Adherence in orthodontics: A review of the literature

The aim of this study was to investigate the factors influencing patient adherence in orthodontics.

A literature review was conducted using keywords on PubMed, focusing on randomized clinical trials.

In total, 31 articles were included. Adults appeared to be more cooperative than adolescents, as were patients of higher socioeconomic status. The influence of gender on adherence remains open to debate. Appointment reminders seem to provide substantial benefit, at least in the short term. The most effective communication is multimodal - oral, written, and participatory. Pain management and adherence to the prescribed treatment duration also play a role. With removable devices, whether during the active phase or retention, a tendency to overestimate wearing time and suboptimal adherence were reported.

The difficulty of evaluation lies in the many forms that adherence can take. Some factors are straightforward and easily quantifiable, such as wearing time of an appliance or auxiliary device - either self-reported or measured electronically via sensors - while others are more difficult to assess and require the use of indirect indicators reflecting the consequences of poor adherence. As a result, potential biases abound. The Hawthorne effect and the novelty effect further complicate the evaluation of adherence.

Identifying uncooperative or non-cooperative patients - both at the initial assessment (motivation, hygiene, etc.) and throughout treatment (missed appointments, late arrivals, breakages/detachments, etc.) - is essential and can help orthodontists adapt their approach and implement measures to optimize patient adherence.