## 4 Discussion  
This study aimed to determine malocclusion complexity and orthodontic treatment need in children with ASD and the impact of orthodontic therapy on the daily care and level of collaboration of children with ASD. As mentioned before, studies on malocclusion traits in children with ASD are scarce. In line with other similar studies, we found a higher prevalence for at least one malocclusion trait in children with ASD as a malocclusion Angle's Class II, a malocclusion Angle's Class III, an open bite, an increased maxillary overjet, and crowding [21; 26; 27; 28]. A recent study among Indonesian children with ASD found that 20% of the tested children showed an IOTN-DHC score of \(\geq\)4 (\(n\) = 4), indicating an orthodontic treatment need, while a study conducted in the lowlands reported 79.2%. In our study, the percentage of the IOTN-DHC score of \(\geq\)4 was 60%, remaining within the range of values found in the literature. The sample of our study aligns to other orthodontics samples found in the literature [22; 26; 27; 28], both for the IOTN scoring and also for the orthodontic therapies performed, the obstacles, and the successes. From the collected data, it is evident that there is a need to make specialized health care services for diagnosis and treatment easily accessible and to ensure an adequate approach that is specific to each age group and indispensable for addressing the complexity and heterogeneity of autistic syndromes. Going to the dentist can be a problem for these patients: They are children who have other medical conditions, often more severe than dental ones, which is why parents/c caregivers become concerned about the oral cavity when the situation has already deteriorated, thus having to intervene on a non-trivial oral problem that is already complex [5]. Relational difficulties and difficulties in managing people with ASD in the dental field often lead to a late diagnosis of malocclusions and preclude interceptive treatment [23]. To provide dental care to such sensitive and complex patients, appropriate tools and personnel who are truly prepared not only from a purely dental point of view but also from a psychological point of view are needed [24]. Studies conducted on samples of orthodontists show that most of them are not interested in treating patients with special needs; time constraints and poor cooperation are the most commonly cited reasons [29]. The creation of a specialized structure for the care of patients with special needs within the Paediatric Dentistry and Special-Needs Patients Unit, and the training of an adequately prepared team, has made it possible to overcome this barrier by offering PhD students and postgraduates adequate preparation to acquire the skills necessary for treating this patient population [21; 29]. The team, composed of dental hygienists and orthodontists, was trained in managing ASD patients using pedagogical sensory techniques that allowed for the proper management of orthodontic treatment issues in these patients and the acquisition of cooperation from caregivers [23; 26; 27; 30; 31; 32]. It is important to note, in our study, the evaluation of the child's collaboration through the Frankl scale, which in most of the sample \begin{table}
\begin{tabular}{c c c} \hline \hline  & **Frequency** & **Percentage** \\ \hline
**Have you experienced a deterioration in the home** & & \\
**management of your child’s oral hygiene during** & & \\
**treatment?** & & \\ Yes & 7 & 35.0 \\ No & 13 & 65.0 \\ Total & 20 & 100.0 \\ \hline
**Have you experienced a change in your child’s** & & \\
**mood/collaboration due to the orthodontic appliance?** & & \\ Yes & 6 & 30.0 \\ No & 14 & 70.0 \\ Total & 20 & 100.0 \\ \hline \hline \end{tabular}
\end{table} 
Table 3: _Cont._returned to a positive value at the end of the treatment, thanks to the sensory approach used in all phases. The number of patients in our study is a limitation in establishing the effectiveness of the approach used and the predictability of the orthodontic treatment outcome.