## 4 Discussion  
This questionnaire-based survey aimed at assessing and comparing the satisfaction levels of patients and parents following orthodontic treatment during mixed dentition with two removable appliances: elastodontic appliances (EAs) and clear aligners (CAs). The two devices are designed to obtain different treatment objectives: CAs are offered to treat dentoalveolar discrepancies, such as crowding, while EAs are meant to provide guidance for the eruption of permanent teeth and myofunctional correction for bad oral habits, such as tongue thrusting. Overall, the results show that both parents and children were very satisfied with the treatment. However, according to parents, EAs seemed to be more uncomfortable to wear, painful, and difficult to get used to, as compared to CAs. The interest in a patient-centered dental practice has increasingly grown in the last decades. Patients' perspectives are critical for evaluating and characterizing the effects of treatments / interventions [36]; however, they are not commonly reported in clinical dental studies [37]. Interestingly, while more than half of parents of the EA group thought that wearing the orthodontic appliance was painful for their children, this was not confirmed by the patients. Previous studies showed that children, in general, are happy to wear EAs because they do not require dental impressions, and they are asked to wear the appliance only \begin{table}
\begin{tabular}{l c c c c} \hline \hline  & \multicolumn{2}{c}{**EAs**} & \multicolumn{2}{c}{**CAs**} \\  & **N = 56** & **n (\%)** & **n (\%)** & **_p-Value_** \\  & & **28 (50.00)** & **28 (50.00)** & & \\ \hline Q12 I am satisfied with the appearance of & & & & 0.307  \\  & & & & & \\ \hline \hline \end{tabular}
\end{table} 
Table 3: Questionnaire’s items addressed to the patients; EAs (Elastodontic Appliances), CAs (Clear Aligners). at night and for a few hours in the afternoon [20]. Concerning comfort and adaptability, both patients and parents in the EA group reported more difficulties as compared to the patients and parents in the CA group. This might be because the appliances had different appearances; while CAs have thin, separate maxillary and mandibular components, an EA is a bulky single-block device that requires a large opening for insertion into the mouth. Clinical experience suggests that it may be due to the type of appliance that prevents easy speaking or drinking during daytime wearing hours. From the parent's point of view, the duration of treatment with CAs was shorter than expected, but it has to be underlined that, in general, the active phase with aligners in growing patients is shorter than the active phase with EAs, which aims at myofunctional rebalancing. No major changes were observed with regards to social and school lives in EA therapy; instead, the treatment with aligners seemed to bring a slight improvement to social and school lives (46.43% \(p<0.001\)). These two devices generally have different treatment objectives: EAs are used for the interception of myofunctional problems [38], while Cas are also for crowding or spaces [39]. Therefore, the results of the CA treatment can be more immediately perceived and have more impact on social life and school life. The results of the current survey show an improvement in different functions after orthodontic treatment. The percentage of parents who reported that the EA treatment led to an improvement in breathing was high (50%). It is widely reported that sleep-disordered breathing is a common problem in children, with snoring and obstructive sleep apnea (OSA) being frequent manifestations [40]. It has been hypothesized that, in patients with skeletal abnormalities, orthodontic treatment for the correction of sagittal and transversal discrepancies might improve OSA [41]. In particular, devices used to displace the mandible in a more forward position during sleep are reported to increase the upper airway volume, thus improve breathing [42].