# Factors Influencing Appliance Wearing Time during Orthodontic Treatments: A Literature Review
## 4 Results and Discussion
### How to Improve Compliance? Telect dentistry Could Be an Answer  
High levels of compliance (such as better attendance, accurate appliance wear-times, and good oral hygiene) are associated with the increased efficacy and effectiveness of orthodontic treatment. [PERSON] et al. reported that messaging apps such as WhatsApp (WhatsApp Inc., Mountain View, CA, USA) and WeChat (Tencent Holdings Limited, Shenzhen, China) have an impact on improving patients' compliance, especially among adolescents, and on reducing the duration of orthodontic treatment (DOT) [28]. Smartphones and tablets have been widely used in health areas (to improve education and to facilitate the patient's management). \"Telecommunication\" is a method of communication between people (the clinician and the patients) who are physically separated: the distance does not inhibit the clinical process but is empowered by the frequent sharing of photos and information, which allows for an increased access to oral care and for remote but strict monitoring of the evolution of a treatment [62]. Recently, the Association of American Medical Colleges coined the term \"Teledentistry\"--the use of digital tools (diagnostic imaging, software, and devices) for diagnosis, follow-ups, and telecommunications in dentistry. Sharing digital information, data, graphics, and photos for clinical care using technology (computers, smartphones, apps) represents an alternative and very innovative method to deliver dental care [18; 42; 62]. Telecommunication in dentistry is a valid tool for the clinician, who can better educate and guide the patient through the therapy with advice, warnings, and reminders for hygiene or time wearing. Additionally, it constantly controls the integrity of appliances, making earlier diagnoses of vestibular cavities (the evidence suggested the effectiveness of this approach in decreasing the incidence of white spot lesions during the first year of treatment with multibracket appliances) [2]. It can also detect irregularities and mistakes in the treatment process. It is also a valid tool for patients, who can solve some doubts by simply sending a WhatsApp message to consult the dentist. Teledentistry is positively judged by both patients and dentists, who consider it as a valid method to increase the accuracy of the treatment [63], and has been an effective aid during the COVID-19 pandemic, which made it possible for a lot of clinicians to monitor the course of orthodontic treatments during the lockdown periods [24, 64]. WhatsApp, WeChat, or any other chat platforms represent an effective way to improve the wearing time of orthodontic devices: it is reported that the DOT is shortened by 7.3 weeks on average [28]. In dentistry, the evidence shows that attendance can be incentivized by simply sending a reminder of any type before the appointments [28]. Dental Monitoring(TM) (DM, Dental Monitoring, Montreal, France) is a further step in Teledentistry. It is a digital system with three integrated platforms (a teeth movement-tracking algorithm, an app for the patient, and a web-based Doctor Dashboard) designed to conduct orthodontic follow-ups at a distance [18]. The dedicated app makes the patient's smartphone a \"remote intraoral scanner\" (the patients themselves can make an intraoral video which is processed by DM) by which orthodontists can control teeth movement and the integrity of the appliances and make assessments about the patient's treatment progress. The DM receives the patient's pretreatment photographs and a 3D model in stereolithography file format (.stl). An artificial intelligence-based algorithm compares pictures taken by the patient's smartphone with the.stl file of the initial scan. With the pictures at the beginning of the therapy, it calculates the tooth positions, the overjet, the overbite, and the interarch relationships, realizing a \"multidimensional information map\" of the teeth (uploaded to the Doctor Dashboard), which provides the clinician with automatically generated information regarding the course of the treatment [18, 63].