PATIENT COMPLIANCE IN ORTHODONTIC TREATMENT: THE ROLE OF BEHAVIORAL, SOCIAL, AND DIGITAL FACTORS – A NARRATIVE REVIEW
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6296Keywords:
Patient Compliance, Patient Adherence, Orthodontic Treatment, Behavioral Factors, Psychological Factors, Social Support, Health Literacy, Digital Technologies, Teleorthodontics, Artificial Intelligence, Social Media, Remote MonitoringAbstract
Objectives: This narrative review aimed to summarize current evidence on factors influencing patient compliance in orthodontic treatment, with particular focus on behavioral, psychological, social, treatment-related and digital technology-related determinants.
Methods: A narrative literature review was conducted using full-text scientific publications available in PubMed, Scopus and Google Scholar. The search included studies published between 1990 and 2026 and used keywords related to patient compliance, adherence, orthodontic treatment, behavioral and psychological factors, social support, health literacy, teleorthodontics, digital technologies and remote monitoring. Original studies, systematic reviews, meta-analyses and narrative reviews were included. The collected data were analyzed qualitatively and synthesized into thematic categories.
Key Findings: The available evidence indicates that orthodontic compliance is a multidimensional and dynamic process rather than a single patient behavior. Patient motivation, attitudes toward treatment, understanding of recommendations, pain, discomfort, family involvement, communication with the orthodontist and the complexity of treatment protocols all contribute to adherence. Digital technologies, including mobile applications, SMS reminders and remote monitoring systems, may improve oral hygiene, reinforce recommendations and facilitate communication, although their long-term effectiveness remains inconclusive.
Conclusions: Improving compliance in orthodontic treatment requires an individualized and patient-centered approach. Clear communication, regular feedback, pain management, family involvement and appropriately selected digital tools may help strengthen patient cooperation and improve treatment predictability.
References
Bos, A., Hoogstraten, J., & Prahl-Andersen, B. (2005). Towards a comprehensive model for the study of compliance in orthodontics. European Journal of Orthodontics, 27(3), 296–301. https://doi.org/10.1093/ejo/cji003
Bos, A., Hoogstraten, J., & Prahl-Andersen, B. (2003). Expectations of treatment and satisfaction with dentofacial appearance in orthodontic patients. American Journal of Orthodontics and Dentofacial Orthopedics, 123(2), 127–132. https://doi.org/10.1067/mod.2003.84
World Health Organization. (2003). Adherence to long-term therapies: Evidence for action. World Health Organization.
Al-Moghrabi, D., Salazar, F. C., Pandis, N., & Fleming, P. S. (2017). Compliance with removable orthodontic appliances and adjuncts: A systematic review and meta-analysis. American Journal of Orthodontics and Dentofacial Orthopedics, 152(1), 17–32. https://doi.org/10.1016/j.ajodo.2017.03.019
Pratt, M. C., Kluemper, G. T., & Lindstrom, A. F. (2011). Patient compliance with orthodontic retainers in the postretention phase. American Journal of Orthodontics and Dentofacial Orthopedics, 140(2), 196–201. https://doi.org/10.1016/j.ajodo.2010.02.035
Albino, J. E. N., Lawrence, S. D., Lopes, C. E., Nash, L. B., & Tedesco, L. A. (1991). Cooperation of adolescents in orthodontic treatment. Journal of Behavioral Medicine, 14, 53–70. https://doi.org/10.1007/BF00844768
Khoroushi, M., & Kachuie, M. (2017). Prevention and treatment of white spot lesions in orthodontic patients. Contemporary Clinical Dentistry, 8(1), 11–19. https://doi.org/10.4103/ccd.ccd_216_17
Alfuriji, S., Alhazmi, N., Alhamlan, N., Al-Ehaideb, A., Alruwaithi, M., Alkatheeri, N., & Geevarghese, A. (2014). The effect of orthodontic therapy on periodontal health: A review of the literature. International Journal of Dentistry, 2014, Article 585048. https://doi.org/10.1155/2014/585048
Littlewood, S. J., Millett, D. T., Doubleday, B., Bearn, D. R., & Worthington, H. V. (2016). Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database of Systematic Reviews, 2016(1), Article CD002283. https://doi.org/10.1002/14651858.CD002283.pub4
Tsomos, G., Ludwig, B., Grossen, J., Pazera, P., & Gkantidis, N. (2014). Objective assessment of patient compliance with removable orthodontic appliances: A cross-sectional cohort study. The Angle Orthodontist, 84(1), 56–61. https://doi.org/10.2319/042313-315.1
Bos, A., Vosselman, N., Hoogstraten, J., & Prahl-Andersen, B. (2005). Patient compliance: A determinant of patient satisfaction? The Angle Orthodontist, 75(4), 526–531. https://doi.org/10.1043/0003-3219(2005)75[526]2.0.CO;2
Sergl, H. G., & Zentner, A. (2000). Predicting patient compliance in orthodontic treatment. Seminars in Orthodontics, 6(4), 231–236. https://doi.org/10.1053/sodo.2000.19070
Daniels, A. S., Seacat, J. D., & Inglehart, M. R. (2009). Orthodontic treatment motivation and cooperation: A cross-sectional analysis of adolescent patients’ and parents’ responses. American Journal of Orthodontics and Dentofacial Orthopedics, 136(6), 780–787. https://doi.org/10.1016/j.ajodo.2007.11.031
Albino, J. E. N. (2000). Factors influencing adolescent cooperation in orthodontic treatment. Seminars in Orthodontics, 6(4), 214–223. https://doi.org/10.1053/sodo.2000.19007
Kiyak, H. A. (2008). Does orthodontic treatment affect patients’ quality of life? Journal of Dental Education, 72(8), 886–894. https://doi.org/10.1002/j.0022-0337.2008.72.8.tb04564.x
Patel, N., Hodges, S. J., Hall, M., Benson, P. E., Marshman, Z., & Cunningham, S. J. (2016). Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life of young people with malocclusion: Part 1—Qualitative inquiry. Journal of Orthodontics, 43(1), 7–13. https://doi.org/10.1080/14653125.2015.1114712
Mandall, N. A., Matthew, S., Fox, D., Wright, J., Conboy, F. M., & O’Brien, K. D. (2008). Prediction of compliance and completion of orthodontic treatment: Are quality of life measures important? European Journal of Orthodontics, 30(1), 40–45. https://doi.org/10.1093/ejo/cjm077
Gray, D., & McIntyre, G. T. (2008). Does oral health promotion influence the oral hygiene and gingival health of patients undergoing fixed appliance orthodontic treatment? A systematic literature review. Journal of Orthodontics, 35(4), 262–269. https://doi.org/10.1179/14653120722770
Meade, M. J., & Millett, D. T. (2013). Retention protocols and use of vacuum-formed retainers among specialist orthodontists. Journal of Orthodontics, 40(4), 318–325. https://doi.org/10.1179/1465313313Y.0000000066
Bos, A., Hoogstraten, J., & Prahl-Andersen, B. (2005). The theory of reasoned action and patient compliance during orthodontic treatment. Community Dentistry and Oral Epidemiology, 33(6), 419–426. https://doi.org/10.1111/j.1600-0528.2005.00241.x
Scheurer, P. A., Firestone, A. R., & Bürgin, W. B. (1996). Perception of pain as a result of orthodontic treatment with fixed appliances. European Journal of Orthodontics, 18(4), 349–357. https://doi.org/10.1093/ejo/18.4.349
Krukemeyer, A. M., Arruda, A. O., & Inglehart, M. R. (2009). Pain and orthodontic treatment. The Angle Orthodontist, 79(6), 1175–1181. https://doi.org/10.2319/121308-632R.1
Zotti, F., Dalessandri, D., Salgarello, S., Piancino, M., 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
Hansa, I., Semaan, S. J., Vaid, N. R., & Ferguson, D. J. (2018). Remote monitoring and “tele-orthodontics”: Concept, scope and applications. Seminars in Orthodontics, 24(4), 470–481. https://doi.org/10.1053/j.sodo.2018.10.011
Moylan, H. B., Carrico, C. K., Lindauer, S. J., & Tüfekçi, E. (2019). Accuracy of a smartphone-based orthodontic treatment-monitoring application: A pilot study. The Angle Orthodontist, 89(5), 727–733. https://doi.org/10.2319/100218-710.1
van der Bie, R. M., Bos, A., Bruers, J. J. M., & Jonkman, R. E. G. (2024). Patient adherence in orthodontics: A scoping review. BDJ Open, 10, Article 58. https://doi.org/10.1038/s41405-024-00235-2
Li, W., Wang, S., & Zhang, Y. (2016). Relationships among satisfaction, treatment motivation, and expectations in orthodontic patients: A prospective cohort study. Patient Preference and Adherence, 10, 443–447. https://doi.org/10.2147/PPA.S101825
Nanda, R. S., & Kierl, M. J. (1992). Prediction of cooperation in orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 102(1), 15–21. https://doi.org/10.1016/0889-5406(92)70010-8
Büyükbayraktar, Z., & Yelboğa, Z. (2021). Psychology and patient cooperation in orthodontics: Is there a relationship between them? Forum Ortodontyczne / Orthodontic Forum, 17(4), 269–277. https://doi.org/10.5114/for.2021.112339
Sergl, H. G., Klages, U., & Zentner, A. (1998). Pain and discomfort during orthodontic treatment: Causative factors and effects on compliance. American Journal of Orthodontics and Dentofacial Orthopedics, 114(6), 684–691. https://doi.org/10.1016/S0889-5406(98)70201-X
Nobre, R., & Pozza, D. H. (2023). Parental influence in orthodontic treatment: A systematic review. Medicine and Pharmacy Reports, 96(1), 28–34. https://doi.org/10.15386/mpr-2415
Huang, J., Yao, Y., Jiang, J., & Li, C. (2018). Effects of motivational methods on oral hygiene of orthodontic patients: A systematic review and meta-analysis. Medicine, 97(47), Article e13182. https://doi.org/10.1097/MD.0000000000013182
Eppright, M., Shroff, B., Best, A. M., Barcoma, E., & Lindauer, S. J. (2014). Influence of active reminders on oral hygiene compliance in orthodontic patients. The Angle Orthodontist, 84(2), 208–213. https://doi.org/10.2319/062813-481.1
Bowen, T. B., Rinchuse, D. J., Zullo, T., & DeMaria, M. E. (2015). The influence of text messaging on oral hygiene effectiveness. The Angle Orthodontist, 85(4), 543–548. https://doi.org/10.2319/071514-495.1
Alfiya, M., Shenoy, R. P., Pasha, M. I., Junaid, J., & Amanna, S. (2025). Effectiveness of the Brush DJ app in improving oral hygiene among patients with fixed orthodontic appliances: A randomized controlled trial. Scientific Reports, 15, Article 42492. https://doi.org/10.1038/s41598-025-26579-9
Nahajowski, M., Lis, J., & Sarul, M. (2022). Orthodontic compliance assessment: A systematic review. International Dental Journal, 72. https://doi.org/10.1016/j.identj.2022.07.004
Egolf, R. J., BeGole, E. A., & Upshaw, H. S. (1990). Factors associated with orthodontic patient compliance with intraoral elastic and headgear wear. American Journal of Orthodontics and Dentofacial Orthopedics, 97(4), 336–348. https://doi.org/10.1016/0889-5406(90)70106-M
Sinha, P. K., Nanda, R. S., & McNeil, D. W. (1996). Perceived orthodontist behaviors that predict patient satisfaction, orthodontist-patient relationship, and patient adherence in orthodontic treatment. American Journal of Orthodontics and Dentofacial Orthopedics, 110(4), 370–377. https://doi.org/10.1016/S0889-5406(96)70037-9
Hansa, I., Semaan, S. J., & Vaid, N. R. (2020). Clinical outcomes and patient perspectives of Dental Monitoring GoLive with Invisalign: A retrospective cohort study. Progress in Orthodontics, 21, Article 16. https://doi.org/10.1186/s40510-020-00316-6
Alkadhi, O. H., Zahid, M. N., Almanea, R. S., Althaqeb, H. K., Alharbi, T. H., & Ajwa, N. M. (2017). The effect of using mobile applications for improving oral hygiene in patients with orthodontic fixed appliances: A randomised controlled trial. Journal of Orthodontics, 44(3), 157–163. https://doi.org/10.1080/14653125.2017.1346746
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