Adolescents' adherence to intraoral removable appliances: a scoping review

Adolescents' lack of adherence to intra-oral removable appliances (IORAs) can lead to poor treatment outcomes. Available literature on this topic hasn't been comprehensively summarized. Existing reviews often combine data from various age groups, lack a standardized conceptual definition of adherence to IORAs, and offer limited evaluation of interventions aimed at improving adherence among adolescents. This scoping review aims to map the breadth and depth of the literature on adolescents' adherence to IORAs and identify research gaps for developing tailored interventions.

In accordance with Arksey and O'Malley's framework and PRISMA-ScR guidelines, a comprehensive search strategy was implemented across MEDLINE, CINAHL, Web of Science, and ProQuest Theses and Dissertations. Two researchers independently screened titles, abstracts, and full texts. A pilot-tested form facilitated data extraction. Risk of bias was evaluated using RoB 2, ROBINS-I, and JBI tools. Extracted data then underwent both descriptive and content analysis.

The 14 included studies focused on adherence to wear-time recommendations (n = 13), with only one examining appointment adherence. Only seven studies (50%) were deemed high-quality. Adherence rates varied across IORAs: vacuum-formed retainers showed wear-time of less than 24 h/day, Hawley retainers averaged 12-15 h/day, Twin Blocks averaged 21 h/day, and Activators averaged 11.5 h/day. Studies pursued various aims: four explored patient perspectives and experiences; one assessed designed interventions; two evaluated treatment adherence and assessed adherence to both recommendations and appointments; and five identified associated factors. Several studies pursued multiple aims. Patient perspectives highlighted challenges like discomfort and social pressures, and enablers such as parental support. Limited intervention studies indicated potential benefits of digital and image-based monitoring. Adherence consistently fell short of recommended daily wear time (DWT), often influenced by motivation, parental involvement, and psychosocial factors.

Adherence among adolescents to the DWT for intraoral removable appliances is frequently suboptimal, displaying considerable variability depending on appliance type. Both individual and social determinants influence adherence. Robust study designs and a standardized conceptualization of adherence are imperative to generate high-quality, comparable evidence. Evidence-based interventions must be developed and tested to enhance adherence and ultimately optimize treatment outcomes within this patient population.