Abstract
Background:
Traditional fixed appliances (TFAs) with metal brackets and wires have long been the modality of choice for treating orthodontic patients. With modern society’s enthrallment with an individuals’ outward appearance, anecdotal evidence from clinical observations suggest a steady increase in the use of clear aligners (CAs) and direct-to-consumer (DTC) CAs. Although the clinical efficacy of DTC CAs remains unsupported by research, there is a growing interest among the public to seek DTC clear aligner (CA) treatment and thus, there is a need to turn to patients to understand their experience with orthodontic treatment.
Methods:
An exploratory case study design was employed to gain an in-depth understanding of the underlying motivations, reasons and perspectives of patients who have undergone orthodontic treatment. Thirty New Zealand based adults over the age of eighteen were recruited via advertisements on social media sites using a purposeful sampling technique. A single investigator conducted one-on-one semi-structured interviews with key questions exploring themes relating to motivation of patients undertaking orthodontic treatment, their choice of a specific treatment modality, the information they received prior to treatment, the challenges they faced, as well as their experience with orthodontic treatment. The interview transcripts were transcribed verbatim and analysed with the NVivo software (Version 1.5.1, QSR International Pty Ltd., Burlington, MA, USA), using inductive thematic analysis. The standard criteria of reporting qualitative studies: Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was followed, as well as the Trustworthiness, Auditability, Credibility and Transferability (TACT) framework to ensure rigour.
Results: The five principal themes identified are as follows: (1) motivation for orthodontic treatment (2) the decision for selecting a specific treatment modality (3) patient information and education (4) patient experience with treatment and (5) the challenges faced during treatment. The commonly shared reasons individuals sought orthodontic treatment included self-consciousness, aesthetics, a need for treatment, familial influence, crooked teeth, relief of previous financial constraints, cleansability and relapse. The rationale behind participants seeking treatment with a specific treatment modality included recommendation by their treatment provider, trust in the treatment appliance, cost, age, working environment, aesthetics, marketing and the idea of DTC CAs being a disrupter to the orthodontic profession. There was a range in the quality and quantity of information provided to each participant prior to commencing orthodontic treatment. The majority of patients’ experiences were positive, with participants expressing satisfaction with their treatment outcome. An increased awareness and self-reported improvement in oral health occurred as a result of orthodontic treatment. The coronavirus disease of 2019 (COVID-19) and pain were common treatment challenges reported by all participants, with other reported problems including broken brackets, appointment availability, the use of DentalMonitoring® (Paris, France), poor aligner fit and quality, poor post-treatment occlusion and the lack of communication from certain DTC CA companies.
Conclusion: Self-consciousness, aesthetics and previous financial constraints were the main motivating factors for participants seeking treatment and cost was the most influential factor when selecting a specific treatment modality. The information provided to each participant prior to commencing treatment was not equal, however patient experience with orthodontic treatment in New Zealand was generally positive. The challenges faced by participants throughout their course of treatment included broken brackets, appointment availabilities, pain, poor aligner fit and quality, a lack of communication from certain DTC CA companies as well as COVID-19.