Digital and Behavioral Approaches to Improve Adherence in Orthodontic Treatment
Keywords:
Orthodontic Compliance, Patient Education, DIgital Health, Motivational Interviewing, Tele Orthodontics, Behavioral Intervention, Audiovisual LearningAbstract
Orthodontic treatment outcomes are heavily influenced by patient compliance, yet ensuring consistent adherence remains a challenge. This narrative review aims to synthesize the effectiveness of educational strategies spanning digital, behavioral, and audiovisual approaches in enhancing compliance among orthodontic patients. A comprehensive literature search was conducted across PubMed, Scopus, Google Scholar, and Web of Science, focusing on studies published between 2013 and 2024. Inclusion criteria targeted peer reviewed articles assessing interventions such as mobile apps, motivational interviewing, audiovisual instruction, and culturally tailored communication. Results indicate that mobile applications and SMS reminders substantially improve adherence by enhancing patient engagement and reducing treatment complications. Audiovisual tools surpass traditional instruction methods by improving knowledge retention and facilitating long term behavioral change. Behavioral techniques, especially motivational interviewing, empower patients through collaborative communication, fostering treatment ownership. Psychological traits such as self-efficacy and social support also emerged as significant predictors of adherence. Despite these positive trends, systemic barriers such as healthcare inequities, clinician training deficits, and limited digital access persist. Addressing these challenges requires policy level action and targeted research. Future studies should prioritize longitudinal designs and include underrepresented populations to ensure generalizability. By integrating personalized education and digital platforms, orthodontic practices can enhance compliance and achieve more favorable treatment outcomes.
References
Al-Abdallah, M., Hamdan, M., & Dar‐Odeh, N. (2021). Traditional vs Digital Communication Channels for Improving Compliance With Fixed Orthodontic Treatment: The Angle Orthodontist, 91(2), 227–235. https://doi.org/10.2319/062720-589.1
Aljabaa, A., McDonald, F., & Newton, T. (2016). A Randomized Controlled Trial to Compare 3 Methods Designed to Enhance Adherence Among Orthodontic Patients. JDR Clinical & Translational Research, 1(1), 59–68. https://doi.org/10.1177/2380084415627130
Almoammar, S. (2024). The Role of Tele-Orthodontics in Enhancing Patient Compliance and Treatment Monitoring. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 3), S2676–S2678. https://doi.org/10.4103/jpbs.jpbs_368_24
Cannatà, D., Galdi, M., Martina, S., Rongo, R., D’Antò, V., Valletta, R., & Bucci, R. (2024). Preformed Elastodontic Appliances: Awareness and Attitude of Orthodontists and General Dental Practitioners. Children, 11(4), 418. https://doi.org/10.3390/children11040418
Cozzani, M., Ragazzini, G., Delucchi, A., Mutinelli, S., Barreca, C., Rinchuse, D. J., Servetto, R., & Piras, V. (2016). Oral Hygiene Compliance in Orthodontic Patients: A Randomized Controlled Study on the Effects of a Post-Treatment Communication. Progress in Orthodontics, 17(1). https://doi.org/10.1186/s40510-016-0154-9
Crerand, C. E., Silveira, A. C. D., Kapa, H. M., Litteral, J. L., Markey, M. K., Mercado, A., & Scott, M. (2019). Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate. The Cleft Palate-Craniofacial Journal, 57(2), 218–227. https://doi.org/10.1177/1055665619867556
Dipalma, G., Inchingolo, A. D., Fiore, A., Balestriere, L., Nardelli, P., Casamassima, L., Venere, D. D., Palermo, A., Inchingolo, F., & Inchingolo, A. M. (2025). The Differential Impact of Clear Aligners and Fixed Orthodontic Appliances on Periodontal Health: A Systematic Review. Children, 12(2), 138. https://doi.org/10.3390/children12020138
Discepoli, N., Mirra, R., Marruganti, C., Beneforti, C., & Doldo, T. (2020). Efficacy of Behaviour Change Techniques to Improve Oral Hygiene Control of Individuals Undergoing Orthodontic Therapy. A Systematic Review. International Journal of Dental Hygiene, 19(1), 3–17. https://doi.org/10.1111/idh.12468
Farhadifard, H., Soheilifar, S., Farhadian, M., Kokabi, H., & Bakhshaei, A. (2020). Orthodontic Patients’ Oral Hygiene Compliance by Utilizing a Smartphone Application (Brush DJ): A Randomized Clinical Trial. BDJ Open, 6(1). https://doi.org/10.1038/s41405-020-00050-5
Favero, R., Fabiane, M., Zuccon, A., Conte, D., & Ludovichetti, F. S. (2024). Maintaining Hygiene in Orthodontic Miniscrews: Patient Management and Protocols—A Literature Review. Dentistry Journal, 12(7), 227. https://doi.org/10.3390/dj12070227
Gandhi, V., Mehta, F., & Joshi, H. (2017). Treatment of Class II Malocclusion and Impacted Canines With Two-Phase Orthodontic Treatment. Contemporary Clinical Dentistry, 8(1), 161. https://doi.org/10.4103/ccd.ccd_394_16
Higgins, E., Garvey, T. M., & Burns, A. (2023). The Effect of Text Message Reminders on Compliance With Twin Block Appliances: A Randomised Controlled Trial. Journal of Orthodontics, 51(2), 202–210. https://doi.org/10.1177/14653125231188378
Hussein, S., & Ismail, H. (2023). Influence of Reminder on Enhancing Compliance in Patients With Fixed Orthodontic Appliance Treatment (A Randomized Controlled Clinical Trial). Patient Preference and Adherence, Volume 17, 1759–1769. https://doi.org/10.2147/ppa.s418109
Jassim, A. A., Alrubayee, M. A., & Kazmi, S. (2024). Smart Phone Application Reminder for Patients With Fixed Orthodontic Appliance to Improve Oral Hygiene. Dentistry 3000, 12(2). https://doi.org/10.5195/d3000.2024.699
Jedliński, M., Grocholewicz, K., Mazur, M., & Janiszewska‐Olszowska, J. (2021). What Causes Failure of Fixed Orthodontic Retention? – Systematic Review and Meta-Analysis of Clinical Studies. Head & Face Medicine, 17(1). https://doi.org/10.1186/s13005-021-00281-3
Karalikkattil, T. L., Batra, N., Vivek, C. R., Reddy, V. R., Manimegalan, P., & Tom, A. (2024). Effectiveness of Invisalign Treatment on Open Bite Correction. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 1), S850–S852. https://doi.org/10.4103/jpbs.jpbs_1058_23
Leone, S. M. M., Souza-Constantino, A. M. d., Conti, A. C. C. F., Filho, L. C., & Almeida‐Pedrin, R. R. d. (2018). The Influence of Text Messages on the Cooperation of Class II Patients Regarding the Use of Intermaxillary Elastics. The Angle Orthodontist, 89(1), 111–116. https://doi.org/10.2319/011218-31.1
Levrini, L., Carganico, A., Deppieri, A., Saran, S., Bocchieri, S., Zecca, P. A., Bertini, S., D’Apote, A., & Segù, M. (2022). Predictability of Invisalign® Clear Aligners Using OrthoPulse®: A Retrospective Study. Dentistry Journal, 10(12), 229. https://doi.org/10.3390/dj10120229
Li, J., Li, S., Chen, H., Feng, J., Qiu, Y., & Li, L. (2024). The Effect of Physical Interventions on Pain Control After Orthodontic Treatment: A Systematic Review and Network Meta-Analysis. Plos One, 19(2), e0297783. https://doi.org/10.1371/journal.pone.0297783
Lim, M. E., Dhaliwal, J. S., Wahab, S. W. H. A., & Rahman, H. A. (2023). A Survey of Patient Compliance With Removable Orthodontic Retainer Wear in Brunei Darussalam. BDJ Open, 9(1). https://doi.org/10.1038/s41405-023-00138-8
Ludovichetti, F. S., Stellini, E., Zuccon, A., Lucchi, P., Dessupoiu, N., Mazzoleni, S., & Parcianello, R. G. (2025). Prevention of White Spot Lesions Induced by Fixed Orthodontic Therapy: A Literature Review. Dentistry Journal, 13(3), 103. https://doi.org/10.3390/dj13030103
Mohanty, B., Chekka, M., Sowmya, C., Khurana, R., Manga, U. M., Varma, P. K., & Somaraj, V. (2024). Evaluation of Pain and Discomfort Associated With Orthodontic Adjustments. Journal of Pharmacy and Bioallied Sciences, 16(Suppl 3), S2400–S2402. https://doi.org/10.4103/jpbs.jpbs_269_24
Nahajowski, M., Lis, J., & Sarul, M. (2022). The Use of Microsensors to Assess the Daily Wear Time of Removable Orthodontic Appliances: A Prospective Cohort Study. Sensors, 22(7), 2435. https://doi.org/10.3390/s22072435
Naseri, N., Baherimoghadam, T., Bassagh, N., Hamedani, S., Bassagh, E., & Hashemi, Z. (2020). The Impact of General Self-Efficacy and the Severity of Malocclusion on Acceptance of Removable Orthodontic Appliances in 10- To 12-Year-Old Patients. BMC Oral Health, 20(1). https://doi.org/10.1186/s12903-020-01293-2
Ong-Artborirak, P., Seangpraw, K., Boonyathee, S., Auttama, N., & Winaiprasert, P. (2023). Health Literacy, Self-Efficacy, Self-Care Behaviors, and Glycemic Control Among Older Adults With Type 2 Diabetes Mellitus: A Cross-Sectional Study in Thai Communities. BMC Geriatrics, 23(1). https://doi.org/10.1186/s12877-023-04010-0
Ross, M. C., Campbell, P. M., Tadlock, L. P., Taylor, R. W., & Buschang, P. H. (2018). Effect of Automated Messaging on Oral Hygiene in Adolescent Orthodontic Patients: A Randomized Controlled Trial. The Angle Orthodontist, 89(2), 262–267. https://doi.org/10.2319/040618-260.1
Sabbagh, Y., Chadwick, S., Lewis, B. R., & Alhaija, E. S. A. (2023). The COVID-19 Experience of Orthodontists in Jordan. Journal of Orthodontic Science, 12(1). https://doi.org/10.4103/jos.jos_48_22
Sivakumar, A., Parolia, A., & Pau, A. (2021). Clinical Audit of Orthodontic Chart Documentation by Dental Undergraduates. European Journal of Dental Education, 26(4), 662–668. https://doi.org/10.1111/eje.12744
Sockalingam, S. N. M. P., Zakaria, A. S. I., Khan, K. A. M., Azmi, F. M., & Noor, N. M. (2020). Simple Orthodontic Correction of Rotated Malpositioned Teeth Using Sectional Wire and http://www.w3.org/1998/Math/MathML" Id="M1">2×4 Orthodontic Appliances in Mixed-Dentition: A Report of Two Cases. Case Reports in Dentistry, 2020, 1–5. https://doi.org/10.1155/2020/6972196
Stonehouse‐Smith, D., Pandis, N., Bister, D., & Seehra, J. (2022). Clinical Communication in Orthodontics: Any Questions? Journal of Orthodontics, 49(4), 448–456. https://doi.org/10.1177/14653125221084314
Tadin, A., Badrov, M., Vitasović, B. M., & Peričić, T. P. (2024). Oral Hygiene Practices and Oral Health Knowledge Among Adult Orthodontic Patients: A Best Practice Implementation Project. Hygiene, 4(2), 221–230. https://doi.org/10.3390/hygiene4020018
Timm, L. H., Farrag, G., Baxmann, M., & Schwendicke, F. (2021). Factors Influencing Patient Compliance During Clear Aligner Therapy: A Retrospective Cohort Study. Journal of Clinical Medicine, 10(14), 3103. https://doi.org/10.3390/jcm10143103
Umeh, O. D., Utomi, I. L., Isiekwe, I. G., & Aladenika, E. (2021). Impact of the Coronavirus Disease 2019 Pandemic on Orthodontic Patients and Their Attitude to Orthodontic Treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 159(5), e399–e409. https://doi.org/10.1016/j.ajodo.2020.11.030
Wafaie, K., Rizk, M. Z., Basyouni, M. E., Daniel, B. K., & Mohammed, H. (2023). Tele-Orthodontics and Sensor-Based Technologies: A Systematic Review of Interventions That Monitor and Improve Compliance of Orthodontic Patients. European Journal of Orthodontics, 45(4), 450–461. https://doi.org/10.1093/ejo/cjad004
Yassir, Y. A., McIntyre, G. T., & Bearn, D. (2019). The Impact of Labial Fixed Appliance Orthodontic Treatment on Patient Expectation, Experience, and Satisfaction: An Overview of Systematic Reviews. European Journal of Orthodontics, 42(3), 223–230. https://doi.org/10.1093/ejo/cjz043
Zotti, F., Dalessandri, D., Salgarello, S., Piancino, M. G., Bonetti, S., Visconti, L., & Paganelli, C. (2016). Usefulness of an App in Improving Oral Hygiene Compliance in Adolescent Orthodontic Patients. The Angle Orthodontist, 86(1), 101–107. https://doi.org/10.2319/010915-19.1
Zotti, F., Zotti, R., Albanese, M., Nocini, P. F., & Paganelli, C. (2019). ≪p>Implementing Post-Orthodontic Compliance Among Adolescents Wearing Removable Retainers Through Whatsapp: A Pilot Study</P> Patient Preference and Adherence, Volume 13, 609–615. https://doi.org/10.2147/ppa.s200822
