Orthodontists’ experiences with clear-aligner treatment discontinuation: A cross-sectional survey

Abstract

Background: The aim of this study was to evaluate orthodontists’ reported experiences with clear aligner therapy and fixed appliances, with particular emphasis on treatment discontinuation, compliance, and conversion to alternative treatment modalities. By analyzing the collected responses, the study seeks to clarify the key contributors to patient discontinuation. Methodology: A cross-sectional survey was distributed to orthodontists in Türkiye who actively provided clear aligner therapy. Eligibility required orthodontic training and clinical practice in Türkiye. A priori power analysis determined a sample size of 134 respondents. Clinicians reported aligner-related outcomes based on clinical records. Data was analyzed using descriptive statistics and Chi-square tests (SPSS v25, p < 0.05). Results: Among the orthodontists, 31.34% (42/134) with more than 10 years of experience reported having over 100 ongoing cases, and 9.70% (13/134) had completed more than 100 clear aligner (CAT) treatments. Treatment discontinuation was predominantly attributed to patient abandonment (63.43%, 85/134), while 31.34% (42/134) of patients transitioned to alternative fixed appliance therapy. Additionally, 5.22% (7/134) of patients who discontinued aligner therapy completed their treatment through restorative dental procedures. 46.27% (62/134) of patients who discontinued treatment had exhibited poor oral hygiene, non-compliance, or motivational issues prior to withdrawal. Among surveyed orthodontists, 45.52% (61/134) reported challenges with CAT planning, while 58.96% (79/134) handled the planning independently. Significant correlation was found between limited clinical experience (1–5 years) and higher discontinuation rates (9.68%, 13/134; p = 0.006). Strong correlation was identified between orthodontists treating 1–10 patients and having more than five discontinuations (3.13%, 4/134; p = 0.009). Discontinuation rates were notably higher among patients under 18 years (65%, 87/134). Conclusions: Orthodontists reported higher discontinuation and conversion rates in clear aligner therapy, emphasizing the importance of realistic treatment planning, regular monitoring, and continued professional education. Standardized tracking systems may provide more precise insights into factors associated with treatment discontinuation.