Orthodontic appliance preferences of children and adolescents

Although attractiveness and acceptability of orthodontic appliances have been rated by adults for themselves and for adolescents, children and adolescents have not provided any substantial data. The objective of this study was to evaluate preferences and acceptability of orthodontic appliances in children and adolescents.

Images of orthodontic appliances previously captured and standardized were selected and incorporated into a computer-based survey. Additional images of shaped brackets and colored elastomeric ties, as well as discolored clear elastomeric ties, were captured and incorporated onto existing survey images with Photoshop (Adobe, San Jose, Calif). The survey displayed 12 orthodontic appliance variations to 139 children in 3 age groups: 9 to 11 years (n = 45), 12 to 14 years (n = 49), and 15 to 17 years (n = 45). The subjects rated each image for attractiveness and acceptability. All images were displayed and rated twice to assess rater reliability.

Overall reliability ratings were r = 0.74 for attractiveness and k = 0.66 for acceptability. There were significant differences in bracket attractiveness and acceptability in each age group. The highest-rated appliances were clear aligners, twin brackets with colored ties, and shaped brackets with and without colored ties. Colored elastomeric ties improved attractiveness significantly over brackets without colored ties for children in the 12-to-14 year group. There was a tendency for older subjects to rate clear orthodontic appliances higher than did younger subjects. Ceramic brackets with discolored ties tended to be rated lower than ceramic brackets with new ties and scored lowest in acceptability and attractiveness in all age groups. Girls rated shaped brackets significantly higher than did boys.

Children's preferences for orthodontic appliances differ by age and sex. Child and adolescent preferences differ from adult preferences.