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FACTORS ASSOCIATED WITH PATIENT NON-COMPLIANCE LEADING TO EARLY DISCONTINUATION OF ORTHODONTIC TREATMENT
Ho, Jessica
Ho, Jessica
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Thesis/Dissertation
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2025-08
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Oral Biology
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https://doi.org/10.34944/hec1-1e05
Abstract
Objectives: Patient compliance is a key factor in the success of any orthodontic treatment. Compliance involves appointment attendance and punctuality, cooperation with elastic and appliance use, good oral hygiene, and no breakage of brackets or appliances. A lack of patient compliance may prompt early discontinuation of treatment. Non-compliance increases treatment times, which impedes on the ability to accomplish orthodontic goals and compromises a patient’s oral health. This study aims to determine the non-compliance percent of orthodontic patients at Temple University Kornberg School of Dentistry (TUKSoD), evaluate the influence of the COVID-19 pandemic on non-compliance, and identify factors that are associated with non-compliance. Understanding these factors can serve as a helpful tool in optimizing patient selection and management for successful completion of orthodontic treatment.
Materials and Methods: To better understand the factors associated with patient non-compliance, a retrospective observational study involving 2,425 patients was conducted using de-identified patient treatment data from the Orthodontic Clinic at TUKSoD over a seven year period from August 1, 2015 to August 1, 2023. A patient was considered non-compliant if they received a final warning letter. Non-compliance percentage was calculated by determining the proportion of non-compliant patients out of the total number of patients. Initial patient records dates were analyzed to identify any significance of the COVID-19 pandemic on non-compliance. Chi-square tests were used to identify factors that were significantly associated with patient non-compliance. Investigated factors included age group, payment type, discrepancy index (DI) score, Angle molar classification, planned extractions, planned adjunctive appliances, treatment modality and estimated treatment time. Adjusted odds ratios were calculated with a 95% confidence interval for all variables that demonstrated significance via the chi-squared test.
Results: The overall non-compliance was 21.4%, with the highest in 2021, at 27.4% and the lowest in 2017, at 15.9%. The non-compliance rates were significantly higher during the COVID pandemic, at 28.3%, as compared to the pre-COVID period, with a p value <0.0001 and an adjusted odds ratio of 1.8. Age groups had a significant association with non-compliance rate, with 18-22 year old patients with the highest rate and 31+ year old patients with the lowest rate (p<0.001). Patients covered by Medicaid insurance showed a higher non-compliance rate, as compared to those who had private insurance or were self-pay (p<0.001). DI score, which measures case complexity, was also found to have a positive correlation with non-compliance (p<0.0001). Angle’s molar classification was found to have a significant association, with Class II molar patients having the highest non-compliance rate (p<0.050). Those with planned adjunctive appliances exhibited a higher non-compliance, as compared to those who did not (p=0.019). Lastly, patients with traditional metal braces were found to have a higher non-compliance than Invisalign users (p=0.048). No statistical significance with non-compliance was found for patients with planned extractions as compared to no planned extractions or different estimated treatment times.
Conclusions: Overall patient non-compliance was 21.4%. The odds of non-compliance was 80% higher during COVID than before COVID. Patients 18-22 years old with Medicaid insurance, a higher case complexity, Class II molar classification, planned adjunctive appliances, and traditional braces were significantly associated with higher non-compliance rates.
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