Our objective was to compare the oral impacts experienced by patients treated with labial or customized lingual fixed orthodontic appliances.
This was an age- and sex-matched prospective longitudinal study of 60 adult patients treated with either labial or customized lingual fixed orthodontic appliances over a 3-month period. Ratings of oral impacts experienced and satisfaction were made on visual analog scales at 3 time points after appliance fixation. Variations in oral impacts and satisfaction over the trajectory of treatment were assessed. Area-under-the-curve analyses were conducted to assess variations in oral impacts and satisfaction between the groups.
All patients experienced oral impact disturbances, although these disturbances decreased over time ( P <0.001). Patients treated with customized lingual appliances reported more oral discomfort ( P <0.001), dietary changes ( P <0.001), swallowing difficulty ( P <0.001), speech disturbances ( P <0.001), and social problems ( P <0.001) than did those in the other group. There was no significant difference between the groups regarding ratings of oral self-care, mastication, and satisfaction level of treatment ( P >0.05).
The findings indicate that oral impacts are commonly experienced during both labial and customized lingual fixed orthodontic therapies. However, the oral impacts decreased over the observational period. Patients treated with customized lingual appliances experienced more oral impacts. Both groups had similar levels of treatment satisfaction.
There has been a paradigm shift in orthodontics to the use of lingual fixed appliances as opposed to conventional labial fixed appliances in the treatment of malocclusion. Lingual fixed appliances can produce comparable treatment outcomes as labial fixed appliances over similar treatment time periods and therefore are an alternative treatment modality for patients to consider. Nevertheless, orthodontic treatment leads to a number of consequences, which also are important to consider in evaluating treatment modalities. Pain, for example, is a well-documented sequela encountered during therapy. In more recent years, there has been growing interest in understanding not just the symptoms experienced during treatment (eg, pain), but also the oral impacts of orthodontic treatment, such as the influence on quality of life. To this end, many oral health-related quality of life measures have been used to assess oral impacts. The measures differ in their underlying theoretic framework, number of items, and scoring methods; there is no single measure that is the gold standard. All measures assess key oral impacts: oral discomfort, oral self-care, mastication, speech disturbances, and social activities.
Different orthodontic treatment modalities function in dissimilar ways, making it imperative to assess the oral impacts of each treatment. In this study, we aimed to compare the oral impacts experienced and the satisfaction of patients treated with conventional labial fixed orthodontic appliances and customized lingual fixed orthodontic appliances during treatment.
Material and methods
This study was approved by the ethics committee of the University of Hong Kong.
An age- and sex-matched prospective longitudinal study of 60 adults treated in the Department of Orthodontics, Prince Philip Dental Hospital in Hong Kong, over a 3-month period was undertaken. It consisted of 30 patients (20 women, 10 men; mean age, 21.6 years; SD, ± 2.24 years) treated with customized lingual appliances (Incognito, 3M Unitek, Bad Essen, Germany), and 30 patients (18 women, 12 men; mean age, 20.3 years; SD, ± 4.21 years) treated with labial appliances (Mini-Diamond, Ormco, Glendora, Calif).
The patients rated their oral impacts experienced (oral discomfort, mastication, speech disturbances, and social functioning) and treatment satisfaction on a 100-mm long visual analog scale at 3 time points during treatment: 1 week, 1 month, and 3 months after the brackets were placed. Variations in oral impacts over the study period were assessed by using Friedman 1-way analysis of variance (ANOVA). Oral impacts experienced over the study period were assessed by area-under-the-curve analyses (AUC):
AUC = ( 1 / 2 ) ∑ i = 0 n − 1 ( t i + 1 − t i ) ( y i + y i + 1 )