Acceso abierto

Clear aligner therapy procedures and protocols of orthodontists in New Zealand

Maurice J. Meade
Maurice J. Meade
 y 
Tony Weir
Tony Weir
   | 07 dic 2023
Australasian Orthodontic Journal's Cover Image
Acerca de este artículo
Artículo anterior
Artículo siguiente
Cite
Publicado en línea: 07 dic 2023
Páginas: 123 - 135
Recibido: 15 sept 2023
Aceptado: 28 oct 2023
DOI: https://doi.org/10.2478/aoj-2023-0031
© 2023 Maurice J. Meade et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Figure 1.

Factors that influence respondents’ decision to offer CAT (N = 66).
Factors that influence respondents’ decision to offer CAT (N = 66).

Figure 2.

Patient cohorts treated by respondents (N = 66).
Patient cohorts treated by respondents (N = 66).

Figure 3.

Areas that respondents reported in need of amendment prior to acceptance of the CAT treatment plan (N = 66). IPR, interproximal reduction.
Areas that respondents reported in need of amendment prior to acceptance of the CAT treatment plan (N = 66). IPR, interproximal reduction.

Figure 4.

Treatment modalities used CAT (N = 66). %, percentage; Exo, extraction; LINC, lower incisor; Ortho, orthodontic treatment; OMS, orthognathic maxillofacial surgery; PM, premolar; TADs, temporary anchorage devices.
Treatment modalities used CAT (N = 66). %, percentage; Exo, extraction; LINC, lower incisor; Ortho, orthodontic treatment; OMS, orthognathic maxillofacial surgery; PM, premolar; TADs, temporary anchorage devices.

Figure 5.

Frequency of aligner changes among different patient cohorts (N = 66).
Frequency of aligner changes among different patient cohorts (N = 66).

Figure 6.

Frequency of interproximal reduction prescription of IPR to address treatment objectives (N = 66). ↓, reduction; Adj, adjustment; Exp, expansion; OJ, overjet; TSD, tooth size discrepancy.
Frequency of interproximal reduction prescription of IPR to address treatment objectives (N = 66). ↓, reduction; Adj, adjustment; Exp, expansion; OJ, overjet; TSD, tooth size discrepancy.

Improvements respondents would like to see with CAT (N = 51)

Theme % N
Actual outcomes closer to planned/ predicted by software 31.4 16
Tooth movement 27.5 14
Costs 17.6 9
Aligner material 11.8 6
Software 11.8 6
Environmental 9.8 5
CAT and GDPs 7.8 4
Need for further research 5.9 3
Acceptance of shortcomings 5.9 3

Patient-reported CAT issues by respondent

Always Mostly Sometimes Rarely Never Total
Issue % N % N % N % N % N N
Discomfort 1.54 1 10.8 7 53.9 35 29.2 19 4.6 3 65
Speech/lisping 0.0 0 9.2 6 38.5 25 46.2 30 6.2 4 65
Smell of aligner 0.0 0 7.8 5 23.4 15 51.6 33 17.2 11 64
Difficulty in compliance with wear protocol 0.0 0 4.6 3 69.2 45 24.6 16 1.5 1 65
Wear/breakage of aligner 0.0 0 3.1 2 58.5 38 33.9 22 4.6 3 65
Loss of aligner(s) 0.0 0 3.1 2 55.4 36 36.9 24 4.6 3 65
Poor fit of aligner(s) 0.0 0 4.6 3 52.3 34 41.5 27 1.5 1 65
Appearance of aligner(s) 0.0 0 1.5 1 7.7 5 63.1 41 27.7 18 65
Appearance/ discomfort of attachments 0.0 0 3.1 2 55.4 36 33.9 22 7.7 5 65
Staining of teeth around attachments 0.0 0 3.1 2 60.0 39 32.3 21 4.6 3 65
Dissatisfaction with treatment length 3.1 2 6.2 4 44.6 29 38.5 25 7.7 5 65
Dissatisfaction with treatment outcome 0.0 0 0.0 0 12.3 8 76.9 50 10.8 7 65
Dissatisfaction with need for refinement 0.0 0 3.1 2 38.5 25 40.0 26 18.5 12 65

Most significant problems with CAT by respondent (N = 62)

Theme % N
Concerns over patient compliance with CAT wear protocols 43.5 22
Tooth movements 16.1 10
Detailing/finishing 16.1 10
Overbite 16.1 10
Torque 14.5 9
Lateral incisors 12.9 8
Tracking 9.7 6
Commercialisation: 6.5 4
Case selection 6.5 4
Costs 4.8 3

Factors that influence the decision not to provide CAT (N = 8)

No Influence Minor Influence Moderate Influence Major Influence Total
% N % N % N % N N
Insufficient post-graduate education 37.5 3 25.0 2 37.5 3 0.0 0 8
Concerns over ongoing aligner treatment education 50.0 4 50.0 4 0.0 0 0.0 0 8
My practice (e.g.- University or public orthodontic service) does not provide it 75.0 6 0.0 0 0.0 0 25.0 2 8
Other clinicians in my practice provide aligner treatment 37.5 3 12.5 1 25.0 2 25.0 2 8
Initial costs to the practice 75.0 6 25.0 2 0.0 0 0.0 0 8
Ongoing costs to the practice 62.5 5 25.0 2 0.0 0 12.5 1 8
Costs to the patient 37.5 3 50.0 4 12.5 1 0.0 0 8
Disruption to practice with the introduction of new technology 37.5 3 50.0 4 0.0 0 12.5 1 8
Dependency on a ‘third party’ for treatment provision 25.0 2 12.5 1 37.5 3 25.0 2 8
‘Fixed appliances provide better treatment outcomes’ 0.0 0 0.0 0 62.5 5 37.5 3 8
Patient expectations 0.0 0 62.5 5 12.5 1 25.0 2 8
Concerns over patient compliance with treatment protocols 25.0 2 12.5 1 37.5 3 25.0 2 8
Other 1

Respondent ‘comfort ‘with treating different case types (+/- extractions)

Comfortable Uncomfortable
N = 66 N = 64
Case type % N % N
Spaced dentition 89.4 59 0 0
0 to 4mm crowding (mild) 100 66 0 0
4.1-8mm crowding (moderate) 68.2 45 23.4 15
>8mm crowding (severe) 24.2 16 70.3 45
↓ OB 90.9 60 1.6 1
↑ OB 1ó.7 11 78.1 50
↓ OJ 45.5 30 10.9 7
↑ OJ 56.1 37 21.9 14
Unilateral posterior x-bite 39.4 26 35.9 23
Bilateral posterior x-bite 15.2 10 79.7 51
Other 7.6 5 23.4 15

Frequency of CAT progress checks by respondents (N = 66)

Responses
Answer Choices % N
Every 12 weeks 15.2 10
Every 8 weeks 40.9 27
Every 6 weeks 15.2 10
Every 4 weeks 1.5 1
Only if the patient has a problem - otherwise provide the aligners and check at completion of treatment 0.0 0
When remote monitoring system indicates 7.6 5
‘Other’ 19.7 13

Frequency of prescription of a clear plastic retainer provided by aligner company at the end of CAT (N = 66)

Responses
Answer Choices % N
Always 21.2 14
Mostly ó.1 4
Sometimes 30.3 20
Rarely 19.7 13
Never 21.2 14
Other 1.5 1

Factors that influence decisions in choosing to use a specific aligner provider

No Minor Moderate Major Total
Factor level of influence % N % N % N % N N
Cost 22.7 15 40.9 27 28.8 19 7.6 5 66
Ease of digital treatment planning 3.1 2 6.2 4 47.7 31 43.1 28 65
Quality of digital treatment plan 3.0 2 16.7 11 42.4 28 37.9 25 66
Sophistication of appliance features 9.2 6 40.0 26 33.9 22 16.9 11 65
Aesthetics of appliances 21.2 14 47.0 31 22.7 15 9.1 6 66
Patient satisfaction 16.7 11 33.3 22 31.8 21 18.2 12 66
Brand awareness (among patients) 30.3 20 39.4 26 21.2 14 9.1 6 66
Ongoing education by provider 31.8 21 30.3 20 28.8 19 9.1 6 66
Assistance in ‘troubleshooting’ 10.8 7 29.2 19 43.1 28 16.9 11 65
Corporate support - advertising 54.6 36 36.4 24 7.6 5 1.5 1 66
 
eISSN:
2207-7480
Idioma:
Inglés
Calendario de la edición:
Volume Open
Temas de la revista:
Medicine, Basic Medical Science, other
RSS Feed de revista