Let’s face it, without patient compliance, we are doomed… is that overstating it??? Maybe, maybe not… Class II malocclusion is everywhere. There are many removable, banded, bonded, and surgical options available for correction. Many of which we try, give up on, and try again. If there was a perfect solution, we would all be doing it! When it comes right down to it, I believe that the simplest solution is often the best. This brings me straight to elastic wear… in a compliant patient (we have those, right?) this is a simple and straightforward solution… noncompliance, however, puts a whole new spin on it.
In an article in the July 2017 AJO-DO, a systemic review was done of patient compliance with removable appliances, including elastics. The authors concur that compliance can have a significant impact on both the short and long term success of orthodontic treatment. The primary focus of the review was to evaluate compliance with removable appliances, and secondly to evaluate the effectiveness of the methods used to improve compliance.
Orthodontic Patients Who Reported 12 Hours of Elastic Wear Were More Likely to Have Gotten 6 Hours
The most interesting finding in the studies reviewed, is the fact that the difference in measured wear versus reported wear was 5-6 hours! In other words, patients who reported 12 hours of wear, were more likely to have gotten 6 hours. Half of what was reported! These same patients were unlikely to be influenced by the argument that if elastic wear is improved, treatment will be completed faster. One that I must admit to using routinely. Why do patients respond this way, even when they were aware that the time of wear was being objectively recorded? The authors conclude that is it simply an effort to try to please their orthodontist and avoid negative feedback.
So, we need compliance, but patients have difficulty giving it to us, and end up giving us even less than they tell us they are giving. If we stick with the premise that the simplest solution (elastics) is probably the best (for class II correction,) how can we help our patients give us their very best? What I did for my practice, and what Docs With Apps can do for you, is an Orthodontic Compliance App. Patients and parents both report that using my custom compliance app greatly improves consistency in elastic wear. And that is music to my ears…
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