. No language limitation was set. A detailed individual search strategy for each of the following bibliographic databases was crafted: MEDLINE, PubMed, EBM Reviews, Web of Science, EMBASE, LILACS, and Scopus. The references cited in the identified articles were also cross-checked, and a partial gray-literature search was undertaken using Google Scholar. Results: Eight articles satisfied the inclusion criteria of this systematic review and accounted for 998 patients. The included studies showed large variation in sample size (range = 44 to 505 patients), age (range = 15 to 72 years old), distinct psychological evaluation tools, and time elapsed between the assessment and the completion of surgery and postorthodontic treatment. Most of the studies (five of eight) were classified as having high risk of bias. Conclusion: Factors associated with satisfaction were final esthetic outcome, perceived social benefits from the outcome, type of orthognathic surgery, sex, and changes in patient self-concept during treatment. Factors associated with dissatisfaction were treatment length; sensation of functional impairment and/or dysfunction after surgery, and perceived omitted information about surgical risks.
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Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. The use of aligners in orthodontic therapy increased strongly during the last decade. In the literature, the reports about effects of aligner treatment on oral hygiene and gingival conditions are scarce. This cross-sectional study evaluated oral hygiene and patient's satisfaction during orthodontic treatment of patients with FOA or Invisalign®. 100 patients (FOA = 50, Invisalign® = 50) were included who underwent orthodontic treatment for more than 6 months. Clinical examinations were performed to evaluate patients' periodontal condition and were compared with clinical data at the beginning of the orthodontic treatment. Oral hygiene, patients' satisfaction and dietary habits were documented by a detailed questionnaire. For statistical analysis, the Mann-Whitney U-Test and Fisher's Exact Test were used; as multiple testing was applied, a Bonferroni correction was performed. At the time of clinical examinations, patients with FOA were in orthodontic therapy for 12.9 ± 7.2 months, whereas patients with Invisalign® were in orthodontic therapy for 12.6 ± 7.4 months. Significantly better gingival health conditions were recorded in Invisalign® patients (GI: 0.54 ± 0.50 for FOA versus 0.35 ± 0.34 for Invisalign®; SBI: 15.2 ± 7.6 for FOA versus 7.6 ± 4.1 for Invisalign®), whereas the amount of dental plaque was also less but not significantly different (API: 37.7 % ± 21.9 for FOA versus 27.8 % ± 24.6 for Invisalign®). The evaluation of the questionnaire showed greater patients' satisfaction in patients treated with Invisalign® than with FOA. Patients treated with Invisalign® have a better periodontal health and greater satisfaction during orthodontic treatment than patients treated with FOA.
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Background Although a great number of specific quality of life measures have been developed to analyze the impact of wearing fixed appliances, there is still a paucity of systematic appraisal of the consequences of orthodontics on quality of life. To assess the current evidence of the relationship between orthodontic treatment and quality of life. Methods Four electronic databases were searched for articles concerning the impact of orthodontic treatment on quality of life published between January 1960 and December 2013. Electronic searches were supplemented by manual searches and reference linkages. Eligible literature was reviewed and assessed by methodologic quality as well as by analytic results. Results From 204 reviewed articles, 11 met the inclusion criteria and used standardized health related quality of life and orthodontic assessment measures. The majority of studies (7/11) were conducted among child/adolescent populations. Eight of the papers were categorized as level 1 or 2 evidence based on the criteria of the Oxford Centre for Evidence-Based Medicine. An observed association between quality of life and orthodontic treatment was generally detected irrespective of how they were assessed. However, the strength of the association could be described as modest at best. Key findings and future research considerations are described in the review. Conclusions Findings of this review suggest that there is an association (albeit modest) between orthodontic treatment and quality of life. There is a need for further studies of their relationship, particularly studies that employ standardized assessment methods so that outcomes are uniform and thus amenable to meta-analysis.
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Objectives: To examine factors associated with treatment outcome satisfaction in a group of adolescent patients. Materials and methods: One hundred and twenty patients (60 girls and 60 boys; mean age, 14.3 years; standard deviation [SD], 1.73 years) were consecutively recruited. The inclusion criteria for all patients were as follows: adolescents with a permanent dentition in need of orthodontic treatment and a treatment plan involving extractions (two or four premolars) followed by fixed appliances in both jaws. Questionnaire 1, concerning treatment motivation and expectations, was assessed prior to treatment start. Questionnaire 2 was assessed after active treatment and included questions about satisfaction with treatment outcome, quality of care and attention, and perceived pain and discomfort during active treatment. Results: One hundred and ten patients completed the trial (54 boys and 56 girls; mean age, 16.9 years; SD, 1.78 years). Median values for satisfaction with treatment outcome were generally high. There was a clear correlation (P ≤ .001) between satisfaction with treatment outcome and patients' perception of how well they had been informed and cared for during treatment. Pain and discomfort during treatment also strongly affected treatment satisfaction. Sex, treatment time, and Peer Assessment Rating index pre- and posttreatment as well as expectations for future treatment showed no correlation with treatment satisfaction. Conclusions: Care and attention was the variable showing the highest correlation with satisfaction with treatment outcome. Patients' perceptions of pain and discomfort during treatment had an overall negative correlation with treatment satisfaction. Satisfaction with treatment outcome is a complex issue and requires further exploration in future research.
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Objective: To assess changes in oral health-related quality of life (OHQoL) in children undergoing fixed orthodontic treatment and compare it to that of two groups not receiving treatment. Materials and methods: Two hundred eighty-four subjects aged 12-15 years were followed for 2 years; 87 were undergoing treatment at a university clinic (TG), 101 were waiting for treatment at this clinic (WG), and 96 were attending a public school and had never sought treatment (SG). OHQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T1), 1 year later (T2), and 2 years later (T3). OHIP-14 scores were analyzed using negative binomial regression in generalized estimating equations for correlated data. Results: During the follow-up period, the WG and TG OHIP-14 scores showed a statistically significant increase and decrease, respectively (P < .001). At T1, the TG had an OHIP-14 score that was 1.9 times higher than that of the SG; however at T3, the TG score was 60% lower than the initial score of the SG. Adjusting for age, gender, dental health status (DMFT), socioeconomic position, malocclusion severity, and self-perceived esthetics did not change the effect of orthodontic treatment on OHQoL. Conclusion: Fixed orthodontic treatment in Brazilian children resulted in significantly improved OHQoL after 2 years.
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Three studies examined generational differences in life goals, concern for others, and civic orientation among American high school seniors (Monitoring the Future; N = 463,753, 1976-2008) and entering college students (The American Freshman; N = 8.7 million, 1966-2009). Compared to Baby Boomers (born 1946-1961) at the same age, GenX'ers (born 1962-1981) and Millennials (born after 1982) considered goals related to extrinsic values (money, image, fame) more important and those related to intrinsic values (self-acceptance, affiliation, community) less important. Concern for others (e.g., empathy for outgroups, charity donations, the importance of having a job worthwhile to society) declined slightly. Community service rose but was also increasingly required for high school graduation over the same time period. Civic orientation (e.g., interest in social problems, political participation, trust in government, taking action to help the environment and save energy) declined an average of d = -.34, with about half the decline occurring between GenX and the Millennials. Some of the largest declines appeared in taking action to help the environment. In most cases, Millennials slowed, though did not reverse, trends toward reduced community feeling begun by GenX. The results generally support the "Generation Me" view of generational differences rather than the "Generation We" or no change views.
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Effective doctor-patient communication is a central clinical function in building a therapeutic doctor-patient relationship, which is the heart and art of medicine. This is important in the delivery of high-quality health care. Much patient dissatisfaction and many complaints are due to breakdown in the doctor-patient relationship. However, many doctors tend to overestimate their ability in communication. Over the years, much has been published in the literature on this important topic. We review the literature on doctor-patient communication.
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To identify factors associated with patient satisfaction at least 5 years after orthodontic treatment. A total of 209 orthodontic patients were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances. Dental casts (n = 627) were examined using the Peer Assessment Rating (PAR) Index pretreatment (T1), at the end of treatment (T2) and at a long-term follow-up (mean, 8.5 years; T3). At T3, a Dental Impact on Daily Living questionnaire was used to assess the long-term effects of orthodontic treatment on daily living and satisfaction with the dentition. Multiple regression analyses were used to quantify associations between patient satisfaction and changes produced by the orthodontic treatment (PAR T2-T1), posttreatment stability (PAR T3), age at the start of treatment (T1), treatment duration (T2-T1), gender, and extraction. Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at least 5 years after treatment. Regression analysis showed that satisfaction was significantly associated only with the long-term posttreatment PAR index (r(2) = 0.125, P < .0001). No significant association was observed with the severity of malocclusion at the beginning (PAR-T1) or end of the orthodontic treatment (PAR-T2), age at T1, the amount of time taken during orthodontic treatment, gender, or extraction. Over the long term, patient satisfaction is slightly associated with the stability of the orthodontic treatment regardless of the initial occlusal condition or the final result of the orthodontic treatment.
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A recent article by Jamieson in Medical Education outlined some of the (alleged) abuses of “Likert scales” with suggestions about how researchers can overcome some of the (alleged) methodological pitfalls and limitations[1]. However, many of the ideas advanced in the Jamison article, as well as a great many of articles it cited, and similar recent articles in medical, health, psychology, and educational journals and books, are themselves common misunderstandings, misconceptions, conceptual errors, persistent myths and “urban legends” about “Likert scales” and their characteristics and qualities that have been propagated and perpetuated across six decades, for a variety of differentreasons. This article identifies, analyses and traces many of these aforementioned problems and presents the arguments, counter arguments and empirical evidence that show these many persistent claims and myths about “Likert scales” to be factually incorrect and untrue. Many studies have shown that Likert Scales (as opposed to single Likert response format items) produce interval data and thatthe F-test is very robust to violations of the interval data assumption and moderate skewing and may be used to analyze “Likert data” (even if it is ordinal), but not on an item-by-item “shotgun” basis, which is simply a current research and analysis practice that must stop. After sixty years, it is more than time to dispel these particular research myths and urban legends as well as the various damage and problems they cause, and put them to bed and out of their misery once and for all.
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Recent studies have shown that there is a distinct relationship between patient satisfaction and patient compliance in orthodontic treatment. The aim of this study was to investigate whether patient compliance, as noticed and recorded by the orthodontist during treatment, can be used as a determinant of patient's satisfaction in the long run. Documentation of 100 patients who completed active orthodontic treatment in the year 2000 at the Academic Centre of Dentistry Amsterdam was analyzed, and compliance scores for patients were computed. Three years after completion of active orthodontic treatment, a questionnaire about satisfaction was sent to all subjects. Items were divided over six subscales on the basis of item content. Compliance and satisfaction scores of both sexes were compared, and correlations between compliance and satisfaction were explored. Regression analyses were done to examine the predictive value of sex and compliance on patient satisfaction. No significant correlations between compliance and satisfaction scores were found. Sex, but not compliance, predicted the patient's satisfaction with the doctor-patient relationship and the situational aspects of the treatment. Compliance, as noticed and recorded by the orthodontist during treatment, is not a decisive determinant of patient satisfaction in the long run. Sex, however, is a predictor of patient satisfaction with regard to the doctor-patient relationship and the situational aspects of the orthodontic treatment.
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To determine patients' motivations for undergoing orthognathic surgery and their experiences of the orthodontic aspects of this treatment. Retrospective questionnaire survey using a patient-centred measure. Thirteen National Health Service (NHS) hospital orthodontic departments. Three-hundred-and-twenty-six patients (58% response rate) who underwent orthognathic surgery during the period 1 January 1995 to 30 September 2001 completed a questionnaire. Motivations for treatment and perception of information about treatment and experiences of orthodontic treatment. Major motivations for treatment were to have straight teeth (80%), to prevent future dental problems (69%) and to improve self-confidence (68%). Females sought treatment to improve self-confidence and their smile. Males wanted treatment to improve their social life. Most of these issues had improved following surgery. Most (94%) respondents felt well-informed about their orthodontics. However, 36% wore braces for longer than they expected. Males and younger patients knew less about the duration of treatment than other groups. Fifty-eight per cent of subjects found their braces difficult to clean and 9% reported that they were very painful. Older patients experienced fewer problems wearing braces than younger patients. Improving dental appearance and preventing future dental problems are major motivators for orthognathic patients. Although patients felt well informed about what to expect from their orthodontic treatment, a significant proportion, particularly younger patients and males, were surprised at the length of treatment and the need to wear retainers. This suggests that orthognathic patients might benefit from better information regarding the orthodontic aspects of their care.
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The objective of this study was to identify factors that may affect patients' satisfaction with their dentition after orthodontic treatment. Fifty patients (20 males and 30 females; mean age 20.7 +/- 4.2 years) who successfully had finished fixed orthodontic treatment were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances for an average duration of 19 +/- 4 months and were in retention stage (6-12 months) with upper Hawley and lower fixed bonded retainers. Dental Impact on Daily Living questionnaire was used to assess the effect of orthodontic treatment on daily living and satisfaction with the dentition in the study sample. The NEO Five Factor inventory was used to assess personality profiles in the study sample. Comparisons between groups were made using chi-square test. Personality traits were found to be correlated with patients' satisfaction with their dentition after orthodontic treatment. Higher neuroticism scores had a significant negative relationship with total satisfaction with the dentition (P < .05). Age, sex, and pretreatment orthodontic treatment need had no relationship with the patient's satisfaction. Patients treated nonextraction showed more dissatisfaction with their dentition (P < .05). In orthodontically treated patients, higher neuroticism scores were associated with lower levels of satisfaction with the dentition.
Article
Introduction Our objective was to identify factors associated with orthodontic treatment satisfaction of patients and their caregivers, when applicable. Methods MEDLINE via Ovid, PubMed, EBM Reviews and EMBASE via OVIDSP, LILACS, Web of Science, and Google Scholar were searched electronically. Reference lists of included articles were also screened for potential relevant studies missed during the electronic searches. Studies evaluating the satisfaction levels of patients or caregivers after orthodontic treatment were considered. Methodologic quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Results Eighteen studies satisfied the inclusion criteria, representing 2891 patients and 464 parents. The risk of bias was moderate in 13 and low in 4 of the included articles. The studies used different questionnaires and timings to assess postorthodontic treatment satisfaction. Based on the available limited evidence, satisfaction was associated with perceived esthetic outcomes, psychological benefits, and quality of care. The latter was specifically linked to dentist-staff-patient interactions. Dissatisfaction was associated with treatment duration, pain levels and discomfort, and the use of retention appliances. When both assessments were available, the patient's and the parent's satisfaction levels were strongly correlated. Conclusions Based on the limited available evidence with moderate risk of bias, we identified factors that appear to be more commonly associated with a high or low level of satisfaction. Consideration of these factors could be important for practitioners attempting to set realistic expectations of their patients and caregivers regarding orthodontic treatment outcomes.
Conference Paper
Objectives: to explore whether there is a relationship between children's objectively and subjectively assessed oral health, their parents' proxy assessment of their child's oral health-related quality of life (ohrqol) and health-related quality of life (hrqol). Methods: Questionnaire data were collected from 353 parents / guardians who brought their child to a regularly scheduled dental appointment. Data from the clinical charts of 309 pediatric patients were used to assess their objective oral health status. The parent survey included the Michigan Oral Health-Related Quality of Life Scale Parent Version (MOHRQOL-P) and the Child Health Questionnaire 28 (CHQ-28). Results: The children's objective oral health indicators correlated significantly with the parents' assessment of their child's subjective oral health, their total and pain related ohrqol scores and their ohrqol score related to psychological aspects. The parents' subjective oral health assessment was significantly correlated with the pain related ohrqol (r=-.400; p<.001) and the psychological aspects of ohrqol (r=.449; p<.001) as well as with the health-related quality of life as measured with the total CHQ score (r=-.230; p<.001). The total ohrqol score as well as the two ohrqol sub scores correlated significantly with the CHQ total score (r=.235, p<.001; pain sub score: r=.187; p<.01; psychological aspects related sub score: r=-.223; p<.001). Conclusion: While children's objective oral health indicators are significantly correlated with children's ohrqol scores, they are not related with their hrqol. However, parents' subjective assessment of their child's oral health is significantly correlated both with their child's ohrqol and hrqol scores. Further research should explore the implications of these findings for clinical practice.
Article
Although the associations between oral biologic variables such as malocclusion and oral-health-related quality of life (OHRQOL) have been explored, little research has been done to address the influence of psychological characteristics on perceived OHRQOL. The aim of this study was to assess OHRQOL outcomes in orthodontics while controlling for individual psychological characteristics. We postulated that children with better psychological well-being (PWB) would experience fewer negative OHRQOL impacts, regardless of their orthodontic treatment status. One hundred eighteen children (74 treatment and 44 on the waiting list), aged 11 to 14 years, seeking treatment at the orthodontic clinics at the University of Toronto, participated in this study. The child perception questionnaire (CPQ11-14) and the PWB subscale of the child health questionnaire were administered at baseline and follow-up. Occlusal changes were assessed by using the dental aesthetic index. A waiting-list comparison group was used to account for age-related effects. Although the treatment subjects had significantly better OHRQOL scores at follow-up, the results were significantly modified by each subject's PWB status (P <0.01). Furthermore, multivariate analysis showed that PWB contributed significantly to the variance in CPQ11-14 scores (26%). In contrast, the amount of variance explained by the treatment status alone was relatively small (9%). The results of this study support the postulated mediator role of PWB when evaluating OHRQOL outcomes in children undergoing orthodontic treatment. Children with better PWB are, in general, more likely to report better OHRQOL regardless of their orthodontic treatment status. On the other hand, children with low PWB, who did not receive orthodontic treatment, experienced worse OHRQOL compared with those who received treatment. This suggests that children with low PWB can benefit from orthodontic treatment. Nonetheless, further work, with larger samples and longer follow-ups, is needed to confirm this finding and to improve our understanding of how other psychological factors relate to patients' OHRQOL.
Article
This study examined how halitosis, oral dryness and general oral health were impacted during treatment with the Invisalign(®) system. Furthermore, the effect of a lowdose chlorhexidine solution (CHX) was evaluated. Thirtyone patients with good periodontal health participated in this crossover study and were divided into two groups (group 1: CHX/no CHX, group 2: no CHX/CHX). The following parameters were recorded during the first 8 months of Invisalign(®) treatment: stimulated saliva flow rate, organoleptic index, tongue coating index, measurement of the oral volatile sulfur compound level (ppb), modified gingival and plaque index and bleeding on probing index. Professional oral cleaning was performed at the beginning of each period lasting 3 months. The patients received a questionnaire at the first, third, fourth, sixth and eighth control visits. The very low volatile sulfur compound level was significantly decreased by CHX (0.06%) during the first examination period (p = 0.02), i.e. for the first group of patients only. Neither halitosis, nor oral dryness, nor high plaque or gingival index measurements were observed. Oral health-related quality of life was hardly influenced by wearing aligners and oral hygiene habits were very good. This study provides evidence that Invisalign(®) treatment is characterized by only minimal impairment of overall oral health and the associated quality of life. Consequently, it appears unnecessary to recommend the general adjunctive use of a low-dose chlorhexidine mouthwash during treatment with Invisalign(®).
Article
To discern patients' opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment success. Materials and Questionnaires regarding orthodontic retention were distributed to first-year undergraduate college students (n = 158), first-year dental students (n = 183), and retention patients at orthodontic offices (n = 214). Items included treatment satisfaction, perceived responsibility for retention, type of retainer prescribed, reasons for discontinuing use of retainers, and relapse experienced. Four hundred twenty-eight of 555 participants indicated that they had received orthodontic treatment. Most indicated they were either "satisfied" or "very satisfied" with their teeth, both at the end of treatment (96%) and currently (84%). There was a strong relationship between the perception of stability of tooth position and current satisfaction level (P < .0001). Most individuals (88%) indicated that they themselves were responsible for maintaining the alignment and fit of their teeth. Those who indicated that someone else was responsible were nearly twice as likely to be dissatisfied with their teeth (P = .0496). Patients who had been prescribed clear, invisible retainers were significantly more likely to be "very satisfied" currently (50%) compared to those with Hawley (35%) or permanently bonded (36%) retainers (P = .0002). Patients with Hawley retainers were significantly less likely to be wearing them currently as prescribed (45%) than those with invisible (65%) or bonded (68%) retainers (P < .0001). Satisfaction with orthodontic results after treatment is related to patient perceptions of responsibility for retention and perceived stability of tooth position. Patients should play a contributory role in formulating orthodontic retention plans.
Article
To determine changes in oral health-related quality of life (OHRQoL) during fixed orthodontic appliance therapy in Chinese patients. Two-hundred fifty Chinese orthodontic patients completed six distinct intervals of the 14-item Oral Health Impact Profile (OHIP-14, Chinese version): before treatment (T0); after the placement of the fixed appliance at 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4); and posttreatment (T5). The overall response rate was 88.8% (222 of 250). Significant differences of overall OHIP-14 scores could be found between any two time points (P < .001), except for between T0 and T2 (P > .05) and between T3 and T4 (P > .05). Overall scores at T1 were significantly higher than the scores at the other intervals (P < .001), with a significant change in the scores on physical pain (P < .001), psychological discomfort (P < .001), and physical disability (P < .001). Scores at T5 were lowest among the six time points (P < .001). Fixed orthodontic appliance therapy did affect Chinese patients' OHRQoL. Patients were considerably compromised in terms of their overall OHRQoL until approximately 1 month after insertion. The severity of the compromised condition in terms of overall OHRQoL was greatest at 1 week with the reported impact on physical pain, psychological discomfort, and physical disability. Patients' OHRQoL was better after they completed the orthodontic treatment than before or during treatment.
Article
The aim of this study was to quantify laypersons' assessments of attractiveness, acceptability, and value of orthodontic appliances. Orthodontic appliances were placed in a consenting adult, and digital images were captured, standardized, and incorporated into a computer-based survey. The survey displayed various images of orthodontic appliances for rating by a sample of adults (n = 50). Subjects rated each image for (1) attractiveness on a visual analog scale, (2) acceptability of placement of each appliance on themselves and their children, and (3) willingness to pay for each appliance for an adult or a child relative to a metal appliance standard. Rater reliability for the attractiveness, acceptability, and value ratings was assessed by rating 3 images twice. Overall reliability values for attractiveness were intraclass correlation coefficient = 0.87 and kappa = 0.81 for acceptability and kappa = 0.88 for value ratings. The raters' annual income was not significant for attractiveness, acceptability, or value ratings. No significant difference was found between parent and child ratings for either the appliance acceptability or value ratings. Appliance brand, material, and wire were significant factors affecting attractiveness and value ratings. Attractiveness ratings were grouped in the following hierarchy of appliance types: alternative appliances such as clear trays and simulated lingual appliances > ceramic appliances > ceramic self-ligation appliances > all hybrid and stainless steel appliances. Acceptability ratings for all alternative and ceramic appliances were statistically equivalent, and statistically higher than those for other appliances. Standard metal braces had the lowest acceptability rate of 55%. The willingness-to-pay value of appliances relative to a metal standard appliance ranged from $629 for lingual appliances to $167 for a hybrid self-ligation appliance. These findings show that a significant number of patients find commonly used appliances unattractive and unacceptable. Patients are willing to pay more money for appliances they deem more esthetic.
Article
Parents' and children's reports of behavioural-emotional problems in 116 children assessed by the Child Assessment Schedule developed by Hodges et al. (Journal of the American Academy of Child Psychiatry, 21, 468-473, 1982) and the Graham & Rutter Parent Interview (British Journal of Psychiatry, 114, 581-592, 1968), both semi-structured interviews, revealed relatively high agreement compared with studies using highly structured assessment procedures. The majority of disagreements could be attributed to higher parents' scores. Only fears were reported more often by children, especially by the better-functioning children, suggesting that children's reports of fears may be related to a higher level of adaptive functioning rather than a higher level of psychopathology. Although the child interview may be crucial to obtain information often not reported by parents such as fears and anxiety, it was found that information from the child contributed only little to overall clinical judgement based on information already available from the parents.
Article
Although clinical dental status has weak correlations with subjective impacts, some of them are significant. Those variables which had significant correlations could be used as a starting point to understand clinical and social characteristics of people who experience dental problems. This is indeed the basis for the current research. The study compares psychosocial impacts on the quality of people's life with their respective oral status. To that end, a socio-dental indicator, the 'Dental Impact of Daily Living' (DIDL), involving five dimensions, together with a scale which assesses dimension impacts, was developed. The resulting instrument was validated and the reliability tested. The instrument generates a total final score, in addition to scores for each dimension. The method was tested in Brazil on a sample of 662 people, aged from 35 to 44 years, of two social classes, both sexes, and with three different levels of dental caries status or with a full upper denture. To test whether DIDL discriminated between groups with different levels of subjective impact, we analyzed how oral status, social class, and gender varied according to impacts. Different levels of oral status had different impacts on people's daily life. On the basis of the results, it is reasonable to suggest that oral status and social and psychological dimensions should be considered simultaneously when in assessment of people's dental needs.
Article
Orthodontist-patient relationships have significant effects on the success of orthodontic treatment. The purpose of this study was to evaluate the effects of patient-perceived orthodontist behaviors on (a) patient perceived orthodontist-patient relationship, (b) patient satisfaction, and (c) orthodontist-evaluated patient adherence or compliance in orthodontic treatment. The sample consisted of 199 orthodontic patients, 94 boys and 105 girls, ages 8 to 17 years, who were recruited at the beginning of orthodontic treatment by a member of the research team who was not involved in treating the patients. The patients were asked to complete standardized questionnaires in a room away from the orthodontic clinic, 8 to 12 months into treatment. At the same time, the orthodontic resident treating each patient completed a standard instrument that evaluated patient compliance. Orthodontist behavior items such as politeness, friendliness, communicativeness, and empathy were evaluated by the patients. Stepwise multiple regression analyses (p < 0.05) showed that eight behaviors predicted perception of the orthodontist-patient relationship (final model R2 = 0.7930 and 0.7333) as well as patient satisfaction (final model R2 = 0.7952) and two behaviors predicted patient compliance (final model R2 = 0.0986). Of the 24 orthodontist behaviors, 22 were significantly correlated (p < 0.0001) with favorable orthodontist-patient relationship and patient satisfaction. Of the 24 behaviors, 10 were significantly correlated (five at p < 0.01 and five at p < 0.05) with patient compliance. Patient-perceived orthodontist behaviors are related to and predict (1) patient perceived orthodontist-patient relationship, (2) patient satisfaction, and (3) orthodontist-evaluated patient adherence or compliance.
Article
Over the last 10-15 years, the terms quality of life (QOL) and health-related quality of life (HRQL) have been seen increasingly in medical literature. Much of the orthodontic treatment that is undertaken is justified on the basis of improving health-related quality of life. With this in mind, studying HRQL in orthodontic patients has the potential to provide information about treatment needs and outcomes, and may also facilitate improved care. Clinicians should therefore be aware of some of the ways in which health-related quality of life may be assessed. The first part of this review article looks at the general concepts of health-related quality of life, whilst the second section focuses on dentistry and orthodontics.
Article
The authors conducted a systematic review of the literature to determine the treatment effects of the Invisalign orthodontic system (Align Technology), Santa Clara, Calif.). The authors reviewed clinical trials that assessed Invisalign's treatment effects in nongrowing patients. They did not consider trials involving surgical or other simultaneous fixed or removable orthodontic treatment interventions. The authors searched electronic databases (PubMed, MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Evidence Based Medicine Reviews, EMBASE Excerpta Medica, Thomsen's ISI Web of Science and LILACS) with the help of a senior health sciences librarian. They used "Invisalign" as the sole search term, and 22 documents appeared in the combined search. Thereafter, they used "clinical trials," "humans" and "Invisalign treatment effects" as abstract selection criteria. Only two published articles met these inclusion criteria, though after reading the actual articles, the authors determined that they did not adequately evaluate Invisalign treatment effects. Both articles identified methodological issues. The inadequately designed studies the authors found represented only a lower level of evidence (level II). Therefore, the authors found that no strong conclusions could be made regarding the treatment effects of Invisalign appliances. Future prospective randomized clinical trials are required to support, with sound scientific evidence, the claims about Invisalign's treatment effects. Clinicians will have to rely on their Invisalign clinical experience, the opinions of experts and the limited published evidence when using Invisalign appliances.
Article
The aim of this study was to evaluate the differences in quality of life impacts between subjects treated with Invisalign aligners (Align Technology, Santa Clara, Calif) and those with fixed appliances during the first week of orthodontic treatment. A prospective, longitudinal cohort study involving 60 adult orthodontic patients (33 with Invisalign aligners, 27 with fixed appliances) was completed by using a daily diary to measure treatment impacts including functional, psychosocial, and pain-related outcomes. A baseline survey was completed before the start of treatment; diary entries were made for 7 consecutive days to measure various impacts of the subjects' orthodontic treatment over time. The data were then analyzed for differences between treatment modalities in terms of the subjects' reported impacts from their orthodontic treatment. The baseline mean values did not differ between groups for pain reports (P = .22) or overall quality of life impact (P = .51). During the first week of treatment, the subjects in the Invisalign group reported fewer negative impacts on overall quality of life (P <.0001). The Invisalign group also recorded less impact in each quality of life subscale evaluated (functional, psychosocial, and pain-related, all P <.003). The visual analog scale pain reports showed that subjects in the Invisalign group experienced less pain during the first week of treatment (P <.0001). The subjects in the fixed appliance group took more pain medications than those in the Invisalign group at days 2 and 3 (both P <.007). Adults treated with Invisalign aligners experienced less pain and fewer negative impacts on their lives during the first week of orthodontic treatment than did those treated with fixed appliances.
Long-term stability of orthodontic treatment and patient satisfaction. A systematic review.
  • Bondemark L.
  • Holm A.K.
  • Hansen K.
  • Axelsson S.
  • Mohlin B.
  • Brattstrom V.
Satisfaction with orthodontic treatment.
  • Keles F.
  • Bos A.