The Effectiveness of Electronic Reminders in Improving Elastic Compliance in Orthodontic Patients

Study Overview
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Brief Summary
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Fixed orthodontic appliances in combination with intraoral elastics are a common and effective method use in the orthodontic correction of malocclusions. However, their success is largely dependent on the patient's compliance. Failure to wear the elastics as instructed will reduce efficacy of treatment, ultimately increasing treatment time and potentially producing imperfect alignment of teeth. The hypothesis tested is that daily electronic reminders via a mobile application can significantly increase patient compliance, thus effectively improving treatment outcomes.

Detailed Description
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Despite advancements in various aspects of orthodontic treatment, patient compliance remains a critical factor in attaining a successful treatment outcome. More specifically, patient compliance in the use of intraoral elastics is an important component of the treatment plan of certain patients. Failure to wear elastics as directed will ultimately result in increased treatment time, and imperfect alignment of the teeth. Persuading adolescent orthodontic patients to wear intraoral elastics consistently is difficult in the short appointment times of a typical practice. Studies have shown that adolescents respond at a higher level to a more constant form of communication, as well as a method more closely associated with their generation. As smartphones have become an everyday appliance for most of the general public, mobile applications (apps) have the capability to serve as an effective avenue for communication between doctor and patient. Recent studies in both dentistry and medicine have reported that active reminders via mobile phone improve appointment attendance, adherence to medication schedules, and positive behaviour changes. The investigators will utilise the Calendar app to communicate via daily reminders with patients undergoing orthodontic treatment with fixed appliances and Class II intraoral elastics, and they will measure the improvement in the malocclusion. This will allow study of whether or not electronic reminders can significantly increase compliance. As more apps are developed, this communication method may have the potential to greatly impact the way orthodontists and patients interact outside of the office. If effective, these apps could become a cornerstone of the compliance efforts of many orthodontic practices. This would benefit both the orthodontist and the patient, as it would decrease time and money spent for both parties as well as reduce the overall sense of frustration felt during extended orthodontic treatment.

Official Title
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The Effectiveness of Electronic Reminders in Improving Intra-oral Elastic Compliance in Orthodontic Patients: A Randomised Clinical Trial

Conditions
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Malocclusion, Compliance, Patient

Intervention / Treatment
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* Behavioral: Reminders


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Full fixed appliances with intraoral class II elastics full-time Wearing class II elastics for between 6 weeks & 3 months Have smartphone with calendar-type app Exclusion Criteria: Orthognathic surgery planned Craniofacial disorders

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 20 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Study group<br>This group will receive 4 daily electronic reminders via the Calendar app on their mobile phones, reminding them to wear their elastics. | Behavioral: Reminders<br>* Four reminders will be set on the patient's mobile phone's Calendar-type app, saying Don't forget to wear your elastics, at 08:00, 13:00, 17:00 and 22:00.<br>|
| No Intervention: Control group<br>This group will receive their orthodontic treatment and elastics instructions as normal, without reminders. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in number of elastics used and collected by the participant | Participants from both arms will collect their used elastics in a plastic bag provided, which will be collected at each recall appointment and counted. | 6 weeks, 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient's self-reported duration of time spent wearing intraoral elastics | Participants will fill out duration journals between appointments, on which they tick boxes to record how many hours a day they have worn their elastics | 6 weeks and 12 weeks | 
| Change in participant's jaw relationship, measured on mm scale by difference in overbite, overjet and molar relationship | Clinicians will record these occlusal measurements at each appointment | Baseline, 6 weeks, and 12 weeks | 
| Clinician-perceived level of compliance of the participant at each appointment, using discrete qualitative scale | Clinicians will record whether they think the patient has been highly, somewhat, or not at all compliant | Baseline, 6 weeks, and 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Intraoral elastics